Nursing Research and Evidence Based Practice - Science topic

Dear author, thank you for sharing this excellent question.

I agree with Dr Ladislav Volicer.

With kind regards.

I agree with Suganthra Devi

Thanks Sally Bennett for your input.

In my PhD, I identified 9 different professions delivering case management. The specific training of each brought an eclectic range of expertise and challenges to the role. However, in nursing poor role definitions and inconsistent use of titles have complicated understanding for the practitioner and the patient. In addition, there may be intra and inter-professional differences in explaining how case management should be delivered and by whom.

The academic and grey literature terms interchangeably including care management, case management, activity, approach and interventions - sometimes, this variation arises within the same article, adding more confusion. Sue Lukersmith’s work has been very helpful but the terminology used still differs within and across various professions adding further misunderstanding between different professional disciplines. EG social workers refer to "care " rather than case management.

Therefore, a sensible approach in defining a case management service should first clarify its purpose and the needs of the people it aims to serve. This will point toward the knowledge and skills needed for the conduct of the role. Have a look at my thesis on : https://eprints.soton.ac.uk/421176/1/Saltrese_A_Final_Thesis_2018_April.pdf

In Canada, the Canadian Nurses Association published a document entitled Ethical Research Guidelines for Registered Nurses in 2002.

In Australia, three nursing organizations collaborated to develop the Code of Ethics for Nurses in Australia (2008).

Nurses in most countries have developed their own professional codes or follow the codes established by their governments.

The International Council of Nurses has developed the ICN Code of Ethics for Nurses, updated in 2006.

Clinical teaching to date should be oriented by Person Centered Medicine and the Person Centered Clinical Method. PBL and Evidence based medicine are obsolete and wrong models, because medical science is changed.

In the assessment of clinical skills in learning Person Centered Medicine, the method we use is correspondent to the Person Centered Medicine Clinical method  learning of its steps trough a questionnaire fulfilled by three clinical teachers after a simulation session, concerning the learning step and, at the end, of  the full procedure.

The problem is to prepare clinical teachers to teach Person centered Medicine and its epistemological basis which is founded on the paradigm shift of Medical Science , born in 1998, and that will be formalized in Milan on 13-14-15 October 2017 in the Congress:

" Medical science and health paradigm change"

Sign if you agree "la Charte Mondiale de la Santé-the World Health Charter"

Text and info on the Congress website

an on line-live course on Person Centered Clinical Method:

Care left undone during nursing shifts: Associations with workload and perceived quality of care

Dear Karen Stone

Adequate knowledge about the health hazard of hospital waste, proper technique and methods of handling the waste, and practice of safety measures can go a long way toward the safe disposal of hazardous hospital waste and protect the community from various adverse effects of the hazardous waste. With this background, you must consider the levels of healthcare professions in you study and you must prepare appropriate questionnaire for each of them...

Hello Panor, I'm Fehim from Faculty of Health Science, Bandırma Onyedi Eylül University  Turkey(Türkiye). I'm an accident epidemiologist  of public health nursing.

thank you very mich

Mary C R Wilson 

We use in Brazil Sodium Chloride 20% if in light bulb, soak a gauze and apply on the granuloma. There is a product in gel form, Hypergel of the Molnlycke which is a gel with 20% sodium, it may also be applied a thin layer on granuloma and cover with gauze.

The faculty member who teach theoretical class, has to be in touch with the clinical settings and keeps following up the students training. This is crucial to link theory with practice and to be realistic with the examples and students feedback.

Look at Yvonne Lu's work from Indiana University and also an intervention called Time Slips. I think these may be helpful

Researcher can prepare a  questionnaire on care of the premature neonatal infants by following recommended books and it can be used as a self administering questionnaire .for research. prepared questionnaire  can be validated by experts in the field before implementing or collecting data- Its my point of view

it seems you are going to compare 2 different scales used in both survyes. If both of them measure the same concept, then you can find the total score for each and do correlation between them

agree with Peter on the fact that attitude and belief scales are content oriented.

