REFERENCES FOR THE TWO ARTICLES
QUANTITATIVE
ARTICLE 1
McIe, S., Petitte, T., Pride, L., Leeper, D., & Ostrow, C. L. (2009). Transparent film dressing vs. pressure dressing after percutaneous transluminal coronary angiography. American Journal of Critical Care, 18(1), 14–20.
QUALITATIVE
ARTICLE 2
Osterman, P. L., Asselin, M. R., & Cullen, H. A. (2009). Returning for a baccalaureate: A descriptive, exploratory study of nurses’ perceptions. Journal for Nurses in Staff Development, 25(3), 109–117.
J O U R N A L F O R N U R S E S I N S T A F F D E V E L O P M E N T � Volume 25, Number 3, 109–117 � Copyright A 2009 Wolters Kluwer Health l Lippincott Williams & Wilkins
One critical role of the staff development spe-cialist is to facilitate competence and contin-
ued professional development of staff (American
Nurses Association, 2000). One approach to this is to
foster an environment which encourages staff to
advance academically, be it from the diploma or
associate’s degree to the baccalaureate level or
beyond. This is especially timely given the push for
Magnet recognition in many hospitals and given the
spotlight that has been placed on quality outcomes
and a culture of safety. Furthermore, although hos-
pitals struggle with fiscal challenges, the financial
benefit of supporting nurses who pursue advanced
education may not be immediately visible to admin-
istrators, but staff development specialists realize the
value of such a move, especially about improving
patient outcomes and enhancing patient safety.
When examining the impact of nurses’ educational
preparation on patient outcomes, Aiken, Clarke, Cheung,
Sloane, and Silber (2003) recognized
a statistically significant relationship between the propor-
tion of nurses in a hospital with bachelor’s and master’s
degrees and the risks of both mortality and failure to
rescue. . .Each 10% increase in the proportion of nurses
with [bachelor’s or master’s] degrees decreased the risk of
mortality and of failure to rescue. . .by 5%. (p. 1620).
Although this study has been the subject of some
controversy within the nursing profession, most
scholars agree that ‘‘[e]ducation makes a difference
in nursing practice. . .education broadens one’s knowl-
edge base, enriches understanding, and sharpens
expertise’’ (Long, Bernier, & Aiken, 2004, p. 48). The
value of these educational benefits, when applied to
patient care, is further clarified by the observation that
[n]urses constitute the surveillance system for early de-
tection of complications and problems in care, and they
are in the best position to initiate actions that minimize
negative outcomes for patients. That the exercise of clinical
judgment by nurses. . .is key to effective surveillance may
explain the link between higher nursing skill mix. . .and
better patient outcomes (Aiken et al., 2003, p. 1617).
The need for increasing numbers of baccalaureate-
prepared registered nurses (RNs) becomes more ob-
vious when viewed through the le ...
MEDSURG Nursing—November/December 2010—Vol. 19/No. 6 335
Carol Isaac MacKusick, PhD(c), MSN,
RN, CNN, is an Assistant Professor of
Nursing, Clayton State University,
Morrow, GA.
Ptlene Minick, PhD, RN, is Doctoral
Faculty and Associate Professor of
Nursing, Georgia State University,
Atlanta, GA.
Carol Isaac MacKusick
Ptlene Minick
Why Are Nurses Leaving? Findings
From an Initial Qualitative Study on
Nursing Attrition
In the United States, nursing workforce projections indicate the registerednurse (RN) shortage may exceed 500,000 RNs by 2025 (American
Association of Colleges of Nursing [AACN], 2010; Cipriano, 2006; U.S.
Department of Health and Human Services, 2002). In 2008, the national RN
vacancy rate in the United States was greater than 8% (AACN, 2010).
Evidence suggests experiences as a newly licensed RN directly impact indi-
vidual perceptions related to the profession (Cowin & Hengstberger-Sims,
2006). An estimated 30%-50% of all new RNs elect either to change positions
or leave nursing completely within the first 3 years of clinical practice
(AACN, 2003; Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; Cipriano, 2006;
Cowin & Hengstberger-Sims, 2006). While an abundance of data exist regard-
ing the RN who stays at the bedside, few studies have explored the percep-
tions of the RN who decides to leave clinical nursing. Understanding factors
associated with RNs’ practice decisions is the first step necessary in devel-
oping effective nursing-retention strategies.
Purpose
The purpose of this study was to identify the factors influencing the
decision of RNs to leave clinical nursing practice. Nurses who had elected
to leave clinical nursing were interviewed at the setting of their choice.
Previous clinical nursing experience included a variety of clinical practice
settings. For this study, the term clinical nursing is defined as providing
direct patient care in the hospital setting.
Background
Limited data exist about individuals no longer employed in nursing; no
literature was found about the perceptions or decision-making processes of
RNs no longer in clinical practice. A review of the literature was conducted
searching nursing, medical, labor, and psychological/sociological databas-
es. Years of search ended with 2007, the year of the interviews. A broad
search began with GoogleScholar® and was narrowed to include CINAHL,
MEDline, PsycINFO, and LexisNexis. Several issues concerning practice
decisions are associated with the current nursing shortage, including job
dissatisfaction (Aiken et al., 2002; Buerhaus, Donelan, Ulrich, Norman, &
Dittus, 2005), an aging workforce coupled with increased demands
(Auerbach, Buerhaus, & Staiger, 2007), and problematic relationships
among members of the health care team (Aiken et al., 2002). While these fac-
tors may lead to increased nursing attrition, they have not been explored
from the perspective of the former RN. A thorough examination of RNs’ per-
ceptions regarding the decision to ...
Running head ASSIGNMENT 4 ROLE AND SETTING1 ASSIGNMENT 4 ROL.docxsusanschei
Running head: ASSIGNMENT 4: ROLE AND SETTING 1
ASSIGNMENT 4: ROLE AND SETTING 5
Assignment 4: Role and Setting
Ricardo Gonzalez Diaz
November 22, 2016
NSG5000 S03 Role of the Advanced Practice Nurse
Faculty Esposito
I was admitted to South University to become Nurse Practitioner specialized in family practice. The role of Nurse Practitioner family practice is purely of clinical nature. It is mainly based on acquiring a sufficient or formal degree of knowledge and skills to do a task effectively, safely, and with competency. It is imperative for Nurse Practitioners to demonstrate that they are qualified with special attributes, skills, and knowledge to be able to deal with medical issues pertaining to disease and death, a situation traditionally carried out by physicians. Through the demonstration of these attributes, Nurse Practitioners elevate and separate them from the traditional nursing role, giving the opportunity to the physicians to corroborate their value in medicine, convincing them, the patients, and their families that Nurse Practitioners are trustworthy enough to carry out the patients’ clinical management at an advanced level. Rashotte, J. (2014).
Walsh, A., Moore, A., Barber, A., & Opsteen, J. (2014). Educational role of nurse practitioners in a family practice centre: Perspectives of learners and nurses. Canadian Family Physician Médecin De Famille Canadien, 60(6), e316, e318.
The authors of this article use a qualitative approach as a design to examine the role of nurse practitioners (NPs) as educators of family medicine residents in order to better understand the interprofessional dynamics in a clinical teaching setting in an urban area in southern Ontario, Canada.
In order to develop this research, first year (8 of 9) and second year (9 of 10) family medicine residents were used as participants and utilized audiotaped and transcribed semistructured interviews.
They were able to identify several points that served as the base for their study. These points included role clarification, professional identity formation, factors that enhance the educational role of NPs, and factors that limit the educational role of NPs. The function of NPs were recognized by the majority of the residents, but they were not sure about the NPs scope of practice. In fact, they responded differently to teaching by NPs. First year residents believed that nurse practitioner offer a better approach when teaching and they perceive a decreased sense of susceptibility when being taught by NPs. On the other hand, second year residents preferred being taught from physician teachers alleging that they needed to think like physicians. This created some discomfort among senior residents and did not appreciate the role of nurse practitioners in providing supervision of the day-to-day care of patients. It was evident the lack of an intentional orientation of the family medicine residents regarding the scope of practice of nurse practitioners ...
Research Paper For this assignment, write about a hazardous mate.docxdebishakespeare
Research Paper
For this assignment, write about a hazardous materials incident or an environmental health and safety (EHS) project that involves a material(s) with a hazard(s) that falls under the hazard classification that we have studied so far (water/air reactive, corrosive, or toxic). The incident or project could be one that you have researched or been involved with.
Your essay must include the following:
summary of the project or incident,
identification of the hazardous material(s) involved and hazardous classification,
discussion of chemical properties and interactions relevant to the incident/project,
any short or long-term mitigation implemented, and
conclusion (your professional opinion on the project/incident).
Your response must be at least 400 words in length. You are required to use at least two references, including your textbook for your response. All sources used, including the textbook, must be referenced. Paraphrased and/or quoted materials must have accompanying citations in APA format.
State Tested Nursing Aides’
Provision of End-of-Life
Care in Nursing Homes
Implications for Quality Improvement
Emma Nochomovitz, MPH
Maryjo Prince-Paul, PhD, APRN, AHPCN, FPCN
Mary Dolansky, PhD, RN
Mendel E. Singer, PhD
Peter DeGolia, MD, CMD
Scott H. Frank, MD, MS
v An increasing prevalence in deaths occurring
within nursing homes has led to a growing
concern surrounding quality issues in end-of-life
(EOL) nursing home care. In addition, prior
research has failed to emphasize the importance
of state tested nursing aides (STNAs) in
providing this type of care. The purpose of this
study was to examine quality issues in EOL
nursing home care within the context of STNAs’
comfort in providing this care. A convenience
sample of 108 STNAs from four nursing homes
in the Cleveland, Ohio area used PDAs to
provide answers to an audio questionnaire.
Questions included emergent themes from the
literature pertaining to EOL care in nursing
homes, as well as materials from a national
education initiative to improve palliative care.
Findings demonstrated lack of comfort in
discussing death with nursing home residents
and their families and insufficient knowledge
surrounding EOL decisions and certain types
of EOL care. Overall, the level of comfort
providing EOL care was found to be associated
with STNAs’ perceived importance of EOL
care, understanding of hospice, and spiritual
well-being.
JOURNAL OF HOSPICE AND PALLIATIVE NURSING v Vol. 12, No. 4, July/August 2010 255
Author Affiliations: Emma Nochomovitz, MPH, is
Research Analyst, National Quality Forum,
Washington, DC and Case Western Reserve
University, Cleveland, OH.
Maryjo Prince-Paul, PhD, APRN, AHPCN, FPCN,
is Assistant Professor, Frances Payne Bolton School of
Nursing, Case Western Reserve University, Cleveland, OH.
Mary Dolansky, PhD, RN, is Assistant Professor,
Frances Payne Bolton School of Nursing, Case
Western Reserve University, Cleveland, OH.
Mendel E. Singer, PhD, ...
State Tested Nursing Aides’Provision of End-of-LifeCare in.docxdessiechisomjj4
State Tested Nursing Aides’
Provision of End-of-Life
Care in Nursing Homes
Implications for Quality Improvement
Emma Nochomovitz, MPH
Maryjo Prince-Paul, PhD, APRN, AHPCN, FPCN
Mary Dolansky, PhD, RN
Mendel E. Singer, PhD
Peter DeGolia, MD, CMD
Scott H. Frank, MD, MS
v An increasing prevalence in deaths occurring
within nursing homes has led to a growing
concern surrounding quality issues in end-of-life
(EOL) nursing home care. In addition, prior
research has failed to emphasize the importance
of state tested nursing aides (STNAs) in
providing this type of care. The purpose of this
study was to examine quality issues in EOL
nursing home care within the context of STNAs’
comfort in providing this care. A convenience
sample of 108 STNAs from four nursing homes
in the Cleveland, Ohio area used PDAs to
provide answers to an audio questionnaire.
Questions included emergent themes from the
literature pertaining to EOL care in nursing
homes, as well as materials from a national
education initiative to improve palliative care.
Findings demonstrated lack of comfort in
discussing death with nursing home residents
and their families and insufficient knowledge
surrounding EOL decisions and certain types
of EOL care. Overall, the level of comfort
providing EOL care was found to be associated
with STNAs’ perceived importance of EOL
care, understanding of hospice, and spiritual
well-being.
JOURNAL OF HOSPICE AND PALLIATIVE NURSING v Vol. 12, No. 4, July/August 2010 255
Author Affiliations: Emma Nochomovitz, MPH, is
Research Analyst, National Quality Forum,
Washington, DC and Case Western Reserve
University, Cleveland, OH.
Maryjo Prince-Paul, PhD, APRN, AHPCN, FPCN,
is Assistant Professor, Frances Payne Bolton School of
Nursing, Case Western Reserve University, Cleveland, OH.
Mary Dolansky, PhD, RN, is Assistant Professor,
Frances Payne Bolton School of Nursing, Case
Western Reserve University, Cleveland, OH.
Mendel E. Singer, PhD, is Associate Professor,
Department of Epidemiology and Biostatistics, Case
Western Reserve University, Cleveland, OH.
Peter DeGolia, MD, CMD, is Director, Center for
Geriatric Medicine, University Hospitals Case
Medical Center and Associate Professor, Family
Medicine, Case Western Reserve University School of
Medicine, Cleveland, OH.
Scott H. Frank, MD, MS, is Director, Master of
Public Health Program, Department of Epidemiology
and Biostatistics, Department of Family Medicine,
Case Western Reserve University, Cleveland, OH.
Address correspondence to Emma Nochomovitz,
MPH, National Quality Forum, 601 13th St
NW, Suite 500 North Washington, DC 20005
([email protected]).
K E Y W O R D S
end-of-life care
hospice
nursing aides
nursing home
I
n recent years, the growth of the older segment of
the population and the prevalence of chronic illness
have led to increased institutionalization of the frail
and elderly prior to their deaths. In particular, nursing
homes have been identified as a place in which end-of-
life .
MEDSURG Nursing—November/December 2010—Vol. 19/No. 6 335
Carol Isaac MacKusick, PhD(c), MSN,
RN, CNN, is an Assistant Professor of
Nursing, Clayton State University,
Morrow, GA.
Ptlene Minick, PhD, RN, is Doctoral
Faculty and Associate Professor of
Nursing, Georgia State University,
Atlanta, GA.
Carol Isaac MacKusick
Ptlene Minick
Why Are Nurses Leaving? Findings
From an Initial Qualitative Study on
Nursing Attrition
In the United States, nursing workforce projections indicate the registerednurse (RN) shortage may exceed 500,000 RNs by 2025 (American
Association of Colleges of Nursing [AACN], 2010; Cipriano, 2006; U.S.
Department of Health and Human Services, 2002). In 2008, the national RN
vacancy rate in the United States was greater than 8% (AACN, 2010).
Evidence suggests experiences as a newly licensed RN directly impact indi-
vidual perceptions related to the profession (Cowin & Hengstberger-Sims,
2006). An estimated 30%-50% of all new RNs elect either to change positions
or leave nursing completely within the first 3 years of clinical practice
(AACN, 2003; Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; Cipriano, 2006;
Cowin & Hengstberger-Sims, 2006). While an abundance of data exist regard-
ing the RN who stays at the bedside, few studies have explored the percep-
tions of the RN who decides to leave clinical nursing. Understanding factors
associated with RNs’ practice decisions is the first step necessary in devel-
oping effective nursing-retention strategies.
Purpose
The purpose of this study was to identify the factors influencing the
decision of RNs to leave clinical nursing practice. Nurses who had elected
to leave clinical nursing were interviewed at the setting of their choice.
Previous clinical nursing experience included a variety of clinical practice
settings. For this study, the term clinical nursing is defined as providing
direct patient care in the hospital setting.
Background
Limited data exist about individuals no longer employed in nursing; no
literature was found about the perceptions or decision-making processes of
RNs no longer in clinical practice. A review of the literature was conducted
searching nursing, medical, labor, and psychological/sociological databas-
es. Years of search ended with 2007, the year of the interviews. A broad
search began with GoogleScholar® and was narrowed to include CINAHL,
MEDline, PsycINFO, and LexisNexis. Several issues concerning practice
decisions are associated with the current nursing shortage, including job
dissatisfaction (Aiken et al., 2002; Buerhaus, Donelan, Ulrich, Norman, &
Dittus, 2005), an aging workforce coupled with increased demands
(Auerbach, Buerhaus, & Staiger, 2007), and problematic relationships
among members of the health care team (Aiken et al., 2002). While these fac-
tors may lead to increased nursing attrition, they have not been explored
from the perspective of the former RN. A thorough examination of RNs’ per-
ceptions regarding the decision to ...
