Phenomenological study of nurses caring for dying patients.

Little is known about how nurses experience caring for dying patients. Yet, entering the patient's world often involves dealing with death and dying and is a major challenge to oncology nurses. The purpose of this article is to describe the shared practices of oncology nurses caring for dying patients. Stories from staff nurses on an oncology unit were analyzed using a hermeneutic method to identify and describe four themes: knowing the patient, preserving hope, easing the struggle, and providing for privacy. The four themes contribute to knowledge development about how nurses enter into and experience caring for dying patients. The growing body of knowledge previously reported has included descriptions of critical behaviors in caring for dying patients, coping strategies nurses used when caring for dying patients and their families, and the meaning of oncology nursing practice. The four themes described in this article expand our understanding of the nurses' experience in caring for dying patients.

Strike-through contamination in saturated sterile dressings: a clinical analysis.

This multisite study examined the risk of strike-through contamination of 4" x 4" gauze sponges using a shortcut method of saturating sterile sponges directly on their wrappers. Sterile gauze sponges were saturated directly on their wrappers on hospital over-bed tables of postoperative general surgical patients. Cultures were taken at 0.5, 1, 3, and 5 minutes after saturation to ascertain whether strike-through contamination occurred. Saturated sponges showed significant microorganism growth when compared to expected zero microorganisms at all sampling times following saturation. Although microorganisms identified in strike-through contamination were not microbiologically or pathogenically threatening, the basic principle of asepsis was violated. There was no significant difference in strike-through contamination between sponges saturated on coated wrappers and sponges saturated on uncoated wrappers. Clinicians should be aware that coated wrappers do not provide a moisture-proof barrier against strike-through contamination. The findings suggest the shortcut method should not be used for saturating sponges.

An interpretive analysis of precepting an unsafe student.

Precepting students during their senior practicum is often viewed as an opportunity to nurture the next generation of nurses. However, when the student has only marginally passed courses or clinical experiences, precepting may become a difficult and challenging process. Little is known about how preceptors teach students and even less is known about precepting unsafe students. The purpose of this article is to describe a preceptor's journey through a difficult senior practicum experience. A hermeneutic analysis of the preceptor's journal revealed two themes important in precepting the unsafe student: knowing the student and creating possibilities for success. Two aspects of knowing the student included watchful listening and assessing dangerousness. These themes are described and the dilemma of bringing an unsafe nurse into the profession is discussed.

Storytelling: an innovative approach to staff development.

Using stories or narratives from clinical practice as a teaching/learning strategy is new in nursing education programs in hospitals. In this article, the authors describe three staff development programs using storytelling to enable others to use the interpretation of stories to promote expertise in clinical practice.

Investigation of a staphylococcal food poisoning outbreak in a centralized school lunch program.

The trend in many communities toward centralized school lunch preparation potentially increases the risk of foodborne illness. Foods often are prepared long before serving and may be distributed to satellite schools by persons with little formal training in safe techniques of food preparation or food service. In May 1990, an outbreak of staphylococcal food poisoning occurred in elementary schools in a Rhode Island community participating in such a program. In the investigation of the outbreak, students in schools that reported cases were interviewed. Food preparation, handling, and distribution were reviewed. At School E, 662 lunches were prepared and distributed to 4 additional schools (schools A-D). Schools A and B accounted for nearly all cases of the food poisoning, with rates of 47 percent and 18 percent. Eating ham increased the risk of illness (62 percent of those consuming ham and 3 percent of those who did not, relative risk = 18.0, 95 percent confidence interval = 4.0, 313.4). Large amounts of Staphylococcus aureus were cultured, and preformed enterotoxin A was identified in leftover ham. A food handler, who tested positive for the implicated enterotoxic strain S. aureus, reported having removed the casings from two of nine warm ham rolls 48 hours prior to service. Because of improper refrigeration, prolonged handling, and inadequate reheating, the ham was held at temperatures estimated at 10-49 degrees Celsius (50-120 degrees Fahrenheit) for a minimum of 15 hours. The potential for larger outbreaks prompted a statewide training program in safe food preparation for school lunch personnel, which may have applications for other communities.

Living with renal failure.

UNLABELLED: In this interpretive study, the experience of patients living with chronic renal failure was studied. Within the framework of Heideggerian phenomenology, a hermeneutic analysis revealed three themes and one constitutive pattern. The three themes were: taking on a new understanding of Being, maintaining hope and dwelling in dialysis. The constitutive pattern was " CONTROL: The Meaning of Technology." The findings provide an understanding of living with renal failure that argues against the traditional understanding of noncompliant behaviors. The study makes visible the meaning of technology in the lives of renal patients and highlights the need for nurses to sustain meaningful human connections with patients.

Social organization of length of stay of psychiatric patients.

1. Length of stay (LOS) is the major factor determining the use of resources in hospitals and is the primary component in reducing hospital costs. However, relatively little is known about the anatomy of the hospital stay. 2. The stage model of treatment is used to examine the LOS of psychiatric patients. The model assumes the patient is admitted to the hospital, undergoes testing or observation to verify a diagnosis or establish a new diagnosis, and then proceeds to therapy, recovery, and discharge. 3. In practice, the treatment process does not follow a stage model, but is much more complicated. Various kinds of information are revealed throughout the course of hospitalization and treatment continues as events unfold. Diagnosis, therapy, and recovery occur in a dialectical process constantly being reconstructed as it is informed by interpretations of everyday events.

Preceptor development programs: an interpretive approach.

The behavioral model commonly used in preceptor educational programs is inadequate for conveying the complexity of precepting. An interpretive approach is offered as an alternative for preceptor education. Using an interpretive approach is one way to extend our understanding of precepting as an educational process. A preceptor education program is described along with examples of narratives from preceptors. Interpretations of each narrative provide nurse educators with a model for utilizing narratives with preceptors. Themes of teaching, nursing as precepting, and timing are explored. Restoring the narrative to the nursing practice of precepting promises to recapture the richness and complexity of precepting.

Computerized databases: privacy issues in the development of the nursing minimum data set.

Nursing leaders promoting the development and use of computerized databases such as the Nursing Minimum Data Set (NMDS) have not adequately addressed the complex ethical issues involved with computerized information systems. The purpose of this article is to describe the privacy issues involved with the NMDS. Moral considerations and principles guiding resolution of ethical issues concerning violations of patient privacy are discussed. A paradigm case is used to demonstrate the significance of privacy violations in computerized databases. Two security systems currently being considered in other disciplines are included for their relevance to the development of the NMDS. The broader implications concerning the impact of technology on preservation of human dignity and the quality of life are addressed.