For faculty, by faculty: a case study of learning to teach online.

The shortage of nursing faculty and the need for MSN-prepared faculty to have access to doctoral education and remain in their teaching roles has resulted in a growing number of nurse education programs moving online. A better understanding of how best to support faculty during this transition is needed. This case study describes the experiences of faculty at one institution as they participated in a grassroots effort to learn about online teaching. Six themes related to the faculty development experience were identified: 1) plugging in; 2) peer sharing, modeling and community building; 3) multidimensional learning; 4) role-shifting and meta-learning; 5) paradigm shifting; and 6) sustaining momentum. Findings are connected to recommendations related to how best to prepare faculty to ensure that quality nursing education continues.

Case management for patients with poorly controlled diabetes: a randomized trial.

PURPOSE: To evaluate the effects of a collaborative case management intervention for patients with poorly controlled type 2 diabetes on glycemic control, intermediate cardiovascular outcomes, satisfaction with care, and resource utilization. METHODS: We conducted a randomized controlled trial at two Department of Veterans Affairs Medical Centers involving 246 veterans with diabetes and baseline hemoglobin A(1C) (HbA(1C)) levels >or=7.5%. Two nurse practitioner case managers worked with patients and their primary care providers, monitoring and coordinating care for the intervention group for 18 months through the use of telephone contacts, collaborative goal setting, and treatment algorithms. Control patients received educational materials and usual care from their primary care providers. RESULTS: At the conclusion of the study, both case management and control patients remained under poor glycemic control and there was little difference between groups in mean exit HbA(1C) level (9.3% vs. 9.2%; difference = 0.1%; 95% confidence interval: -0.4% to 0.7%; P = 0.65). There was also no evidence that the intervention resulted in improvements in low-density lipoprotein cholesterol level or blood pressure control or greater intensification in medication therapy. However, intervention patients were substantially more satisfied with their diabetes care, with 82% rating their providers as better than average compared with 64% of patients in the control group (P = 0.04). CONCLUSION: An intervention of collaborative case management did not improve key physiologic outcomes for high-risk patients with type 2 diabetes. The type of patients targeted for intervention, organizational factors, and program structure are likely critical determinants of the effectiveness of case management. Health systems must understand the potential limitations before expending substantial resources on case management, as the expected improvements in outcomes and downstream cost savings may not always be realized.

Ready for the World: preparing nursing students for tomorrow.

In 2004, a 5-year plan of international and intercultural education was developed by the University of Tennessee, Knoxville (UTK) to help students become ready for the changing world in which they will live. This program is called "Ready for the World." The University of Tennessee College of Nursing in Knoxville has integrated many of the suggestions from this program into the undergraduate nursing curriculum to prepare students for the world by making the world their classroom. Intercultural learning includes both a solid base of knowledge obtained in the classroom and multiple experiences that involve cultural interaction. Experiences begin on UTK's diverse campus and expand to the surrounding city of Knoxville, including interactions with vulnerable populations such as the homeless or elderly persons, then to nearby Appalachian communities, and on to Central America. Many of these experiences are offered for credit in the Community Health Nursing or the Transcultural Nursing courses. The knowledge nursing students acquire and their varied experiences will help them gain cultural competence for their future nursing practice.

Evaluating quality of nursing care: the gap between theory and practice.

The purpose of this article is to determine whether nursing practice, as judged by nurse peer reviewers, varies by type or location of hospital and to assess which aspects of practice tend to be most at variance with nursing theory. This article provides a framework of continued quality assessment and improvement that is based on prior research. Trained nurse peer reviewers carried out structured implicit review, which utilized their professional judgment to evaluate the process of nursing care for patients admitted to acute hospitals with heart failure or cerebrovascular accident. Findings show significant variations in the quality of nursing care and support the continued development of nursing quality assessment and improvement initiatives directed at reducing the gap between nursing theory and practice.

The HANDS project: studying and refining the automated collection of a cross-setting clinical data set.

The consistent availability of a core set of clinical nursing data is essential to promote quality patient care. Although important work to improve terminology and enhance comparability of data is underway, the efforts do not address the immediate need for useful nursing data sets and valid methods of collection at the point of data entry. The Hands-on Automated Nursing Data System (HANDS) project is dedicated to refining a feasible methodology for gathering, storing, and retrieving a standardized nursing data set. To date the project team has developed and tested a prototype research tool that is automated and contains the structured terminologies (North American Nursing Diagnosis Association, Nursing Outcomes Classification, and Nursing Interventions Classification) to represent nursing diagnoses, outcomes, and interventions, respectively. The Phase I project development activities are reported in this article, along with Phase II and III plans for testing and refining the methodology under actual clinical conditions. Results and lessons learned during Phase I are reported.