Perceptions of pharmaceutical care among pharmacists offering compounding services.

OBJECTIVES: To identify and describe pharmaceutical care practices implemented by independent community pharmacists who provide compounding services. DESIGN: Qualitative study. SETTING: Independent community pharmacies in Illinois, Missouri, and Iowa in July 2006. PARTICIPANTS: 12 independent community pharmacists with compounding practices. INTERVENTIONS: Semistructured telephone interviews. MAIN OUTCOME MEASURES: Response themes describing pharmaceutical care in compounding practices. RESULTS: Most participants described having a closer relationship with patients receiving compounded preparations than with patients receiving only manufactured products. Higher compounded prescription volume was associated with a higher level of pharmaceutical care services for patients receiving compounded preparations. Patient health and prescription records, the nature and duration of patient counseling, and interaction with physicians differed depending on the type of preparation (compounded or manufactured) provided. CONCLUSION: Community pharmacists provided descriptions of pharmaceutical care and their satisfaction with patient and pharmacist relationships in the context of providing compounded preparations. Pharmacists, especially those providing compounded hormone replacement therapy, developed a hybrid clinical-community practice.

Is it time for a new category of nursing diagnosis?

Professional vigilance, the art of "watching out," is the essence of nursing. Vigilance is the mental process that makes the informed nursing actions of assessment, diagnosis, intervention, and evaluation possible and meaningful. Nursing vigilance must be described in our nursing terminology or it risks remaining invisible to others. We propose that the current definition of nursing diagnosis be expanded to include surveillance diagnoses for which the nurse has the responsibility for problem identification and ongoing monitoring. Inclusion of surveillance diagnoses in the NANDA International taxonomy will better reflect the breadth and depth of nursing practice.

Development and evaluation of evidence-based nursing (EBN) filters and related databases.

OBJECTIVES: Difficulties encountered in the retrieval of evidence-based nursing (EBN) literature and recognition of terminology, research focus, and design differences between evidence-based medicine and nursing led to the realization that nursing needs its own filter strategies for evidence-based practice. This article describes the development and evaluation of filters that facilitate evidence-based nursing searches. METHODS: An inductive, multistep methodology was employed. A sleep search strategy was developed for uniform application to all filters for filter development and evaluation purposes. An EBN matrix was next developed as a framework to illustrate conceptually the placement of nursing-sensitive filters along two axes: horizontally, an adapted nursing process, and vertically, levels of evidence. Nursing diagnosis, patient outcomes, and primary data filters were developed recursively. Through an interface with the PubMed search engine, the EBN matrix filters were inserted into a database that executes filter searches, retrieves citations, and stores and updates retrieved citations sets hourly. For evaluation purposes, the filters were subjected to sensitivity and specificity analyses and retrieval set comparisons. Once the evaluation was complete, hyperlinks providing access to any one or a combination of completed filters to the EBN matrix were created. Subject searches on any topic may be applied to the filters, which interface with PubMed. RESULTS: Sensitivity and specificity for the combined nursing diagnosis and primary data filter were 64% and 99%, respectively; for the patient outcomes filter, the results were 75% and 71%, respectively. Comparisons were made between the EBN matrix filters (nursing diagnosis and primary data) and PubMed's Clinical Queries (diagnosis and sensitivity) filters. Additional comparisons examined publication types and indexing differences. Review articles accounted for the majority of the publication type differences, because "review" was accepted by the CQ but was "NOT'd" by the EBN filter. Indexing comparisons revealed that although the term "nursing diagnosis" is in Medical Subject Headings (MeSH), the nursing diagnoses themselves (e.g., sleep deprivation, disturbed sleep pattern) are not indexed as nursing diagnoses. As a result, abstracts deemed to be appropriate nursing diagnosis by the EBN filter were not accepted by the CQ diagnosis filter. CONCLUSIONS: The EBN filter capture of desired articles may be enhanced by further refinement to achieve a greater degree of filter sensitivity. Retrieval set comparisons revealed publication type differences and indexing issues. The EBN matrix filter "NOT'd" out "review," while the CQ filter did not. Indexing issues were identified that explained the retrieval of articles deemed appropriate by the EBN filter matrix but not included in the CQ retrieval. These results have MeSH definition and indexing implications as well as implications for clinical decision support in nursing practice.

The development and testing of the PATCOA to assess pain in confused older adults.

The purposes of this study were to develop and evaluate the psychometric properties of an instrument with nonverbal cues to assess pain in confused older adults, and to describe the differences among selected demographic variables and scores on the pain and confusion measures. The Pain Assessment Tool in Confused Older Adults (PATCOA) was evaluated with 116 cognitively intact older adults undergoing orthopedic surgery. The interrater reliability for each nonverbal cue ranged from 56.5% to 100%, and the Spearman correlations were .16 to 1.00. Nine nonverbal pain cues were subjected to exploratory factor analysis. Four components explained 69.83% variance. Older adults reported significantly higher levels of pain on the visual analog scale, yet age was not related to the nonverbal pain cues. Women reported significantly more pain than did men. No significant gender differences were found regarding the display of nonverbal pain cues and the level of acute confusion, or with race and self-report of pain, display of nonverbal pain cues, or level of confusion. The development and testing of the PATCOA are initial steps that contribute to our knowledge about acute pain assessment in confused older adults.