Exploring leadership roles, goals, and barriers among Kansas registered nurses: a descriptive cross-sectional study.

OBJECTIVES: The Institute of Medicine's Future of Nursing report advocates for full nurse leader representation across multiple settings to address current challenges in our health care system. The purpose of this study was to examine nursing leadership development needs among Kansas registered nurses (RNs). METHODS: Data were collected through an online survey and analyzed using quantitative and qualitative methods. RESULTS: Nearly 1,000 Kansas RNs participated. Most reported holding one or more leadership positions. Prevalent leadership goals were health care organization volunteer administrative roles. The most frequently identified barrier to developing leadership roles was time constraints. Many wanted to develop skills to serve on a board, 20% were interested in personal leadership development, and 19% in policy development. CONCLUSIONS: Based on the findings, the Kansas Action Coalition leadership team is developing programs to address the leadership needs of Kansas RNs. By building capacity in advanced leadership roles, RNs will be better prepared serve as full partners and lead efforts to promote the health of Kansans.

Common themes in clinical education partnerships.

The concurrent nursing and faculty shortages continue to be critical issues for the nation's health care system. As academic nursing programs struggle with maintaining and increasing enrollment in the midst of a faculty shortage, one solution is to expand the faculty's capacity through innovative academic-service partnerships. Schools and clinical partners identified as having implemented innovative partnerships were invited to participate in this descriptive study. Site visitations to schools in Florida and Texas were conducted to gain in-depth knowledge of the clinical education model, the academic-service partnership, and the strengths and challenges associated with planning, implementing, and sustaining programs. Four underlying features were common across the successful implementation: supportive relationships, goodness of fit, flexibility, and communication. Consideration of the four features will be useful as nursing programs and their clinical partners are developing, implementing, and evaluating new models for increasing educational capacity and lessening the nursing shortage.

Five recommendations for prelicensure clinical nursing education.

The acute shortage of RNs is both well established and projected to continue. Two primary factors contributing to the nursing shortage are insufficient numbers of faculty and insufficient clinical sites for students. Innovative academic-service partnerships are realigning these scarce resources to improve the quality of clinical education and build cultures of safety. Relationships among students, staff nurses, faculty, and the institutions where they practice are central to students' socialization, professional role development, and transition to practice. Five recommendations to strengthen these professional relationships are suggested to: reenvision nursing student-staff nurse relationships, reconceptualize the clinical faculty role, enhance development for school-based faculty and staff nurses working with students, reexamine the depth and breadth of the clinical component, and strengthen the evidence for best practices in clinical nursing education. Five key outcomes are suggested to evaluate both traditional and emerging approaches to clinical nursing education.

Infected Lives: Lived Experiences of Young African American HIV-Positive Women.

This hermeneutic phenomenological study explored the lived experiences of young African American HIV-infected women. Eleven women between the ages of 21 and 35 participated. One pattern, Infected Lives, and three themes--Living Alone With HIV, Living With Unresolved Conflicts, and Living With Multiple Layers of Betrayal--emerged. The pattern and themes portray the very complex and challenging experiences faced by these young women living with HIV infection. They have experienced isolation, abandonment, betrayal, and discrimination in their interpersonal and social systems. They often dealt with conflicts of hope and anguish in the relationships with their children, and portraying strength, while feeling fragile. These complexities negatively influence the ability to fully engage in self-care activities. Implications for future research include further investigation about the experiences of psychological distress experienced post-diagnosis, development and evaluation of holistic nursing interventions, and evaluative research on mass media educational campaigns to reduce HIV-related stigma.

Strategies for Building Advocacy Skills Among Undergraduate and Graduate Nursing Students.

BACKGROUND: Nursing faculty are challenged to create learning experiences that both reflect the complexities of the current health care system and are relevant. Experiential learning opportunities should promote engagement in health care that extends beyond direct patient care to advocacy in larger systems. METHOD: To meet this challenge, faculty developed course assignments for students at baccalaureate, master's, and doctoral levels in which students worked with state Action Coalitions to implement the Institute of Medicine Future of Nursing report's eight recommendations. With faculty guidance, student teams developed and implemented projects or conducted research to assist the coalitions in their grassroots initiatives. RESULTS: Students at all program levels reported high levels of satisfaction and engagement with these unique projects. Students reported understanding the importance of the Future of Nursing recommendations and intended to continue participating in statewide initiatives. CONCLUSION: Experiential learning opportunities at all program levels can engage students in learning more about advocacy, health care trends, and leadership.

