Research-based planning for change: assessing nurses' attitudes toward governance and professional practice autonomy after hospital acquisition.

OBJECTIVE: This article describes one medical center's experience in using research to plan for nursing staff integration after hospital acquisition. BACKGROUND: Resistance to new policies, procedures, and standards; passive acceptance of new leadership; limited support for management plans; and failure to integrate with new nursing units are common staff reactions after acquisitions. Little has been written regarding which key staff variables to assess after acquisitions and how to use this data to plan for change. Structural contingency and attribution theory were used to guide leadership staff's assessment of acquired staff attributes to determine their congruence with concepts valued by the acquiring organization. METHODS: Qualitative and quantitative data were collected using a survey method. All 141 registered nurses and licensed practical nurses of the acquired medical center received a mailed survey. Sixty-six completed surveys were returned through the U.S. mail. No identifying information was placed on the survey to assure anonymity. RESULTS: The survey results described nurses perceptions of the advantages, concerns, and suggestions for a smooth transition after acquisition. In addition, the results clarified that nurses in the newly acquired hospital preferred a shared governance structure (congruent with the acquiring medical center's values) and the nurses perceived professional nursing autonomy was similar to that of nurses who worked at the acquiring medical center. CONCLUSIONS: By sharing the findings, both staffs were sensitized to the similarities among the staff as well as to their differences. Transition strategies were planned to capitalize on this knowledge. This process may be useful for other nurse executives to replicate as they guide their organizations through similar transitions.

Family members' experiences with the nursing home placement of an older adult.

Although there is substantial literature available on a variety of aspects of nursing home placement, relatively little is known about the experiences of family members confronted with this challenge. This study involved in-depth interviews with nine adult family members within 2 weeks of the relocation of the older adult relative. Factors related to recognition of the need for placement, selection of a facility, managing the relocation, and effects of placement on the family decision-makers were explored. Results have significant implications for nursing practice related to the lack of advanced planning, needs for time and information, and supportive interventions.

A conceptual foundation for human suffering in nursing care and research.

Suffering is a significant, yet elusive, phenomenon in nursing and health care. Despite the importance and prevalence of suffering, there is only a small body of substantive literature on this topic. Some of the difficulty in expanding this knowledge base undoubtedly is related to the lack of a solid conceptual foundation for exploration of this phenomenon. Although there have been attempts to provide needed conceptual clarity, these efforts typically have not been based on systematic inquiry. In this study, the method of concept analysis was used to inductively generate a definition of the concept of suffering and to clarify various contextual aspects of the concept. Suffering is defined as an individualized, subjective, and complex experience that involves the assignment of an intensely negative meaning to an event or a perceived threat. Implications of these findings and additional contextual aspects of the concept for nursing practice and inquiry are presented. These results help to provide the conceptual foundation needed to enhance recognition and understanding of the human experience of suffering.

Nurses' reactions to participation in cardiopulmonary resuscitation on the nursing unit.

A wide range of emotions are associated with cardiopulmonary resuscitation (CPR) attempts. Articles documenting nurses' reactions to CPR situations are scarce in the nursing literature. This study contains nurses' own descriptions of feelings experienced during and after CPR attempts and the nurses' suggestions for what could make the experience easier, what makes it more difficult, and what interventions the nurses use to reconcile their emotions. The participants were 29 registered nurses employed at an urban Midwestern hospital who completed an open-ended questionnaire that elicited descriptions of CPR events. The data were analyzed using a process of thematic analysis.

Walker-Warburg syndrome: report of three affected sibs.

Walker-Warburg syndrome (WWS) is a lethal, autosomal recessive disorder characterized by Type II lissencephaly, retinal malformation, cerebellar malformation, and congenital muscular dystrophy. We report on 3 sibs with WWS born to a consanguineous couple. The fetal hydrocephalus associated with this syndrome, while not consistent or necessary for diagnosis, is the key manifestation for its prenatal detection. These sibs illustrate the importance of a careful search for associated malformation(s) in a fetus or newborn infant with hydrocephalus and the potential pitfalls of accurate genetic risk estimation in families of such propositi.

The qualitative research audit trail: a complex collection of documentation.

A qualitative study typically involves a large volume of researcher-generated data, including notes about the context of the study, methodological decisions, data analysis procedures, and self-awareness of the researcher. Such data are important in many aspects of the study, particularly in the development of an audit trail to substantiate trustworthiness. Unfortunately, there is little information available to assist researchers in generating the needed documentation. In this article, we discuss the types of data that contribute to credible investigations. Strategies for maintaining effective records in qualitative studies are included, along with examples from our own research.

Living with recurrent ventricular dysrhythmias.

