Graduate forensic nursing education: how to better educate nurses to care for this patient population.

Nurses are often the first healthcare contact for those affected by violence. Despite the impact of violence on healthcare across specialties and ages, forensic nursing content is limited in undergraduate and graduate curricula. The purpose of this article is to provide background on forensic nursing and present a model of a graduate forensic nursing program that can be used as a curriculum guide.

University of Illinois at Chicago's interdisciplinary center for research on violence: changing systems to prevent violence in Chicago and beyond.

This article describes an interdisciplinary center at the University of Illinois at Chicago focused on collaborative research on violence. Our center is unique in its emphasis on developing infrastructure and distinctive processes for overcoming obstacles to interdisciplinary research; the involvement of outside policy makers, advocates, and service providers in jointly discussing and developing research proposals; the breadth of commitments from leading violence researchers and administrators across five colleges; and the innovativeness of proposed research projects that support interdisciplinary activity and show promise for funding. The center has developed an infrastructure to address violence-related issues in both research and teaching. This article discusses the challenges of implementation and boundary spanning in a university context and makes recommendations for sustainability.

Clinical reasoning: concept analysis.

AIM: This paper is a report of a concept analysis of clinical reasoning in nursing. BACKGROUND: Clinical reasoning is an ambiguous term that is often used synonymously with decision-making and clinical judgment. Clinical reasoning has not been clearly defined in the literature. Healthcare settings are increasingly filled with uncertainty, risk and complexity due to increased patient acuity, multiple comorbidities, and enhanced use of technology, all of which require clinical reasoning. Data sources. Literature for this concept analysis was retrieved from several databases, including CINAHL, PubMed, PsycINFO, ERIC and OvidMEDLINE, for the years 1980 to 2008. REVIEW METHODS: Rodgers's evolutionary method of concept analysis was used because of its applicability to concepts that are still evolving. RESULTS: Multiple terms have been used synonymously to describe the thinking skills that nurses use. Research in the past 20 years has elucidated differences among these terms and identified the cognitive processes that precede judgment and decision-making. Our concept analysis defines one of these terms, 'clinical reasoning,' as a complex process that uses cognition, metacognition, and discipline-specific knowledge to gather and analyse patient information, evaluate its significance, and weigh alternative actions. CONCLUSION: This concept analysis provides a middle-range descriptive theory of clinical reasoning in nursing that helps clarify meaning and gives direction for future research. Appropriate instruments to operationalize the concept need to be developed. Research is needed to identify additional variables that have an impact on clinical reasoning and what are the consequences of clinical reasoning in specific situations.

Intimate partner violence in older women: what home healthcare clinicians should know.

Older women can be victims of intimate partner violence (IPV), and home healthcare clinicians should know what they can do. Although there is no instrument specific to screening for IPV in older women within the home environment, home healthcare clinicians can use currently available resources and lobby for better resources to screen for and serve older women who may be victims of IPV. Forensic nursing education can provide additional skills to identify possible victims of violence, gather evidence, document findings, and provide treatment and referrals.

Schistosomiasis: a case study.

Schistosomiasis is a parasitic infection caused by trematodes (flatworms). It is second only to malaria in public health significance, with an estimated 200 million people infected worldwide. Schistosoma haematobium is endemic in Africa and the Middle East. This case study discusses a 36-year-old Somalian male who immigrated to a Northeastern city in the United States from a refugee camp in Kenya. He presented with episodic gross hematuria and flank pain, and was eventually diagnosed with urinary tract schistosomiasis, which was successfully treated with praziquantel. While the disease is not common in the United States, this case is presented for both its urological and cultural considerations.

Laparoscopic radical robotic prostatectomy: a case study.

The management of prostate cancer includes observation, hormonal therapy, radical prostate surgery (open, laparoscopic, or laparoscopic robotic), external beam radiation, brachytherapy, or cryotherapy. Laparoscopic radical robotic prostatectomy is the newest technology in minimally invasive surgery. This is a case study of a patient who chose to undergo laparoscopic robotic prostatectomy for his prostate cancer.

