Joanne V. Hickey

Human Development in the Context of Aging and Chronic Illness: The Role of Attachment in Alzheimer's Disease and Stroke:

Does chronic illness in older people provide potentials for human development? To date, this question has not been adequately addressed by dynamic theorists of human development. In this article, two illness trajectories, Alzheimers disease and stroke, are examined to illustrate emerging changes in human development over each course of illness and the increasing importance of attachment behavior among ill elders and their family members. It is argued that the phenomenon of attachment links ailing older people to their environment, and that attachment is vital if human development is to continue.

Faculty workload calculation

Faculty members and nursing education administrators have long examined faculty workloads and documentation thereof but have had difficulty quantifying the work faculty members accomplish in academia. Workloads become even more complicated as faculty members incorporate many activities into their roles of teaching, research, clinical practice, and community service. A form that was simple yet fairly complete was developed at the University of Texas Health Science Center at Houston School of Nursing. The purpose of this article is to describe our workload documentation and issues surrounding its use. This form has been a useful beginning for discussions about accomplishing the work of the mission areas of the school. Our experience and documents may be useful to others.

Credentialing: The need for a national research agenda

A national research agenda is needed to promote inquiry into the impact of credentialing on health care outcomes for nurses, patients, and organizations. Credentialing is used here to refer to individual credentialing, such as certification for nurses, and organizational credentialing, such as American Nurses Credentialing Center Magnet recognition for health care organizations or accreditation of providers of continuing education in nursing. Although it is hypothesized that credentialing leads to a higher quality of care, more uniform practice, and better patient outcomes, the research evidence to validate these views is limited. This article proposes a conceptual model in which both credentials and standards are posited to affect outcomes in health care. Potential research questions as well as issues in research design, measurement, data collection, and analysis are discussed. Credentialing in nursing has implications for the health care professions and national policy. A growing body of independent research that clarifies the relationship of credentialing in nursing to outcomes can make important contributions to the improvement of health care quality.

Intracranial Pressure Waveform Analysis During Rest and Suctioning

Cerebral compliance is a measure of cerebral adaptability to increases in volume within the intracranial space and an indicator of risk for neurological deterioration. However, no direct measurement of compliance exists in clinical practice to guide nursing care or treatment decisions. Current use of mean intracranial pressure (MICP) and gross morphological intracranial pressure waveform (ICPW) analysis have great variability in predicting outcomes. The purpose of this review and pilot study was to evaluate the effects of suctioning on MICP and other measures estimating cerebral compliance derived from analysis of ICPW on patient outcome. We analyzed arterial blood pressure waveforms (ABPWs), ICPWs, and respiratory cycle variations using Fourier Transform analysis, to explore the potential benefits of studying ICPWs across single cardiac and respiratory cycles using linear modeling and calculation of correlation coefficients. ABPWs, ICPWs, and MICP were measured over individual cardiac cycles across multiple respiratory phases in five critically ill neurological patients. Both direct and derived ICP measures, including Fourier analysis of ABP and ICP and the cross-transform between ABP and ICP, were correlated with patient outcome. This more complex waveform analysis of individual ABPW and ICPW together, and derived measures during both single cardiac and respiratory cycles, may provide information relevant to cerebral compliance and patient outcomes. Pending confirmation with additional data sets, this technique may be a useful real-time clinical tool to provide a measure of compliance and risk of neurological deterioration for clinicians.

Funding big research with small money.

This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the guest authors introduce crowd sourcing as a strategy for funding big research with small money.

The Magnet Recognition Program: understanding the appraisal process.

THE MAGNET RECOGNITION PROGRAM® of the American Nurses Credentialing Center awards Magnet status to healthcare organizations for excellence in nursing services. Originating in the early 1980s from a study of nurse retention during a period of shortage,1 the concept of a Magnet environment encompasses many organizational features that facilitate the professional practice of nursing in addition to the organization and delivery of nursing services itself.2 To receive Magnet Recognition, an applicant must demonstrate that a Magnet environment—as defined by current program criteria—has been achieved and embedded throughout the organization wherever nursing is practiced. The purpose of this article is to describe the details of the Magnet appraisal process and the approaches it incorporates

What is the Role of Stroke Units in Overall Care

Stroke is a heterogeneous cerebrovascular disorder that is a major cause of death and disability in the industrialised world. Anecdotal clinical evidence and expert opinion has suggested that organised stroke care results in better patient outcomes compared with care provided in general medical units, although results from randomised control trials (RTC) have been inconclusive. However in 1993, a meta-analysis of 10 RTCs of patients assigned to acute care stroke units (ACSUs) versus routine ward care reported a reduction of early mortality rate of 28% for those assigned to ACSUs. In 1997, the Stroke Unit Trialist Collaboration conducted a meta-analysis of 18 RTCs and concluded that organised inpatient care is effective in reducing death, dependency and institutionalisation after stroke. The analysis also found that age, gender and stroke severity should not be restricting factors to stroke unit care because all categories benefit from organised stroke care. These important studies establish the efficacy of organised stroke care.A variety of stroke care models are used throughout the world. The distinguishing characteristic, regardless of model, is the organisation of a specialised, coordinated, multidisciplinary team of professionals who are interested and knowledgeable about stroke, and who provide comprehensive assessment, management and rehabilitation services for stroke patients. This article discusses a model of a dedicated ACSU used in some centres in the US. Dedicated ACSUs are gaining prominence because of the emergence of time-sensitive therapeutic strategies such as thrombolytics. The major organisational components of the ACSU include: policies and procedures; protocols, guidelines, and pathways; discharge planning; patient/family education; staff education; research; and outcomes management.Leadership in stroke care includes creating a comprehensive programme of primary and secondary prevention and a comprehensive stroke recovery programme. Primary prevention strategies are supported through education of the public and health professionals about stroke risk factor identification and modification, and information about ‘brain attacks’. A comprehensive stroke recovery programme creates a seamless continuum of care of timely emergency medical transport to an appropriate healthcare facility at the time of stroke, comprehensive acute, subacute and long term care, and secondary prevention strategies.In the future, the challenge for practitioners will be to combine contemporary models of acute stroke care and the characteristics of care that have been shown to be effective in randomised trials.