The number of patients who live with recurrent ventricular dysrhythmias is increasing as medical advances such as pharmacologic and electrical therapies decrease mortality rates in this population. As a result, nurses frequently encounter patients who are trying to learn to live with chronic aspects of recurrent life-threatening dysrhythmias. The findings of this study provide an important beginning description of strategies used by patients to address their concerns. The RVD patients in this study reported using a variety of strategies to manage their physiologic and psychosocial concerns. Their responses described a continuum of strategies to handle concerns that ranged from "compensate for the concern" to "unable to handle the concern." These findings suggest several implications for nursing. Careful assessment of all patients with RVD is appropriate to detect areas where patients perceive a need for additional strategies to manage their concerns, require support for existing self-reliance strategies, and need identification of additional nursing interventions. Individualized or group programs may be appropriate interventions to assist some patients. Strategies to support patients who report an inability to manage specific concerns need clarification. Ideally, as further research defines the processes patients with RVD use to manage their concerns, high-risk patients can be discovered and provided with interventions to promote their adjustment to living with life-threatening dysrhythmias.

The concept of integration: a foundation for evaluating outcomes of nursing care.

Changes in the health care environment, an aging population, and an increase in chronic health conditions require consideration of the adequacy of concepts available for demonstrating the effectiveness of nursing care. One concept that has potential utility for nursing in this regard is the concept of integration. Analysis of the concept of integration was conducted to alleviate existing ambiguity and to explore ways in which this concept has been employed in diverse disciplines. The concept of integration is characterized primarily as a process of combination: two or more elements are merged with sufficient interaction so that unity of the newly formed entity is achieved. The attributes of the concept of integration, therefore, include process, combination, interaction, and unity. The concept of integration is useful in evaluation of reconciliation of past and present identities and altered role relationships within the environment.

When a loved one has AIDS: care for the significant other.

1. The significant others of persons with AIDS, whether they assume the role of primary caregiver or not, have a number of unique experiences, concerns, and needs specifically related to their situations. 2. During the initial period following the diagnosis of a loved one, the significant others indicated their primary needs as sensitivity to their situations, assistance in securing appropriate information, and psychological support in dealing with uncertainty, and a general sense of dread. 3. Other common concerns and needs expressed by the significant others included support and reassurance, assistance in adjusting to a myriad of personal relationship changes, and help in meeting needs for active involvement in some form of AIDS-related work.

The concept of grief: a foundation for nursing research and practice.

In spite of the significance of grief as a human response, research to expand knowledge of this phenomenon has been impeded by the existence of a conceptual problem. In this study, a comprehensive and systematic review of both current and classic literature concerning grief was conducted within the disciplines of nursing and medicine. Findings contributed to the definition of grief as a pervasive, highly individualized, dynamic process that often is discussed normatively within professional disciplines. This definition provides not only a synthesis of knowledge concerning grief but a reconceptualization that can promote efforts to clarify this important concept for nursing.

Deconstructing the dogma in nursing knowledge and practice.

The existence of dogma, the unquestioning adherence to authority and tradition, is well documented as a barrier to knowledge development. Numerous examples of dogma can be found in nursing, particularly in regard to the nature of nursing as a discipline and practice of nursing. While authority and tradition provide a foundation of stability and consensus, blind faith is to be avoided. In this paper, the critical examination of examples of dogmatic belief is encouraged so that clear and useful characterizations of the nature of nursing may be developed.

Using concept analysis to enhance clinical practice and research.

Describing human responses in critical care nursing is fundamental to the implementation and evaluation of therapeutic interventions. This article explains how concept analysis facilitates care planning, communication, nursing diagnoses, and clinical nursing research in critical care.

The advanced practicum project.

How do you impress students with the importance of research in clinical practice? Involve them in every phase of an actual research project.

Loneliness. Easing the pain of the hospitalized elderly.

For the older adult, loneliness may contribute to deterioration in physical and mental health. Some factors that may contribute to loneliness in the older adult include the death of a spouse, loss of a pet, lack of visitors, physical incapacity, role changes, and relocation. In general, loneliness may be the result of events that typically occur as a part of the aging process. Nurses can decrease the incidence of loneliness in the older adult by ensuring access to visitors and facilitating involvement in usual activities. Assessment information that is needed to plan nursing care to decrease the incidence of loneliness includes data regarding the patient's cultural background; significant persons, objects, and activities; and previous hospitalization experiences.

Concepts, analysis and the development of nursing knowledge: the evolutionary cycle.

Nursing currently evidences concern with the development and clarification of its knowledge base. As a part of this focus, attention has often been directed towards concepts and methods of clarification. Although the method of concept analysis has been employed often to provide conceptual clarity, the foundations and implications of conducting an analysis of a concept have not been well explored in nursing. In this article, the philosophical foundations of the approach to concept analysis popularized by Walker & Avant (1983) are examined. Modifications of this method are offered, along with a framework for interpreting the findings of an analysis. The result is a view of concepts and an approach to analysis that may be of use in the clarification of a variety of concepts of interest in nursing.