The content or the situation or intervention  (specify the attitude or belief towards which) you intend to measure. As the scale varies from situation to situation.

As it wont be appropriate to use one scale to all..as a matter of fact it would be irrelevant.

In case you are looking for a sample to formulate or understand the structure of an attitude or belief scale, you may find may of them by google search.

regards

Rathish

You may want to look at the work of Dr. Audrey Nelson on safe patient handling. She did much with the Veterans' Administration to reduce injuries to health care professionals when moving patients. Her research resulted in numerous articles and I incorporated her work in the chapter on Mobility and Immobility in Fundamentals of Nursing by Potter and Perry published by Elsevier.    I also agree with my previous colleague's posting. Do not use abbreviations. Clearly articulate your needs so others may understand your question

Grants, scholarships, tuition vouchers, and loan reimbursements, designed to lower the cost of a nursing education, have also tended to depress starting wages. This is because nursing graduates who receive subsidized education through these programs are willing to, or in some cases are required to, work for lower starting wages than they would without the subsidies.As a result all nursing graduates are lower, including for those who did not receive a subsidy for their education through the government programs.

I'm sorry, I do not have information to assist with your question.

Dear Pat, 

Check these three studies out: 

Wishing you and your family all the best, more power and success, and be blessed with love, peace, joy, good health, and prosperity, and with what your heart desires. Happy new year

Thank you for your up votes, endorsement, and following my posts.

Sincerely,

Florencia T. Maldia RN.,PhD

I know of the communication assessment tool for therapeutic communication (2009) which has domains.

they include: domain 1-professional practice

domain 2-critical thinking and analysis

domain 3-provision and coordination of care

domain 4-collaborative and therapeutic practice

each domains is rated on scale 0-2 with their descriptions, at the end of the assessment the score is totalled and compared with the performance level.

performance level includes: ESTABLISHED COMPETENT, BEGINING COMPETENT AND NOT YET COMPETENT.

I hope this gives a helping clue while you research more on it.

best regards....

Dear Nilüfer, 

attached you find an abstract about this research. Unfortunately this is only published as book: Pflegespezifische Kompetenzen im europäischen Bildungsraum. V & R GmbH.

You can check the ptb-diagonistic ecg database available in Physionet.

You might try reviewing the guidelines for care established at the major neurosurgical care centers.  Also, the device manufacturer may be able to help.  Meanwhile, check out http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450504/

Hi Irena,

would be useful to provide both a link and a title

Thanks

In a DNP project, I compared outcomes of new graduates in three sites, with only one having a nurse residency program. I used the Casey-Fink Graduate Nurse Experience Survey from the University of Colorado. It measure five subscales of stress, support, ability to organize and prioritize, communication and leadership, and professional satisfaction. The tool was developed in 1999 to measure newly licensed RN comfort with skills over time. Casey et al. have used the survey as part of the Nurse Residency Program developed in collaboration between UHC and AACN. The CFCNES has a Cronbach alpha of .89 and validity testing was done using an expert panel of educators. Pub med link to my article: http://www.ncbi.nlm.nih.gov/pubmed/24658039?otool=mnmcclib&myncbishare=mnmcclib (Harrison, D. & Ledbetter, C. (2014). Nurse Residency Programs - Outcome Comparisons to Best Practices. JNPD, 30(2), 76-82.)

THANK YOU KINDLY 

I also think that retrospective analysis is the only option. Is it accurate to limit failure to rescue to cardiac arrest? Perhaps one of the early warning system frameworks (EWS; http://www.ihi.org/resources/Pages/ImprovementStories/EarlyWarningSystemsScorecardsThatSaveLives.aspx) could be used to expand the conceptualization of "failure to rescue" . It seems that failure to respond, or a delay in response, at any point when the evidence (i.e., vital signs, O2 sat) suggests an intervention could be on a continuum of failure to rescue.  