Introducing generic workers to the care of spinal cord injury.

The generic worker role extends the HCA role in spinal cord injury care. The development of the generic worker role took place at the Midland's Centre for Spinal Injuries (MCSI) in order to implement a number of government policies. There remains room for improvement, development and audit of the role.

Multicenter evaluation of the Bayer ADVIA Centaur HIV 1/O/2 enhanced (EHIV) assay.

BACKGROUND: It is important that serological assays detect antibodies to human immunodeficiency virus (HIV) in all infected individuals, including those infected with less prevalent, more diverse subtypes. METHODS: Performance of the ADVIA Centaur HIV 1/O/2 Enhanced (EHIV) Assay was tested on 1344 samples from HIV-positive subjects, 6061 samples from groups at low-risk for HIV infection, and 1042 samples from groups at high-risk for HIV-1 and HIV-2 infection. Results were compared with those of an FDA-approved predicate assay. RESULTS: The ADVIA Centaur EHIV Assay showed good precision with a diagnostic specificity of 99.9% and diagnostic sensitivity of 100%. HIV seroconversion was detected earlier in 6 panels, at the same time in 13 panels and later in only 1 of the panels when compared to the predicate assay, thereby narrowing the window period between infection and antibody detection. Of clinical significance, a blood donor sample that was indeterminate by HIV-1 Western blot and non-reactive by the predicate assay was repeatedly reactive in the ADVIA Centaur Assay and confirmed as positive by HIV-2 immunoblot. CONCLUSIONS: The ADVIA Centaur EHIV Assay is useful as an aid in the diagnosis of individuals infected with HIV-1 and/or HIV-2.

Performance of hepatitis B assays on the Bayer ADVIA Centaur Immunoassay System.

Bayer HealthCare LLC, Diagnostics Division, has developed several new assays on the ADVIA Centaur immunoassay system for the detection of markers of hepatitis B virus infection in human serum and plasma. This panel includes assays for: hepatitis B surface antigen (HBsAg), a confirmatory test method for HBsAg, antibodies to hepatitis B surface antigen (anti-HBs), IgM and IgG antibodies to hepatitis B core antigen (anti-HBc Total) and IgM antibodies to hepatitis B core antigen (anti-HBc IgM). These assays employ magnetic particle separation technology with direct chemiluminescence for optimal assay performance. All of the assays are fully automated, require sample volumes ranging from 15 microl to 100 microl (with the exception of the ADVIA Centaur HBsAg Confirmatory Assay, which requires 2 x 100 microl), and have throughputs of up to 240 tests per hour. The five ADVIA Centaur HBV assays were tested in extensive performance evaluations conducted at two sites in Europe. The performance evaluations, which included samples from HBV-infected individuals, blood donors, hospitalized/clinical patients, and HBV vaccinees (for Anti-HBs evaluation), generated performance data in support of obtaining the Communautés Européennes (CE) mark for European market distribution. The HBV performance evaluations resulted in an overall diagnostic specificity > 99%, i.e. 99.94% for the ADVIA Centaur HBsAg Assay, 100% for the ADVIA Centaur Anti-HBs Assay, 100% for the ADVIA Centaur HBc IgM Assay and 99.94% for the ADVIA Centaur HBc Total Assay. All of the ADVIA Centaur assays showed a very good diagnostic sensitivity on these populations with 100% for the ADVIA Centaur HBsAg Assay, 99.0% for the ADVIA Centaur Anti-HBs Assay, 98.53% for the ADVIA Centaur HBc IgM Assay and 100% for the ADVIA Centaur HBc Total Assay. The ADVIA Centaur HBsAg Confirmatory Test confirmed 100% of the positive HBsAg samples. Testing of interfering substances and potential cross-reacting samples for all ADVIA Centaur HBV assays resulted in no change in interpretation of the results. Assay performance was further evaluated using HBV seroconversion panels with comparable or better results when compared to the comparison assays. The performance evaluation data demonstrate that the ADVIA Centaur HBV assays are specific and sensitive automated immunoassays for detection of antigens and antibodies to hepatitis B virus with performance that is comparable to those of currently marketed assays. Additionally, these assays have the advantage of being available on the ADVIA Centaur immunoassay system, which provides for the flexibility of high throughput and full automation.

