Biomedical subjects
Publications and source records attributed to Z R Wolf.
In this article, two clinical nurse researchers describe experiences with integrating a program of nursing research, including the use of the findings and methods of research and the conducting and disseminating of research, into two acute care hospitals. Strategic and contextual factors are specified in relation to targets within and outside of the hospitals.
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To determine if factors associated with medication errors explained perceived harmful outcome from such errors, perceptions of vividly recollected medication errors were reported by a convenience sample of 206 hospital-employed RNs and LPNs who completed the Medication Error Risk Profile (MERP). Symptoms related to the error, radiology studies performed, the toxicity of the medication given, adverse drug reaction unrecognized at first, and transfer of the patient to another unit explained 38% of the variance in perceived harmful outcome. The implications of the this study for medical-surgical nurses are explored.
Brain-dead donors (ie, heartbeating cadaver donors) have been an accepted source of transplantable organs for many years. Clinicians in some medical centers are considering nonheartbeating cadaver donors (ie, patients who decide to discontinue life-support measures and become organ donors) as another source of transplantable organs. This study explored registered nurses' responses to caring for nonheartbeating cadaver donors and described their intentions to care for such donors, their reactions to caring for them, and the meaning of these reactions and intentions. The nurses interviewed expressed resentment at the intrusion of technology; they preferred brain-dead status in organ donors; they feared legal repercussions from families; they speculated about nonheartbeating cadaver donors' ability to feel pain, and they expressed concern about withdrawing life-support measures, honoring patients' wishes, allocating nursing care as a scare resource, and witnessing family members' pain.
An urban school of nursing and a 631-bed acute care teaching facility, two independent organizations, created a faculty-practice program in 1990 modeled after one at Cedar Crest College, Allentown, Pennsylvania. Currently there are two full-time faculty joint appointees on 12-month contracts: an Associate Director for Nursing Research/Clinical Nurse Researcher (CNR) and an Associate Director for Nursing Administration. The benefits and challenges of the faculty-practice appointments are explored from three viewpoints: those of the (1) Chief Nurse Executive of the medical center, (2) the Dean of the School of Nursing, and (3) the Joint Appointee, Associate Director for Nursing Research. The joint appointee also describes the roles and functions inherent in the joint appointee role, for example, researcher, teacher, consultant, collaborator, and grant writer. Position descriptions for each joint appointment are included.
Dimensions of nurse caring were elicited through nurse and patient responses on the revised Caring Behaviors Inventory (CBI), a 43-item instrument. Subjects included 278 nurses and 263 patients and former patients. An exploratory factor analysis using the principal components method with varimax rotation was used to identify CBI dimensions; a five factor solution resulted. The five dimensions of nurse caring were respectful deference to others, assurance of human presence, positive connectedness, professional knowledge and skill, and attentiveness to the other's experience.
The purpose of this study was: (a) to describe the self-reported use of the methods and products of research by medical-surgical nurses, and (b) to identify attitudes toward the use of research-based knowledge in clinical nursing practice. Two hundred and twelve registered nurses completed the Research Utilization Questionnaire. Survey results indicated that it was difficult for respondents to change practice based on research. Nurses were willing to participate in research if investigations were relevant to practice. Articles from nursing research journals were ranked low by the respondents as sources of knowledge, while information gained from individual patients was ranked high.
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This article examines the bath as a nursing ritual, using examples from the literature from the 1880s to the present time. Selections from nursing periodicals and other literature are used to support the connections between past and present nursing practices in relation to bathing and hygienic care. The bath represents part of the essential character of nursing and is rooted in the beliefs, art, and science of the profession. It is a channel for many other nursing activities and responses, and as such, occupies a necessary part of nursing's repertoire and identity.
