Developing clinical practice environments supporting the knowledge work of nurses.

Registered nurses represent the largest group of healthcare knowledge workers. They accomplish their knowledge work by engaging in the roles of data gatherer, information user, knowledge user, and knowledge builder. To successfully implement these roles, nurses rely on healthcare settings to provide supportive clinical practice environments that recognize their information and knowledge management needs. The authors describe the various knowledge-worker roles, delineate computerized mechanisms that can support these roles, and examine the ability of current healthcare settings to provide an environment conducive to successful knowledge-worker role performance. The article concludes with specific recommendations for development of clinical practice environments supportive of nurses' knowledge work.

Subjective responses to caregiving for a spouse with dementia.

Family members, typically spouses, serve as the primary caregivers for individuals with dementia. While it is recognized that caregivers experience both positive and negative subjective responses to caregiving, relatively little research has been done on the relationship between these types of responses. The objectives of the study were to examine the relationships between and among spouse caregivers' positive and negative subjective responses to caregiving, and increase understanding of the experience of being a spouse caregiver for a person with dementia. Fifty spouse caregivers completed quantitative measures of positive subjective responses (Positive Aspects of Caregiving and Caregiver Competence) and negative subjective responses (Relational Deprivation, Role Captivity, and Loss of Self). Additionally, participants were interviewed concerning their caregiving experiences. Positive Aspects of Caregiving and Caregiving Competence were significantly related to each other (p < .01), as were the three measures of negative subjective responses (p < .01). No significant correlations were found between any measures of a positive and a negative subjective response, suggesting the two types of responses are independent. Duration of caregiving was significantly related to Positive Aspects of Caregiving (p < .05), Caregiver Competence (p < .05), and Relational Deprivation (p < .01). Qualitative interview data revealed that participants simultaneously experienced caregiving as self-affirming, while also enduring losses and difficulties resulting from their caregiving role. Integrating the positive and negative aspects of the whole of caregiving is important to understand the caregiving experience and to design interventions to support caregivers.

Women's approaches to decision making about mammography.

Health professionals have an obligation to understand women's decision making about mammography and to advocate for their active participation in health care decision making. Although mammography is a major screening measure for the second largest cancer killer of women, only approximately half of women older than age 50 years, and fewer older than age 70 years, undergo mammography in accordance with American Cancer Society (ACS) guidelines. Therefore, the purpose of this study was to identify women's overall decision-making approaches when considering mammography. Subjects were a purposive, convenience sample of 50 women in the community who had made a decision about mammography; they included those who chose to have mammograms and those who decided not to have mammograms according to the pre-1997 ACS guidelines. Subjects participated in audiotaped interviews. Results indicated that women approached the mammography decision differently, regardless of the decision they made. Three overall decision-making approaches to addressing risk factors, issues about mammography, or other factors before their decision were evident. The approaches were (1) thoughtful consideration; (2) cursory consideration; and (3) little or no consideration. Each approach has implications for nurses who assist women in making decisions about mammography.

Coronary care nurses' clinical decision making.

Increasing acuity of hospitalized persons with cardiac disease places great demands on nurses' decision-making abilities. Yet nursing lags in knowledge-based system development because of limited understanding about how nurses use knowledge to make decisions. The two research questions for this study were: how do the lines of reasoning used by experienced coronary care nurses compare with those used by new coronary care nurses in a representative sample of hypothetical patient cases, and are the predominant lines of reasoning used by coronary care nurses in hypothetical situations similar to those used for comparable situations in clinical practice? Line of reasoning was defined as a set of arguments in which knowledge is embedded within decision-making processes that lead to a conclusion. Sixteen subjects (eight experienced and eight new nurses) from coronary care and coronary step-down units in a large, private, teaching hospital in Minnesota, USA, were asked to think aloud while making clinical decisions about six hypothetical cases and comparable actual case. One finding was that most subjects in both groups used multiple lines of reasoning per case; but they used only one predominantly. This finding highlighted the non-linear nature of clinical decision making. Subjects used 25 predominant lines of reasoning, with intergroup differences on six of them. Where there were differences, experienced nurses used lines of reasoning of lower quality than did new subjects. The type variability in lines of reasoning suggested that multiple pathways should be incorporated into knowledge-system design. One implication of the variability in subjects' line of reasoning quality is that nurses at all levels of expertise are fallible and could benefit from decision support. The finding that subjects tended to use similar lines of reasoning for comparable hypothetical and actual cases was modest validation of subjects' performance on hypothetical cases as representing their decision making in practice. Consequently, there was support for using simulations and case studies in teaching and studying clinical decision making.

Options, outcomes, values, likelihoods decision-making guide for patients and their families.

When family caregivers are faced with making daily decisions, they may feel burdened, frustrated, and even in conflict with other family members. The OOVL Guide is a tool to help people think about the various aspects of a decision situation and combine them to make a decision. The OOVL Guide supports nurses in their advocacy role because it affirms the importance of the clients' values and preferences. The OOVL Guide provides decision-makers, both professionals and lay people, with a structure and procedure for making choices for themselves or others.

Decision making by elderly patients with cancer and their caregivers.