Performance of a new hepatitis C assay on the Bayer ADVIA Centaur Immunoassay System.

Bayer HealthCare LLC, Diagnostics Division has developed a new third-generation assay for the detection of antibodies to hepatitis C (anti-HCV) in human serum and plasma on the ADVIA Centaur immunoassay system. This assay employs magnetic particle separation technology with direct chemiluminescence for optimal assay performance. The assay is fully automated, requires a sample volume of 10 microl and has a throughput of up to 120 tests per hour. The ADVIA Centaur HCV2 Assay was tested with samples from HCV-infected individuals, blood donors, and hospitalized patients in an extensive performance evaluation at two sites in Europe in order to generate performance data in support of obtaining the Communautés Européennes (CE) mark for European market distribution. The HCV performance evaluation resulted in an overall diagnostic specificity of 99.9% and a diagnostic sensitivity of 100%. Assay performance evaluation, using HCV seroconversion performance panels, resulted in comparable or better results when compared to the comparison assay (Abbott AxSYM3 HCV Version 3.0 Assay). Data from the performance evaluation demonstrate that the ADVIA Centaur HCV Assay is a specific and sensitive automated immunoassay for detection of antibodies to hepatitis C virus with performance that is comparable to that of currently marketed assays. Additionally, this assay has the advantage of being on the ADVIA Centaur immunoassay system, which provides the flexibility of high throughput and full automation.

Performance of a new HIV 1/O/2 assay on the Bayer ADVIA Centaur immunoassay system.

Bayer HealthCare LLC, Diagnostics Division, has developed a new third-generation assay for the detection of antibodies to HIV 1, including group O, and HIV 2 in human serum and plasma on the ADVIA Centaur immunoassay system. The ADVIA Centaur HIV 1/O/22 Assay employs magnetic particle separation technology with direct chemiluminescence for optimal assay performance. The assay is fully automated, requires a sample volume of 50 microl and has a throughput of up to 120 tests per hour. The ADVIA Centaur HIV 1/O/2 Assay was tested in an extensive performance evaluation at two sites in Europe. Samples from HIV-1 and HIV-2 infected individuals, blood donors, hospitalized patients, and high-risk individuals were utilized to generate performance data in support of obtaining the Communautés Européennes (CE) mark for European market distribution. The comparison assay for the performance evaluation was the Abbott AxSYM HIV 1+2 gO Assay. The performance evaluation resulted in an overall diagnostic specificity of 99.9 % and a diagnostic sensitivity of 100%. Assay performance was further evaluated using HIV seroconversion panels. Equivalent results were obtained when the ADVIA Centaur HIV 1/O/2 Assay was compared to the comparison assay. The performance evaluation data demonstrate that the ADVIA Centaur HIV 1/O/2 Assay is a specific and sensitive automated immunoassay for detection of antibodies to HIV-1, including group O, and HIV-2 with performance that is comparable to that of currently marketed assays. Additionally, the ADVIA Centaur HIV 1/O/2 Assay has the advantage of being on an immunoassay system, which provides the flexibility of high throughput and full automation.

Clinical reasoning in experienced nurses.

As an essential component of nursing practice, clinical reasoning is used to assimilate information, analyze data, and make decisions regarding patient care. Little is known about the reasoning strategies of experienced nurses who are not yet experts. This qualitative descriptive study explored the cognitive strategies used by experienced nurses as they considered assessment findings of assigned patients. To date, few studies of nurses' clinical reasoning have been conducted in a practice setting during actual patient care. A small group research design was employed using the think-aloud (TA) method with protocol analysis. A total of 15 experienced nurses were asked to "think aloud" about patient assessment findings. Data were audiotaped, transcribed, and analyzed using the three steps of protocol analysis. The results suggest that experienced nurses used a conceptual language to reason about assessment findings and used heuristics to reason more quickly and efficiently.