Running head ASSIGNMENT 4 ROLE AND SETTING1 ASSIGNMENT 4 ROL.docxsusanschei
Running head: ASSIGNMENT 4: ROLE AND SETTING 1
ASSIGNMENT 4: ROLE AND SETTING 5
Assignment 4: Role and Setting
Ricardo Gonzalez Diaz
November 22, 2016
NSG5000 S03 Role of the Advanced Practice Nurse
Faculty Esposito
I was admitted to South University to become Nurse Practitioner specialized in family practice. The role of Nurse Practitioner family practice is purely of clinical nature. It is mainly based on acquiring a sufficient or formal degree of knowledge and skills to do a task effectively, safely, and with competency. It is imperative for Nurse Practitioners to demonstrate that they are qualified with special attributes, skills, and knowledge to be able to deal with medical issues pertaining to disease and death, a situation traditionally carried out by physicians. Through the demonstration of these attributes, Nurse Practitioners elevate and separate them from the traditional nursing role, giving the opportunity to the physicians to corroborate their value in medicine, convincing them, the patients, and their families that Nurse Practitioners are trustworthy enough to carry out the patients’ clinical management at an advanced level. Rashotte, J. (2014).
Walsh, A., Moore, A., Barber, A., & Opsteen, J. (2014). Educational role of nurse practitioners in a family practice centre: Perspectives of learners and nurses. Canadian Family Physician Médecin De Famille Canadien, 60(6), e316, e318.
The authors of this article use a qualitative approach as a design to examine the role of nurse practitioners (NPs) as educators of family medicine residents in order to better understand the interprofessional dynamics in a clinical teaching setting in an urban area in southern Ontario, Canada.
In order to develop this research, first year (8 of 9) and second year (9 of 10) family medicine residents were used as participants and utilized audiotaped and transcribed semistructured interviews.
They were able to identify several points that served as the base for their study. These points included role clarification, professional identity formation, factors that enhance the educational role of NPs, and factors that limit the educational role of NPs. The function of NPs were recognized by the majority of the residents, but they were not sure about the NPs scope of practice. In fact, they responded differently to teaching by NPs. First year residents believed that nurse practitioner offer a better approach when teaching and they perceive a decreased sense of susceptibility when being taught by NPs. On the other hand, second year residents preferred being taught from physician teachers alleging that they needed to think like physicians. This created some discomfort among senior residents and did not appreciate the role of nurse practitioners in providing supervision of the day-to-day care of patients. It was evident the lack of an intentional orientation of the family medicine residents regarding the scope of practice of nurse practitioners ...
Research Paper For this assignment, write about a hazardous mate.docxdebishakespeare
Research Paper
For this assignment, write about a hazardous materials incident or an environmental health and safety (EHS) project that involves a material(s) with a hazard(s) that falls under the hazard classification that we have studied so far (water/air reactive, corrosive, or toxic). The incident or project could be one that you have researched or been involved with.
Your essay must include the following:
summary of the project or incident,
identification of the hazardous material(s) involved and hazardous classification,
discussion of chemical properties and interactions relevant to the incident/project,
any short or long-term mitigation implemented, and
conclusion (your professional opinion on the project/incident).
Your response must be at least 400 words in length. You are required to use at least two references, including your textbook for your response. All sources used, including the textbook, must be referenced. Paraphrased and/or quoted materials must have accompanying citations in APA format.
State Tested Nursing Aides’
Provision of End-of-Life
Care in Nursing Homes
Implications for Quality Improvement
Emma Nochomovitz, MPH
Maryjo Prince-Paul, PhD, APRN, AHPCN, FPCN
Mary Dolansky, PhD, RN
Mendel E. Singer, PhD
Peter DeGolia, MD, CMD
Scott H. Frank, MD, MS
v An increasing prevalence in deaths occurring
within nursing homes has led to a growing
concern surrounding quality issues in end-of-life
(EOL) nursing home care. In addition, prior
research has failed to emphasize the importance
of state tested nursing aides (STNAs) in
providing this type of care. The purpose of this
study was to examine quality issues in EOL
nursing home care within the context of STNAs’
comfort in providing this care. A convenience
sample of 108 STNAs from four nursing homes
in the Cleveland, Ohio area used PDAs to
provide answers to an audio questionnaire.
Questions included emergent themes from the
literature pertaining to EOL care in nursing
homes, as well as materials from a national
education initiative to improve palliative care.
Findings demonstrated lack of comfort in
discussing death with nursing home residents
and their families and insufficient knowledge
surrounding EOL decisions and certain types
of EOL care. Overall, the level of comfort
providing EOL care was found to be associated
with STNAs’ perceived importance of EOL
care, understanding of hospice, and spiritual
well-being.
JOURNAL OF HOSPICE AND PALLIATIVE NURSING v Vol. 12, No. 4, July/August 2010 255
Author Affiliations: Emma Nochomovitz, MPH, is
Research Analyst, National Quality Forum,
Washington, DC and Case Western Reserve
University, Cleveland, OH.
Maryjo Prince-Paul, PhD, APRN, AHPCN, FPCN,
is Assistant Professor, Frances Payne Bolton School of
Nursing, Case Western Reserve University, Cleveland, OH.
Mary Dolansky, PhD, RN, is Assistant Professor,
Frances Payne Bolton School of Nursing, Case
Western Reserve University, Cleveland, OH.
Mendel E. Singer, PhD, ...
State Tested Nursing Aides’Provision of End-of-LifeCare in.docxdessiechisomjj4
State Tested Nursing Aides’
Provision of End-of-Life
Care in Nursing Homes
Implications for Quality Improvement
Emma Nochomovitz, MPH
Maryjo Prince-Paul, PhD, APRN, AHPCN, FPCN
Mary Dolansky, PhD, RN
Mendel E. Singer, PhD
Peter DeGolia, MD, CMD
Scott H. Frank, MD, MS
v An increasing prevalence in deaths occurring
within nursing homes has led to a growing
concern surrounding quality issues in end-of-life
(EOL) nursing home care. In addition, prior
research has failed to emphasize the importance
of state tested nursing aides (STNAs) in
providing this type of care. The purpose of this
study was to examine quality issues in EOL
nursing home care within the context of STNAs’
comfort in providing this care. A convenience
sample of 108 STNAs from four nursing homes
in the Cleveland, Ohio area used PDAs to
provide answers to an audio questionnaire.
Questions included emergent themes from the
literature pertaining to EOL care in nursing
homes, as well as materials from a national
education initiative to improve palliative care.
Findings demonstrated lack of comfort in
discussing death with nursing home residents
and their families and insufficient knowledge
surrounding EOL decisions and certain types
of EOL care. Overall, the level of comfort
providing EOL care was found to be associated
with STNAs’ perceived importance of EOL
care, understanding of hospice, and spiritual
well-being.
JOURNAL OF HOSPICE AND PALLIATIVE NURSING v Vol. 12, No. 4, July/August 2010 255
Author Affiliations: Emma Nochomovitz, MPH, is
Research Analyst, National Quality Forum,
Washington, DC and Case Western Reserve
University, Cleveland, OH.
Maryjo Prince-Paul, PhD, APRN, AHPCN, FPCN,
is Assistant Professor, Frances Payne Bolton School of
Nursing, Case Western Reserve University, Cleveland, OH.
Mary Dolansky, PhD, RN, is Assistant Professor,
Frances Payne Bolton School of Nursing, Case
Western Reserve University, Cleveland, OH.
Mendel E. Singer, PhD, is Associate Professor,
Department of Epidemiology and Biostatistics, Case
Western Reserve University, Cleveland, OH.
Peter DeGolia, MD, CMD, is Director, Center for
Geriatric Medicine, University Hospitals Case
Medical Center and Associate Professor, Family
Medicine, Case Western Reserve University School of
Medicine, Cleveland, OH.
Scott H. Frank, MD, MS, is Director, Master of
Public Health Program, Department of Epidemiology
and Biostatistics, Department of Family Medicine,
Case Western Reserve University, Cleveland, OH.
Address correspondence to Emma Nochomovitz,
MPH, National Quality Forum, 601 13th St
NW, Suite 500 North Washington, DC 20005
([email protected]).
K E Y W O R D S
end-of-life care
hospice
nursing aides
nursing home
I
n recent years, the growth of the older segment of
the population and the prevalence of chronic illness
have led to increased institutionalization of the frail
and elderly prior to their deaths. In particular, nursing
homes have been identified as a place in which end-of-
life .
Getting Your Feet Wet Becoming a PublicHealth Nurse, Part 1.docxgilbertkpeters11344
Getting Your Feet Wet: Becoming a Public
Health Nurse, Part 1
Lee SmithBattle, R.N., D.N.Sc.,
Margaret Diekemper, R.N., M.S.N., C.S.,
and Sheila Leander, R.N., M.S.N.
Abstract While the competencies and theory relevant to public
health nursing (PHN) practice continue to be described, much
less attention has been given to the knowledge derived from
practice (clinical know-how) and the development of PHN
expertise. A study was designed to address this gap by recruiting
nurses with varied levels of experience and from various practice
sites. A convenience sample of 28 public health nurses and seven
administrators/supervisors were interviewed. A subsample, com-
prised of less-experienced public health nurses, were followed
longitudinally over an 18-month period. Data included more
than 130 clinical episodes and approximately 900 pages of tran-
scripts and field notes. A series of interpretive sessions focused
on identifying salient aspects of the text and comparing and
contrasting what showed up as compelling, puzzling, and mean-
ingful in public health nurses’ descriptions. This interpretive
analysis revealed changes in understanding of practice and cap-
tured the development of clinical know-how. In Part 1, we
describe the sample, study design, and two aspects of clinical
knowledge development—grappling with the unfamiliar and
learning relational skills—that surfaced in nurses’ descriptions of
early clinical practice. In Part 2, which is to be published in the
next issue of Public Health Nursing (SmithBattle, Diekemper, &
Leander, 2004), we explore gradual shifts in public health nurses’
understanding of practice that led to their engagement in
upstream, population-focused activities. Implications of these
findings for supporting the clinical learning of public health
nurses and the development of expertise are described.
Key words: clinical knowledge, community health nursing,
home visiting, public health nursing.
While the competencies and theory relevant to public
health nursing (PHN) practice continue to be described
(Kenyon et al., 1990; Bramadat, Chalmers, & Andrusyszyn,
1996; Block et al., 2001), much less attention has been
given to the knowledge derived from practice (clinical
know-how) and the development of PHN expertise. This
study was designed to address this gap and to draw
on scholarship regarding the role of experience, percep-
tion, embodiment, and engaged reasoning in the develop-
ment of expertise (Schon, 1983/1994; Dunne, 1993;
Benner, Tanner, & Chesla, 1996; Dreyfus & Dreyfus,
1996; Benner, 1999, 2000a; Benner, Hooper-Kyriakidis,
& Stannard, 1999). In describing the experiential gains,
ethical discernment, and perceptual acuity central to clin-
ical expertise in acute care settings, Benner and her col-
leagues (1984, 1996, 1999, 2000b) have articulated crucial
distinctions between theoretical, applied knowledge
(knowing-that) and the practical, engaged reasoning
(knowing-how) that responds to.
A Career in Nursing Essay example
Advanced Practice Nursing Essay examples
What Is Nursing? Essay
The nursing process Essay
Essay on Nursing Care Plan
Nursing Exemplar
MR. BHUSHAN R JOSHI (IV B. BSc. NSG
The curriculum must reflect the needs of patients and be immediately relevant and applicable to the central role of nurses: caring for patients.”
Respond to at least two of your colleagues in one or more of t.docxwilfredoa1
Respond
to at least
two
of your colleagues in one or more of the following ways:
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Validate an idea with your own experience and additional research.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
POST 1
According to Cleary and Hunt, (2011), recent studies have shown the majority of nursing doctoral candidates are female, clinically experienced, and in their 40s or 50s at the time of starting their PhD. Based on that criteria, this writer fits exactly into that criteria. It is noted that other disciplines tend to start doctoral training much earlier (Cleary & Hunt, 2011). As a practicing nurse of 30 years, most of it as an Associate Degree nurse the recognition of the PhD nurse was seen as a profession in a nursing league of their own. According to Michael and Clochesy, (2016), the PhD in nursing was predominant throughout the 20th century with members of the academic nursing community recognizing the need for the development of knowledge to inform practice and to promote the credibility of the profession. Nursing theorists such as Jean Watson and Patricia Benner were game changers in the industry of theoretical nursing. The ability in achieving higher levels of education and in conducting research are hallmarks of professionalism (Houser, 2018).
This writer has a passion for teaching students and wants to be the best instructor she can be. She chose to go down the path of the PhD in Nursing education to increase skills and knowledge to improve what is delivered to students every day. The PhD is being pursued to separate myself from the growing amount of DNP faculty that she works with daily. Being an alumni with Walden University for the MSN, it was an easy choice to pick Walden University for the terminal degree. Michael and Clochesy, (2016), states the PhD and DNP represent complementary and alternative approaches to the highest level of educational preparation in nursing. PhD programs prepare nurse scientists to conduct original research and to generate knowledge that may be broadly applicable or generalizable using advanced research designs and statistical evaluative methods. Conversely, DNP programs prepare students for advanced specialty practice at a high level of complexity with a concurrent focus on the development of knowledge and skills required for translation of evidence to improve health outcomes and health care delivery (Michael & Clochesy, 2016).
Michael and Clochesy, (2016), also states two of the main reasons for not completing a doctoral program are financial and family stresses. Strategic plans must include financial considerations (e.g., research costs), support systems and a systemic approach to the d.
Ethical Case Study 2Gloria is a housekeeper in an independent li.docxdebishakespeare
Ethical Case Study 2
Gloria is a housekeeper in an independent living community. While walking through a hallway, she noticed the door of a resident’s apartment was left open, which was unusual. She stepped in to check on Louis, and quickly realized that he was on the phone in his living room. As she turned to leave, she over heard him saying that he had stopped taking all of his medications because he was ready to die. She could tell that the person that he was speaking with was trying to reason with him. Gloria knows that Louis has a very loving and involved daughter that visits him every Saturday. She left the room determined that she would tell his daughter what she heard when she saw her on Saturday.
You have to answer all the questions below
What issues are facing Gloria? Discuss the possible ethical principles at play and your recommendation to Gloria.
Hint: Confidentiality, Beneficence, Self-determination
.
Ethical consideration is important in nursing practice, especial.docxdebishakespeare
Ethical consideration is important in nursing practice, especially when providing care to patients from diverse sociocultural backgrounds. The population of the United States comprises various ethnic/racial groups with different cultural and social beliefs, practice, norms, and values. There is an increasing disparities on the incidence and prevalence of type 2 diabetes among different communities in the United States. According to the Center for Disease Control and Prevention (CDC), Hispanics and African Americans have the highest incidence and prevalence of type 2 diabetes in the country (Concha, Mayer, Mezuk, & Avula, 2016). Caring for patients from different ethnic/racial groups require consideration of ethical principles and concepts to prevent ethical issues that may arise during nurse-patient interaction.
Recently, I cared for patient with type 2 diabetes mellitus who had been hospitalized for more than two weeks due to acute hypertension, partial loss of vision. Also, the patient had a chronic diabetic foot ulcer. The analysis of his medical history revealed that the diabetic foot ulcer had developed in the last two years and had never healed. The patient was so worried about his health status and kept asking when he was going to be discharged from the hospital. The patient came from the Hispanic community, which is one of minority groups with the highest incidence and prevalence of type 2 diabetes mellitus in the country. Being a culturally competent registered nurse, I had an obligation to take into account the specific ethnic background of the patient when providing care. Considering patient’s ethnic/racial background is important in providing quality, holistic, and patient-centered care based their health concerns, preferences, and values (Concha et al., 2016).
When collecting subjective data for analysis and planning for the care. I asked the patient about his perceptions about the possible causes of type 2 diabetes that he was suffering from. Hispanics have different beliefs in the causation of diabetes mellitus (Frieden, 2016). First, the patient believed that diabetes is a temporary condition that is not fatal. Second, the patient narrated a story that attempts to identify the cause of diabetes and concluded that they believe that people with “good diabetes” do not experience a lot of complications. The Hispanics use the term “good diabetes” when referring to the type of diabetes that do not require insulin for therapeutic purposes; non-insulin-dependent diabetes mellitus (T2DM) (Frieden, 2016). Also, the patient had a fatalistic attitude and believed that his health condition is likely to be a punishment from God.
The patient had a low health literacy level because caregivers had encouraged him to engage in some physical exercise and adopt a self-management approach as a way of controlling and preventing complications related to his condition, but he never implemented them. Also, the pat.
Ethical Competency Writing Assignment Description
PHI 108 Spring 2019
Dr. David M. DiQuattro
March 5, 2019
1 Basic Assignment Description
For your ethical competency writing assignment, you will write analyze a disagreement between two authors/viewpoints
that we discussed this semester. I am calling the assignment a critical disagreement analysis. Below I will
provide a number of examples of disagreements between the authors we discuss this semester. Your
paper will have the following components
1. Hone the disagreement
• I want you to start by taking my general statement of disagreement and providing your own clear specifics
that focus on particular claims or passages. Here you are taking my starting point, but providing your
own framing of the disagreement that will provide focus for your paper.
