Biomedical subjects
Publications and source records attributed to J H Barnsteiner.
Research-based practice requires a practice setting that promotes the use of knowledge, access to current scientific knowledge, and the ability of the clinician to think critically about using the knowledge to positively affect patient outcomes. This article presents an overview of what is known about the research utilization process and describes a variety of approaches to facilitate research-based practice.
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A model of research utilization directing clinical practice has been described. Clinical practice is conceptualized as a pyramid, with research knowledge forming the base. Department and unit-level activities are designed to promote the identification of research-based practices for incorporation into practice. Practice Committee structures are designed to facilitate the dissemination and utilization of research-based practices. This model has evolved over the past 10 years, and current refinements include movement toward an interdisciplinary focus, support of unit level practice groups, and increased integration of the work of each practice committee.
As family-centered care gradually became the norm in care of infants and children, relationships between staff, patients, and families became more complex. Because the complexity of these relationships was rarely, if ever, addressed, widely divergent, sometimes detrimental, behaviors evolved. Therapeutic relationships, which promote caring and define relationships with patients and families, are a positive and professional means to promote a family's control over their own child's health. This article describes assessment of nurse/patient/family relationships using family systems theory as a framework. The experience of implementing a culture shift toward therapeutic relationships is described.
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This article describes a model of advanced nursing practice, jointly funded through nursing and medicine. The model is based on a matrix reporting structure with the clinical nurse specialist reporting to both a physician and a director of nursing. The authors discuss how the various role components are enacted and the benefits of the model to the specialist, institution, physicians, staff, and patients and their families.
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A challenge in the current nursing environment is the ability to provide care cost-effectively and yet achieve desired patient outcomes. The managed care delivery system facilitates achievement of these goals. The system incorporates management of time, resources, and personnel so that patient outcomes are achieved within appropriate time frames. This article describes the design and implementation of a managed care delivery system in a children's hospital.
This study provides nursing administrators with data regarding stressors of the pediatric critical care nurse in order of priority. Death of patients was the only item isolated and compared to the other stress categories. It is suggested that death of patients be compared to all other items on the audit. The authors recommend expanding this study by asking two additional questions: Does the amount of time spent caring for dying patients correlate with the nurses' estimate of patient deaths and is there a relationship between the time spent caring for patients who die and perception of death as a stressor? This information can be utilized at the unit level in the development of stress management activities. At the hospital administrator level, this information can assist in the expansion of retention and recruitment strategies.
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The evolution of family-centered pediatric care coupled with the increasing complexity of healthcare environments has had a tremendous impact on the nature of relationships between nursing staff and the children and families they serve. In order to address this, in 1988 the Nursing Department at the Children's Hospital of Philadelphia (CHOP) identified parameters for the development and maintenance of therapeutic relationships. A therapeutic relationship is an interactive relationship with a child and family that is caring, clear, boundaried, positive, and professional. It encompasses the philosophy of the institution, empowerment of the caregivers, and empowerment for families. Utilizing family-centered care as a framework for the delivery of care, this article describes the evolution of therapeutic relationships as a standard of practice including the articulation of principles, clinical examples, implications for practice, and strategies for assessment, management, and evaluation.
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Explore the source record for details and available documents.