Noncompliance in heart transplantation: a role for the advanced practice nurse.

Many organ transplant recipients experience organ rejection because they are noncompliant with the requirements of the health care regimen. The advanced practice nurse is in an ideal position to assess predictors of noncompliance as well as to implement interventions to enhance patient compliance. The purpose of this paper is to present a case study of a young female heart transplant recipient whose death due to organ rejection was related to noncompliance. The role of the advanced practice nurse in reducing noncompliance is identified and relevant nursing interventions are discussed.

Spinal cord injury providers' perceptions of barriers to implementing selected clinical practice guideline recommendations.

BACKGROUND/OBJECTIVE: Twelve focus groups were conducted at 6 Department of Veterans Affairs (DVA) Spinal Cord Injury (SCI) Centers. The purpose of these focus groups was to identify provider-perceived barriers to implementing selected recommendations of two clinical practice guidelines (CPGs)--Prevention of Thromboembolism in Spinal Cord Injury and Management of Neurogenic Bowel in Adults With Spinal Cord Injury--at their sites. METHODS: A total of 75 SCI direct-care staff (including physicians, nurses, dieticians, rehabilitation therapists, psychologists, and social workers) participated in the focus groups, which were conducted by trained focus group facilitators. Woolfs framework was used to classify perceived barriers into 1 of 4 categories: (a) lack of knowledge, (b) lack of agreement, (c) lack of ability, or (d) lack of systematic reminders for implementation. The "lack of ability" category was further expanded to reflect which specific aspect of the environment was seen as the obstacle: (a) patient, (b) provider, (c) SCI unit, (d) hospital or medical center, or (e) non-Veterans Affairs (VA) hospital setting. RESULTS: Providers disagreed with the recommendation to reinstitute prophylaxis in patients with nonacute SCI to prevent deep vein thrombosis and identified a number of system-level problems with providing appropriate prophylaxis. Providers identified patient reluctance to changing their bowel programs and difficulties in documenting changes in the patients' bowel program as obstacles to implementing the neurogenic bowel CPG. CONCLUSION: Based on this feedback, interventions were developed to address provider-perceived barriers. These interventions were implemented at 6 Veterans Affairs SCI Centers.

Management of Bartholin's duct cyst and gland abscess.

Bartholin's duct cysts and gland abscesses are common problems in women of reproductive age. Bartholin's glands are located bilaterally at the posterior introitus and drain through ducts that empty into the vestibule at approximately the 4 o'clock and 8 o'clock positions. These normally pea-sized glands are palpable only if the duct becomes cystic or a gland abscess develops. The differential diagnosis includes cystic and solid lesions of the vulva, such as epidermal inclusion cyst, Skene's duct cyst, hidradenoma papilliferum, and lipoma. The goal of management is to preserve the gland and its function if possible. Office-based procedures include insertion of a Word catheter for a duct cyst or gland abscess, and marsupialization of a cyst; marsupialization should not be used to treat a gland abscess. Broad-spectrum antibiotic therapy is warranted only when cellulitis is present. Excisional biopsy is reserved for use in ruling out adenocarcinoma in menopausal or perimenopausal women with an irregular, nodular Bartholin's gland mass.

Data abstraction: designing the tools, recruiting and training the data abstractors.

Data abstraction is very exacting work requiring that data abstractors have both knowledge and experience of phenomena being studied. Quality of the data and efficiency of the data abstractors are dependent upon the content and design of the data abstraction tools. Taking the time to recruit and train qualified data abstractors and to develop effective data abstraction tools will result in data that not only answers the research question, but also withstands the most rigorous critique.