Characteristics of the trauma recidivist: an exploratory descriptive study.

INTRODUCTION: The purpose of this study was to identify characteristics and perceptions of trauma recidivists. Information obtained from this study will help health care professionals better understand trauma patients and design more effective trauma prevention programs. METHODS: An exploratory descriptive, correlational design was used. A convenience sample of 100 trauma patients entering a midwestern university medical center were studied. A demographic chart review and a personal interview consisting of 29 questions were conducted for each subject. The interview questions sought information regarding high-risk behavior, risk-taking personality traits, safety precautions used, and social, psychological, and environmental factors surrounding the patient's traumatic event. RESULTS: Thirty-six percent of trauma patients studied were recidivists. The recidivist was more likely to be male, younger than 45 years, a member of a racial minority, single, uninsured, and have less than 12 years of education. Behavioral characteristics common to most recidivists included a history of past arrests, illegal drug use, and having witnessed past violent injuries. DISCUSSION: Trauma remains one of the most devastating diseases facing americans. Characteristics of trauma recidivists have been identified, and further research is needed to test possible interventions to curb the unnecessary trauma injuries that occur every day.

Midwifery in Northern Belize.

During several volunteer experiences in the Corozal District in Northern Belize, the authors worked with and interviewed traditional midwives, midwife educators, administrators, and professional midwives, who practice in public health clinics, rural health outposts, and a government hospital. One interview with a traditional midwife from a rural Mayan village, garnered interesting information about her 63-year practice, which is compared with the practice of professional midwives. Issues important to midwifery and health care in Belize are discussed. The interviews and the authors' own experiences reveal changing birthing practices, as well as the continued importance of midwives in the care of childbearing women in Northern Belize.

Development and testing of the Clinical Post-Conference Learning Environment Survey.

Clinical postconference is an integral component of the required laboratory hours in undergraduate baccalaureate nursing education. Empirical evidence supporting the educational benefits of this activity are nearly nonexistent. This article describes the development and psychometric testing of a self-report instrument designed to measure clinical postconference learning environments as perceived by undergraduate nursing students and faculty. The Clinical Post-Conference Learning Environment Survey (CPCLES) consists of 54 items and has been tested with more than 500 participants in three schools of nursing in the Midwest. Based on theoretical support and comprehensive review of the literature, six components of the learning environment are measured in two forms of the instrument; an actual scale and an importance scale. Content validity, internal consistency, and test-retest reliability are discussed. Using the CPCLES, perceptions of undergraduate nursing students and faculty were measured. Significant differences between the actual components of the learning environment and the correlated ratings of the importance of these components were found. Faculty perceived a significantly greater amount of teacher support, task orientation, and innovation in the postconference learning environment than did undergraduate students. No differences were noted between faculty and students regarding the importance of the learning environment components. This study presents findings with the use of the first instrument developed to measure clinical postconference learning environments. The congruence and discrepancy among and between learning groups' perceptions carry implications for educational practices in this setting. Subseqent investigations using this tool may be able to link the perceived learning environment to valued cognitive, affective, and behavioral learning outcomes.

A review of preceptorship in undergraduate nursing education: implications for staff development.

Nurse educators regularly develop clinical learning experiences for undergraduate students using the expertise of experienced RNs as preceptors. Preceptors help students develop a knowledge base and clinical skills. This article reports a literature review and summarizes the benefits of preceptorship, outlines preceptor responsibilities and qualities, and discusses the process of preceptor selection and role preparation. Suggestions for collaborative efforts regarding the preceptor experience among staff nurses, nurse educators, and staff development educators are highlighted.

A collaborative program for advanced practice in trauma/critical care nursing.

