Cardiovascular nursing research: past, present, and future.

This review has suggested that while study methodology may be improving, the topics investigated have been largely content poor and have not contributed to theory development or to the advancement of a science of cardiovascular nursing. This, in essence, should be the focus of future work.

Cardiac surgical patients' telephone calls use of a decision-making algorithm.

CARDIAC SURGERY, ALTHOUGH becoming relatively common, still poses a significant life stress for patients. As a result of managed care contracting, length of stay has decreased to an average of 4-6 days. The Transitional Care Model was the framework used in identifying a way to bridge the gap between home and hospital. Providing patients with the unit's telephone number and encouraging them to call with questions was the means established toward this end. Algorithms were developed around the seven most frequently occurring problems so that nurses would be able to offer interventions consistent with our program. Approximately 300 telephone calls have been logged in annually. Weekly review of the log revealed compliance with the algorithms and appropriate recommendations made by nurses.

Learning from patients: a discharge planning improvement project.

BACKGROUND: In 1991 Beth Israel Hospital (Boston) joined nine other hospitals in using the Picker/Commonwealth survey instrument to tap patients perceptions of their hospitalization experience. Beth Israel focused on one of the nine dimensions of the instrument-continuity and transition (discharge planning). FOUR WORK TEAMS: In 1992 four multidisciplinary work teams were formed-for cardiac surgical patients, stroke patients, patients on a medical unit, and patients on a medical and surgical unit. Each team conducted a patient/family discussion group, during which recently discharged patients and their families were asked about their preparation for discharge and asked for input on how to improve the process. INTERVENTIONS: Each work team developed interventions on the basis of information specific to their patients. The cardiac work team, for example, developed interdisciplinary practice guidelines for patient care management for the entire postoperative period; the guidelines include a patient education component on what patients and families can expect during hospitalization. OUTCOMES: Clinicians practice differently, inviting more patient feedback and other involvement in care, as a results of their involvement in the project. On the first annual patient survey, administered in 1994, only 6% of 1,179 randomly selected patients (versus 20% of the 100 patients first surveyed in 1993) indicated that they did not receive the information they needed to help themselves recover. CURRENT PROGRESS AND FUTURE DIRECTIONS: A standardized teaching packet containing material developed during the discharge planning improvement project is now distributed. In May 1995 the nursing department launched a patient and family learning center to better meet the health education needs of patients.

Uncovering the knowledge embedded in clinical nurse manager practice.

To redesign effective nurse manager roles, data-based descriptions of their skilled performance and developmental learning are essential. This article is the first report of an interpretive, phenomenologic study to identify the skills and expertise embedded in the practice of nurse managers. The data describe how nurse managers operationalize institution values for patient care, and conversely, the impact of organization values on nurse managers' everyday behavior.

Vision for a treasured resource. Part 2. Nurse manager learning needs.

Part 1 in this two-part series focused on the meaning of significant incidents in nurse managers' practice related to role implementation. Explanation of the authors' application of the Manager as Developer Model (MADM) as a useful model for organizing and understanding some of the data was also discussed. Part 2 describes significant incidents in nurse managers' practice related to their ongoing learning needs. The authors address issues of performance counseling and intervention versus coaching and make recommendations for management development programs.

Vision for a treasured resource. Part 1, Nurse manager role implementation.

The importance of the nurse manager for both quality patient care and organizational effectiveness seems indisputable. With decentralized decision-making, the role of the nurse manager has expanded in both scope and accountability. In this two-part article, role implementation of the nurse manager and associated learning needs are described. This article focuses on interpreting significant incidents related to role implementation in nurse managers' practice. It also shows how the authors used the Manager as Developer Model for organizing and understanding some of the data. Part 2 (April 1997) will describe and interpret significant incidents related to nurse managers' ongoing learning needs.