Maintaining a healthy work environment and staffing adequacy required to reduce the burnout among nurses.  

I wish this paper might help (included references of prof Linda Aiken).

1. The Impact of Patient to Nurse Ratio on Quality of Care and Patient Safety in the Medical and Surgical Wards in Malaysian Private Hospitals: A Cross-sectional Study

The attached file one paper I wish this will help as well. 

Warm regards, 

Dear Ruby 

I agree with the point of view that multi-dimensional interventions required to optimize the outcomes of care. Maintaining a healthy work environment and staffing adequacy required. skilled and trained employees required as well. 

I wish these papers might help (included references could help).

1. The Impact of Patient to Nurse Ratio on Quality of Care and Patient Safety in the Medical and Surgical Wards in Malaysian Private Hospitals: A Cross-sectional Study

2. Nurse Level of Education, Quality of Care and Patient Safety in the Medical and Surgical Wards in Malaysian Private Hospitals: A Cross-sectional Study

Warm regards, 

Thank you for the clarification Dean. A bio-medically driven use of informational power (see 6 bases of power-over) to coerce individual behaviour change is not empowerment, even under the constraints of a nursing context. The end does not justify the means either because this is contrary to an empowerment approach that aims to build capacity, confidence, autonomy etc, Information exchange alone is insufficient and in fact could be disempowering. This is really about professional honesty and a willingness to accept that as practitioner we are not experts and may even not be able to help others to empower themselves within a work setting. 

One thing that has been done for a while in my neck of the woods is the Research Challenge. It is a small grant $5000, that is specifically for nursing and allied health to conduct a research study.  It is a team's grant. Potential teams submit first a letter of intent, they are then matched with a research mentor that is committed to help the team, and the teams must attend a series of compulsory and optional workshops on literature search, grant proposal development, ethics etc. before submitting the final proposal. I believe this year there is funds to support 18 teams at our facility. It is quite amazing what past recipients have accomplished with these small grants. they have turned into ongoing research, larger projects, masters thesis, and organization wide QI projects. Here is the website for this current year's competition. Feel free to contact the team at VCHRI for more information. I have found them to be incredibly supportive.

 Dear Dr. Ruby ,

I think this article may be useful:

Worldviews Evid Based Nurs. 2008;5(2):75-84. doi: 10.1111/j.1741-6787.2008.00123.x.

Effectiveness of a computer-based educational program on nurses' knowledge, attitude, and skill level related to evidence-based practice.

Hart P1, Eaton L, Buckner M, Morrow BN, Barrett DT, Fraser DD, Hooks D, Sharrer RL.

Regards,

once the operating room has been turned over and cleaned by the surgical patient service team and anesthesia techs, then the surgical team opens the trays to make sure that the necessary equipment is available for the surgical procedure.

Attached implications of my study:

Nurses, who represent 65% of human resources in the Bolivian health system structure, must actively participate in the design of culturally adapted prevention programmes and health education interventions. In this regard, governmental health authorities, NGOs and international organisations should be actively engaged and aware of our study’s results, particularly highlighting the importance of local agents to promote their capacitation as well as the empowerment of indigenous populations. Nursing could develop programmes and interventions based on the transcultural care theory, preserving healthy cultural practices, negotiating the adaptation of others and remodelling those which support risk behaviours. Without an in-depth knowledge of this population’s cultural framework, any attempt at an intervention runs the risk of being done in vain.

Hi Rabin,

Thanks for your really detailed response I've been doing some reading around dual process theory (Pat Croskerry has written a couple of nice articles), but haven't come across the naturalistic model, so I'll look that up thanks.

I'm working up an observational study investigating how clinical staff review images and make clinical/patient management decisions in the oncology setting.

I'll check out those references thanks and would appreciate any other thoughts you have.

