Promoting outcomes for patients with spinal cord impairments and ostomies.

Patients with spinal cord impairments (SCI) and ostomies have unique needs which must be addressed by medical-surgical nurses. By considering the anatomy and physiology of SCI, functional ability, cognitive limitations, and a myriad of other factors, nurses can positively influence clinical and social outcomes.

Dualistic level competencies for professional nursing practice: an international educational initiative.

Ensuring professional nurses are competent is integral to promoting quality outcomes for persons with spinal cord impairment (SCI). This project, funded by the American Association of Spinal Cord Injury Nurses (AASCIN), was designed to develop instruments to validate the competencies of registered nurses (RNs) caring for persons with SCI. The project expanded a 1994 model project focusing on the competencies of licensed practical nurses and licensed vocational nurses (LPNs/LVNs) and RNs in an adult rehabilitation setting. Using the earlier project as a foundation, investigators identified competencies for RNs applicable to the life span trajectory of persons with SCI including pediatric, adolescent, adult, and geriatric populations. Additionally, the focus was broadened to encompass acute, rehabilitation, outpatient community, and long-term settings. This innovative project resulted in the development of the SCI Knowledge/Skill Competency tool for dualistic competency levels of "competent" RNs with two years of recent SCI nursing experience, and "expert" RNs with five years of recent SCI experience. Additionally, the SCI Behavior Competency tool for the "competent" level was developed using hermeneutic techniques and Patricia Benner's (1983) framework, "Novice to Expert." This complemented the "expert" level tool devised in the 1994 model project. Implementation will enable RNs to validate the competencies that are essential to provide care that results in quality outcomes for persons with SCI, their families, and other consumers of SCI health care services.

Management of patients with venous ulcers in the community setting.

Venous ulcers, a chronic disabling condition, present a complex management challenge to the interdisciplinary team in the community setting. The incidence of venous ulcers is increasing as the population ages with such comorbidities as congestive heart failure (CHF), deep vein thrombosis (DVT), obesity, and others. Disability associated with venous ulcers may increase caregiver burden in accomplishing the patient's activities of daily living (ADL), and handicap may exist from difficulty in community participation because of impaired mobility. Venous hypertension, the primary culprit in venous ulcerations, must be managed with an arsenal of strategies to control the underlying condition, heal the wound, and prevent recurrence.

Paradigm for SCI nurse competency on adult-geriatric SCI rehabilitation unit.

This article is based upon an SCI Model Project, funded by the American Association of Spinal Cord Injury Nurses (AASCIN). The purpose of this project was to develop a model to validate theoretical and practical knowledge of Registered Nurses and Licensed Practical Nurses/Licensed Vocational Nurses in an SCI rehabilitation setting. The investigators were direct care providers in a 68 bed SCI rehabilitation service at the James A. Haley Veterans Hospital in Tampa, Florida. The theoretical framework was based upon three aspects: Competency Validation, Theoretical Knowledge, and Practical Knowledge. Competency Validation was directed towards incorporating the elements of assessment, maintenance, demonstration, and improvement of competencies on an ongoing basis. Theoretical knowledge encompassed the cognitive and psychomotor aspects of SCI nursing, and Practical Knowledge highlighted the application of principles of caregiving. Two instruments were developed to harmonize theoretical and practical dimensions for competency validation: SCI Knowledge/Skill Appraisal (SKA) and Expertise in SCI Nursing Practice (ESNP). The purpose of this project was to design a model for validating theoretical and practical knowledge of Registered Nurses (RN's) and Licensed Practical Nurses/Licensed Vocational Nurses (LPN/LVN's) in an SCI rehabilitation setting. The investigators were direct care Licensed Practical Nurses/Licensed Vocational Nurses (LPN/LVN's) in an SCI rehabilitation setting. The investigators were direct care providers in a 68 bed spinal cord injury (SCI) rehabilitation service at the James A. Haley Veterans Hospital in Tampa, Florida.

Achieving maximal utilization of an advanced practice council.

In the James A. Haley Veterans' Hospital, it became increasingly apparent to those in advanced practice roles that a forum was needed to provide a supportive milieu in which nursing staff in expanded and advanced practice roles could come together and discuss the clinical needs of patients and nursing practice issues. Using a dynamic theoretical framework based upon the identification of need for such a forum, an Advanced Practice Council was established to: (1) enhance an understanding of the advanced practice role; (2) promote consultation, support, and networking among Council members; (3) facilitate and refine communication systems; (4) share new ideas; (5) collaborate for research; (6) contrast methods of practice; and (7) increase consultation services. The current activities of this group focus around role clarification and utilization. Peer review of advanced practice roles, for example, has been explored by the council and is in the stages of implementation. Future activities include examining the effects of expanded roles on staff practice and patient care, expanding standards of clinical nursing practice, and facilitating the autonomy of nursing practice through a privileging process.

Evaluating quality and ongoing improvement of clinical practice following HIV/AIDS education.

a comprehensive effort to improve quality and appropriateness of care in a large teaching hospital has been planned and implemented. Fuel for the initiative was gleaned from the combined energies of QA education, infection control, and administration. Challenges for continuous improvement of care for persons who are HIV positive are being anticipated through educational interventions and a program of ongoing evaluation. In concert, movement is toward a safer, more compassionate, cost-effective, and clearly communicated approach to care for patients with HIV/AIDS.