• You will hone your statement of the disagreement in a way that sets things up for the next parts of the
paper.
• For example:
– In number 2 below, you will identify a specific critique of Rawls from either Kittay or Noddings.
You need to explain where the disagreement is and set the stage for a fruitful dialogue to follow in
the paper.
• This part of the paper should be focused. You should discuss the two views in a way that sets the stage
for your objection and response.
• In the opening part of the paper you need to preview what is ahead - you may only write this part late
in the writing process, but you need to provide a clear preview of where the rest of the paper goes.
2. Provide the best objection from one point of view to another
• I want you to do more than just state the two sides of the issue in this paper. I want you to bring the
authors into dialogue. You will do this by articulating an objection to one position from the point of
view of the other, then responding to the objection.
– You want your objection to be more than just restating a point where the authors diagree. Here’s
what I mean by just restating, as an example:
1
Kant believes that there are absolute rules that should be followed without regard to conse-
quences. The strongest utilitarian objection to this is that Kant disregards the importance
of how an action affects overall happiness.
– The above is an example of what not to do. That way of stating things won’t get you far because
it is just a re-stating of a key difference between Kant and utilitarianism.
• You should look for an objection that raises a new question for the other point of view, or points out
an unforeseen implication of the view. In some way it should move discussion forward. I am not
asking you to discover something that has never been said about these issues. I just want
you to deepen your understanding of the two views by raising a serious objection to one
position, then responding to it.
– In some way the objection should force you to think in new ways about the position objected to.
• In this section you should explain as clearly as you can how the objection presents a proble.
Ethical Case StudyAn example of unethical treatment of participa.docxdebishakespeare
Ethical Case Study
An example of unethical treatment of participants was the Tuskegee syphilis experiment, who believed they were being treated for “bad blood”
“Bad blood”: A term used to describe problems like anemia, fatigue, and syphilis
Those in the control group were not given treatment for syphilis, and many died
Why would this research study not fall under the present ethical and legal restraint? Please support your answer with scholarly articles.
.
Ethical AwarenessDEFINITION a brief definition of the k.docxdebishakespeare
Ethical Awareness
DEFINITION
:
a brief definition of the key term followed by the APA reference for the term; this does not count in the word requirement.
SUMMARY
:
Summarize the article in your own words- this should be in the
150-200 word range
. Be sure to note the article's author, note their credentials and why we should put any weight behind his/her opinions, research or findings regarding the key term.
DISCUSSION
:
Using
300-350 words
, write a brief discussion, in your own words of how the article relates to the selected chapter Key Term. A discussion is not rehashing what was already stated in the article, but the opportunity for you to
add value by sharing your experiences, thoughts, and opinions
.
This is the most important part of the assignment.
REFERENCES
:
All references must be listed at the bottom of the submission--in APA format.
Please follow the above format, No Plagiarism, APA format, add citations and references.
.
More Related Content
Similar to REFERENCES FOR THE TWO ARTICLESQUANTITATIVEARTICLE 1McIe, S.docx
Getting Your Feet Wet Becoming a PublicHealth Nurse, Part 1.docxgilbertkpeters11344
Getting Your Feet Wet: Becoming a Public
Health Nurse, Part 1
Lee SmithBattle, R.N., D.N.Sc.,
Margaret Diekemper, R.N., M.S.N., C.S.,
and Sheila Leander, R.N., M.S.N.
Abstract While the competencies and theory relevant to public
health nursing (PHN) practice continue to be described, much
less attention has been given to the knowledge derived from
practice (clinical know-how) and the development of PHN
expertise. A study was designed to address this gap by recruiting
nurses with varied levels of experience and from various practice
sites. A convenience sample of 28 public health nurses and seven
administrators/supervisors were interviewed. A subsample, com-
prised of less-experienced public health nurses, were followed
longitudinally over an 18-month period. Data included more
than 130 clinical episodes and approximately 900 pages of tran-
scripts and field notes. A series of interpretive sessions focused
on identifying salient aspects of the text and comparing and
contrasting what showed up as compelling, puzzling, and mean-
ingful in public health nurses’ descriptions. This interpretive
analysis revealed changes in understanding of practice and cap-
tured the development of clinical know-how. In Part 1, we
describe the sample, study design, and two aspects of clinical
knowledge development—grappling with the unfamiliar and
learning relational skills—that surfaced in nurses’ descriptions of
early clinical practice. In Part 2, which is to be published in the
next issue of Public Health Nursing (SmithBattle, Diekemper, &
Leander, 2004), we explore gradual shifts in public health nurses’
understanding of practice that led to their engagement in
upstream, population-focused activities. Implications of these
findings for supporting the clinical learning of public health
nurses and the development of expertise are described.
Key words: clinical knowledge, community health nursing,
home visiting, public health nursing.
While the competencies and theory relevant to public
health nursing (PHN) practice continue to be described
(Kenyon et al., 1990; Bramadat, Chalmers, & Andrusyszyn,
1996; Block et al., 2001), much less attention has been
given to the knowledge derived from practice (clinical
know-how) and the development of PHN expertise. This
study was designed to address this gap and to draw
on scholarship regarding the role of experience, percep-
tion, embodiment, and engaged reasoning in the develop-
ment of expertise (Schon, 1983/1994; Dunne, 1993;
Benner, Tanner, & Chesla, 1996; Dreyfus & Dreyfus,
1996; Benner, 1999, 2000a; Benner, Hooper-Kyriakidis,
& Stannard, 1999). In describing the experiential gains,
ethical discernment, and perceptual acuity central to clin-
ical expertise in acute care settings, Benner and her col-
leagues (1984, 1996, 1999, 2000b) have articulated crucial
distinctions between theoretical, applied knowledge
(knowing-that) and the practical, engaged reasoning
(knowing-how) that responds to.
A Career in Nursing Essay example
Advanced Practice Nursing Essay examples
What Is Nursing? Essay
The nursing process Essay
Essay on Nursing Care Plan
Nursing Exemplar
MR. BHUSHAN R JOSHI (IV B. BSc. NSG
The curriculum must reflect the needs of patients and be immediately relevant and applicable to the central role of nurses: caring for patients.”
Respond to at least two of your colleagues in one or more of t.docxwilfredoa1
Respond
to at least
two
of your colleagues in one or more of the following ways:
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Validate an idea with your own experience and additional research.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
POST 1
According to Cleary and Hunt, (2011), recent studies have shown the majority of nursing doctoral candidates are female, clinically experienced, and in their 40s or 50s at the time of starting their PhD. Based on that criteria, this writer fits exactly into that criteria. It is noted that other disciplines tend to start doctoral training much earlier (Cleary & Hunt, 2011). As a practicing nurse of 30 years, most of it as an Associate Degree nurse the recognition of the PhD nurse was seen as a profession in a nursing league of their own. According to Michael and Clochesy, (2016), the PhD in nursing was predominant throughout the 20th century with members of the academic nursing community recognizing the need for the development of knowledge to inform practice and to promote the credibility of the profession. Nursing theorists such as Jean Watson and Patricia Benner were game changers in the industry of theoretical nursing. The ability in achieving higher levels of education and in conducting research are hallmarks of professionalism (Houser, 2018).
This writer has a passion for teaching students and wants to be the best instructor she can be. She chose to go down the path of the PhD in Nursing education to increase skills and knowledge to improve what is delivered to students every day. The PhD is being pursued to separate myself from the growing amount of DNP faculty that she works with daily. Being an alumni with Walden University for the MSN, it was an easy choice to pick Walden University for the terminal degree. Michael and Clochesy, (2016), states the PhD and DNP represent complementary and alternative approaches to the highest level of educational preparation in nursing. PhD programs prepare nurse scientists to conduct original research and to generate knowledge that may be broadly applicable or generalizable using advanced research designs and statistical evaluative methods. Conversely, DNP programs prepare students for advanced specialty practice at a high level of complexity with a concurrent focus on the development of knowledge and skills required for translation of evidence to improve health outcomes and health care delivery (Michael & Clochesy, 2016).
Michael and Clochesy, (2016), also states two of the main reasons for not completing a doctoral program are financial and family stresses. Strategic plans must include financial considerations (e.g., research costs), support systems and a systemic approach to the d.
Ethical Case Study 2Gloria is a housekeeper in an independent li.docxdebishakespeare
Ethical Case Study 2
Gloria is a housekeeper in an independent living community. While walking through a hallway, she noticed the door of a resident’s apartment was left open, which was unusual. She stepped in to check on Louis, and quickly realized that he was on the phone in his living room. As she turned to leave, she over heard him saying that he had stopped taking all of his medications because he was ready to die. She could tell that the person that he was speaking with was trying to reason with him. Gloria knows that Louis has a very loving and involved daughter that visits him every Saturday. She left the room determined that she would tell his daughter what she heard when she saw her on Saturday.
You have to answer all the questions below
What issues are facing Gloria? Discuss the possible ethical principles at play and your recommendation to Gloria.
Hint: Confidentiality, Beneficence, Self-determination
.
Ethical consideration is important in nursing practice, especial.docxdebishakespeare
Ethical consideration is important in nursing practice, especially when providing care to patients from diverse sociocultural backgrounds. The population of the United States comprises various ethnic/racial groups with different cultural and social beliefs, practice, norms, and values. There is an increasing disparities on the incidence and prevalence of type 2 diabetes among different communities in the United States. According to the Center for Disease Control and Prevention (CDC), Hispanics and African Americans have the highest incidence and prevalence of type 2 diabetes in the country (Concha, Mayer, Mezuk, & Avula, 2016). Caring for patients from different ethnic/racial groups require consideration of ethical principles and concepts to prevent ethical issues that may arise during nurse-patient interaction.
Recently, I cared for patient with type 2 diabetes mellitus who had been hospitalized for more than two weeks due to acute hypertension, partial loss of vision. Also, the patient had a chronic diabetic foot ulcer. The analysis of his medical history revealed that the diabetic foot ulcer had developed in the last two years and had never healed. The patient was so worried about his health status and kept asking when he was going to be discharged from the hospital. The patient came from the Hispanic community, which is one of minority groups with the highest incidence and prevalence of type 2 diabetes mellitus in the country. Being a culturally competent registered nurse, I had an obligation to take into account the specific ethnic background of the patient when providing care. Considering patient’s ethnic/racial background is important in providing quality, holistic, and patient-centered care based their health concerns, preferences, and values (Concha et al., 2016).
When collecting subjective data for analysis and planning for the care. I asked the patient about his perceptions about the possible causes of type 2 diabetes that he was suffering from. Hispanics have different beliefs in the causation of diabetes mellitus (Frieden, 2016). First, the patient believed that diabetes is a temporary condition that is not fatal. Second, the patient narrated a story that attempts to identify the cause of diabetes and concluded that they believe that people with “good diabetes” do not experience a lot of complications. The Hispanics use the term “good diabetes” when referring to the type of diabetes that do not require insulin for therapeutic purposes; non-insulin-dependent diabetes mellitus (T2DM) (Frieden, 2016). Also, the patient had a fatalistic attitude and believed that his health condition is likely to be a punishment from God.
The patient had a low health literacy level because caregivers had encouraged him to engage in some physical exercise and adopt a self-management approach as a way of controlling and preventing complications related to his condition, but he never implemented them. Also, the pat.
Ethical Competency Writing Assignment Description
PHI 108 Spring 2019
Dr. David M. DiQuattro
March 5, 2019
1 Basic Assignment Description
For your ethical competency writing assignment, you will write analyze a disagreement between two authors/viewpoints
that we discussed this semester. I am calling the assignment a critical disagreement analysis. Below I will
provide a number of examples of disagreements between the authors we discuss this semester. Your
paper will have the following components
1. Hone the disagreement
• I want you to start by taking my general statement of disagreement and providing your own clear specifics
that focus on particular claims or passages. Here you are taking my starting point, but providing your
own framing of the disagreement that will provide focus for your paper.
• You will hone your statement of the disagreement in a way that sets things up for the next parts of the
paper.
• For example:
– In number 2 below, you will identify a specific critique of Rawls from either Kittay or Noddings.
You need to explain where the disagreement is and set the stage for a fruitful dialogue to follow in
the paper.
• This part of the paper should be focused. You should discuss the two views in a way that sets the stage
for your objection and response.
• In the opening part of the paper you need to preview what is ahead - you may only write this part late
in the writing process, but you need to provide a clear preview of where the rest of the paper goes.
2. Provide the best objection from one point of view to another
• I want you to do more than just state the two sides of the issue in this paper. I want you to bring the
authors into dialogue. You will do this by articulating an objection to one position from the point of
view of the other, then responding to the objection.
– You want your objection to be more than just restating a point where the authors diagree. Here’s
what I mean by just restating, as an example:
1
Kant believes that there are absolute rules that should be followed without regard to conse-
quences. The strongest utilitarian objection to this is that Kant disregards the importance
of how an action affects overall happiness.
– The above is an example of what not to do. That way of stating things won’t get you far because
it is just a re-stating of a key difference between Kant and utilitarianism.
• You should look for an objection that raises a new question for the other point of view, or points out
an unforeseen implication of the view. In some way it should move discussion forward. I am not
asking you to discover something that has never been said about these issues. I just want
you to deepen your understanding of the two views by raising a serious objection to one
position, then responding to it.
– In some way the objection should force you to think in new ways about the position objected to.
• In this section you should explain as clearly as you can how the objection presents a proble.
Ethical Case StudyAn example of unethical treatment of participa.docxdebishakespeare
Ethical Case Study
An example of unethical treatment of participants was the Tuskegee syphilis experiment, who believed they were being treated for “bad blood”
“Bad blood”: A term used to describe problems like anemia, fatigue, and syphilis
Those in the control group were not given treatment for syphilis, and many died
Why would this research study not fall under the present ethical and legal restraint? Please support your answer with scholarly articles.
.
Ethical AwarenessDEFINITION a brief definition of the k.docxdebishakespeare
Ethical Awareness
DEFINITION
:
a brief definition of the key term followed by the APA reference for the term; this does not count in the word requirement.
SUMMARY
:
Summarize the article in your own words- this should be in the
150-200 word range
. Be sure to note the article's author, note their credentials and why we should put any weight behind his/her opinions, research or findings regarding the key term.
DISCUSSION
:
Using
300-350 words
, write a brief discussion, in your own words of how the article relates to the selected chapter Key Term. A discussion is not rehashing what was already stated in the article, but the opportunity for you to
add value by sharing your experiences, thoughts, and opinions
.
This is the most important part of the assignment.
REFERENCES
:
All references must be listed at the bottom of the submission--in APA format.
Please follow the above format, No Plagiarism, APA format, add citations and references.
.
ETHICAL CHALLENGES
JOYCAROLYNE MUIGAI
NTC/302
5/26/2020
INTRODUCTION
Ethics in business is mainly concerned with the good or bad actions and behaviors that often take place in the world of business
Ethical challenges have often resulted from lack of a clear and distinctive description of norms that ought to be used
Business ethics hence help economists to think productively along moral dimensions on matters regarding policy problems
Ethics could be a complex aspect in business as it influences all aspect of business as it provides the most adequate action that ought to be taken. Ethics causes huge conflicts as morality may not be clearly definitive and situations in many cases greatly vary (Nuseir & Ghandour, 2019).
2
Ethics in intellectual property
Intellectual property rights is a socio-economic tool that create some form of monopoly for firms to charge a price for their innovations
For many innovative firms, it is a timely and expensive to come up with new innovations for the market yet other competitors in the market will attempt to copy new design of products launched.
Firms have however, taken advantage of intellectual property rights by asking for high prices for products
Intellectual property rights are a tool that protects innovators from losing their innovations to counter-feighting firms in the market. However many have leveraged this property rights to put high prices on their products to maximize their profits from their innovations (Sonderholm, 2018).
3
Policy statement on Ethics in intellectual property
To ensure easy and right access of new innovated products, it is important to come up with an ethical way to reduce exploitation by firms.
Firms can take up he differential pricing strategy that has in the past been articulated to be of great influence and guarantees the firm’s profitability
Through differentia; pricing, the protected innovation can be offered at different prices based on the socio-economic demographics of the area. A product can be offered at a cheaper price at a low-earning area while it is offered at different price at a different location (Sonderholm, 2018).
4
Corruption index
Corruption is seen as legal complication that is often manifested in the absence of controls over power
Corruption in business could come in many ways but it is always some grease payment paid to expedite decision or transactions
Connection are as well viewed as to have an effect on business processes as they have a negative connotation regardless of their informality.
In many business ventures, corruption has been indicated to grow over time and is often seen in terms of exchange of favors for the sake of expedition of certain process to take a shorter time without necessarily having to undergo the require stipulated process (Samuel, 2019).
5
Policy statement in corruption index
Transparency is key in business processes hence all actions need to be accounted for
As a way to reduce the corruption index and subsequ.