Good luck with the publication

Best wishes

Mark

Buildings are never neutral: they define relationships and organise our lives. In numerous ways hospitals reflect the categories of society, by showing age and gender differentiation, for example, and by articulating wards in accordance with specialisms and diseases. Miasma theory which designated 'bad air' as a cause of disease resulted in great emphasis on cross-ventilation, because it was only in the 1870s that Pasteur established the existence of microbes, and before that what one could smell was self-evidently dangerous. However, in modern hospitals air-conditioning has taken over, and whole buildings are planned for ease of servicing, to the detriment of way-finding. Until the mid 19th century the chapel had a hierarchically dominant role because God was still in the picture and many people died. Today most people die in hospital but we don't acknowledge it because is it supposed to be a healing place. In the 19th century operating theatres were just that, with lots of dirty people in ranks of seats looking on, now it is one of the most tightly defined enclaves of modern life with stringent barriers and ritual cleansing. In the 1920s tuberculosis was a major killer and without antibiotics was difficult to cure, but UV light in sunlight killed the bacillus, so patients were exposed to the open air in buildings like Aalto's Paimio, and this idea was reflected in many other buildings of the period, such as open-air schools. For a good history of the building type see Thompson and Goldin 1975, and on miasma theory and birth Ann-Marie Adams. There will be a chapter in hospitals in my forthcoming book Architecture and Ritual.

We see the world around us through colors. Whenever there is light there is color, and therefore we see the surfaces that (in)form visual space perception. More than 85% or 90% of all information that arrives to our brain from the exterior comes from the sense of sight. So, light and color are, together, the main keys for our communication with the world, and the way the world communicate with us. 

I do not agree with some color palettes that are being used, leading to the 70´s and 80's approach of having a color for each floor, etc. Color should respond to functional an aesthetic issues, promoting at same time comfort for the patients and adequate professional care. If we have the same concerns in two or more floors we should address them in the same way. A waiting area should be designed in a balanced harmony between hot and cold colors, nor having to be blue just because you are in the "blue" floor!

Dear Rafael,

J Psychiatr Ment Health Nurs. 2001 Feb;8(1):25-32.

Something special: forensic psychiatric nursing.

Martin T

Abstract

In this paper the claims that forensic psychiatric nursing has achieved the status of a specialist area of nursing are refuted. An examination of the literature demonstrates that specialist knowledge and skills have not been documented. It is suggested that three requirements are necessary if forensic psychiatric nurses wish to achieve specialty status. Forensic nurses have to consolidate their role in the containment and care of patients, they have to return to the nurse-patient relationship as the foundation of psychiatric nursing practice, then, within that relationship, nurses must expand their practice to include dealing with offence issues.

I think the following article has a good answer for this question:

Aqel A., Ahmad M. (2014). High Fidelity Simulator effects on CPR Knowledge and Skills Acquisition and Retention. Worldviews on Evidence-Based Nursing, 11(6), 394-400. DOI:10.1111/wvn.12063

from its name, adhoc, it can be done when the participants are available. The researcher is ready. and the expected outcome from the research is decided

Hi Bindu,

i used before 2 books which are helpful

if you are interested communicate with me in this email and I will send the 2 books to you by the end next week

Even in clinical situation/clinical simulation one (the clinical instructor )needs to consider the level of knowledge that has to be assessed or taught. Therefore bloom's taxonomy is still appliable. The scenario has to be formulated in such a way that reflects or conforms to the objectives to the outcome.

Hello Pattie,

I have used the work of Harold G. Koenig. His basic book is entitled Handbook of Religion and Health. He defines spirituality as, "...the personal quest for understanding answers to ultimate questions about life, about meaning, and about relationship to the sacred or transcendent, which may or may not lead to or arise from the development of religious rituals and the formation of community."  I hope this helps. When providing spiritual care, nurses must pause to reflect on their own definitions of spirituality, as well as their values and beliefs.  Presence and listening are of importance.

