International education: developing site visit guidelines to enhance understanding.

International educational activities, whether organized as study tours or conferences, often include visits to various health care or educational facilities. These visits can provide a unique perspective on health care delivery, nursing education, and nursing practice. To maximize learning during such visits, a clear focus and guidelines are needed. The experience of conducting a conference in Russia is used as a basis for developing recommendations and creating guidelines for site visits that promote understanding of the nursing role and the health care system in another country. This article describes the process of developing educational objectives and guidelines for clinical and educational site visits. It is hoped the examples will be useful in planning site visits for other international educational activities.

Creating international conference submission and review guidelines to facilitate transnational dialogue.

Globally, nurses have much knowledge to share and the increased calls for conference presentation abstracts reflect this. However, a recent literature review revealed no guidelines for presentation submission and review processes for international nursing conferences. During the past decade, one conference, the U.S.-Russian Conference Cruise, has used evaluation data from each conference to shape its submission and review processes in a way that promotes transnational dialogue during the conference. The purpose of this article is to describe the challenges and evolution of designing submission and review processes that support the goal of a scholarly program of intercultural exchange.

Striving for nursing excellence to strengthen nursing practice for the future.

The practice of nursing continues in a state of change, with a number of issues challenging us as we strive for excellence. Nursing leaders must confront these on a daily basis and are passionate about and committed to continually strengthening nursing practice for the delivery of excellent patient care. The nursing workforce issues, nursing leadership challenges, focus on quality, safety and evidence based practice, decreasing health disparities and creating patient partnerships all must be addressed for us to succeed. Through exploring the interconnections of these issues, we can make a significant change in one to affect other areas. Challenges bring opportunities and we are seeing our hard work begin to make significant improvements. The work force is stabilizing, we are experimenting with ways to get staff excited about becoming nurse leaders, focusing on improving care through quality and safety initiatives, moving toward evidence based practice and achieving partnerships with patients other healthcare providers and our communities.

Creating a context for professional dialogue between United States and Russian nurses: design of an international conference.

This age of globalization challenges nurses to find effective ways to promote interaction to further scholarly efforts across cultural boundaries. This article describes critical conference design elements necessary to create a context for transnational professional dialogue. Collaborative efforts such as study exchanges and workshops resulting from this conference have fostered dialogue on ways to strengthen nursing practice to improve patient and family outcomes in the United States and Russia. The design of such a conference can serve as a model for promoting joint scholarly efforts to increase understanding among nurses across the globe.

Are evidenced-based practice and best practice the same?

In summarizing this discussion of the meaning of EvBP and best practice and their relationship to each other, there is merit in beginning with a delineation of six characteristics of quality care. These six characteristics synthesized by Brown (2001, p. 1) consist of care that is (a) patient centered, (b) scientifically based, (c) population outcomes based, (d) refined through quality improvement and benchmarking, (e) individualized to each patient, and (f) compatible with system policies and resources. These characteristics set the stage and reinforce critical aspects of the definition of both concepts: EvBP and best practice. For evidence to be meaningfully and successfully translated into practice by individuals, and groups of practitioners, the concept of best practice adds an organizational and ongoing quality monitoring to promote continual improvement. Best practice is not a specific practice per se but rather a level of agreement about research-based knowledge and an integrative process of embedding this knowledge into the organization and delivery of health care. The question "Are EvBP and best practice the same?" has guided this discussion, which has focused on how these concepts are related to each other but not the same. Best practice requires a level of agreement about evidence to be integrated into practice. The challenge now is to answer this question: "How can practice be built based on evidence and an environment supportive of this kind of practice?" The struggle needing to be faced is how to devise strategies to operationalize best practice. A beginning identification of the multiple questions and issues in doing so are outlined by Harrison, Logan, Lynn, and Graham (1998), and Newman and Papadopoulos (2000). Plus, Mulhall (1998) poses the challenging question of how is nursing best placed to maximize the benefits that some kind of evidenced-based care can bring? Research is needed into the situations under which evidence can be adopted into practice--and into the consequences of doing so. Best practice, built on a foundation of EvBP, can bridge the practice-research gap and provide a basis for researchers and clinicians to work together to translate research into meaningful practice. Understanding the concept of EvBP and joining together to devise best practice for health care organizations can promote achieving the goal of desired patient outcomes.

Clinical decision rules as tools for evidence-based nursing.

Nursing practice is fraught with uncertainty and our patients do not always respond predictably to our interventions. Properly developed and tested Clinical Decision Rules (CDRs), a special type of decision support tool, help organize research evidence into standardized patient assessments and treatments, thereby increasing the probability of attaining the desired outcome and reducing uncertainty in practice. The purpose of this article is to examine CDRs as one kind of decision support tool that can be used to facilitate nursing decision making and evidence-based practice (EBP). CDRs differ from both treatment algorithms and clinical pathways in the ways they are developed and in their scope of applicability. CDRs are developed using strict methodological standards, with the goal that they function well when used by a variety of care providers, with various patient populations, and in different patient care settings.