Distance learning for hospital managers.

Telemedicine technology enabled this class to meet. The Chapel Hill instructor could not have traveled to Scotland Neck for the classes, and the class members could not have taken time away from their jobs to travel to Chapel Hill. The technology allowed the participants to fit the classes into their schedules. For the group of managers at this small, isolated hospital, the experience of participating in a management class with an expert was a positive one. They were introduced to standard management practices, learned new skills, and formed a support group/team onsite. The students felt close to the leader, yet the physical distance made her an outsider in a way that encouraged frankness. The technology seemed to foster the best of both worlds--intimacy, yet physical distance and, thus, safety. These new managers were able to take part in a course that taught tangible skills for improving their job performance and, more important, afforded access to resources outside of Halifax County. They were able to step away from their daily routine and interact with outsiders and each other in new ways, without the stress and expense of travel. The results of this pilot study indicate that distance learning is feasible for courses of this kind. Staff burnout and turnover are chronic problems in rural facilities, with isolation contributing to job dissatisfaction. Distance learning offers exciting possibilities for addressing these problems in healthcare settings across the country.

Use of theory to guide nurses in the design of health messages for children.

To be effective, presentation of health messages for development of self-care agency must be age and developmentally appropriate. Blending cognitive development theories with selected foundational capabilities and dispositions from Self-Care Deficit Nursing Theory (SCDNT) has resulted in five concrete factors for successfully designing and delivering health messages for optimal learning in children. The capacity to learn requires perception, attention, play, communication, and memory. Actual evidence of learning about healthy choices by elementary school-aged children is illustrated. Indications of successes and deficiencies in design and delivery of health promotion messages during a school health fair are presented.

Campaign '92: three more years!

Creative planning and well-executed graphics produced an upbeat approach to preparing staff for a JCAHO accreditation visit. Five humorous and highly visible strategies were used in a coordinated eight-week "campaign." Not only did the institution "pass the test" but there was a consensus among staff nurses that they had felt comfortable, confident and in control during interviews with the JCAHO surveyor.

Effects of policy manual reorganization on user proficiency.

This study compared the proficiency of nurses who located policies in a traditional, alphabetically arranged policy manual vs. a reorganized, indexed manual. Nurses were asked to locate policy statements that would resolve issues presented in three vignettes that were typical of the decisions nurses must regularly make. Answers were scored as correct or incorrect; time to respond and search strategies were also recorded. Data analyses show the overall superiority of the reorganized, indexed manual.

Pulmonary function measurements in patients with thermal injury and smoke inhalation.

We performed serial pulmonary function measurements in 28 patients with thermal injury in order to investigate the pulmonary effects of smoke inhalation, small and large surface burns, and the combination of burn and inhalation. Patients were studied at postinjury time intervals of 9.0 +/- 0.6 (M +/- SEM), 22.0 +/- 1.6, 37.3 +/- 2.2, 58.4 +/- 2.5 hours; 11.5 +/- 0.6 days; 1.1 +/- 0.1 and 5.0 +/- 0.5 months. Spirometry was found to be as useful as more sophisticated measurements in the examination of both burn and smoke inhalation groups. Smoke inhalation caused severe airway obstruction 9 h after exposure. Patients with surface burn resuscitated with 4 ml of Ringer's lactate/per cent surface area burn/kilogram developed a significant restrictive defect over the first 58 h, despite normal pulmonary capillary wedge pressures. The restrictive defect in these patients correlated with the size of surface and chest burn, degree of fluid retention, and reduction in colloid osmotic pressure. Surface burn and smoke inhalation caused the greatest deterioration in pulmonary function. These defects gradually resolved during the period of observation.