Ethical Conduct of Researchpower point from this document, 1.docxdebishakespeare
Ethical Conduct of Research
power point from this document, 15 slides
Introduction
Depending on the context of the study, researchers often encounter ethical dilemmas that are associated with respect for privacy, establishment of honest and open interactions, and avoidance of misrepresentation. From an ethical standpoint, such challenging circumstances may surface if researchers are grappling with conflicting issues and have to choose between different methodological approaches in complex circumstances. In such circumstances, disagreements among different components including participants, researchers, researchers’ disciplines, the financing organization, and the society might be inevitable. Therefore, there are numerous ethical concerns that should be taken into account when undertaking studies that deal with human subjects. Understanding ethical principles can guide researchers to conduct studies that safeguard the wellbeing of human subjects.
Overview of the Research
In a research work titled
Resilience of People Living with HIV/AIDS in Indonesia: a Phenomenological Study
, Kumboyono et al. (2018) observe that HIV/ AIDS is among the most prevalent and expanding communicable diseases on the planet. The number of individuals who are diagnosed with HIV/AIDS continues to skyrocket every year in Indonesia and other parts of the world. According to Kumboyono et al. (2018), individuals who suffer from HIV/AIDS often plunge themselves into a series of crises, which indicate the challenges of living with the chronic pathological condition. As such, resilience is one distinct phenomenon that is common among persons living with the diseases Indonesia, a pattern that indicates the results of current health management and expectations of HIV/AIDS patients for better and improved health outcomes. In light of this concern, Kumboyono et al. (2018) undertook a study that sought to examine the mechanism of resilience in Indonesian people living with HIV/AIDS and the factors that influence their specific mechanisms.
Using qualitative phenomenological design, the researchers sampled a total of 27 people living with HIV/AIDS from a primary health care institution in Malang City, East Java, Indonesia. The participants were selected from different socioeconomic, gender, and sexual orientations. The researchers informed participants about the conduct and processes involved in the study, resulting in their consent to participate in the interview process. The findings of the study indicated that the diagnosis of HIV/AIDS reflects the onset of psychological and social distress. Moreover, Kumbomoyo et al. (2018) found that the spiritual response that follows diagnosis is a state that is characterized by crises. As a consequence, the coping strategies and understanding of life by HIV patients is a definite sign on resilience. Based on these findings, Kumbomoyo et al. (2018) infer that HIV/AIDS is a chronic infection that has the potential to induce the unique .
Ethical Approaches
An Overview of:
(1)Consequential,
(2) Nonconsequential, and
(3) Virtue Ethics Theories
What is Ethics?
Ethics is the study of those values that relate to our moral conduct,
including questions of good and evil, right and wrong, and moral responsibility.
Consequentialist Theoretical Approach:
-Consequentialist theories claim that the morality of an action depends only on its consequences.
-It only considers the result of actions and not principles or rules in determining morality.
1
Three (3) Types of Consequentialist Theories:
-Ethical Egoism argues that each person should act in his/her own self-interest.
-Act Utilitarianism argues that each person should act in a way that produces the greatest happiness
for everyone.
-Rule Utilitarianism argues that each person should follow rules that tend to produce the greatest
happiness for everyone.
Weaknesses of Consequentialist Theories
-Requires person to predict the future and all possible outcomes.
-Can easily be used to justify questionable actions (the ends justifies the means).
2
Nonconsequentialist Theoretical Approach:
Nonconsequentialist theories claim that the morality of an action depends on principles or other factors
that are not related to consequences.
Two (2) Types of Nonconsequentialist Theories:
-Divine command theory argues that we should obey the laws of God.
-Kant’s Categorical Imperative states that we should always act in a way that is based on reason, duty,
and would be considered ethical if everyone acted in the exact same way. Also, people should be
treated as an end and not as a means.
Weaknesses of Nonconsequentialist Theories: Self-Challenge Question:
Question: What might prove a problem in a country so diverse as the U.S. with regards to
Nonconsequentialist theories?
When you are ready check the expert’s response.
3
https://kapextmediassl-a.akamaihd.net/business/CS125/1902c/ethics_challenge_expert1.pdf
Virtue Ethics Theoretical Approach:
-Virtue ethics seeks to identify character traits of a moral person and develop those with the idea that the
virtuous person will act in a virtuous manner. It does not look to principles or consequences.
-Virtue ethics was developed among the ancient Greek philosophers such as Aristotle and the Chinese
teacher and philosopher Confucius.
-Virtue ethics enjoys modern support as an approach that avoids many of the problems with
Consequential and Nonconsequential ethical theories.
Weaknesses of Virtue Theory
-Difficulty in determining just which characteristics are virtues
-Justification for respecting a virtue usually brings one back to either consequences or principles.
-Difficulty in applying it to specific situations
4
Example of all Three Theoretical Ethical Approaches:
Scenario: The air quality in a particular city Y is so polluted, people are getting physically ill and are on .
Ethical and Professional Issues in Group PracticeThose who seek .docxdebishakespeare
Ethical and Professional Issues in Group Practice
Those who seek to be professional group leaders must be willing to examine both their ethical standards and their level of competence. Among the ethical issues treated in this chapter are the rights of group members, including informed consent and confidentiality; the psychological risks of groups; personal relationships with clients; socializing among members; the impact of the group leader’s values; addressing spiritual and religious values of group members; working effectively and ethically with diverse clients; and the uses and misuses of group techniques. In my opinion, a central ethical issue in group work pertains to the group leader’s competence. Special attention is given to ways of determining competence, professional training standards, and adjuncts to academic preparation of group counselors. Also highlighted are ethical issues involved in training group workers. The final section outlines issues of legal liability and malpractice.
As a responsible group practitioner, you are challenged to clarify your thinking about the ethical and professional issues discussed in this chapter. Although you are obligated to be familiar with, and bound by, the ethics codes of your professional organization, many of these codes offer only general guidelines. You will need to learn how to make ethical decisions in practical situations. The ethics codes provide a general framework from which to operate, but you must apply these principles to concrete cases. The Association for Specialists in Group Work’s (2008) “Best Practice Guidelines” is reproduced in the Student Manual that accompanies this textbook. You may want to refer to these guidelines often, especially as you study Chapters 1 through 5.
The Rights of Group Participants
My experience has taught me that those who enter groups are frequently unaware both of their basic rights as participants and of their responsibilities. As a group leader, you are responsible for helping prospective members understand what their rights and responsibilities are. This section offers a detailed discussion of these issues.
A Basic Right: Informed Consent
If basic information about the group is discussed at the initial session, the participants are likely to be far more cooperative and active. A leader who does this as a matter of policy demonstrates honesty and respect for group members and fosters the trust necessary for members to be open and active. Such a leader has obtained the informed consent of the participants.
Informed consent is a process that begins with presenting basic information about group treatment to potential group members to enable them to make better decisions about whether or not to enter and how to participate in a group (Fallon, 2006). Members have a right to receive basic information before joining a group, and they have a right to expect certain other information during the course of the group. Discussing informed consent is not a one-t.
Ethical AnalysisSelect a work-related ethical scenario that .docxdebishakespeare
Ethical Analysis
Select a work-related ethical scenario that you (or someone close to you) have experienced. Organizations and names should be changed when identifying references in the assignment. Compose an essay that addresses the following requirements:
Identify the key positions, titles, and assigned responsibilities in the organization.
Discuss and illustrate the individual pressures faced and how the issues were handled or delegated to another position.
Describe how changing attitudes and behaviors evolved as the incidents occurred.
Compare and contrast the behaviors in the scenario with the philosophical theories of ethical decision-making that are referenced in Unit II. Examples may include Utilitarianism or Deontology application.
Illustrate any mishandling of the decision-making process that resulted in lessons learned.
Summarize what you have learned from an analysis of this event.
Your response should be at least 500 words in length (not including the references page) in APA style. You are required to use at least your textbook as source material for your response. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citation.
.
Ethical (Moral) RelativismIn America, many are comfortable describ.docxdebishakespeare
Ethical (Moral) Relativism
In America, many are comfortable describing ethics as follows: “Well, what’s right for me is right for me and what’s right for you is right for you. Let’s just agree to disagree.” This is an affirmation of what philosophers call
individual
or
subjective moral relativism
. In this understanding of relativism, morality is a matter of individual feelings and personal preference. In individual moral relativism, the determination of what is right and wrong in a situation varies according to the individual. Moral relativists do not believe in natural law or universal truths.
Cultural moral relativism
puts culture at the forefront of relative ethical decision-making. It says the individual must include the precepts of his or her culture as a prominent part of the relativistic moral action.
Lawrence
Kohlberg,
a prominent psychologist known for recognizing moral stages of development, takes it a step farther saying cultural relativists are persons stuck in the “
Conventional
Stage” of ethical development
.
In your paper, please define individual moral relativism and cultural moral relativism in detail, noting how they differ from each other, their strengths and weaknesses, and give your position on Kohlberg’s stance on ethical relativism.
What aspects of ethical relativism do you identify and agree with? What aspects do you disagree with? Give a personal example that illustrates your stance on ethical relativism, describing how you made a moral decision in an ethical dilemma. Include at least two references to support your thoughts.
Post a 500-word paper to the
M4: Assignment 2 Dropbox
by due
Wednesday, April 9, 2014
. All written assignments and responses should follow proper citation rules for attributing sources. Please use Microsoft Word spelling/grammar checker. Be mindful of plagiarism policies.
.
Ethical Analysis on Lehman Brothers financial crisis of 2008 , pleas.docxdebishakespeare
Ethical Analysis on Lehman Brothers financial crisis of 2008 , please include bibliography and footnotes and answer the questions below.
It must be between 5-7pgs.
1. What was the case about?
2. Who was (were) the individual(s) and company (ies) involved?
3. When did it happen?
4. Why did it happen?
5. How did it come to the attention of the media?
6. What was the outcome of the case?
7. How could this case been avoided?
8. What can we learn from the case?
.
Ethical Analysis on Merrill lynch financial crisis of 2008 , please .docxdebishakespeare
Ethical Analysis on Merrill lynch financial crisis of 2008 , please include bibliography and footnotes and aswer the questions below.
It must be between 5-7pgs.
1. What was the case about?
2. Who was (were) the individual(s) and company (ies) involved?
3. When did it happen?
4. Why did it happen?
5. How did it come to the attention of the media?
6. What was the outcome of the case?
7. How could this case been avoided?
8. What can we learn from the case?
.
ETHC 101
Discussion Board Reply Grading Rubric
Criteria
Levels of Achievement
Content 70%
Advanced
Proficient
Developing
Not Present
Points Earned
Word Count
15 points
Word count is between 500 and 600 words.
11 to 14 points
Word count exceeds 600 words.
1 to 10 points
Word count is less than 500 words.
0 points
Not present
Style
10 points
Reply offers constructive feedback to a classmate in a manner that is polite, rationally argued, and not overly emotional.
7 or 9 points
Reply offers constructive feedback to a classmate but with some deficiency of politeness, reasonableness, and/or dispassion.
1 to 6 points
Reply offers little to no constructive feedback, and/or is strongly impolite, and/or is very emotional.
0 points
The post is not a reply (it is off-topic).
Understanding
10 points
Reply utilizes many of the concepts and technical vocabulary taught in the class in a manner that demonstrates accurate understanding.
7 to 9 points
Reply utilizes some of the concepts and technical vocabulary taught in the class in a manner that demonstrates accurate understanding.
1 to 6 points
Reply utilizes some of the concepts and technical vocabulary taught in the class but sometimes in ways that suggest that they are not correctly understood.
0 points
Reply does not utilize the concepts and technical vocabulary taught in the class.
Structure 30%
Advanced
Proficient
Developing
Not Present
Points Earned
Spelling, Punctuation, and Grammar
10 points
Reply is written in paragraph form and is devoid of spelling, punctuation, and grammar errors.
7 or 9 points
Reply is not written in paragraph form and/or has occasional spelling, punctuation, and grammar errors.
1 to 6 points
Reply is not written in paragraph form and has numerous spelling, punctuation, and grammar problems.
0 points
Not present
Turabian formatting
5 points
Direct references and/or allusions to outside resources (such as the textbooks) are present and are cited using footnotes in current Turabian format.
4 points
Direct references and/or allusions to outside resources (such as the textbooks) are present but are cited otherwise than using footnotes in current Turabian format.
1 to 3 points
Direct references and/or allusions to outside resources (such as the textbooks) are present but the sources are not cited. (Note: if plagiarism is present, that requires additional corrective action.)
0 points
No direct references and/or allusions to outside resources are present.
Total
/50
Instructor's Comments:
Page 1 of 1
For this untimed, open-resource essay exam, answer each question thoroughly and clearly, and ground it in course reading material. Essay answers must be more than 3 or 4 brief sentences, but kept within the bounds of an essay exam (4 - 6 paragraphs). All your writing must be in your own words. Paraphrase (restate what you read) rather than copying material from the course textbook or the Internet. No copying is permitted in this course and doing so will result in zero points on th.
Ethical and Human Rights Concerns in Global HealthChapter Fou.docxdebishakespeare
Ethical and Human Rights Concerns in Global Health
Chapter Four
Chapter four: Ethical and human rights concerns in global health.
As with any area of health, global health is affected by the issues of ethics and right for sound health outcome. In this chapter we will explore ethical and human rights concerns, some of the central treaties and conversions related to human rights, some historically significant cases in human subject research and key principles for making critical decisions in health research.
1
Failure to respect human rights is often associated with harm to human health
Health research with human subjects puts people at risk for the sake of other people’s health
Health investments must be made in fair ways since resources are limited
The Importance of Ethical and Human Rights Issues in Global Health
Access to the health care is human right and failure to respect this right might causes harm for health. For example, the stigma associated with HIV, TB and leprosy makes it difficult for the patient to obtain necessary health care, it not only cause harm to individual health but as a whole community health even. For example, if a TB patient remains untreated by the health care workers, then that individual could be a source of infection for other people.
Health research with human subject in particular in low income countries where study participants may not have other option to obtain the medication might become a proxy of clinical trial for other people .Lastly, fair decision in health investment is critical because in low income countries where health resources are scare difficult decisions need to be made depending on the priority and severity of disease.
2
The Foundations for Health and Human Rights
Universal Declaration of Human Rights and other legally binding multilateral treaties
Governments are obliged to respect, protect, and fulfill the rights they state
International Bill of Human Rights is the cornerstone for human rights. This bill include couple of documents including the Universal declaration of human rights that was officially declared in 1948, that place obligation on Government to respect , protect, and fulfill the rights of the state.
3
Selected Human Rights
The Rights-Based Approach
Assess health policies, programs, and practices in terms of impact on human rights
Analyze and address the health impacts resulting from violations of human rights when considering ways to improve population health
Prioritize the fulfillment of human rights
In considering human right, first we are going to examine the issue of right based approach. Some global health advocates argue that this approach, which thinks that fulfillment of people’s human right is conducive to their health, should be followed in global health. This means we need to assess health policies, programs or practices in terms of its impact on human right and analyze the health impacts from the perspective of violation of human rights
.
Ethical & Legal Aspects in Nursing WK 14Please answer the .docxdebishakespeare
Ethical & Legal Aspects in Nursing WK 14
Please answer the following Discussion Question. Please be certain to answer the four questions on this week DQ and to provide a well-developed and complete answer to receive credit.
Case Study, Chapter 23, Professional Identity and Image
Nursing care is frequently perceived by the public as simple and unskilled. Many male nurses live in fear of how their caring actions might be interpreted. Many nurses hold that stereotypes about the profession are true, just as the general public does. Public identity and image has been a struggle for nurses for a long time. The greater public clearly does not understand what professional nursing is all about, and the nursing profession has done a poor job of correcting long-standing, historically inaccurate stereotypes.
1. What are the common nursing stereotypes?
2. What was the role of the Center for Nursing Advocacy? Discuss the role of Truth about Nursing in addressing inaccurate or negative portrayals of nursing in the media and the process they use to raise public and professional awareness of the issues surrounding nursing public image?
3. What are some of the ways of changing nursing’s image in the public eye?
4. One of the most important strategies needed to change nursing’s image is to change the image of nursing in the mind of the image makers. What are some of the key ways for nurses to interact with the media?
INSTRUCTIONS:
APA FORMAT
IN TEXT CITATIONS WITH 3 REFERENCES NO LESS THAN 5 YEARS
.
EthernetSatellite dishInternational Plastics, Inc. - C.docxdebishakespeare
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Ethanolv.DrizinUnited States District Court, N.D. Iowa, Eastern .docxdebishakespeare
Ethanolv.Drizin
United States District Court, N.D. Iowa, Eastern DivisionFeb 7, 2006
No. C03-2021 (N.D. Iowa Feb. 7, 2006) Copy Citation
No. C03-2021.
