Difficulties in the integration of psychological and medical practices.

The authors, who support in principle the important goal of integrated psychological and physical care, discuss five sources of difficulty in the practical application of such integration: 1) differences in values and, consequently, in systems of practice, 2) training influences, 3) differences in dealing with emotions, 4) conflicting patient expectations, and 5) limitations on the degree of intimacy tolerable in professional relationships. They suggest that practitioners and educators take these difficulties into account without abandoning a holistic perspective.

Mentoring students in writing: "gourmet express" versus "fast food service".

Is writing a process or a product? To be an effective and an efficient mentor in the writing process, the answer must be "Both!" The final written manuscript is important, but the process by which the student learns to produce that manuscript is equally important. A graduate student recently remarked to one of the authors: "How did you learn to write? I don't remember anyone ever talking to me before about how to write. Professors seem to feel I should already know how." When writing is thought of as a cognitive process, rather than a static product, the benefits to be gained from coaching this process become evident. Many students are hungry for information about becoming better writers. Too often we offer them the "fast food service" approach, concentrating on the appearance of the final product, rather than the potential benefits to be gained in the preparation of the product. It is by mentoring students in both the process and product aspects of writing that nurse educators can realize the satisfaction of moving away from "fast food service" and investing their energies in the "gourmet express" approach, where the emphasis is not only on helping students learn to write, but also helping them use writing to learn.

Searching for a dean: getting the qualities you want.

The committee had a strong sense of accomplishment when they submitted the names to the Provost. Both the process and the screening tool worked well for the search process.

Mentoring new faculty.

This is a report of the process and evaluation of 12 years of mentoring new faculty in a university nursing faculty of 48 members. Each new faculty member is paired with an experienced faculty member who serves as a mentor for a year. Evaluations completed by both new faculty and mentors at the end of the year are positive.

Designing class participation experiences for the introverted student.

Class participation for students is such a common expectation of nurse educators that it is easy to overlook the need to tailor class participation activities to individual student needs. An understanding of the various temperaments of individuals, especially preferences related to extroversion and introversion, can help nurse educators to plan class participation experiences that foster skills in critical thinking and enhance personal growth.

Use of clinical journals to enhance critical thinking.

The clinical journal offers a valuable medium through which faculty can teach critical thinking. Both analysis and evaluation of the interactions and relationships between clinical practice, theory, and research can be greatly enhanced through careful structuring of clinical journal assignments. The authors discuss ideas about structuring clinical and journal assignments and strategies for giving feedback.

Self-scheduling with Microsoft Excel.

Excessive time was being spent by the emergency department (ED) staff, head nurse, and unit secretary on a complex 6-week manual self-scheduling system. This issue, plus inevitable errors and staff dissatisfaction, resulted in a manager-lead initiative to automate elements of the scheduling process using Microsoft Excel. The implementation of this initiative included: common coding of all 8-hour and 12-hour shifts, with each 4-hour period represented by a cell; the creation of a 6-week master schedule using the "count-if" function of Excel based on current staffing guidelines; staff time-off requests then entered by the department secretary; the head nurse, with staff input, then fine-tuned the schedule to provide even unit coverage. Outcomes of these changes included an increase in staff satisfaction, time saved by the head nurse, and staff work time saved because there was less arguing about the schedule. Ultimately, the automated self-scheduling method was expanded to the entire 700-bed hospital.

Effects of hospital downsizing on surviving staff.

In 1993, 27% of 1,147 surveyed hospitals planned to decrease staff size in the next year. This study surveyed 48 vice presidents of nursing in North Carolina hospitals with an average inpatient census over 100 using a 13-item questionnaire in an effort to discover strategies that were helpful in effective downsizing endeavors. Of the 31 (48%) returned questionnaires, 11 (35%) of the VPs reported downsizing in the past 3 years, most of which required the closing of one or more units. The respondents ranked attrition as the most common strategy, followed by relocation, early retirement, a change in skill mix, and layoffs. The most important components in successful downsizing or reorganization efforts were: two-way communication and sufficient planning, as well as seeking and using input from a broad group of staff (using both individual meetings and group forums/discussions).

Case management: implementing the vision.

Case management is a strategy for restructuring the health care delivery system. The system requires critical planning and implementation steps to achieve quality care at reduced cost.

Developing an instrument for measuring patient satisfaction.

We developed a 21-item questionnaire to evaluate the effectiveness of nursing care provided in an outpatient surgery center. The four constructs of the instrument for measuring patient satisfaction are caring, continuity of care, competence of nurses, and education of patients and family members. Content validity and test-retest reliability have been established. Using this tool to analyze patients' responses to nursing care can help perioperative nurses improve patient care and patient satisfaction.

Use of writing portfolios for interdisciplinary assessment of critical thinking outcomes of nursing students.

This article discusses an interdisciplinary research project in which faculty from nursing and english collaborated in the assessment of students' critical thinking skills as reflected in writing portfolios. Faculty reviewed students' writing portfolios and then corresponded on email from two different universities about evidence of critical thinking in the portfolios. Findings suggest that writing portfolios can provide important evidence of critical thinking outcomes. To do this, however, faculty need to design writing assignments to foster critical thinking skills, helping students to think not only about learning to write, but also about using writing to learn.

Calling all patients.

Hospitals must establish patients' expectations of care and their satisfaction with the care delivered. This telephone survey tool measures patient satisfaction based on empathy, communication, competence and continuity of care, and amenities.

Supervision. How satisfied are middle nurse managers?

A study examines the relationship between middle nurse managers' (MNMs) job satisfaction and how they perceive their chief nurse executive's (CNE) leadership style and adaptability. The CNE's own leadership style and adaptability were studied. The study thus examined the interplay between job satisfaction (specifically satisfaction with supervision), leadership style and leadership adaptability.