Building and critiquing qualitative research websites: a cyberspace project to connect undergraduate nursing students in Canada and the United States.

This project had a dual purpose: 1) to facilitate student learning about qualitative research methods, and 2) to promote collegiality and professional development among senior nursing students in Canada and the United States through the use of distance technology. In each of three project years, students at St. Francis Xavier University (STFX) in Nova Scotia initiated the experience by working in small groups to develop websites about different methodological approaches in qualitative research. Site information included an overview of the selected approach, discussion of trustworthiness issues, citation of journal articles in which authors used the approach, additional references, and some personal information about the student developers. Also working in small groups, University of Kansas students identified and read related research articles, reviewed website information, and responded to the STFX groups about the usefulness of site information in increasing understanding of qualitative methods and using the information for evaluation of research. The experience promoted active use of qualitative research concepts and facilitated the development of skills in evaluating research article content and website content. Participation in the activity fostered positive perceptions about the value and use of research and helped students appreciate the similarities in courses, programs, and professional requirements and values among international peers.

An analysis of partnership performance: the St. Johns Mercy Medical Center-Saint Louis University School of Nursing dedicated education unit project.

The purpose of this article is to analyze the St. Johns Mercy Medical Center (SJMMC)-Saint Louis University School of Nursing (SLUSON) dedicated education unit (DEU) project for partnership effectiveness. The DEU, an innovative and collaborative academic-service partnership, reconceptualizes the role of the faculty and staff nurse in the clinical educational process. In a DEU, the staff nurse provides the clinical instruction to the student, and the faculty member coaches the staff nurse on the teaching-learning process. Rather than explore the effectiveness of the DEU as an innovative clinical pedagogy, this article analyzes the relationship between the academic and service institutions for strategic effectiveness. The analysis is based on themes found across three successful and distinct academic partnerships and other evaluative models from business, government, and alliance research. The themes and models provide the frameworks needed to analyze the SJMMC-SLUSON academic-service partnership for structure, process, and outcomes. This analysis can serve as a guide for the development of academic-service partnership practices to facilitate successful, sustainable, and replicable partnerships that benefit both institutions.

Nurses' assessment of rehabilitation potential and prediction of functional status at discharge from inpatient rehabilitation.

The goals of this study were to evaluate the accuracy of nurses' predictions of rehabilitation potential in older adults admitted to inpatient rehabilitation facilities and to ascertain whether the addition of a measure of executive cognitive function would enhance predictive accuracy. Secondary analysis was performed on prospective data collected for 362 Medicare beneficiaries enrolled in a national, multicenter study of rehabilitation outcomes. Ordinary least squares regression analysis was performed. Nurses' admission prognoses for rehabilitation potential predicted patients' functional status for observed activities of daily living upon discharge (r = 0.20, R = 0.04, P< 0.001). The addition of a measure of executive cognitive function, the Behavioral Dyscontrol Scale, significantly enhanced the variance explained by the model (r = 0.48, R = 0.23, P< 0.001). Nurses' prediction of functional outcome for hip fracture patients was significant (r = 0.26, R=0.07, P< 0.001). Predictions for patients with medical-surgical diagnoses did not achieve significance (r = 0.12, R = 0.02, P = 0.13). The findings show the independence of nursing prognoses and the level of executive cognitive function, and suggest that inclusion of this measurement of executive cognitive function may significantly enhance the accuracy of nursing prognoses. Development and implementation of related nursing education might be warranted. Further research is needed to ascertain the best method to introduce assessment of executive cognitive function into the rehabilitation environment.

Designing a Resource Guide to help promote health in caregiving.

Aim. To describe development of a Resource Guide, one component of a theory-based intervention. The Guide contains information and ideas to illuminate caregivers' self-care knowledge as a basis for organizing and reinforcing self-care activities. Background. Inherent in the complexity of caregiving roles is the emergence of caregiving as a responsibility, often overshadowing caregiver's personal care needs. Health care professionals can partner with caregivers to promote caregiver health. Self-Care TALK is a multimodal intervention to support this partnership. Methods. Two theoretical perspectives guided Resource Guide content; adult learning theory and the schema model of cognitive behavioural theory. Materials to stimulate conversations about caregivers' personal concerns about self-care were adapted from extant literature. Sources of information were chosen based on caregivers' learning needs and images of health. Areas of development focused on content, reading level/readability, graphic design, and self-evaluation. Results. The Resource Guide standardizes Self-Care TALK protocol while personalizing caregivers' self-care. The Resource Guide provides structure for conversations about what self-care is and ways to promote health. Conclusion. The Resource Guide promotes a learning environment that complements interests and experiences of older caregivers. Use of the Guide supports and extends caregivers' self-care vocabularies, and helps clarify self-care schemas and health promotion.