February 7, 2006
Be a better lawyer. Casetext is legal research for lawyers who want do their best work.
ORDER
JOHN JARVEY, Magistrate Judge
This matter comes before the court pursuant to trial on the merits which commenced on January 23, 2006. The above-described parties have consented to jurisdiction before a United States Magistrate Judge pursuant to 28 U.S.C. § 636(c). The court finds in favor of the plaintiff and awards compensatory damages in the amount of $3,800,000 and punitive damages in the amount of $7,600,000.
In this case, the plaintiff brings numerous theories of recovery against defendant Jerry Drizin arising out of the misappropriation of escrow funds that were to serve as security for financing for the construction of an ethanol plant in Manchester, Iowa. The plaintiff contends that defendant Drizin, in concert with others, knowingly converted funds from an escrow account that were not to have been spent on anything without the plaintiff's prior written permission. Defendant Drizin contends that his only client and only duty of loyalty was to a Nigerian citizen living in Munich who caused the funds to be sent to bank accounts controlled by Defendant Drizin. The court makes the following findings of fact and conclusions of law.
In 2000 in Manchester, Iowa, farmer and President of the local Co-op, Douglas Bishop, began meeting with representatives of the United States Department of Agriculture to explore the feasibility of building an ethanol plant in the Manchester area. The idea was to assist farmers in the area in getting more value for their crops. An ethanol plant produces ethanol and feed grain which can be sold at a profit exceeding that associated with the mere sale of grain.
A series of 40 local meetings culminated in a membership drive. The Plaintiff, Northeast Iowa Ethanol, L.L.C., was later formed in order to sell 2500 shares of stock in the L.L.C. to raise funds for the financing of the plant. The construction of the plant was expected to cost $21 Million. It would have a capacity for producing 15 million gallons of ethanol per year. Through the meetings, Mr. Bishop and others raised $2,365,000. The average investor purchased two shares.
The membership drive ended in September 2001. The original plan was to begin construction in the fall of 2001 and have the plant operating by the fall of 2002. However, the issue of financing for the plant was more problematic than plaintiff had anticipated. Traditional lenders (banks) demanded that the plaintiff raise forty percent of the construction costs. It was clear that the plaintiff could not raise $8 Million. Plaintiff's proposed marketing partner, Williams Ethanol Services, agreed to invest $1 Million in the project. The contractor anticipated to build the facility, North Central Construction from North Dakota,.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
MATATAG CURRICULUM: ASSESSING THE READINESS OF ELEM. PUBLIC SCHOOL TEACHERS I...NelTorrente
In this research, it concludes that while the readiness of teachers in Caloocan City to implement the MATATAG Curriculum is generally positive, targeted efforts in professional development, resource distribution, support networks, and comprehensive preparation can address the existing gaps and ensure successful curriculum implementation.
MATATAG CURRICULUM: ASSESSING THE READINESS OF ELEM. PUBLIC SCHOOL TEACHERS I...
REFERENCES FOR THE TWO ARTICLESQUANTITATIVEARTICLE 1McIe, S.docx
1. REFERENCES FOR THE TWO ARTICLES
QUANTITATIVE
ARTICLE 1
McIe, S., Petitte, T., Pride, L., Leeper, D., & Ostrow, C. L.
(2009). Transparent film dressing vs. pressure dressing after
percutaneous transluminal coronary angiography. American
Journal of Critical Care, 18(1), 14–20.
QUALITATIVE
ARTICLE 2
Osterman, P. L., Asselin, M. R., & Cullen, H. A. (2009).
Returning for a baccalaureate: A descriptive, exploratory
study of nurses’ perceptions. Journal for Nurses in Staff
Development, 25(3), 109–117.
J O U R N A L F O R N U R S E S I N S T A F F D E V E L O
P M E N T � Volume 25, Number 3, 109–117 � Copyright A
2009 Wolters Kluwer Health l Lippincott Williams & Wilkins
One critical role of the staff development spe-cialist is to
facilitate competence and contin-
ued professional development of staff (American
Nurses Association, 2000). One approach to this is to
foster an environment which encourages staff to
advance academically, be it from the diploma or
associate’s degree to the baccalaureate level or
beyond. This is especially timely given the push for
Magnet recognition in many hospitals and given the
spotlight that has been placed on quality outcomes
and a culture of safety. Furthermore, although hos-
pitals struggle with fiscal challenges, the financial
benefit of supporting nurses who pursue advanced
2. education may not be immediately visible to admin-
istrators, but staff development specialists realize the
value of such a move, especially about improving
patient outcomes and enhancing patient safety.
When examining the impact of nurses’ educational
preparation on patient outcomes, Aiken, Clarke, Cheung,
Sloane, and Silber (2003) recognized
a statistically significant relationship between the propor-
tion of nurses in a hospital with bachelor’s and master’s
degrees and the risks of both mortality and failure to
rescue. . .Each 10% increase in the proportion of nurses
with [bachelor’s or master’s] degrees decreased the risk of
mortality and of failure to rescue. . .by 5%. (p. 1620).
Although this study has been the subject of some
controversy within the nursing profession, most
scholars agree that ‘‘[e]ducation makes a difference
in nursing practice. . .education broadens one’s knowl-
edge base, enriches understanding, and sharpens
expertise’’ (Long, Bernier, & Aiken, 2004, p. 48). The
value of these educational benefits, when applied to
patient care, is further clarified by the observation that
[n]urses constitute the surveillance system for early de-
tection of complications and problems in care, and they
are in the best position to initiate actions that minimize
negative outcomes for patients. That the exercise of clinical
judgment by nurses. . .is key to effective surveillance may
explain the link between higher nursing skill mix. . .and
better patient outcomes (Aiken et al., 2003, p. 1617).
The need for increasing numbers of baccalaureate-
prepared registered nurses (RNs) becomes more ob-
vious when viewed through the lens of the current
3. emphasis on evidence-based practice. The critical-
thinking skills that accompany bachelor of science in
nursing (BSN) education are paramount to developing
a nursing workforce that is able not only to review
Returning for a
Baccalaureate
A Descriptive Exploratory Study of
Nurses’ Perceptions
Paulette LaCava Osterman, PhD, RN
Marilyn E. Asselin, PhD, RN-BC
H. Allethaire Cullen, MSN, RN
................................................
This qualitative study examines the
experience of the RN who pursues a bachelor
of science to determine the meaning found
by pursuit of a baccalaureate, the extent to
which the pursuit of the degree influences
one’s perception of oneself as a professional,
and the impact of the degree on one’s
practice. The participants found personal
satisfaction in pursuing their degrees and
4. developed a broader approach to nursing
practice. Implications for staff development
specialists are discussed.
.................................................
..........................................
Paulette LaCava Osterman, PhD, RN, at the time this research
was con-
ducted, was Professor of Nursing, Community College of Rhode
Island, Warwick, Rhode Island.
Marilyn E. Asselin, PhD, RN-BC, is Assistant Professor, Adult
and
Child Nursing Department, College of Nursing, University of
Massachusetts, North Dartmouth, Massachusetts.
H. Allethaire Cullen, MSN, RN, is Assistant Professor of
Nursing,
Community College of Rhode Island, Warwick, Rhode Island.
JOURNAL FOR NURSES IN STAFF DEVELOPMENT 109
9Copyright @ 200 Lippincott Williams & Wilkins.
Unauthorized reproduction of this article is prohibited.
literature competently but also to apply true evidence-
based practice changes at the bedside.
REVIEW OF THE LITERATURE
The current nursing workforce is composed of RNs
5. with a variety of entry-level credentials—whether hos-
pital diplomas, associate degrees, or baccalaureates—
and 57.3% of nurses practicing in 2000 were doing
so at the subbaccalaureate level (Spratley, Johnson,
Sochalski, Fritz, & Spencer, 2000). These nurses often
express a desire to ‘‘return for my BSN’’ and appear
highly motivated to do so but find that full-time em-
ployment and family responsibilities place too high
a burden on their time to allow them to pursue a
baccalaureate. Delaney and Piscopo (2004) found that
‘‘competing priorities. . .multiple role demands, com-
bined with limited resources, as the greatest barriers
to their enrolling in a BSN program’’ (p. 158).
There has been little published research done
within the last 10 years on the topic of RNs return-
ing for their baccalaureates. What recent literature
is available has centered on teaching and learning
methods (Cangelosi, 2004; Cox, 1996; Hegge, 1995;
Stringfield, 1993), variables of empowerment and au-
tonomy (Horne, 1998; Malizia, 2000), and the meaning
of having baccalaureate-prepared nurses in the practice
setting (McCray, 1995). Much of the literature over the
past 5 years has focused on nontraditional education,
such as accelerated RN-to-BSN programs (Boylston,
Peters, & Lacey, 2004), case study analysis in lieu of
clinical requirements for experienced RNs (Hall, 2003),
and online or distance learning programs (Huston,
Shovein, Damazo, & Fox, 2001). Several doctoral dis-
sertations have addressed the RN-to-BSN student,
looking at such subjects as the motivation for return-
ing to school (Corbett, 1997) or students’ perceptions
of curriculum content as related to their already-
significant nursing experience (Clark, 2004).
It is critical to understand how the pursuit of a
6. baccalaureate impacts one’s self-perception as a pro-
fessional and how it influences an individual’s nursing
practice to provide a work environment that fosters
professional development, knowledge acquisition, and
transfer of new knowledge to practice such that patient
care is enhanced.
PURPOSE AND RESEARCH QUESTIONS
The purpose of this study was to describe the meaning
of personal and professional growth for experienced
RNs who return for a baccalaureate in nursing. An
additional aim of the study was to identify ways in
which the baccalaureate influences one’s approach to
nursing practice.
The following research questions served to guide
the researchers in the choice of method and analysis
of data:
1. What meaning does the RN find in the pursuit of a
baccalaureate in nursing?
2. To what extent does the pursuit of a baccalaureate
in nursing influence one’s perception of being a
professional nurse?
3. To what extent does the pursuit of a baccalaureate
in nursing influence one’s nursing practice?
RESEARCH DESIGN AND METHODS
A qualitative research design using in-depth interview
as the principle method was chosen to elicit data in
this research study. With this methodology, research
questions focus on the perception and the experience
7. of the RN returning for baccalaureate education.
Because the focus of the research was to explore the
meaning of pursuit of a BSN, a qualitative design was
appropriate. Qualitative research seeks to understand
phenomena from the participant’s perspective and
view of reality. In-depth interviews allow time and
space for participants to share their perceptions, be-
liefs, and experience, thus allowing the researcher to
gain an understanding of a particular phenomenon
from the perspective of those who experienced it. The
interview approach is based on the assumption that
‘‘understanding is achieved by encouraging people to
describe their worlds in their own terms’’ (Rubin &
Rubin, 1995, p. 2).
Participants
A purposive sample of 11 RNs volunteered to par-
ticipate in this study. In purposive sampling, research
participants are chosen based on their knowledge of
the phenomenon under study. The 11 participants,
who ranged from age 40 to mid-50 years, were all
women and worked in an acute care hospital on a wide
variety of patient care units including the emergency
department, medical–surgical units, operating room,
postanesthesia care unit, endoscopy unit, dialysis unit,
and critical care unit. Participants’ nursing experience
ranged from 14 to 34 years, with a mean of 24 years of
nursing experience. Most had as their basic nursing
education an associate degree in nursing; 1 participant
had a hospital diploma, and another participant be-
gan as a practical nurse. Two of the participants had
bachelor’s degrees in nonnursing fields: 1 in journal-
ism and 1 in liberal arts. Seven participants attended
the on-site baccalaureate program at the hospital (see
the Setting section), and the other 4 participants at-
8. tended other baccalaureate programs within the state.
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All participants were interviewed in their last semester
of study or within 1 year of graduation from the bac-
calaureate in nursing program.
Setting
The study took place in a 275-bed community hospital
in the northeast. The hospital has traditionally had a
low RN turnover rate and a significant number of long-
term RN employees; 25% of the RNs are older than the
age of 55 years. There is a high percentage of associate
degree nurses (54%) compared with that of baccalau-
reate-prepared nurses (26%). Nursing leadership has
set a goal of increasing the number of baccalaureate-
prepared nurses. The hospital has recently imple-
mented structures to promote a professional practice
model which has included a shared leadership model,
RN professional advancement ladder, and a change
from team to a modified primary model of care. To
promote nurses’ return to college for the baccalaure-
ate, the hospital expanded its tuition reimbursement
program to offer additional assistance for nurses who
chose to return to school. In addition, the education
department collaborated with a local university to cre-
ate a hospital-based dedicated on-site satellite program
for baccalaureate education in nursing.
9. Procedures and Data Analysis
Approval for the study was obtained through the
institutional review board process. Participants were
assigned code numbers to assure anonymity and con-
fidentiality. Each participant was asked to share her
thoughts regarding the research questions. Following
the flexible interview design of Rubin and Rubin
(1995), questions were added or probed to gain a bet-
ter understanding of responses. Interviews were ap-
proximately 1 hour in length, conducted in a private
conference room, audiotaped, and transcribed verba-
tim by a professional transcriptionist who was not
employed by either the hospital or the participating
academic institutions. The same researchers were pres-
ent at all interviews.
With each interview, significant statements were
identified. Significant statements were then grouped
into themes based on the research questions. The re-
searchers agreed on the analysis of each interview.
Data across interviews were then analyzed for similar
and contrasting themes based on the research ques-
tions. Saturation of data was reached at 11 participants.
Trustworthiness of data was determined by comparing
audiotapes of interviews against transcripts. In addi-
tion, researcher-corroborated data analysis and mem-
ber checks were used. Also, data were examined for
coherence and consistency within and across interviews.
FINDINGS
Overarching Observations
As data were analyzed, several factors emerged which
10. reflected common perspectives of the participants. The
participants all related examples of attending continu-
ing education programs and inservice classes at the
hospital. Primarily, these were attended on a voluntary
basis—the nurses sought out education based on their
assessed needs at that particular time. In a sense, this
group could be viewed as ‘‘knowledge seekers.’’ For
these individuals, moving from inservice classes to
classes leading to a degree was a natural progression
of their lifelong learning philosophy.
Participants generally identified ‘‘support’’ as a key
factor contributing to their success in achieving the
degree. Various sources of support were identified
including peers, family, and hospital-based sources.
Participants tended to search out peers who had simi-
lar thinking. This tactic was useful as the program
progressed because it formed a basis for peer support
throughout the program. It was especially helpful to
those participants who progressed through the bacca-
laureate program as a cohort and who worked to-
gether on either the same floor or the same shift.
The support groups also served as vehicles for criti-
cal discussion of class content, for expansion of one’s
view of other units, and for the development of new
professional networks within the organization. One
nurse stated,
I found that I met people that I’ve never had a relationship
with before, and we developed [relationships]. I really
enjoyed speaking with other nurses who were in the course
with me because. . .you find out what they’re doing in their
department. So, we shared a lot of that stuff, about what
everyone else does, and that was great.
11. Participants also spoke of support received from
family members who picked up extra household re-
sponsibilities. The majority also identified support
from their managers. One participant stated of the
manager,
[She] always did whatever she had to with the schedule to
make it easier for me to go to school. Unbelievable
support.
Other participants spoke of the librarian’s assis-
tance in literature searches and the preparation of class
presentations.
Participants considered several factors when choos-
ing a baccalaureate program. Factors included
1. a fit between the student’s work and class schedules,
2. issues at home,
3. anecdotal information about the program,
JOURNAL FOR NURSES IN STAFF DEVELOPMENT 111
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4. travel time to school,
5. perceived willingness of the program coordinator to
‘‘personalize’’ a course of study,
6. how many credits would be accepted,
7. length of time until degree completion, and
8. the degree of tuition assistance/personal financial
12. status.
Research Question 1: The Meaning of Returning
for the Bachelor of Science Degree
An interesting finding was that, on entering the pro-
gram, participants gave little thought to what getting
a baccalaureate would mean to the patients or the
care they would deliver. However, the impact on prac-
tice and professionalism did emerge as they pro-
gressed through the program; this will be discussed
later in this article.
Data related to meaning were grouped into two
categories—meaning on entering the program and
meaning on preparing to graduate or graduating.
Participants, reflecting on their experiences when
entering the baccalaureate program, presented themes
related to meaning. These included waiting for the
right time, being a means to a higher goal, address-
ing issues of aging and physical demands, role mod-
eling for others, and testing one’s ability to succeed.
For most of the participants, waiting for the right
time was a central theme that described their deci-
sion to return to school. Some described waiting for
the right time from a personal perspective. One par-
ticipant stated,
I had been single and had three children and just couldn’t
do it all, so I put that [the degree] on hold at that point.
Now, the children are older.
For several participants, the impetus to seek the
degree was spurred by other changes in their lives. For
example, one participant stated,
13. . . .at that point I was getting older. . .I was going to be
55. . .I felt like I deserved it [the baccalaureate] at this time
in my life. . .I felt I had a lot more to offer.