The students and faculty enrolled in the first TNP class have set a standard for future TNPs: a rigorous course of education with advanced practice and scholarship within an advanced practice collaborative model. Because of the increasingly number of trauma victims and the highly specialized care they require, nurses must come forward and provide quality care. The TNPs and their faculty must promote further recognition of the TNP role, become leaders in the field of acute care, and continue to develop and maintain collaborative relationship with physicians in support of advanced practice nursing in many areas of tertiary care. The first three graduates of the trauma/critical care practitioner class are now employed in advanced practice roles and are applying their education within trauma/critical care settings. Two of the students are trauma nurse practitioners in a community hospital, and one is a critical care nurse practitioner in a university hospital. Currently, there is an acute care nurse practitioner certification examination that is appropriate for nurses in the field of trauma/critical care. Co-sponsored by the AACN Certification Corporation and the American Nurses Credentialing Center, this examination is offered twice a year, in June and October. AACN is active in supporting and promoting the TNP role and, in conjunction with the American Nurses Association, has developed new standards of care and scope of practice to include this expanded role for the advanced practice nurse. The future for this exciting and demanding role looks bright for the advanced practice nurse interested in the care of the acutely ill patient. The time is right for this collaboration between nurses and physicians.

Right ventricular infarction vs. left ventricular infarction: review of pathophysiology, medical treatment, and nursing care.

Myocardial infarction is a significant health problem causing tremendous morbidity and mortality in the United States. Differences exist between right and left ventricular wall myocardial infarction which influence the treatment and nursing care rendered. Knowledge of the pathophysiology and management of right versus left ventricular infarction is important in providing proper patient care.

Programmed instruction booklet for cardiac rehabilitation teaching.

Programmed instruction is an underused approach for educating hospitalized patients. This educational technique is based on the work of Skinner, who developed the linear programmed instruction technique. To test the effectiveness of this technique as a patient education tool, a programmed instruction booklet was developed for patients who were hospitalized after myocardial infarction. The booklet included basic information on cardiac anatomy and pathology, risk factors, diet, exercise, and medications. A quasi-experimental study design was implemented in which 59 hospitalized patients who had had a myocardial infarction underwent pretesting and posttesting. Patients were alternately assigned to a control group or an experimental group. The control group (n = 30) participated in the hospital's existing cardiac rehabilitation program, and the experimental group (n = 29) used the programmed instruction booklet. A one-way analysis of variance revealed a statistically significant improvement (p less than 0.05) in the posttest scores of the experimental group. The results of this study support the use of the programmed instruction method as one means of teaching cardiac rehabilitation information to hospitalized patients after myocardial infarction.

The amount of blood withdrawn for diagnostic tests in critically ill patients.

This study involved the measurement of blood withdrawn from critically ill patients for diagnostic tests during their first 3 days in eight intensive-care units. The study was conducted over a 2 to 3 week period. Data were collected on the number of draws performed per day, the total volume of blood withdrawn per day, and the volume of blood per draw on 253 patients. The subject population was divided into four general diagnostic categories: Post-open-heart surgical, surgical, medical, and cardiac. Approximately 85 per cent of the blood samples were drawn via venipuncture with arterial and capillary samples performed less frequently. The results demonstrate that the total volume of blood withdrawn differed among the diagnostic categories and hospitals. The average amount ranged from 20 ml. per day in surgical patients to 50 ml. per day in post-open-heart surgical patients. The volumes withdrawn daily from the subjects were generally lower than the authors had anticipated.

Some aspects of the nursing care for patients on hemodialysis.

Currently the majority of patients receiving hemodialysis for chronic renal failure are treated as outpatients in hemodialysis units of large hospitals. In most of these units it is the nurses that handle the entire dialysis procedure with little if any direct supervision from physicians. The nurses are also the ones on the health team that have the most contact with the patients. Thus the nurse must have a thorough knowledge of the pathophysiology of renal failure, of the mechanics and technical aspects of the dialyzer, of the expected outcomes and complications of hemodialysis and, particularly, the needs of the hemodialysis patient. The nurses that choose to work with chronic hemodialysis patients can enjoy much satisfaction in assisting in maintaining both a productive life and a long-term relationship with chronic renal failure patients. The nurse makes the difference.