Clinical decision making of nurses regarding elder abuse.

A descriptive correlational design was used to examine the clinical decision making of nurses regarding elder abuse. The relationship of the nurses' applied knowledge of elder abuse, years of experience as a Registered Nurse (RN), clinical level of practice status, the use of intuition, and clinical decision outcomes for patients in cases of suspected elder abuse were examined. The convenience sample of 84 RNs consisted of 68 females and 16 males. Results indicated an overall model of two predictors that significantly predicted outcomes. The t-test revealed no difference between RNs who received elder abuse education and those who did not.

The wisdom of retaining experienced nurses at the bedside: a pilot study examining a minimal lift program and its impact on reducing patient movement related injuries of bedside nurses.

This Robert Wood Johnson Foundation grant-funded research examined nursing satisfaction with devices used in the target hospital's minimal lift program. It also investigated the possibility of maintaining or increasing retention of experienced nurses at the bedside by reducing potential patient movement-related injuries.

Challenges in sustaining excellence over time.

A culture of excellence is not synonymous with a culture of perfection. Perfection is not attainable but excellence is when an infrastructure is developed that can rapidly and effectively adapt to change. Saint Joseph's Hospital in Atlanta, Georgia, is often asked about the challenges faced in developing, and sustaining, a culture of nursing excellence over time. Topics such as organizational hardiness, the emergence of a professional practice model, the development of a clinical nurse advancement program, and the implementation of the Forces of Magnetism and the Essentials of Magnetism will be discussed in relation to sustaining a culture of excellence.

Structures and practices enabling staff nurses to control their practice.

This mixed-methods study uses interviews, participant observations, and the CWEQII empowerment tool to identify structures and attributes of structures that promote control over nursing practice (CNP). Nearly 3,000 staff nurses completed the Essentials of Magnetism (EOM), an instrument that measures CNP, one of the eight staff nurse-identified essential attributes of a productive work environment. Strategic sampling is used to identify 101 high CNP-scoring clinical units in 8 high-EOM scoring magnet hospitals. In addition to 446 staff nurses, managers, and physicians on these high-scoring units, chief nursing officers, chief operating officers, and representatives from other professional departments are interviewed; participant observations are made of all unit/departmental/hospital council and interdisciplinary meetings held during a 4 to 6 day site visit. Structures and components of viable shared governance structures that enabled CNP are identified through constant comparative analysis of interviews and observations, and through analysis of quantitative measures.

The coordinator role for a nursing online graduate practicum.

Although graduate students in nursing are adult learners and expert clinicians, they are often novices in the roles they seek upon graduation. Practicum experiences help students bridge the gap between theory learned in course work and beginning practice at the master's level. However, finding practica for online nursing graduate students at great distances is often a challenge. The value of having a point person for the coordination of students' practicum experiences in multiple settings is well known. What is less well known is how this coordination occurs across great distances in online courses that include a practicum component. The authors discuss the design and implementation of a practicum coordinator position in a graduate online program.

Nurse manager support: what is it? Structures and practices that promote it.

Professional nursing organizations identify nurse manager (NM) support of staff nurses as an essential component of a productive, healthy work environment. Role behaviors that constitute this support must be identified by staff nurses. In this mixed-method study, supportive role behaviors were identified by 2382 staff nurses who completed the investigator-developed Nurse Manager Support Scale. In addition, semistructured interviews were conducted with 446 staff nurses, managers, and physicians from 101 clinical units in 8 Magnet hospitals in which staff nurses had previously confirmed excellent nurse manager support. Through individual and focus group interviews with NM and chief nurse executives in the 8 participating hospitals, the organizational structures and practices that enabled NM to be supportive to staff were determined. The 9 most supportive role behaviors cited by interviewees were as follows: is approachable and safe, cares, "walks the talk," motivates development of self-confidence, gives genuine feedback, provides adequate and competent staffing, "watches our back," promotes group cohesion and teamwork, and resolves conflicts constructively. Supporting structures and programs identified by managers and leaders include the following: "support from the top," peer group support, educational programs and training sessions, a "lived" culture, secretarial or administrative assistant support, private office space, and computer classes and seminars.

A comparison of three measures of elder abuse.

PURPOSE: To present a comparison of three measures for assessing elder abuse. DESIGN AND METHODS: Three measures for assessing elder abuse were identified through a literature review. The characteristics and uses of each measure were reviewed and evaluated. FINDINGS: The Indicators of Abuse (IOA) is a 22-item tool for discriminating abuse and nonabuse cases; it is completed by a health care professional after a home assessment is conducted. The Elder Abuse and Neglect Assessment (EAI) is a 44-item scale comprised of seven sections to review signs, symptoms, and subjective complaints of elder abuse, neglect, exploitation, and abandonment; it can be used by health care providers in all clinical settings. The Elder Abuse Screening Test (EAST) is a 15-item tool to be completed by a health care provider based on the patient's responses. This screening tool is limited because of the small unrepresentative samples used to test it, the low internal consistency, and a relatively high false-negative rate. CONCLUSIONS: An instrument to accurately assess elder abuse in long-term care is needed. Proper identification of elder abuse is the first step in assisting victims in dealing with abusive situations.