The State of the Science on Clinical Evaluation in Nursing Education.

AIM: The purpose was to synthesize the published evidence to present the state of the science in clinical evaluation research in nursing education. BACKGROUND: Clinical evaluation is key to ensuring nursing students' clinical competence, application of knowledge, and critical thinking, all of which are important to patient safety and quality nursing care. METHOD: Cooper's research synthesis method was used. RESULTS: A comprehensive literature search resulted in 250 documents, of which 88 met study criteria. Topics were exhaustive but not mutually exclusive and included competence, instrumentation, congruence, teaching methods, objective structured clinical evaluation, faculty/preceptor issues with clinical evaluation, essential clinical behaviors, topic-based evaluation, decision-making about clinical grade, and clinical reasoning. CONCLUSION: Nursing education science is in its infancy in many areas. Two areas most in need of future research are the need to accurately define and efficiently measure competence in the clinical area and the need for reliable and valid instrumentation.

Sex and Intimacy after Stroke.

PROBLEM: The sequelae of a stroke can negatively affect sex and intimacy for survivors and their partners. PURPOSE: This clinical article offers practical evidence-based recommendations for nurses to use in advising couples who may be experiencing sexual problems due to decreased desire, erectile dysfunction, vaginal dryness, paraparesis, pain, spasticity, fatigue, aphasia, concrete thinking, emotional lability, shame, embarrassment, fear, depression, or neurogenic bladder. KEY FINDINGS AND CLINICAL RELEVANCE: Recent research and clinical articles show that intimacy and sexual concerns are often ignored by the rehabilitation team, yet research shows that couples want information to assist them to maintain their sexual relationships. Using the PLISSIT model to address sexual concerns, nurses can facilitate discussions to aid couples toward improved sexual function and quality of life.

Teaching pathophysiology: strategies to enliven the traditional lecture.

The depth and breadth of pathophysiology content, foundational for nursing practice, is well suited for traditional lecture delivery. Use of creative strategies can deepen students' understanding while respecting students' diverse talents and ways of learning. The authors discuss strategies they used, including case studies, questions asked during lecture using immediate feedback technology, creative visual demonstrations, group pathophysiologic theory projects, short videos, and games, to enhance students' understanding and retention of content.

The effects of correction insulin and basal insulin on inpatient glycemic control.

Hospitalized patients with type 2 diabetes may benefit from tighter glycemic control to prevent hyperglycemia and its complications. The glycemic control of two groups of inpatients with diabetes receiving subcutaneous insulin via a basal-bolus approach or sliding scale was compared.

NNN language and evidence-based practice guidelines for acute cardiac care: retaining the essence of nursing.

Multidisciplinary management of the acute cardiac patient, for decades, has been driven by best practices, treatment algorithms, and research-based protocols. As nurses continue to develop and implement evidence-based care, they must ensure that the essence of nursing is not lost in the process. In this article, strategies for the development of evidence-based practice guidelines for acute cardiac patients using standardized nursing language are provided.

Impact of intravenous insulin protocols on hypoglycemia, patient safety, and nursing workload.

The practice of tight glycemic control using an intravenous insulin infusion has been adopted in many clinical settings, and although beneficial patient outcomes have been clearly documented, the therapy poses potential risks to patient safety related to hypoglycemia and increases nursing workload. This article examines these issues through a review of current research on tight glycemic protocols. Strategies for nurse leaders are provided to improve patient safety and support bedside nurses in the administration of insulin infusion protocols.

Loss and depression after traumatic injury: the importance of case management in the recovery process.

