Dorothy A. Jones

Standardized nursing languages: essential for the nursing workforce

The evolution of standardized nursing languages (SNLs) has been occurring for more than four decades. The importance of this work continues to be acknowledged as an effective strategy to delineate professional nursing practice. In todays health care environment, the demand to deliver cost-effective, safe, quality patient care is an essential mandate embedded in all health reform policies. Communicating the contributions of professional nursing practice to other nurses, health providers, and other members of the health care team requires the articulation of nursings focus of concern and responses to these concerns to improve patient outcomes. The visibility of the electronic health record (EHR) in practice settings has accelerated the need for nursing to communicate its practice within the structure of the electronic format. The integration of SNLs into the patient record offers nurses an opportunity to describe the focus of their practice through the identification of nursing diagnosis, interventions and outcomes (IOM, 2010). Continued development, testing, and refinement of SNLs offers nursing an accurate and reliable way to use data elements across populations and settings to communicate nursing practice, enable nursing administrators and leaders in health care to delineate needed resources, cost out nursing care with greater precision, and design new models of care that reflect nursepatient ratios and patient acuity that are data driven (Pesut & Herman, 1998). The continued use of nursing languages and acceleration of nursing research using this data can provide the needed evidence to help link nursing knowledge to evidence-driven, cost-effective, quality outcomes that more accurately reflect nursings impact on patient care as well as the health care system of which they are a part. The evaluation of research to support the development, use, and continued refinement of nursing language is critical to research and the transformation of patient care by nurses on a global level.

Profession at the crossroads: A dialog concerning the preparation of nursing scholars and leaders

The purpose of a practice disciplines terminal degree is to develop wise scholars to guide the profession in anticipating and meeting the health-related needs of those served via philosophical, conceptual/theoretical, and empirical inquiry on behalf of professional practice. Each of these dimensions is important for the disciplines ability to meet its obligations to society. However, contemporary circumstances have created a context within which the maturation of the profession may be threatened by an imbalance among the three dimensions of PhD education. Specifically, we discuss the possibility of a tilt toward the empirical at the expense of the other two. Yet, the philosophical and conceptual/theoretical dimensions are those that have permitted core disciplinary knowledge to be developed. We aim to create a dialog about current challenges and the responsibilities of the disciplines scholars for stewardship of the discipline and offer some strategies to ensure balance among the three equally important dimensions.

High‐Frequency Nursing Diagnoses Following Same‐Day Knee Arthroscopy

PURPOSE The purpose of this study was to determine the acceptability and feasibility of two screening tools at 12 and 72 hr postoperatively, and to determine the high-frequency, high-risk nursing diagnoses encountered by patients at 12 and 72 hr postoperatively following a same-day outpatient arthroscopy. METHOD This study utilized a nonexperimental descriptive correlational design with pre- and posttest measures. FINDINGS High-frequency problems were identified on the evening of surgery and at 72 hr postoperatively. CONCLUSIONS Findings suggest that the screening tools were feasible and acceptable ways to determine high-frequency problems in this population. IMPLICATIONS FOR NURSING PRACTICE There is a continued need for nursing contact and support by telephone post same-day surgery to guide individuals through the process of healing.

Randomized clinical trial testing efficacy of a nurse-coached intervention in arthroscopy patients.

Background:Emerging data suggest limited patient preparation for ambulatory surgery, decreased access to healthcare providers postoperatively, increased patient and family anxiety, and increased patient suffering. Thus, there is a need for nursing interventions to improve the postoperative experience for patients and families. Objective:The purpose of this study was to test the hypothesis that ambulatory arthroscopic surgery patients who receive a nurse-coached telephone intervention will have significantly less symptom distress and better functional health status than a comparable group who receive usual practice. Methods:The study sample in this randomized clinical trial with repeated measures was 102 participants (52 in the intervention group and 50 in the usual practice group) drawn from a large academic medical center in the Northeast United States. Symptom distress was measured using the Symptom Distress Scale, and functional health was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey General Health Perceptions and Mental Health subscales. Results:Multivariate analysis of covariance, with three repeated measures of the Symptom Distress Scale (baseline, 72 hours postsurgery, and 1 week postsurgery) and five covariates, was used to test the hypothesis. After removal of the covariate influence, intervention participants had significantly less symptom distress at 72 hours and 1 week postsurgery and significantly better overall physical and mental health at 1 week postsurgery than those who received usual practice. Discussion:The findings suggest that telephone calls from nurses during the immediate postoperative period resulted in improved patient outcomes, namely, less symptom distress and better physical and mental health states. In future research, the study sample should be expanded to older and more diverse patients.