This study explored the scope of decisions encountered by elderly cancer patients and/or their family caregivers, and the types of decision-making assistance requested and required within one practice setting. Semistructured interviews were conducted with five cancer center nurse coordinators (CCNCs). The CCNCs were interviewed weekly for 16 weeks to identify decision-making topics addressed, assistance requested, and perceptions of assistance required during telephone conversations. The CCNCs' reports of 41 telephone conversations revealed 44 specific decision-making topics. Content analysis uncovered 11 categories: symptom management, use of chemotherapy, ancillary choices selection of a medical provider, planning for end-of-life care, alternative therapy, vacation planning, weekend-pass planning, discharge planning, family survivor issues, and involvement of adult children in the elder's care. Elderly patients and/or their family caregivers requested information and assistance with making decisions. CCNCs perceived that callers also needed information clarification, reassurance about their decisions, a listener, permission to change the treatment regimen, and help with communication among health professionals, the elderly patient, and the family.

Line of reasoning as a representation of nurses' clinical decision making.

Line of reasoning (LOR) is offered as an alternative representation of clinical decision making for studies using protocol analysis. A LOR is defined as an argument or set of arguments leading to a conclusion. Because LOR combines both knowledge and cognitive processes, it provides a more complete representation of how a person uses knowledge to make a decision in a particular situation than do other representations. Operationalization of LOR in the form of templates and narratives enhances systematic data interpretation and coding. The use of LOR as a representation is illustrated in a study of critical care nurses' clinical decision making, specifically the determination of a patient's readiness to wean from mechanical ventilation.

A process model to guide selection of essential curriculum content.

The purpose of this qualitative study was to develop and test the usefulness of a process model to identify guidelines for selecting essential content in undergraduate nursing curricula from nursing and related disciplines. The study was designed to test the usefulness of the model. Usefulness was determined by evaluating the operationalization of the model and the product resulting from operationalization of the model. The criteria of practicality, purposiveness, realism, and judiciousness were used. The model consists of four steps. In Step 1, the content area is delineated. Step 2 consists of a review of the literature of both disciplines. Analysis and synthesis of this information results in guidelines, stated in conceptual terms and accompanied by brief rationale, for essential content. In Step 3, educators and clinicians are interviewed to determine reliability and validity of the guidelines. In Step 4, guidelines are revised based on comments obtained in Step 3. Operationalization of the model using nutrition content resulted in five content and three process guidelines. Both the process described by the model and the guidelines which resulted from that process were evaluated as useful. Suggestions for future research using the model are made.

Nutrition in nursing curricula: recent developments and recommendations.

In summary, nursing and nutrition have matured as scholarly professional disciplines. Both have bodies of knowledge and professional practice arenas that are unique, yet interrelated. Professional maturity and social necessity are resulting in increased collaboration and cooperation between nurses and dietitians after a time of separation and lack of communication. The status of nutrition education for nurses at this time is complex. There is consensus that nurses have a role in the nutritional care of clients and that nutrition content is essential. But what that content should be has not been generally accepted. Consequently, questions related to what content should be emphasized, its proper placement in the curriculum, and the best way to teach nutrition have not been answered. The eight guidelines developed by Morse offer a basis for the development, implementation and evaluation of essential nutrition content in undergraduate nursing curricula. The SNE content used in conjunction with these guidelines can help direct the selection of specific content. The professional background of the educator who teaches nutrition in nursing curricula influences content. We believe that both nurses and dietitians must be actively involved in the nutrition education of nurses. Both professions have as part of their perspective the health of people. The focus of nursing has been described as "the study of caring in the human health experience." The focus of dietetics has been described as the study of the impact of food and nutrients on the health of people.(ABSTRACT TRUNCATED AT 250 WORDS)

Enhancing orthopaedic nurses' clinical decision making.

Clinical decision making ability is necessary for safe and effective orthopaedic nursing practice. By clinical decision making, we mean the rendering of a judgment about patient care using analytical and intuitive processes and incorporating professional knowledge. Although recent research findings indicate that there is no single approach that clinicians use to make all decisions, there are several general aspects of decision making processes. Among these are the development of mental representations, decision-making procedures, and pattern recognition. Five selected strategies for enhancing these general processes are described and illustrated with patient situations relevant to orthopaedic nursing.

The focus of the discipline of nursing.

The focus of nursing as a discipline has not been clearly defined but is emergent in the centrality of the concepts of caring and health. The authors propose a focus for nursing as a professional discipline in the form of a statement that identifies a domain of inquiry that reflects the social relevance and nature of its service. Several perspectives from which the focus can be studied are described. The authors assert that a unitary-transformative perspective is essential for the full explication of nursing knowledge.

Supplemental-information-seeking behavior of cardiovascular nurses.

The Krikelas model was used as a framework for investigating supplemental-information-seeking behavior of cardiovascular nurses. (Supplemental information is that which is not available from memory and could be made available by computer). One hundred seventy-five instances of supplemental-information-seeking behavior were collected from 46 cardiovascular nurses in three metropolitan hospitals. Self-report and observation-interview methods were used. Findings indicated that the nurses sought patient-specific data most frequently, followed by institution-specific data and domain knowledge. They needed a surprisingly large portion of the information to track people, equipment, medications, and reports. The findings have implications for nursing information system design.