UNLABELLED: PURPOSES OF STUDY: This study aims to (1) explore the types of resource loss commonly experienced by trauma patients as a result of their injuries, (2) examine the relationship between loss of resources and depressive symptoms after traumatic injury, (3) identify the types of coping behaviors used during trauma recovery, and (4) identify other factors influencing depression after injury. PRIMARY PRACTICE SETTING(S): Primary settings comprise the case managers working with trauma patients in hospital, rehabilitation, outpatient, and home environments. METHODOLOGY AND SAMPLE: This study used a cross-sectional design. A sample of 50 trauma patients who had sustained an unintentional injury in the prior 1-4 months completed a single interview during which participants completed measures of general health, loss of resources, coping, and depressive symptoms. Types of resource losses were also explored through open-ended questions. RESULTS: Symptoms of depression were prevalent in the sample. Participants experienced multiple and varied loss of resources, especially in financial and personal realms. Loss of resources and depression scores were significantly related. Participants reported using a variety of coping strategies, most commonly accepting the reality of their circumstances and limitations. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The case manager can serve an important role in the recognition of depression in trauma patients and the implementation of appropriate interventions, including referral to mental health professional for further evaluation. Strategies to aid in the prevention of depression after injury include early identification of individuals who are more vulnerable to resource loss, assessment of current resource stores, and facilitating and coordinating access to essential resources to aid in trauma recovery.

Promoting cultural awareness and knowledge among faculty and doctoral students.

This article describes the activities conducted by the Race and Gender Committee of one school of nursing in North Carolina to promote cultural awareness and knowledge among faculty and doctoral students. Wells's Institutional Cultural Development Model provided a theoretical framework for a systematic approach to the development of activities designed to identify cultural issues as they relate to teaching and research. Strategies used included a variety of seminars and workshops and the participation of consultants and experts. The workshops and other programs led to improved interdepartmental dialogue among faculty and doctoral students, facilitated faculty and students' understanding of cultural diversity, provided the groundwork for promotion of attitudinal and behavioral changes, and increased cultural awareness and knowledge. Recommendations are included for developing similar programs.

An exemplar of the use of NNN language in developing evidence-based practice guidelines.

PURPOSE: To explore the use of standardized language, NNN, in the development of evidence-based practice (EBP). DATA SOURCES: Published research and texts on family interventions, nursing diagnoses (NANDA-I), nursing interventions (NIC), and nursing outcomes (NOC). DATA ANALYSIS: Research literature was summarized and synthesized to determine levels of evidence for the NIC intervention Family Integrity Promotion. CONCLUSIONS: The authors advocate that a "standards of practice" category of levels of evidence be adopted for interventions not amenable to randomized controlled trials or for which a body of research has not been developed. Priorities for nursing family intervention research are identified. IMPLICATIONS FOR NURSING PRACTICE: The use of NANDA-I nursing diagnoses, NIC interventions, and NOC outcomes (NNN language) as research frameworks will facilitate the development of EBP guidelines and the use of appropriate outcome measures.

Promotion of family integrity in the acute care setting: a review of the literature.

The acute illness of 1 family member can then negatively affect all family members and lead to the disruption of family functioning and integrity. During the patient's hospitalization, nurses are in a key position to support family members, maintain family integrity, and ready them for assuming the role of caretaker during the patient's recovery and management of health at home. This article reviews current research findings that provide empirical support for activities that promote family integrity. Strategies for nurses to support family members during the hospitalization of an adult family member and suggestions for future research are provided.

A modified technique for anterior multilevel cervical fusion.

Anterior cervical fusion with interbody bone graft and anterior plating is commonly performed. Unfortunately, the plate has been reported to shield the graft from loading, thus reducing fusion rates. Interbody fusion cages have been effective in the lumbar spine and have gained acceptance in the cervical spine. Twenty-five patients underwent anterior cervical fusion with this modified technique. All patients received anterior diskectomy and corpectomy, placement of an interbody fusion cage packed with corpectomy bone, and application of an anterior cervical plate. Fusion was defined by radiographic evidence of trabecular bone bridging through the cage. No external bracing was used except soft collars as needed. Pre- and postoperative pain scales were completed and statistically analyzed using paired t tests. There were no cases of pseudoarthrosis or major neurological, vascular, or wound complications. There was one case of mild dysphagia that remained unresolved. Mean operative time was comparable to standard instrumented multilevel cervical fusion surgeries. Visual analogue pain scales were significantly improved following surgery. The advantages of using interbody cages with anterior plating include immediate stability and support, elimination of donor site pain from iliac crest bone autograft, and a decrease in pseudoarthrosis by halving the number of fusion surfaces.