Types of nursing rituals identified in this study include therapeutic and occupational rituals. Therapeutic rituals (Douglas, 1963, 1966, 1975; Turner, 1957, 1967, 1969) are identified as symbolic healing actions that improve the condition of patients. Occupational rituals or rituals of socialization include symbolic actions that facilitate the transition of professional neophytes into their professional role (Bosk, 1980; Fox, 1979; Zerubavel, 1979). Nursing rituals fulfill an important although not highly visible function in a nursing unit of a modern American hospital. They enable nurses to carry out caring activities for patients who are acutely or chronically ill, old, and dying. Rituals help to reaffirm values and beliefs of nurses. Explication of the implicit meanings of nursing rituals illuminates nursing for nurses and others who seek to understand nursing services. Descriptive analyses of nursing rituals direct attention to the hidden work of the hospital staff nurse, work sometimes taken for granted by professionals and the public who fail to see the many difficult, intimate, and risky aspects of nursing work and how certain ritual behavior promotes its accomplishment. Other studies on nursing ritual are needed to expand the theory of nursing ritual in this descriptive analysis, and to move it from descriptive to explanatory theory. For example, the transmission of the beliefs, rules of conduct, and customs that take place during change-of-shift report has not been extensively investigated. Neither have the more practical aspects of shift report been studied, including the types of information exchanged or the influence of shift report on planning and priority setting for the nurses who work during the ensuing shift. Also, few empirical studies examine the effects of bathing on patient outcomes, such as skin integrity, cardiac function, and comfort levels, and patient bathing preferences. This is surprising, because the bath is such an essential ritual for the nursing profession and is thought to help patients. Nursing's close association with profane materials, including excretions and secretions, has most likely affected society's perception of the role of nurse. Investigations about these influences may reveal valuable insights into some of the status problems that nurses have encountered for many years. Equally important is the association of nurses with death. Although nurses are frustrated with the intrusion of hospital technology on patients' deaths, they have not yet established themselves as standard setters for helping patients achieve tranquil deaths.(ABSTRACT TRUNCATED AT 400 WORDS)
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This study examined nurses' experiences in giving postmortem care to organ donors. A descriptive, phenomenological approach was used. Operating room, organ procurement agency, and critical care nurses were interviewed; audiotaped interviews were transcribed verbatim. Text-based analysis according to Colaizzi's (1978) approach was employed. Postmortem care took place in the context of the gift of the organs by the family, the tragedy of traumatic injury and resulting brain death of a young, healthy person, and procurement surgery. Nurses were saddened by the death of a donor, and viewed postmortem care as the opportunity to achieve closure with the patient. Nurses became temporary kin with the family and the patient. They respected the body, and saw giving after-death care as providing comfort even after death. As they cared for the patient throughout the experience, nurses confronted the dilemma of maintaining the brain-dead patient on life support until donor surgery.
Graduate nursing students created posters to illustrate their practicum projects at the end of a field course. Posters were presented at a poster session on a university campus in Philadelphia, open to preceptors, other nurse colleagues, and the university community. Students recognized the advantages of the poster session, including learning how to conduct a professional presentation in public and how to construct an attractive, literature-based poster to hold the attention of colleagues attending the session.
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Medication errors could effectively be reduced by systematically identifying, eliminating, or minimizing human and system risks. However, errors associated with random events may never be controlled by risk reduction efforts because of the unpredictability of the events preceding the error. Identifying and reducing risks is as important as acknowledging medication errors after they occur. A preliminary model including risks and types of medication errors is presented in Fig 1. Additional classification and explanation is needed in order to identify strategies to reduce medication errors. Medication administration is a nursing function that incorporates scientific knowledge, technical skill, and ritualistic practice. When nurses give medications and make medication errors, they remember their responsibility to do good and avoid harm. Nurses can better exert this responsibility by taking a more prospective, risk-reduction approach to medication errors.
Nurses discuss their patients in sequence during change of shift report. Guided by the patient record, this orderly progression of facts and words takes place repeatedly at specific time intervals and imposes order on the easily disordered events of patient units. The amount of information shared by reporting nurses increases when the acuity level of patients is high and when patients are recently admitted to patient units. Shift report functions as a forum for the socialization of nurses into the role of the nurse. During shift report, nurses express worries, complain, warn about possible errors, acknowledge errors, and set standards of nursing care. Using the language of nursing and telling "war stories" of their nursing experiences, nurses gently guide inexperienced nurses. Change of shift report is a nursing ritual that allows the hidden commitment of nurses to continuous coverage and responsibility for patients visible through the professional jargon of nursing.