Enhancing clinical decision making: development of a contiguous definition and conceptual framework.

Clinical decision making is a term frequently used to describe the fundamental role of the nurse practitioner; however, other terms have been used interchangeably. The purpose of this article is to begin the process of developing a definition and framework of clinical decision making. The developed definition was "Clinical decision making is a contextual, continuous, and evolving process, where data are gathered, interpreted, and evaluated in order to select an evidence-based choice of action." A contiguous framework for clinical decision making specific for nurse practitioners is also proposed. Having a clear and unique understanding of clinical decision making will allow for consistent use of the term, which is relevant given the changing educational requirements for nurse practitioners and broadening scope of practice.

A teaching mentorship program to facilitate excellence in teaching and learning.

The impact of decreasing faculty numbers on the nursing shortage has been well documented. Mentoring is recognized as the most significant way to grow and nurture nurse educators. The purpose of this article was to describe the Teaching Mentorship Program within the College of Nursing Department of Biobehavioral Health Science at a Midwestern state university. The program activities are designed to facilitate new faculty members' transition from the role of nurse clinician to the role of nurse educator, to support the implementation of evidence-based teaching practices, and to encourage the development of teaching scholarship. Outcomes of the program include retention of new faculty, improved student satisfaction with the quality of instruction, and increased teaching scholarship activities. The program demonstrates the three hallmarks of an effective mentoring program. First, the program is supported by an institutional culture that values mentoring and provides it with an organizational home. Second, the Associate Department Head and primary mentor has been an educator for 37 years with expertise in curriculum development, program evaluation, and teaching methodologies. Third, because the associate department head's principle role is to implement the program and serve as the primary mentor, her commitment is to provide flexible, timely access to faculty.

Perceptions of effective and ineffective nurse-physician communication in hospitals.

PROBLEM: Nurse-physician communication affects patient safety. Such communication has been well studied using a variety of survey and observational methods; however, missing from the literature is an investigation of what constitutes effective and ineffective interprofessional communication from the perspective of the professionals involved. The purpose of this study was to explore nurse and physician perceptions of effective and ineffective communication between the two professions. METHODS: Using focus group methodology, we asked nurses and physicians with at least 5 years' acute care hospital experience to reflect on effective and ineffective interprofessional communication and to provide examples. Three focus groups were held with 6 participants each (total sample 18). Sessions were audio recorded and transcribed verbatim. Transcripts were coded into categories of effective and ineffective communication. FINDINGS: The following themes were found. For effective communication: clarity and precision of message that relies on verification, collaborative problem solving, calm and supportive demeanor under stress, maintenance of mutual respect, and authentic understanding of the unique role. For ineffective communication: making someone less than, dependence on electronic systems, and linguistic and cultural barriers. CONCLUSION: These themes may be useful in designing learning activities to promote effective interprofessional communication.

Communicating across cultures: suggested teaching strategies.

CONTEXT: Quality healthcare for diverse populations requires providers that understand the impact of culture on health and health-seeking behaviors. Recruiting individuals from diverse cultures into healthcare professions facilitates this understanding. Although nursing education programs have been successful in recruiting such individuals, they often experience difficulties communicating with faculty and patients, which contributes to attrition from their first clinical course. Communicating Across Cultures is an innovative learning experience at our school to facilitate achievement of clinical competencies in the first nursing course. The purpose of this paper is to describe the teaching strategies used in this course that have increased achievement of clinical competencies and decreased the attrition rate of students from diverse cultures at our school. SUGGESTED TEACHING STRATEGIES: First, assessing the students' specific communication difficulties guides what learning objectives and content are appropriate. Second, an immersion experience immediately before students begin their first clinical course provides experiential learning suited to acquiring new communication styles. Third, the experience and subsequent reinforcement are facilitated by faculty with expertise in teaching communication skills and with guiding the learning experiences of students from diverse cultures. Fourth, delineation of eligibility criteria allows students to self-identify their need to participate. Finally, an evaluation plan provides information to help make decisions about subsequent implementation of the learning experience.

Designing a data and safety monitoring plan.

Evidence-based nursing practice is now the expected standard of care intensifying the need to conduct clinical research studies to investigate the efficacy of nursing interventions. To ensure that the urgency to document such efficacy does not compromise human participant safety, government research funding agencies are advocating special procedures to protect individuals who voluntarily participate in research studies. The National Institutes of Health application for clinical trial funding requires a data and safety monitoring plan (DSMP) to enhance human participant safety and clinical research integrity. This article describes an approach to developing a DSMP that includes a study risk assessment and a monitoring design based on that assessment.