Others spoke of waiting until the right time from a
professional perspective. Several nurses spoke of
having worked on a particular unit for many years
and having acquired an expert level of knowledge but
knowing there was more to learn.
I felt that the associate degree program was excellent but
basically focused a lot on clinical aspects, so I just felt
there was more—just a little bit that I had been
missing. . .Basically just seeing people [who] started as
staff nurses, then assistant nurse manager, seeing other
people go on. . .It was just the way that the other nurses
who had the bachelor’s degree behaved.
The decision of the hospital for which they worked
to create an on-site degree program also played a role
in ‘‘right timing.’’
When the program came along to me, it was an absolute
no-brainer. The hospital is paying for the vast majority of
it. . .[The hospital is] bringing the professors to us. How
could you turn down something like that?
For others, the meaning of returning for a degree
was seen as a means to achieving a higher goal.
A CNS program is where I’m really heading, so of course I
had to get the bachelor’s degree first.
Other participants needed the degree to progress
within the organization—for example, to work in a
surgical unit or on an IV team.
14. Because most participants were older, several ex-
pressed concerns about the physical demands on the
older staff nurses, and some saw the degree as a means
of staying in nursing while doing less physical work.
I decided that, first of all to do anything in nursing,
the minimum standard is going to be a bachelor’s
degree. . .looking to the future, I probably have another
15 years to work, and because we work physically hard on
the floors, I want to have other options available to me. . .I
know that in order to do that I need to have at least a
bachelor’s degree to be able to open more doors so that I
don’t have to work physically hard on the nursing units.
I need to start thinking about the future. . .prepare myself
for physical changes.
By returning to school, several participants also saw
themselves as role models for family members and
other staff members. One participant who shares an
attention-deficit disorder diagnosis with her son spoke
of being a role model:
. . .when I went back to school, I did that to show my son
that the ADD diagnosis doesn’t mean anything. You can
do whatever you set your mind to. It showed my son that
you can do anything that you need to do. . .
Some nurses recognized that by returning for a
degree, they were setting a good example for other
nurses, whereas still others saw returning as a test of
their ability to succeed.
Two other themes related to meaning emerged as
the nurses graduated: an enhanced self-esteem and
15. confidence.
It did a lot for [me] personally with self-esteem. . .thinking
that I was [not] ‘smart enough’ to go to college was gone.
It has made me very proud of myself. I’m much more
confident. If you can instill confidence in anyone, then
you have accomplished everything because once you have
made someone confident and proud of themselves [sic],
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they can do everything. I would never have applied for a
management job. . .but now I would. . .
Research Question 2: How the Bachelor of
Science Influences One’s Perception of Being a
Professional Nurse
In some cases, the participants identified a basic
broadening of their own knowledge about the scope
of professionalism. One participant, displaying admi-
rable honesty, said,
I didn’t know what professionalism was. I didn’t know
anything about theory. I didn’t know there were nursing
theories!
Learning how to use a computer for research—
indeed, learning how to use a computer at all—was
identified by some as an epiphany. Others identified an
16. appreciation for the history of nursing, the value of
research, and an understanding of an ethical code for
nursing as areas that they believe increased their
perceptions of themselves as professionals.
On a somewhat more sophisticated scale, research
was identified as an element of their education that
played a major role in the participants’ perceptions
of themselves as professionals. Not all ‘‘research’’
was scholarly inquiry; some was just grassroots in-
vestigation that would be used for public policy
purposes. Even so, the desire to inquire, to find out,
was recognized by the participants as a vital part
of their educational growth. Some observations in-
clude the following:
It’s research; some of it’s knowing what the resources are
out there. The associate degree program prepares you
well for bedside care, but it doesn’t show you the
resources at a larger level and understanding that there
may be legislation that bears on what you’re doing. . .
I never really gave much thought to how the policies and
procedures that we have now came about. . .[It’s] made
me a little bit more aware of why we are doing what we’re
doing. . .You know, [it] comes down to patient care. You
use evidence-based practice and [get] the best patient
outcomes. . .Somebody studies it, there were better
patient outcomes. . .
I was not familiar with the research process; just the
concept of evidence-based practice was a fairly new
concept to me. . .
In addition, the participants believed that baccalau-
reate education helped them answer long-standing
17. questions concerning their professional practice and its
scope. One of the areas where insight was most evi-
dent was in the roles of management and leadership:
I found there were several things in those [leadership and
management] courses that gave me a better understand-
ing of what some of the women I have worked for were
doing and why they were doing things a certain way—I
had a better understanding of what management does. . .
As a result of my education, I think that I would manage
things a little differently. . .I would have more interaction
with my staff. . .I would understand their concerns and try
to help them work through. . .and find an answer. . .If you
treat them with respect. . .they know what you have to
accomplish. . .[and] they are going to work harder and
more diligently to help you accomplish what it is that
you’re doing.
I think that I’m more comfortable with leadership. I’ve
always had a difficult time delegating to other people,
and it [leadership education in the baccalaureate pro-
gram] helped me understand a bit more why I can’t be
the one to do everything. So, it’s helped me to share
responsibilities.
One participant related an eye-opening experience
watching two nurses interact with staff members.
These insights were a direct result of the leadership
component of baccalaureate education. She noted,
In observing two nurses. . .prior [to my return to school], I
would have said, ‘What a [expletive]. What a [expletive]
that woman in the ER was,’ but not think further to say,
‘She just doesn’t have natural leadership ability,’ where
18. this young nurse on the unit, in contrast, wasn’t
threatened, she wasn’t intimidated. She just made it like
a team effort, a teaching experience.
Another insight of participants was the value of
challenging assumptions and, by doing so, broadening
their perspectives:
I found a difference in speaking with each other. If there’s
something not quite right, I wouldn’t hesitate to try to
talk about it or try to resolve things. . .I feel I have a few
more resources to be able to try to change something if
something could be done better or in a different way that
would be beneficial to patients.
Nobody likes change. I remember over the past year,
having gone through change and we were all up in arms.
But, you know, now, there’s been research into it, and
this is proven to be a better way to do it. Well, I have
changed how I view change because now I can’t
say. . .‘What a pain this is, adopting a whole new way.’
Now, I know that there is probably a good reason that I
never would have thought of before.
Many of the participants tied their beliefs of how the
baccalaureate influenced their perceptions of them-
selves as professional nurses with their newfound
ability to influence others:
You’re trying to be proactive, and I think that by having
that degree behind you [you have] that sense that you
can be proactive without being a complaining individual
. . .The way I approach things is different.
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The participants in this study also identified an
expanded awareness of others and a more mature
type of empathy in their dealings with patients, peers,
and members of the interdisciplinary team. A long-
time preceptor, having returned for her bachelor of
science (BS), made this observation about precepting
new graduates:
Being a student myself has kind of made me step back
and look more at why I’m doing that and think a little bit
less of myself and my schedule.
The participants also noted that having nurses from
other units in their classes helped them better un-
derstand the challenges faced by all nurses—that
knowing one another’s experiences increased empathy
for each other.
. . .you kind of get to know what really their concerns are,
what’s going on on those different units that I would
normally have no knowledge of, really. . .I think that
definitely knowing and hearing what they’re going
through and how they’re feeling about it definitely helps
to say, ‘Wow, they had to deal with this!’ So, I think that
it does kind of make me more empathetic to what’s
going on. . .
Finally, and perhaps most important, a common
theme throughout the interviews was that of partici-
pants learning to reframe their thinking, seeing a big
picture as a sign of their increased professionalism.
20. Consider this observation from a preceptor, a seasoned
RN who had returned for her baccalaureate:
I think that my approach to precepting is different this
year than it was 3 years ago because 3 years ago, I was
focused on the physical—the actual activity which is what
you’re doing for this patient. Now, [I] see things more as
a whole picture. It’s constantly saying to her or working
with her to not just focus on all of the little things but to
bring it all together. As graduates, they bring things in
separately. Now, it’s not just task oriented.
Research Question 3: How the BS Influences
One’s Nursing Practice
One of the findings in this section was that the
curriculum focus specific to the school of nursing
seemed to influence the participants’ approaches to
practice. One program appears to focus on disease and
the physiological aspects of patient care, with a strong
emphasis on peer and patient education. Another
program seems to focus on more global issues and an
evidence-based approach, where nursing theory and
leadership are of paramount importance.
There were, however, some consistencies across the
programs. All of the 11 participants, for example, in-
dicated in some way that their studies enabled them
to view patient care as the sum of many parts.
Some refer to a ‘‘broader picture’’ or seeing ‘‘broader
strokes;’’ others refer to ‘‘taking all things into ac-
count’’ or having a ‘‘wider perspective,’’ but all men-
tioned that the baccalaureate has given them a greater
awareness that enables them to focus on the entire
patient.
21. I think my nursing role now is. . .not as task oriented as
much as it was before. It’s more education, it’s more
prevention. It’s more not just taking care of that patient
in the bed but the whole patient—everything about
the patient.
You tend to see more sides. . .because of the things
that I’ve learned though research, through community,
through just learning about the history of nursing and
transition. . .you start thinking about more than one
avenue. . .
There was also a shift in thinking, from the tech-
nical to the professional, from practice that was
automatic—almost by rote—to creative, intuitive prob-
lem solving.
I think that before, if a situation arose—any situation—
you would almost take the avenue that you already knew;
but now that I’ve been exposed to research and other
venues of care and holistic nursing, community nursing,
other things that I really hadn’t even been exposed to
before, I kind of view things from a different viewpoint
now. I kind of take all things into perspective before I
make an opinion of one certain situation.
[My education] enhanced the skills that I had so that
instead of just listening to somebody’s lung sounds, now,
I’m listening to where they are and how do they
change. . .If I make them cough, does it clear? Is it one
particular spot?. . .I became more aware of why I was
listening to certain things. . .
One of most prevalent concepts that filtered
through each of the interviews is the participants’
22. enhanced focus on education.
Perhaps by educating myself more, [it] helps me educate
[patients] better and helps my coworkers by educating
them also. I think that it all comes down to education.
I think I’m more in tune to educating my coworkers,
patients, families—promoting maybe a better atmo-
sphere because they are now more educated and
understand better.
. . .even though I have contacts with patients, I feel that
I’m doing my fellow nurses more good, and I almost feel
I’m helping my colleagues and coworkers. . .I like it when
people ask me [my] opinion or ask questions and I find
that people come to me first—a resource, and I like that!
. . .in informal ways when there is an opportunity to tell
somebody, ‘This is what I’m doing and I think it would be
good if you do this.’
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For some of the participants, particularly those
from one college’s program, there was a realization
of the importance of applying the sciences to pa-
tient care:
I have a deeper understanding of the physiological aspects
of some disease processes, and I am more apt to go after
what I don’t know as far as the disease process. . .I feel
that I have a deeper knowledge than just the human body,
23. and now I’m also more apt, if I don’t understand it, I’m
going to ask until I do understand it.
Whether through the fine-tuning of skills or the
application of research to practice, participants fre-
quently verbalized a new appreciation of research and
scholarly thought.
I think that you need to pay attention to the research,
which is not something that I ever did previously. You
know, I think you do need to be current. . .and I just
didn’t pay attention to that very much before I went back
to school.
Of course, not every attempt to implement research
goes smoothly because such implementation involves
change—change that is not always welcomed by those
who have not had the exposure to the concept or value
of evidence-based practice. One participant relates a
story of how she tried to convince her peers on the
postanesthesia care unit that the environment should
be kept quieter for the well-being of the recovering
surgical patients. At the time, it had not been unusual
for a rock-and-roll radio station to be blaring loudly
and for staff members to be holding noisy conversa-
tions. Having found research to support the value of
a quieter environment, this nurse wanted to see a
change in the unit’s practice. She was not totally
successful, but she changed her own practice and
influenced a colleague as well:
[My peers] basically just disregarded it. One nurse actually
said, ‘Well, I don’t believe in any of that stuff,’ so now that
I did that research project, I keep my little two units nice
and quiet and slightly darkened. . .Well, there is one nurse
who I work with. . .and she does that now, too. . .She puts
24. the lights off.
DISCUSSION AND IMPLICATIONS
The study of Lillibridge and Fox (2005), which ex-
amined the perceptions of six RNs who returned for
their BSN degrees, has some congruencies with this
study, including the participants’ desire for career
mobility and the belief that the degree was instrumen-
tal in making this possible, significant peer resistance
to the participants’ pursuit of a degree, the improved
ability to see the entire patient, interest in applying
newfound appreciation for research and evidence-
based practice in the clinical setting, and feelings of
personal accomplishment.
However, participants in this study did not ex-
press the perception of not fitting in with inexperi-
enced undergraduate students, as the participants of
Lillibridge and Fox’(2005) did. Neither did partici-
pants of this study express the cynicism shown by
the participants of Lillibridge and Fox, which is thus
best described by the question, ‘‘What do you think
you can teach me that I don’t already know?’’ Instead,
most participants in this study began the baccalaure-
ate course knowing that they had much to learn and
looking forward to challenging themselves. Unlike
the participants of Lillibridge and Fox, this group
also felt that being role models and better patient
and peer teachers were positive outcomes of the bac-
calaureate education.
One difference between the study of Lillibridge and
Fox (2005) and this study may well explain these
discrepancies. More than half of the participants in the
25. current study participated in an on-site RN-to-BS pro-
gram, so issues of travel and intermingling with in-
experienced undergraduates were not concerns. An
interesting finding was that those four participants
who attended on-campus classes still did not mention
the campus-related issues of the other study.
The reasons an experienced nurse returns for a bac-
calaureate are personal and varied, but in this study,
each of the participants found a sense of betterment
and enhanced professionalism as she progressed
through the program. Staff development specialists
are in a unique position to support both the organi-
zation and the nurse student in the education process.
Although it is not always possible for the hospital
or agency to have a dedicated relationship with a
school of nursing, doing so can provide advantages for
all involved: For example, integration of the organi-
zation’s mission, vision, and goals into the curriculum
can further their realization while helping the nurse
student to understand their value, and assistance with
the transfer of knowledge from the classroom to the
bedside brings applicability to the curriculum while
enhancing patient care. Seven of the 11 participants
in this study benefited from such an arrangement
between a university and the hospital where they
worked: The school provided faculty for classes on the
hospital campus, and the hospital provided a gener-
ous tuition reimbursement that essentially made the
program free for participating employees. In return,
those employees promised to work for a minimum
of two additional years at the hospital. The hospital
found this to be a valuable retention strategy; the
school was able to expand its nursing program at
minimal cost; and the participants believed that the
26. decision to become a nurse student was, in the
JOURNAL FOR NURSES IN STAFF DEVELOPMENT 115
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words of one of them, ‘‘a no-brainer.’’ Open commu-
nications between schools and agencies are, obviously,
the foundation for such an arrangement, but if all
parties are willing, they can establish an arrangement
that benefits everyone.
Whether or not there is a dedicated relationship
between school and agency, there must be support
structures within the practice environment to en-
sure optimal outcomes. In addition to the aforemen-
tioned sharing of the organization’s mission, vision,
and goals so that these might be integrated into
the curriculum; the provision of tuition assistance;
and the accessibility of classes (e.g., on the hospital
campus), there are other ways an agency can support
the nurse student. An encouraging nurse manager
can make a tremendous impact on the success of the
nurse student, particularly if that manager is reason-
able regarding the need for flexible work hours. The
staff development specialist can work with both the
manager and the student to determine the best ways
to provide staffing coverage for the unit while allow-
ing the student to attend classes or have time off to
write papers or study.
Staff development specialists can especially provide
structures to support the transfer of new knowledge
27. and skills. Some of these include:
1. providing the nurse manager with information
about the curriculum to encourage a parallel be-
tween what is being learned and what is being
practiced in daily assignments;
2. advocating for administration, management, and
physician support;
3. promoting a shared decision-making model and
ensuring that nurse students participate;
4. using baccalaureate-prepared nurses as preceptors
and resource nurses, giving them an opportunity to
use and share their knowledge;
5. advocating for the inclusion of degree attainment
in the performance evaluation and career develop-
ment plan;
6. encouraging nurse students and recent baccalaure-
ate graduates to participate on appropriate com-
mittees; and
7. planning organization-wide recognition programs
for staff members who attain their baccalaureates.
Staff development specialists are ideally positioned
to take the lead in promoting a ‘‘return for your
baccalaureate’’ movement, of course, but there is so
much more that they can do. Providing discussion/
support groups for nurse students is of tremendous
value, especially if run collaboratively with the schools
of nursing. After graduation, it is the staff develop-
ment specialist who can help new graduates synthe-
28. size and transfer what they have learned into the
work setting. In addition, the staff development spe-
cialist can support, advocate for, or run interference
for the new BS graduate who attempts to institute
change but runs into barriers by providing evidence-
based practice research, for example, or helping the
graduate determine the best ways to approach change
on his or her unit. With such occurrences fairly com-
mon, it might be wise for an agency to dedicate one
staff development specialist as a ‘‘baccalaureate tran-
sition partner.’’
