The clinical imperative in clinical nursing research.

Conducting preliminary clinical fieldwork to update clinical knowledge in preparation to plan and perform relevant, meaningful, credible and feasible clinical research is imperative. Clinical nurse investigators cannot generate relevant questions to study a current phenomenon with which they are not experienced. The nurse researcher's early involvement in the clinical world of health care as a prerequisite of proposal development not only contributes to the design of a study that has rigor and significance, but it also augments his or her competence and commitment to the improvement of patient outcomes.

Clinical practice of doctorally prepared nurses.

This study describes the clinical experiences of doctorally prepared nurses whose primary professional role is providing care as advanced practice nurses. Telephone interviews were conducted with 20 participants who lived and practiced in 13 states. Practice settings for these nurses included inpatient acute care and various outpatient/community health settings. Several themes describe the nature of the participants' practice: management of patient care, interwoven partnerships, leadership, and practice values. Major themes relating to the contribution of doctoral education to practice were abilities gained and changes in image and status. The findings of this study demonstrate that doctorally prepared nurses are actively involved in nursing practice by affecting patient outcomes, promoting cost-effective care, and using clinical research.

African-American families with chronically ill children: oversights and insights.

From a critical review of the literature concerning African-American families' management and care of children having chronic illness, we concluded that information on culture-related experiences in such families remains seriously deficient. To present an accurate picture of African-American life as these families manage a child with a chronic illness, more comprehensive and detailed descriptions of family caregiving styles and other experiences are needed.

Parents' resources and home management of the care of chronically ill infants.

PURPOSE: To identify resources of parents or primary caretakers who managed chronically ill infants at home and to determine psychometric properties of Home Care Resources Inventory (HCRI). DESIGN: Cross-sectional, descriptive SETTING: Outpatient clinics. PARTICIPANTS: Parents or primary caretakers (N = 100) of chronically ill infants who were discharged from hospital at least one week; 93% of sample were mothers; infants' ages ranged from 1-22 months. MAIN OUTCOME MEASURES: HCRI, the Spielberger State Anxiety Inventory, and a demographic questionnaire. RESULTS: Parents reported strong resources in the area of support and inconsistent resources in areas of coping, time, and respite. The HCRI has acceptable psychometric properties. CONCLUSIONS: Identifying resources, especially personal time and respite, is essential for successful home management of chronically ill infants. The HCRI can be used to pinpoint areas that are strong or weak in the two resource areas measured.

Case management roles of clinicians: a research case study.

The purpose of this research multiple case study was to determine case management roles as demonstrated by four clinicians employed at a university medical center. Multiple sources of evidence were used to collect data, including interviews, nonparticipant observations, and chart audits. Case management was defined by the clinicians as a process for delivery of health care at the institution studied. Despite a lack of a uniform framework for case management practice, the clinicians used similar case management components. Chart audits demonstrated deficits and inconsistency in documentation that were supported by interview and observations. It was recommended that exposure to formal case management models and theory could strengthen clinical practice in this area. Additionally, investigation of factors that facilitate and/or impede consistent documentation of interventions and patient outcomes, particularly by CNSs is recommended.

Single-subject research for nursing practice.

Presenting the characteristics of single-subject research, the authors advocate greater use of the method by clinical nurse specialists and explore issues implicit in the research design (external validity, rigor, statistical versus clinical significance, ethics, and service versus research orientation). Replicated single-subject designs seem well suited to link process-based nursing practice and research. Such designs may make better investigative use of daily observations and interventions that are part of nursing practice. They propose that, despite concerns raised by others, single-subject research as a viable adjunct to existing research methods be considered as a means for increasing the contribution of clinical nurse specialists in the development of clinical nursing knowledge.

Application of the case study design: nursing interventions for discharge readiness.

A single case study design was used to explore the nursing process and intervention related to discharge preparation of one family with a child requiring complex care at home. Helping methods described by Orem were used to categorize identified nursing interventions. Discharge readiness was assessed to verify consideration of conditions for discharge. The major study question was "How is discharge preparation conducted?" Collected data provided evidence to support each of three case study propositions: (1) patients and their home caregivers are involved in discharge preparation as planners and as learners, (2) nursing interventions occur in five major helping areas as outlined by Orem, (3) discharge preparation addresses each component of discharge readiness. The case study design was effective as an approach to explore nursing interventions, verify considerations of discharge conditions, and refine the concept of discharge readiness. A decision trail is presented for nurses to replicate the process with questions related to their practice.