Identification of the psychometric properties of the leadership influence over professional practice environments scale.

This study uses the qualitatively developed Adams Influence Model© (AIM) and concepts from the psychometrically validated Revised Professional Practice Environment scale to guide the development of the Leadership Influence Over Professional Practice Environments Scale. Nurse executives and others can use this scale individually or in conjunction with instruments targeting staff or patient perceptions of their influence as part of health services research, leadership development, and professional practice environment enhancement strategy.

Commonalities of nurse-designed models of health care

The American Academy of Nursing has identified examples of care redesign developed by nurses who address the health needs of diverse populations. These models show important clinical and financial outcomes as summarized in the Select Edge Runner Models of Care table included in this article. A study team appointed by the Academy explored the commonalities across these models. Four commonalities emerged: health holistically defined; individual-, family-, and community-centric approaches to care; relationship-based care that enables partnerships and builds patient engagement and activation; and a shift from episodic individual care to continuous group and public health approaches. The policy implications include examining measures of an expanded definition of health, paying for visionary care, and transparency and rewards for community-level engagement.

Newman’s Health as Expanding Consciousness

human becoming, we’ve had our eyes opened to the process of living the art of true presence, the art of really listening with a non-judgmental ear and an open heart, because when it comes down to it, all anybody ever wants is to be listened to and to be respected. Listening, and truly bearing witness to the paradoxical realms of one’s experiential existence, is done without offering suggestions or reassurances, and without trying to fix their situation—something so easy, yet so hard to do. I feel honored and truly grateful for the times when my patients feel comfortable enough with me to share their feelings, whether it be anger, frustration, joy, or sorrow. What has changed for me is how I no longer label these people. They are no longer “annoying Mr. P in Room 124-2,” or “Crazy old Mrs. C. in Room 144,” but rather unique and mysterious individuals, each with a lifetime of personal experience that influences their thoughts and behaviors. This whole experience has been a progression and I am still learning and changing with it. I’ve found that it’s given me a sense of hope, and with that a reason to get up in the morning, looking forward to the infinite possibilities. I feel so thankful to have had the opportunity to use work time as a means of learning more about nursing and to work on projects that make a difference in our patients’ lives. We began this journey with the purpose of bettering our practice and becoming stronger nurses. I believe that the 80/20 project was a success for me in this regard and hope that everyone involved has found it to be as rewarding of an experience as I have.

Psychometric Evaluation of the Functional Health Pattern Assessment Screening Tool (FHPAST)

PURPOSE   To report findings of psychometric testing of the Functional Health Pattern Screening Tool (FHPAST). METHODS   Psychometric evaluation including internal consistency and principal components analysis. FINDINGS   The findings indicate that the FHPAST is a reliable, three-component, 57-item valid instrument. CONCLUSIONS   Psychometric testing supports the use of the FHPAST in research. The instrument captures each of the 11 functional health patterns as described by Gordon (1994) and has been translated into, and is available in, several languages. PRACTICE IMPLICATIONS   Continued testing and refinement is needed across populations to support the findings from this investigation and to evaluate the outcomes of patient-centered interventions over time.

Development and psychometric evaluation of the patient care associates' work environment scale.

OBJECTIVE: The purpose of this study is to examine the psychometric properties of the Patient Care Associates’ Work Environment Scale (PCA-WES). BACKGROUND: Few studies exist examining patient care associates (PCAs) working in acute care settings, and no instruments are available to examine the impact of the work environment on their practice. METHODS: A psychometric evaluation using a nonprobability purposive sample of 390 PCAs was undertaken. RESULTS: Cronbach’s &agr; internal consistency reliability of the total score was .95. Principal components analysis with varimax rotation and Kaiser normalization identified 5 components that accounted for 57.2% of variance and confirmed the original theoretical structure. The resulting 35-item scale had subscale Cronbach’s &agr; reliability estimates that ranged from .84 to .93. CONCLUSIONS: The multidimensional PCA-WES is a psychometrically sound measure of 5 components of the PCA practice environment in the acute care setting and is sufficiently reliable and valid for use as independent subscales in healthcare research.

Interdisciplinary Institute for Patient Care: advancing clinical excellence.

Healthcare leaders are searching for ways to create new synergies and efficiencies in todays complex health environments to enhance patient care, education, and research and nurture collaborative and rewarding professional practice environments. The authors discuss how the creation of a multidisciplinary Institute for Patient Care is an important innovation that is helping us achieve these aims.