SUMMARY
Regardless of the impetus that drove these participants
back to school, each one reported tremendous satis-
faction with degree attainment. One of those inter-
viewed summed up the experience with these words:
The rewards are so great. I’m not even sure that you can
enumerate properly all of the rewards. You can make a
great salary, but there are things that are so much
more. . .Did you ever think what it would be like without
you? I can honestly go home at night and realize that it
would be different without me—that I made a big
difference. I’m really lucky to be able to say that.
ACKNOWLEDGMENT
The authors wish to thank the Delta Upsilon Chapter-
at-Large of Sigma Theta Tau International for providing
funding for this research.
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29. Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., &
Silber, J. H. (2003). Educational levels of hospital nurses and
surgical patient mortality. Journal of the American Medical
Association, 290(12), 1617–1623.
American Nurses Association. (2000). Scope and standards of
practice for nursing professional development. Washington,
DC: American Nurses Publishing.
Boylston, M. T., Peters, M. A., & Lacey, M. (2004). Adult
student
satisfaction in traditional and accelerated RN-to-BSN pro-
grams. Journal of Professional Nursing, 20(1), 23–32.
Cangelosi, P. R. (2004). The tact of teaching RN-to-BSN
students.
Journal of Professional Nursing, 20(3), 167–173.
Clark, K. (2004). A qualitative study of faculty/student per-
ceptions of RN to baccalaureate nursing degree curricula
and instructional needs through focus groups and follow-
up interviews. Dissertation Abstracts International-A, 65(6),
2109. (UMI No. AAI3135840).
30. Corbett, S. A. (1997). Factors that motivate RNs to return to
school for the BSN and to remain in school to complete the
degree. Unpublished doctoral dissertation [abstract], Florida
International University. (UMI No. AAI9724561). Retrieved
November 9, 2005, from http://digitalcommons.fiu.edu/
dissertations/AAI9724561/
Cox, L. S. (1996). A comparison of two teaching delivery
systems
for registered nurse baccalaureate education: Traditional
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9Copyright @ 200 Lippincott Williams & Wilkins.
Unauthorized reproduction of this article is prohibited.
classroom setting and interactive video. Dissertation Abstracts
International-B, 57(7), 4294. (UMI No. AAI9640309).
Delaney, C., & Piscopo, B. (2004). RN–BSN programs:
Associate
degree and diploma nurses’ perceptions of the benefits and
barriers to returning to school. Journal for Nurses in Staff
Development, 20(4), 157–161.
31. Hall, D. B. (2003). Use of professional nurse case study as a
method to earn credit in an RN to BSN program. ABNF
Journal, 14(4), 86–88.
Hegge, M. (1995). Restructuring nursing curricula. Nurse
Educator, 20(6), 39–44.
Horne, C. D. (1998). Alienation, self-esteem, and perceived
self-
efficacy: A comparison of returning registered nurse students,
prelicensure nursing students, and non-nursing major
students in baccalaureate programs. Dissertation Abstracts
International-B, 59(3), 1047. (UMI No. AAI9828090).
Huston, C., Shovein, J., Damazo, B., & Fox, S. (2001). The
RN–BSN
bridge course: Transitioning the re-entry learner. Journal of
Continuing Education in Nursing, 32(6), 250–253.
Lillibridge, J., & Fox, S. D. (2005). RN to BSN education:
What do
RNs think? Nurse Educator, 30(1), 12–16.
Long, K. A., Bernier, S., & Aiken, L. H. (2004). RN education:
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32. matter of degrees. Nursing, 34(3), 48–51.
Malizia, E. E. (2000). Professional socialization of the
registered
nurse returning for a baccalaureate degree. Dissertation
Abstracts International-A, 61(2), 524. (UMI No. AAI9964396).
McCray, J. M. (1995). Learning for meaning: The lived ex-
perience of returning registered nurse learners. Dissertation
Abstracts International-B, 56(5), 2561. (UMI No.
PUZ9527110).
Rubin, H. J., & Rubin, I. S. (1995). Qualitative interviewing:
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art of hearing data. Thousand Oaks, CA: Sage.
Spratley, E., Johnson, A., Sochalski, J., Fritz, M., & Spencer,
W.
(2000). The registered nurse population: Findings from the
national sample survey of registered nurses, March 2000.
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Services.
Stringfield, Y. N. (1993). Perceptions of senior re-entry
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33. nurse students in baccalaureate nursing programs. Dissertation
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PUZ9326228).
ADDRESS FOR CORRESPONDENCE: Marilyn E. Asselin,
PhD,
RN-BC, Adult and Child Nursing Department, College of
Nursing, University of Massachusetts, 285 Old Westport
Road, North Dartmouth, MA 02747-2300
(e-mail: [email protected]; [email protected]).
JOURNAL FOR NURSES IN STAFF DEVELOPMENT 117
9Copyright @ 200 Lippincott Williams & Wilkins.
Unauthorized reproduction of this article is prohibited.
By Stacie McIe, RN, BSN, Trisha Petitte, RN, BSN, Lori Pride,
RN, BSN, Donna Leeper,
RN, BSN, and C. Lynne Ostrow, RN, EdD
Background Pressure dressings have been used as the standard
following sheath removal after percutaneous transluminal
angioplasty in many institutions. Patients complain about dis-
comfort while the dressing is in place, pain when the dressing
is removed after discharge, and skin complications afterward.
Many patients have experienced skin irritation where tape has
been applied. Nurses have also described difficulty assessing
the sheath insertion site in the groin when a pressure dressing
is in place.
Objectives To compare 3 different dressings with respect to
effect on bleeding, discomfort voiced by patients, and ease of
groin assessment in patients after percutaneous transluminal
34. coronary angiography.
Methods A total of 100 patients were randomly assigned to
1 of 3 groups: pressure dressing, transparent film dressing, or
adhesive bandage. Outcome variables were bleeding, patient
discomfort, and nurse-reported ease of observation of the
groin site.
Results No bleeding occurred in patients with transparent film
dressings or adhesive bandages. Patients rated these dressings
significantly higher than they rated the pressure dressing.
Because two-thirds of the sample had previously undergone
percutaneous transluminal coronary angiography, they could
compare their experience with the new dressing with previous
experiences with pressure dressings. Nurses rated the ease of
assessing the groin significantly higher for the transparent film
and adhesive bandage dressings than for pressure dressings.
Conclusions As a result of this study, a practice change was
made hospital-wide: rather than a standard opaque pressure
dressing, a transparent film dressing is used for all patients
after removal of a femoral sheath. (American Journal of Critical
Care. 2009;18:14-20)
14 AJCC AMERICAN JOURNAL OF CRITICAL CARE,
January 2009, Volume 18, No. 1 www.ajcconline.org
TRANSPARENT FILM
DRESSING VS PRESSURE
DRESSING AFTER PERCU-
TANEOUS TRANSLUMINAL
CORONARY ANGIOGRAPHY
C E 1.5 Hours
Notice to CE enrollees:
A closed-book, multiple-choice examination
following this article tests your under standing
of the following objectives:
36. tions at an early stage when the pressure dressing
was in place. They also were concerned for patients
who experienced discomfort, especially during and
after dressing removal.
Review of the Literature
A literature search of PubMed and CINAHL was
done by using the search terms dressings, bandages,
and catheterization and/or angioplasty. We found only
2 studies3,4 that addressed the issue of dressing type
after cardiac catheterization. In the first study,3
researchers compared traditional pressure dressing
by means of an elastic adhesive bandage (Tensoplast)
with use of a light transparent tape (Tegaderm). No
significant differences in bleeding were found between
the 2 groups, but the group that used the light trans-
parent tape reported significantly less pain and dis-
comfort. In the second study,4 a total of 739 patients
undergoing diagnostic catheterization or interven-
tional procedures were randomly assigned to receive
either a pressure dressing or an adhesive bandage.
The groups did not differ significantly in either inci-
dence or size of bruising or hematoma, or in the
frequency of complications such as pseudoa-
neurysm, embolism, or bleeding.
The authors4 concluded that the rou-
tine use of a pressure dressing was
unnecessary, and, as a result, the
institution where that study origi-
nated (in Edinburgh, Scotland) dis-
continued the use of pressure
dressings for all cardiac catheteriza-
tion patients.
37. The goal of our study was to
determine whether a change in the
type of dressing used after PTCA
reduced patients’ complaints and improved nurses’
abilities to assess the sheath insertion site after the
procedure while maintaining patients’ safety. Three
different types of dressings—transparent film,
A
ngioplasty, which was first performed in 1997 for treatment of
occluded coronary
arteries, is now used in more than 1 million patients a year in
the United States
alone.1 In 2005, a total of 1265000 percutaneous transluminal
coronary angio-
plasties (PTCAs) were performed.2 Nurses at West Virginia
University Hospitals,
Ruby Memorial, Morgantown, West Virginia, noted that the
type of dressing
used after PTCA sheath removal was a cause for concern,
especially for patients who had pre-
viously undergone PTCA and anticipated pain and discomfort
with the dressing because of
that experience.
About the Authors
Stacie McIe, Trisha Petitte, Lori Pride, and Donna Leeper
are nurses at West Virginia University Hospitals, Ruby
Memorial Hospital, Morgantown, West Virginia. C. Lynne
Ostrow is an associate professor at West Virginia Uni-
versity School of Nursing in Morgantown.
Corresponding author: C. Lynne Ostrow, RN, EdD, PO Box
9260, West Virginia University School of Nursing, Mor-
38. gantown, WV 26506 (e-mail: [email protected]).
www.ajcconline.org AJCC AMERICAN JOURNAL OF
CRITICAL CARE, January 2009, Volume 18, No. 1 15
Patients have
discomfort and
skin irritation
during and after
pressure dressing
removal.
Figure Skin breakdown across the posterior part of the thigh
where tape had been placed.
time was less than 150 seconds (eptifibatide) or less
than 200 seconds (bivalirudin). Mechanical pressure
was maintained with the FemoStop device for 60
minutes or manually for 30 minutes in each
patient. The sheath removal site was then dressed
with 1 of the 3 dressings as described earlier.
All 60 nurses employed on the unit where
patients were admitted after PTCA were trained to par-
ticipate in the study. The nurses assessed the patients
every 4 hours for complaints of discomfort in addition
to the routine checking of vital signs and assessment
of the groin site after sheath removal. The first assess-
ment of the groin site was made when the dressing
was applied, and additional assessments were done at
4-hour intervals after that. This frequency yielded a
mean of 4.7 (SD, 0.06) assessments per patient. The
nurses also recorded whether they were able to
observe the groin site directly and rated the ease of
39. assessment of the site for bleeding or hematoma for-
mation on a scale of 1 (difficult to assess) to 5 (easy to
assess). Patients’ complaints about the groin site were
noted during these assessments.
Patients were discharged 24 hours after admis-
sion and removed the dressing at home. A follow-
up telephone call was made within 48 to 72 hours
after discharge by a nurse investigator (T.P.). Patients
were asked to rate how comfortable it was to remove
the dressing and to rate the condition of the groin
site when the dressing was removed. In order to rate
the pain, patients were asked, “On a scale of 1 (very
comfortable) to 10 (painful), how comfortable was
it for you to remove the dressing?” The scale used
was based on the Numeric Pain Scale5 rating of 1
through 10 used in clinical nursing practice. Patients
also were asked if they had ever had a catheterization
with a pressure dressing before and, if so, how this
experience compared with the previous one. Patients
were given the opportunity to provide additional
comments about the experience. The nurse surveyor
recorded the comments verbatim.
Data Analysis
A power analysis was conducted on the basis
of previous work3 that showed a 40% difference
between the 2 groups (pressure dressing vs light
transparent tape) on the variable of discomfort.
Thus, in order to test for that same difference among
3 groups, 26 patients per group would yield 80%
power. The actual sample sizes of 32, 33, and 35
patients in each group yielded approximately 90%
power. Descriptive statistics, χ2 tests, and Kruskal-
Wallis tests were used to analyze the data from the
40. patients and nurses.
adhesive bandage, and pressure dressings—were
compared with respect to 3 outcomes: bleeding
after PTCA, satisfaction of patients, and ease of
nursing assessment of the sheath insertion site in
the groin. The study was conducted at
a tertiary care center (West Virginia
University Hospital, a level I trauma
center) that provides care for patients
undergoing elective and emergent per-
cutaneous coronary interventional pro-
cedures. The hypotheses for this study
were as follows:
• Bleeding complications will not
differ among the 3 dressing groups.
• Satisfaction will be higher
among patients with a transparent film dressing
and/or an adhesive bandage than in patients with a
pressure dressing.
• Nurses will rate ease of assessment of the groin
site higher in patients with a transparent film dress-
ing and/or an adhesive bandage than in patients with
a pressure dressing.
The study was approved by the institutional
review board at West Virginia University.
Methods
In this 3-arm experimental design, participants
were randomly assigned to 1 of 3 dressing conditions:
41. 1. Pressure dressing: 4-in (10-cm) Elastikon
(Johnson & Johnson, New Brunswick, New Jersey)
elastic tape (3 pieces, each about 10-12 in [25-30 cm]
long) secured over 1 box of 4 x 4-in
(10 x 10-cm) gauze sponges
2. Transparent film dressing:
Opsite IV3000 Standard (Smith &
Nephew, London, England), a 4 x 5½-
in (10 x 14-cm) transparent dressing
applied over one 2 x 2-in (5 x 5-cm)
gauze sponge
3. Adhesive bandage: Flexible
adhesive bandage (Kendall, Covidien,
Mansville, Massachusetts), 4 x 2-in
(10 x 5-cm) opaque dressing applied
directly to the puncture site
Patients who underwent PTCA
with eptifibatide or bivalirudin and
sheath sizes ranging from 6F to 8F
were included in this study. Depending on the med-
ication used, patients’ sheaths were removed by
using either the manual technique or the FemoStop
device (RADI Medical Systems, Uppsala, Sweden).
Activated clotting times were measured hourly, and
sheaths were removed when the activated clotting
16 AJCC AMERICAN JOURNAL OF CRITICAL CARE,
January 2009, Volume 18, No. 1 www.ajcconline.org
No bleeding was
42. noted when
either transpar-
ent film dressings
or adhesive band-
ages were used.
Ease of groin
assessment was
greater with both
the transparent
film dressing and
adhesive band-
age compared
with the pressure
dressing.
Results
A total of 213 patients gave consent to be in the
study. Of these, 100 had catheterizations that showed
stenosis and underwent angioplasty and stent place-
ment. The study sample was 68% men and 32%
women, with a mean age of 62 years (SD, 13.3).
The majority (67%) of the sample had previously
undergone catheterization. The mean number of
previous catheterizations per patient was 2.06 (SD,
2.83). The type of drugs received during catheteriza-
tions, type of pressure applied after sheath removal,
and activated clotting times are described in Table 1.
None of the demographic variables differed signifi-
43. cantly among the 3 dressing groups.
Patient Data
The 100 patients were each hospitalized for a
mean of approximately 24 hours if they had no
complications. After sheath removal, the mean num-
ber of hours until discharge was 14.8 (SD, 2.3).
Only 2 of the 100 patients, both in the pressure
dressing group, had bleeding after sheath removal.
One of these patients had a pseudoaneurysm. None
of the patients in the transparent film dressing or
adhesive bandage groups had any bleeding.
All but 4 patients were contacted via phone 48
to 72 hours after discharge. One patient had no
memory of the event, so the final telephone sample
was 95. A Kruskal-Wallis test was done to analyze
for any differences in scores on the pain rating scale
among the 3 dressing groups. Patients in the pressure
dressing group rated the experience of removing the
dressing as significantly more painful than did
patients in either of the other 2 groups (Table 2).
Patients in the transparent film group and patients
in the adhesive bandage group did not differ signifi-
cantly on this variable.
At each assessment from when the sheath was
removed to when the patient was discharged from
the hospital, the nurses recorded what complaints
(if any) the patients had about the groin site. A total
of 26 patients (79%) with a pressure dressing had 1
or several complaints about the groin site (Table 3).
Only 1 patient (3%) in the transparent dressing group
had a complaint (skin irritation), and 3 patients
44. (9%) in the adhesive bandage group had complaints.
Patients were also asked how this experience
compared with their last catheterization (67% of
the sample had experienced at least 1 catheteriza-
tion before this study, some at other institutions).
Table 4 shows patients’ assessments of the transpar-
ent film dressing and adhesive bandage compared
with prior pressure dressings.
The patients’ qualitative comments were coded
as either positive or negative depending on the words
they used to describe removal of the dressing. Almost
half (48%) of the patients in the pressure dressing
group had negative comments about the dressing.
