Coping while caring for the dying child: nurses' experiences in an acute care setting.

The aim of this study was to describe and understand behavior and coping strategies used by pediatric nurses caring for dying children on an inpatient acute care cardiology unit. Qualitative descriptive methods consisting of semistructured questions were presented to acute care nurses participating in focus groups. The nurses who participated in the focus groups had cared for an acutely ill child who died. Conventional content analysis was used to analyze data and organize results. The categories that emerged included the following: boundaries, memories, disconnecting, and labeling. Colleague support, institutional resources, and nurses' experience level were critical to the process of coping. Coping and grieving are facilitated by colleague and unit resources. Studies exploring job dissatisfaction, stress, and burnout from an inadequate grieving process are required.

Evidence-based practice implementation strategy: the central role of the clinical nurse specialist.

The Hospital of the University of Pennsylvania Model of Excellence in Nursing Professional Practice serves to fully integrate the role of the clinical nurse specialist (CNS) in the implementation of evidence-based care and the role of organizational change agent. In this role, the CNS is responsible for the identification and remedy of system-wide challenges to optimal quality care, mentorship of clinical nurses both as clinicians and as leaders, and enhancement of interdisciplinary partnerships. Integrating the CNS role as the nursing department knowledge keepers, knowledge seekers and knowledge disseminators able to proactively develop and enhance interdisciplinary partnerships required systematic educational sessions and use of outcome measurement tools. Resources have included role development seminars, individual mentoring and standardization of role expression, across service lines. Development and implementation of an outcome measurement tool has served to further quantify the contribution of the CNS and standardized role implementation across service divisions. This dedication of resources has resulted in a significant number of unit-based and system-wide CNSs, serving as a significant support to the clinical nurse's practice and leadership development. This article will describe some of the processes used to enhance the role of the CNS implementing change and practice improvement at the Hospital of the University of Pennsylvania.