Integrating the Institute of Medicine future of nursing report into the American Association of Neuroscience Nurses strategic plan.

The release of the Institute of Medicine (IOM) Future of Nursing report in October 2010 makes this an unprecedented time in healthcare and nursing IOM, 2010b). The political, economic, and social drivers of change include the focus on healthcare reform as well as the public demand for access to quality care and practice and care changes. There is also mounting evidence in respected reports about anticipated changes in nursing practice, education, recognition, and other aspects of the profession. These forces have coalesced, opening a rare opportunity for the estimated 3 million registered nurses in the United States. There is a great incentive for nursing to act urgently, because this window will close as soon as the focus shifts to other pressing matters. Change is inevitable, healthcare is quickly evolving, and the ultimate outcome of the present healthcare reform is unknown. To prepare neuroscience nurses to lead change and advance health for all Americans, the American Association of Neuroscience Nurses (AANN) Board of Directors (BOD) passed a motion in July 2011 to adopt the following four key messages of the IOM Future of Nursing call to action and tie them to the AANN strategic plan.

Twenty-four-Hour blood pressure variability after acute ischemic stroke.

In people who are healthy, circadian rhythm in blood pressure is well established, with a 10% to 20% decrease in systolic and diastolic blood pressure during nighttime. Deviations correlate with target organ disease such as left ventricular hypertrophy, retinopathy, renal disease, and stroke. Little is known about blood pressure and circadian patterns in stroke patients. This study examined 13 patients hospitalized after ischemic stroke and monitored 24-hour blood pressure with ambulatory blood pressure monitors programmed to collect readings every 30 minutes. All subjects had an abnormal pattern in blood pressure that did not dip during nighttime. Blood pressure load, a reported indicator of risk for target organ damage, was exceeded in all subjects during daytime and nighttime. Thus stroke patients are at high risk for target organ disease including recurrent stroke. Hypertensive management of stroke patients requires further investigation.

Patients in stroke units have better outcomes, but receive less personal nursing care

Methods Using a qualitative non-participant observation method, the researcher recorded full descriptions of everything she saw and heard. Meetings and observation periods were conducted throughout the week, primarily during ward rounds, multidisciplinary team meetings, therapy sessions and assessments, and general activity on early and late shifts during a 2–3 month period in each setting. Observation included 40 hours at both the ECU and GMW, and 66 hours at the stroke unit. Data were content analysed by setting, then by event or activity, and then compared among the 3 settings. Main findings The philosophy of stroke rehabilitation is that nurses liaise with therapists about patients’ treatment, then help patients to apply what they learn to daily ward activities. Relationships and functioning between nurses and patients, nurses and therapists, and among multidisciplinary teams were observed in terms of the extent to which this philosophy was applied in practice. Interactions between nurses and patients in the GMW were observed to be kind, but often “standardised and impersonal,” and patients’ independence was rarely encouraged. In the stroke unit, patients were sometimes observed to be ignored, and work was sometimes done “on” rather than “with” a patient. Nurses in the ECU often encouraged patients to do grooming activities independently, and were observed to be “gentle, warm, respectful, and attentive” in their interactions with patients. These nurses also showed a tendency toward “emotional labour”—the giving of oneself in a more personal, rather than standardised way. Observed communication between nurses and therapists in the ECU was “mutually respectful and full of interest for the patient.” Nurses had worked in the ECU for a long time, so therapists had given them individualised training sessions. PTs communicated with nurses who they felt would use the information and follow a rehabilitation philosophy. In the GMW, therapists reported that rehabilitation was considered secondary to getting a patient medically stable. In the stroke unit, tension was observed between nurses and therapists, and further observation suggested a relationship in which therapists expected nurses to carry out orders rather than to work together. In the ECU, weekly multidisciplinary team meetings were led by a consultant and focused on practical issues related to patient discharge. Team members were not forthcoming with information during meetings, and therapists did not feel meetings were useful for exchanging information about patients. In the stroke unit, multidisciplinary team meetings were also led by a consultant and focused on rehabilitation and patients’ goals. PTs and OTs participated more in meetings than therapists on the ECU, and nurses contributed least and were least comfortable. On the GMW “little formalised communication between the professions” was observed. Different therapists did not work well together and no multidisciplinary team meetings were held.