Conversely, 71% of the transparent film dressing
group and 58% of the adhesive bandage group had
positive comments. Many negative comments about
previous pressure dressings were contained within
www.ajcconline.org AJCC AMERICAN JOURNAL OF
CRITICAL CARE, January 2009, Volume 18, No. 1 17
Table 1
Demographic data about the sample (N = 100)
Age, mean (SD), y
No. of previous catheterizations, mean (SD)
Activated clotting time, mean (SD), s
Sex, % of patients
Male
Female
45. First catheterization, % of patients
Yes
No
Drug during angioplasty, % of patients
Bivalirudin
Eptifibatide
Abciximab
Clopidogrel, % of patients
Yes
No
Aspirin, % of patients
Yes
No
Abciximab, % of patients
Yes
No
Tirofiban, % of patients
Yes
No
Eptifibatide, % of patients
Yes
No
Type of pressure applied, % of patients
Manual
FemStop device
62 (13.3)
47. Table 2
Discomfort score by dressing
Pressure (n = 33)
Transparent film (n = 35)
Adhesive bandage (n = 32)
6.0 (0.67)a
2.5 (0.44)
2.0 (0.43)
a Kruskal-Wallis test, χ2 = 22.7, P < .001.
Type of dressing Mean score (SD)
the praise for the transparent film dressing or adhe-
sive bandage. Examples of actual statements by the
patients are presented in Table 5.
Nurse Data
Each patient had a minimum of 2 nurses (range,
2-4 nurses) who made the assessments every 4 hours.
The nurses were asked to respond to 2 questions at
each of these assessments. The first question was,
“Were you able to directly observe the groin site?”
Percentages of yes and no responses were averaged
for all nurses over all observation points. For the
transparent film dressing, 97% of the nurses answered
48. yes, as did 59% for the adhesive bandage group
(Table 6). Only 15% of the nurses in the pressure
dressing group said that they were able to observe the
groin site directly. These percentages are significantly
different from one another (χ2 = 47.2, P < .001).
The nurses also were asked to rate the ease of
assessment of the groin for bleeding or hematoma
once the dressing was in place. The scores were again
averaged for all nurses across all observation points
to determine a mean score for ease of observation.
Because the data were ordinal, a Kruskal-Wallis test
was done to assess for any differences in ease of
observation among the 3 types of dressings. A sig-
nificant χ2 of 67.1 (P < .001) was found (Table 7).
Mann-Whitney tests were used to determine which
pairs differed; differences were significant (P < .001)
between the pressure dressing and the transparent
film and between the pressure dressing and the
adhesive bandage, but not between the transparent
film and the adhesive bandage. Ease of observation
of the groin was rated significantly lower for the
pressure dressing group than for either the transpar-
ent film or adhesive bandage groups.
Discussion
No bleeding complications occurred in patients
in the transparent film or adhesive bandage dress-
ing groups, but 2 complications occurred in the
pressure dressing group. Patients rated the transpar-
ent film and adhesive bandage dressings as more
comfortable while the dressings were in place, easier
to remove at home, and better than their last expe-
rience with cardiac catheterization when they had
had a pressure dressing. Patients gave graphic com-
49. ments about the discomfort felt while the pressure
dressing was in place and after it was removed. In
contrast, patients in the transparent film and adhe-
sive bandage groups had positive comments about
the dressings and viewed them much more favor-
ably than pressure dressings. Although ratings for
the transparent film dressing were slightly higher
18 AJCC AMERICAN JOURNAL OF CRITICAL CARE,
January 2009, Volume 18, No. 1 www.ajcconline.org
Table 4
Comparison of present dressing with pressure
dressing used in prior catheterization (n = 63)a,b
Pressure (n = 17)
Transparent film (n = 25)
Adhesive bandage (n = 21)
2 (12)
24 (96)
18 (86)
7 (41)
1 (4)
1 (5)
6 (35) 2 (12)
2 (9)
50. Type of dressing Better Same Worse No memory
No. (%) of responses
Table 5
Examples of statements by patients
Pressure
Transparent
film
Adhesive
bandage
Rated as an 8 (10 being most painful) because of pain
associated with pulling hair off back of leg when
removing dressing.
Red welts all over his leg when tape came off.
Adhesive turned to glue in shower and became part
of my body.
Liked transparent dressing much better than pressure
dressing in past.
Dressing came off so easily.
Dressing this time was much better than pressure dressing.
Pressure dressing pulled skin off with last catheterization.
Lots better than when they used all tape in the hospital!
Much better than pressure dressing by far.
51. Dressing was a godsend. This dressing so much better.
It was much easier to walk around. Would recommend
to anyone having a catheterization.
More than better. “Fantastic.” Comes off easily.
You don’t have to pull, tug, scream, and yell.
Recommend the adhesive bandage to anyone. If he
has another catheterization, will not have that “big”
dressing again.
Type of dressing Statement
Table 3
Complaints about groin site while dressing in place
Pressure (n = 33)
Transparent film (n = 35)
Adhesive bandage (n = 32)
a Includes itching, skin irritation, burning, tightness, and
pulling.
Type of dressing Complaints
No. (%) of
patients
Pulling
Discomfort
Anticipating pain on
removal of dressing
52. Several complaintsa
Skin irritation
Discomfort
Anticipating pain
Skin irritation/itching
5 (15)
3 (9)
4 (12)
14 (42)
1 (3)
1 (3)
1 (3)
1 (3)
a Percentages may not total 100 because of rounding.
b χ2 = 42.15, P < .001.
REFERENCES
1. National Heart, Lung, and Blood Institute. Diseases and
conditions index: what is coronary angioplasty? http://www
53. .nhlbi.nih.gov/health/dci/Diseases/Angioplasty/Angioplasty_
WhatIs.html. Published July 2007. Accessed October 2,
2008.
2. American Heart Association. Angioplasty and cardiac
revascularization statistics. http://www.americanheart.org/
presenter.jhtml?identifier=4439. Accessed October 5, 2008.
3. Boonbaichaiyapruck S, Hutayanon P, Chanthanamatta P, et
al. Groin dressing after cardiac catheterization. Comparison
among light dressing with thin transparent tape (Tega-
derm) and conventional tight/pressure dressing and elastic
adhesive bandage (Tensoplast). J Med Assoc Thai.
2001;84(12):1721-1728.
4. Robb C, McLean S. Using pressure dressings after femoral
artery sheath removal. Prof Nurse. 2000;15(6):371-374.
5. McCaffery M, Pasero C. Pain: Clinical Manual. St Louis,
MO: Elsevier Saunders; 1999.
6. American Association of Critical-Care Nurses. Procedure
Manual for Critical Care. 5th ed. St Louis, MO: Elsevier
Saunders; 2005.
To purchase electronic or print reprints, contact The
InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656.
Phone, (800) 809-2273 or (949) 362-2050 (ext 532); fax,
(949) 362-2049; e-mail, [email protected]
than ratings for the adhesive bandage, those differ-
ences were not statistically significant.
Nurses reported that they could directly observe
the groin for bleeding in patients with transparent
film or adhesive bandage dressings. Nurses also
reported greater ease in assessing the groin site with
54. both the transparent film dressing and the adhesive
bandage as opposed to the pressure dressing. Our
findings in relation to bleeding and increased com-
fort of patients are similar to results reported for
both earlier studies3,4 in which different types of
dressings were examined.
As a result of this research study, a practice
change has been instituted at West Virginia Univer-
sity Hospital. We discussed the study results with all
persons in the institution who had an interest in
the issue, including interventional radiologists, car-
diology physicians, and vascular surgeons, and
changes in policy and procedure were reviewed and
agreed on. Nursing staff were oriented to the policy
change via posters and staff meetings. The new pol-
icy was developed after review of the latest proce-
dure guidelines from the American Association of
Critical-Care Nurses6 and incorporates the changes
as a result of our research.
The results of our study, which had a 3-arm
experimental design, revealed significantly greater
satisfaction among patients after cardiac catheteriza-
tion when the sheath insertion site in the groin was
dressed with either a transparent dressing or a sim-
ple adhesive bandage rather than the standard pres-
sure dressing. Nurses also reported improved ease
of assessment of the groin site in patients with the
transparent film or adhesive bandage dressings.
Our report illustrates the process of making a
practice change based on research evidence. The
clinical problem of dissatisfaction among patients
was identified by the nurses caring for patients after
PTCA and spurred a review of literature on the topic.
55. Consultation with a faculty member in the school
of nursing enabled us to plan and implement this
study. The result has been an institution-wide change
in practice. Not only have patients benefited from
this change, but members of the nursing staff have
increased their knowledge, skills, and commitment
to evidence-based nursing practice.
FINANCIAL DISCLOSURES
None reported.
www.ajcconline.org AJCC AMERICAN JOURNAL OF
CRITICAL CARE, January 2009, Volume 18, No. 1 19
Table 6
Ability to directly observe the groin site
Pressure (n = 33)
Transparent film (n = 35)
Adhesive bandage (n = 32)
(15)
(97)
(59)
(85)
(3)
(41)
28
56. 1
13
5
34
19
a χ2 = 47.2, P < .001.
Type of dressing
No. (%) of dressings
Yesa No
Table 7
Ease of assessment of groin for bleeding or hematoma
Pressure
Transparent film
Adhesive bandage
2.12
4.04
3.73
0.63
57. 0.28
0.99
a χ2 = 67.1, P < .001. Significant difference between pressure
dressing and the
other 2 types of dressings.
Type of dressing Mean scorea SD
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Title of Paper
Below is some information related to the article review
(Week 3 Assignment). Be certain that your paper has all of the
components of a paper written in APA format: title page,
introduction, purpose statement, headings, summary and
reference list.
Always add a title page. Your title can be anything that
you feel is appropriate. Then, on page 2, write a brief
introduction and purpose statement. Use Level 2 headings for
each section of the research article. Remember to use in text
citations just as you would for any other scholarly writing.
For this assignment, select two research studies from the
list of articles provided in Doc Sharing. One of the studies
selected needs to be a qualitative. Write a three to four -page
summary of each of the articles (total of 5-6 pages), and after
summarizing each, explain why you think each is a strong or
weak study. Use the following guidelines and evaluation criteria
to guide your paper. Use the headings below for each section.
Include the reference for each of the articles.
Overview of Quantitative Article--45 points
Level 1 heading
Level 2 heading
Research Question
In this section of the paper, identify the research question
59. and discuss briefly according to information found in Chapter 3
(Adams, 2012) of the Schmidt and Brown (2012) text
book.Provide the name of the article with an in text citation so
that the instructor knows which article is being reviewed. The in
text citation for the article must be included in each
section/paragraph below.
Study Design
In this section identify whether the study is quantitative or
qualitative. Then discuss the specific design. Information is
found in Chapters 6, 7 and 8.
Sample Size and Representativeness
Identify the size of the sample and whether is it
representative of the population.
Results of Data Analysis
Present the results of the data analysis and discuss the
analysis procedures. Be specific about the procedures used and
actual findings. Identify the statistical test used in the research
study.List the statistical results of the test used in the research
study. This will include all of the statistical results, not just the
p value.Identify whether the results of the statistical analysis
were significant. Include the p value for the tests that are
statistically significant.
Summary of Strengths and Weaknesses--45 points
Identify the strengths and weaknesses of the study.
Remember to use the textbook for supporting citation and
referencewhen making this evaluation so that quantitative
studies are evaluated for reliability and validity.
Overview of Qualitative Article --45 points
Research Question In this section of the paper, identify
the research question and discuss briefly according to
information found in Chapter 3 of the Schmidt and Brown
(2012) text book. Provide the name of the article with an in text
citation so that the instructor knows which article is being
reviewed. The in text citation for the article must be included in
each section/paragraph below.
Study Design
60. In this section identify whether the study is quantitative or
qualitative. Then discuss the specific design. Information is
found in Chapters 6, 7 and 8.
Sample Size and Representativeness
Identify the size of the sample and whether is it
representative of the population. Remember that the criteria for
evaluating a qualitative sample aredifferent from evaluating a
quantitative sample.
Results of Data Analysis Procedures
Present the results of the data analysis and the themes
identified. Be certain to describe the data analysis procedures
used.
Summary of Strengths and Weaknesses--45 points
Identify the strengths and weaknesses of the study.
Remember to use the textbook for supporting citation and
reference when making this evaluation. Qualitative studies are
evaluated for trustworthiness (credibility, transferability,
dependability and confirmability).
Summary of the Main Points of the Paper
Always summarize the main points of a paper. A brief summary
of the articles reviewed is sufficient. On a separate page add
the references which are the citations for each of the articles
reviewed and any other sources that you used for the paper.
References
Adams, S. (2012). Identifying research questions.In N.A.
Schmidt & J.M. Brown. (Eds.). Evidence-based practice for
nurses: Appraisal and application of research. (2nd ed., pp. 66-
87). Sudbury, MA: Jones & Bartlett Learning.
The correct citation of each article is worth 15 points so the
citation of the two articles reviewed is worth 30 points.
NOTE: Format/style
Proofread the paper as described in the tips for success in this
course and correct any typos, grammar, spelling, punctuation,
61. syntax, or APA format errors before submitting your paper to
Turnitin. Up to 40 points can be deducted from the grade for
this assignment for these types of errors, or for not using at
least the minimum number of required references.
Total possible points for assignment = 210 points
Application
Analyzing the Research
For the Week 3 Application, you will select two articles from a
list, identify the components of a research project and evaluate
the strengths and weaknesses of the articles.
· Select two studies from the list of articles provided in Doc
Sharing. The articles are accessed through the Course Readings
in the Library. Look for the Week 3 Articles tab.
· Choose one quantitative article and one qualitative article.
· Review each selected article based on what you have learned
about study design, identifying information from each
component of the study.
· Evaluate the strengths and weaknesses of each study.
· Based on your review, write a 6-7-page summary of the two
articles using the NURS 4000 Week 3 Assignment Rubric.
· Identify each component of the research article as outlined in
the rubric.
Explain why each is a strong or weak study based upon criteria
for reliability and validity for quantitative studies. Use criteria
for trustworthiness for qualitative studies. Refer to your
textbook for information related to evaluation of research.
· Readings
· Course Text: Evidence-Based Practice for Nurses: Appraisal
and Application of Research
62. ·
2. Chapter 5, "Linking Theory, Research, and Practice"
This chapter begins by exploring the relationship between
theory, research, and nursing practice. It then covers the
language of research, including specific terminology. The
chapter illustrates how scientific research supports nursing
practice and how nursing practice informs scientific research.
2. Chapter 7, "Quantitative Designs: Using Numbers to Provide
Evidence"
Quantitative research designs seek to explain a phenomenon
through numerical findings. This chapter discusses key concepts
related to quantitative design, different types of quantitative
studies, and strategies nurses can use to appraise quantitative
research study designs presented in the literature.
2. Chapter 8, "Qualitative Designs: Using Words to Provide
Evidence"
Chapter 8 defines qualitative research as the focus on words
instead of numbers to give meaning to phenomena. This chapter
discusses four major types of qualitative research as well as
different sources of data. Strategies for evaluating qualitative
study designs are also presented.
2. Chapter 9, "Collecting Evidence"
This chapter describes the process of planning data collection.
The authors cover methods of collecting quantitative and
qualitative data while stressing the importance of recognizing
validity and measurement error.
63. 2. Review this completed Journal Club Template for one
example of how this document is used to support the evaluation
of a research article. The article reviewed for this template is:
5. Hurlbut, J.M., Robbins, L.K. & Hoke, M.M. (2011).
Correlations between spirituality and health-promoting
behaviors among sheltered homeless women. Journal of
Community Health Nursing, 28(2), 81-91.
DOI:10.1080/07370016.2011.564064
2. This PDF version of a PowerPoint presentation presents
another example of how an article evaluation can be presented
to a journal club:
6. Mulligan, E. (2001). Healthsouth Orthopedic Extremity/Foot-
Ankle Journal Club. Retrieved from http://www.continuing-
ed.cc/newsletter/Thessaly%20Test%20Journal%20Club%20hand
out.pdf
. Articles
3. Schmelzer, M. (2004). Understanding statistics: What is
alpha (á)? Gastroenterology Nursing, 27(6), 292–293.
Use the Ovid Nursing Journals Full Text database, and search
using the article's author, title, or journal title.
This article, written by a nurse, explains the alpha statistic.
Using common examples, such as tossing a coin, the author
describes what the alpha statistic represents and suggests
strategies for evaluating the statistical analysis of a research
study.
.
4. Schmelzer, M. (2000). Understanding the research
methodology: Should we trust the researchers' conclusions?
Gastroenterology Nursing, 23(6), 269–274.
64. Use the Ovid Nursing Journals Full Text database, and search
using the article's author, title, or journal title.
In this article, Dr. Schmelzer discusses strategies for evaluating
the methodology of a research study. She also examines the
statistics presented in the methodology section and explains
common statistical terms.