Relational conversation as method for creating partnerships: pilot study.

AIM: This paper reports a pilot study testing the intervention, Self-Care TALK, whose aim was to describe communication skills used by an advanced practice nurse to create partnerships with caregivers. The communication process and examples of skills used in creating partnerships are described. BACKGROUND: Decades of exploring nurse-client relationships provide a knowledge base for describing a structure and process for building partnerships. Self-Care TALK functions as a vehicle for an education and support partnership. Self-Care TALK, a theory-derived intervention, is based on the Self-Care for Health Promotion in Aging model. Implementation of the intervention was evaluated in a pilot study in 2003, with older spouse caregivers of persons with early dementia. METHODS: Pilot testing of Self-Care TALK followed Lichstein's criteria of tracking three phases of intervention: delivery, receipt and enactment. Henson's communication elements for establishing partnership relationships provided a guide for advanced practice nurse communication. Self-Care TALK was delivered during six phone conversations with caregivers for a total of 36 phone conversations. All phone conversations were audiotape recorded. Field notes were taken during each conversation. Data analysis followed a qualitative descriptive process of comparative analysis in which communication skills were compared across conversations. Categories of skills were named based on communication elements that dominated the category. Communication skills were compared to literature addressing communication and nurse-client partnerships. FINDINGS: Communication examples described the structure for interaction (Self-Care TALK protocol), process of interaction (relational conversation) and caregiver identified outcomes (intentions to enact self-care). CONCLUSION: Conversations to create partnerships depended on one theme: language that supported relational conversation. Four communication skills illustrated the how of relational conversation: listening with intent, affirming emotions, creating relational images, and planning enactment.

Developing and testing a self-care intervention for older adults in caregiving roles.

BACKGROUND: Theory-based interventions incorporating a self-care perspective for health promotion and protection are needed for older adults. The Self-Care for Health Promotion in Aging (S-CHPA) model provided the basis for development of an intervention focused on promoting health among older adults who provide care for their spouses with dementia. OBJECTIVES: To describe the development of a theory-based intervention (Self-Care Talk) and to describe the process of evaluating the implementation of the intervention when it was pilot tested with older spouse caregivers of persons with dementia. METHODS: The S-CHPA model was used to guide development of Self-Care Talk, a series of telephone-based sessions between advanced practice nurses and older adults. Session content included practicing healthy habits, building self-esteem, focusing on the positive, avoiding role overload, communicating, and building meaning. Specific self-care strategies were explored in the context of an individual's experiences, relationships, and condition. Intervention implementation was evaluated using Lichstein's criteria of delivery, receipt, and enactment. RESULTS: Six spouse caregivers of persons with dementia participated in the pilot study. The education and support intervention was delivered as intended (delivery). Participants reported understanding session content (receipt), and planned to use the information (enactment). Participants also reported an increased awareness about self-care practices and offered specific examples of how they intended to practice better self-care. DISCUSSION: The theory-based Self-Care Talk intervention can be implemented as intended and is ready for use in future randomized clinical trials with older spouse caregivers of persons with dementia.

Building a model of self-care for health promotion in aging.

PURPOSE: To synthesize knowledge about self-care in older community-dwelling people, identify essential dimensions of self-care related to health promotion and well-being in aging, and organize the findings into a literature-based, integrated model with applicability in practice, research, and education. ORGANIZING CONSTRUCT: Self-care and health promotion. Related concepts included self-concept, self-care ability, and self-care activity. METHODS: These terms were used to search Medline, CINAHL, and PsycINFO data bases. Theoretical and research articles from the last decade that related to self-care and health promotion in community-dwelling elders and that provided recommendations for education and practice were selected for inclusion in the analysis. FINDINGS: Self-care for health promotion in independent elders is multidimensional. Synthesis of literature findings resulted in development of the model of Self-care for Health Promotion in Aging, with five dimensions: internal and external environment, self-care ability, education, self-care activity, and outcomes. Examples of education plans that are developed in partnership with clients to promote better health and maximize quality of life are presented. CONCLUSIONS: Findings from current theoretical and empirical literature were synthesized to develop a model of self-care for health promotion in aging. Suggestions are made regarding application of the model in clinical practice and further theory building and hypothesis testing.