Student assistance program outcomes for students at risk for suicide.

Pennsylvania's response to adolescent suicide is its Student Assistance Program (SAP). SAP has been funded for 27 years although no statewide outcome studies using case-level data have been conducted. This study used logistic regression to examine drug-/alcohol-related behaviors and suspensions of suicidal students who participated in SAP. Of the 46 services, 10 best predicted (p<.01) that these undesirable outcomes would cease. Although no study subjects died by suicide, 42 of 374,626 referred students did die by suicide. Suicidal students who did not participate had double the rate of suicide of suicidal participants of SAP. Students referred for other reasons also killed themselves. Further work must be done to assess all referred students for suicide risk, examine educational outcomes, monitor substance-related crimes and overdoses, and examine school-related factors postmortem. Evidence from this study can be used by researchers to plan future studies and by Pennsylvania's school nurses when planning services.

Cognitive maturity and readiness for evidence-based nursing practice.

Individual factors are known to influence engagement in research utilization and evidence-based practice (EBP). Cognitive maturity is one factor that may enhance interest in and willingness to engage in clinical inquiry, research utilization, and EBP. Adult cognitive development theory explains why research training alone may not suffice to prepare nurses for EBP. Epistemic assumptions held by pre-reflective and quasireflective thinkers interfere with openness to uncertainty and ambiguity in practice and accurate understanding of the value of research for practice. Nurses may use good formal logic, but they also believe in authority, or revealed truth, as the criterion for knowledge and sometimes fail to perceive the need to evaluate evidence. Developmentally oriented educational efforts informed by the reflective judgment model have the potential to foster the cognitive development required in students of EBP. Further inquiry into the relationship between cognitive maturity and EBP will enhance these educational efforts.

Use of intuition by nursing students: instrument development and testing.

BACKGROUND: Intuition has been described as an important type of nursing knowledge and has gained acceptance as a valid way of knowing in clinical nursing. Use of intuition has become one way of explaining professional expertise. Measures of the use of intuition have been developed primarily for experienced nurses, but few measures of intuition use among nursing students exist. AIM: The aim of this paper is to describe the development and psychometric testing of an instrument to measure use of intuition by nursing students. METHODS: Instrument development consisted of concept clarification, item development, and psychometric testing. Intuition was defined as a non-linear process of knowing perceived through physical awareness, emotional awareness, and/or through physical or spiritual connections. Initial measurement items were derived inductively from the literature and informal interviews with senior nursing students. Seven content experts established a content validity index of 0.86 for the initial 33-item measure. It was pretested with a sample of 20 senior nursing students prior to its nationwide validation with a random sample of 1000 senior bachelor of science and associate degree nursing students. RESULTS: Postal mail data collection resulted in 349 responses (35% response rate). Principal component analysis with orthogonal varimax rotation resulted in seven factors accounting for 66.2% of the variance: physical sensations (28.4%); premonitions (9.7%); spiritual connections (7.7%); reading of cues (6.1%); sensing energy (5.7%); apprehension (4.3%); and reassuring feelings (4%). Eigenvalues ranged from 1 to 7.1 and factor loadings ranged from 0.534 to 0.858. The validation resulted in a revised 25-item measure that demonstrated an overall Cronbach's alpha of 0.89 and a range of 0.69-0.84 for each factor. The study is limited by the use of a self-report measure and the attrition in the randomized sample. CONCLUSIONS: The intuition measure for use with students showed evidence of construct validity and reliability. With further testing, the measure could serve as a stimulus to foster students' intuitive abilities.

Shifting the healthcare paradigm: the case manager's opportunity and responsibility.

Recent shifts in the healthcare system reflect a shift in thinking from sickness to wellness. This article reviews the paradigm shift, incentive system, and issues related to cost and quality. The role of case management in facilitating this transition is discussed. The article concludes with a discussion of the challenge to use nursing's unique disciplinary perspective that is focused on health to develop new approaches and strategies and the opportunities for case management to expand its scope of practice.

Counteractions to the paradigm shift.

While the benefit of a health-focused paradigm is clear theoretically, the transition is tortuous. This article reviews the difficulties of implementing the paradigm shift presented in the preceding article. This article presents counteractions, clarifies underlying assumptions, presents the need for collaborative action, and highlights the potential contribution of case management to the paradigm shift.

Information management as a process and product of case management.

Information technology is an invaluable tool in case management practice management. Informed use of information technology can facilitate and enhance the work of case managers. This article reviews the usefulness of information management to nursing case management. The article discusses system requirement, security considerations, and database structure for a practice database. Voice-recognition software, video conferencing, and use of the Web sites are discussed as additional practice enhancement.

Case management: a source of support and stability for the client and the healthcare system.

This article is updated from a series written to introduce a Japanese audience to case management after the enactment of Japan's Long Term Care Insurance Acted in 2000. This act includes a provision for care management, and its anticipation resulted in the creation of a new professional called 'care manager' or 'kaigo shien senmon in.' The series was published last summer in Quality Nursing: The Japanese Journal of Research and Scholarship. The article presents the role of the case manager in the United States including background, definition, and functions of assessment planning, implementation, coordination, monitoring, and evaluation. Benefits of case management to the consumer, providers, payors, and the system are discussed. New directions for case management discussed include working with Community Health Workers to reach culturally diverse populations, population health management case management for long-term care populations, and direct contracting. The article is accompanied by a sidebar, which discusses case management as a linchpin, or central cohesive element that enhances the work of other health system components.