Hi Charlotte,

thanks for your comments. As you know, three dimensions or levels of health literacy were identified: functional (where is icluded the numeracy capability you pointed about), interactive and critical. 

In my opinion, it is necessary to take into account these dimensios in the design of assesment tools and interventions. In our mobile application, we ask the user, after use, to perform what they learned. For example, accesing and request a medical appointment. At the same time, the app returns information, thus having objective data of user empowerment. 

Written information, especially if autoinformed, has its drawbacks and limations.

Greetings.

In my practice I provide hypothetical case Study with study guide

Just got through reading on emotional fatigue and burnout in ED nurses.  One of the major items discussed was the failure of management to acknowledge or provide positive feedback as a major source of stress (Riahi, S. 2011).  Further more, when the stress signals started to be displayed, the stress only increased when management was insensitive to the stress displayed (Riahi S, 2011).  

Reference

Riahi, S. (2011). Role stress amongst nurses at the workplace: Concept analysis. Journal of Nursing Management, 19, 721-731. http://dx.doi.org/10.1111/j.1365-2834.2011.01235.x

We have recently implemented an on-line portfolio in the midwifery trainning programme , and we are having good feed-back from midwifery students and mentors. This dynamic tool is intended to support theoretical teaching during clinical training period. As a dynamic tool, it allows to continuously incorporate  emerging evidence into teaching. The main goal of this tool is to support mentors task and students clinical trainning process trough a continuous feed-back while "learning by doing"

Dear Lisa

I spent a year following the stories of frail older people in hospital waiting for a bed in a nursing home. I visited them during this time and collected stories full of humour, resilience and despair. These people were 'bed blockers' and we still have this in the UK

 

Yes, Lubricating the urethra (preferentially by gentle injection via a 10 cc syringe) can reduce traumatic effect of catheterization in male, lidocaine gell %2 also helps to painless insertion provided that it be left at least 5 min before  catheterzation. this lubrlcating process is not limited the "male" gender and should be applied for females also. 

 

 

I believe this question has very deep roots. Replies to it, would certainly reflect culture of a respondent. Therefore, my reply can also be seen as well as considered as culturally bound, no problem.  I prefer Place of Habitual Residence to Nursing Homes if one can afford nurse/doctor at home.

hi kevin

i just came across a few article on capillary dressing hope it helps you.

VACUTEX™ capillary action dressing: a multicentre, randomized trial

Linda Russell, Michelle Deeth, Helen M Jones, Tim Reynolds

British Journal of Nursing, Vol. 10, Iss. Sup2, 08 Jun 2001, pp S66 - S70

Importance of moisture balance at the wound-dressing interface (107kb)

S.M. Bishop, M. Walker, A.A. Rogers, W.Y.J. Chen

Journal of Wound Care, Vol. 12, Iss. 4, 02 Apr 2003, pp 125 - 128

A Randomized Crossover Investigation of Pain at Dressing Change Comparing 2 Foam Dressings

Woo, Kevin Y. RN, MSc, PhD, GNC(C), FAPWCA; Coutts, Patricia M. RN, IIWCC; Price, Patricia BA(Hons), PhD, CHPsychol, AFBPsS, FIHE; Harding, Keith MB, ChB, MRCGP, FRCS; Sibbald, R. Gary MD, FRCPC(Med Derm), MEd, MACP, FAAD, FAPWCA

Evaluation of a wound dressing using different research methods (98kb)

Tim Reynolds, Linda Russell

British Journal of Nursing, Vol. 13, Iss. Sup2, 10 Jun 2004, pp S21 - S24

Drawtex: a unique dressing that can be tailor-made to fit wounds (143kb)

Linda Russell, Amanda Evans

British Journal of Nursing, Vol. 8, Iss. 15, 12 Aug 1999, pp 1022 - 1026

Article: Debridement of necrotic tissue and eschar using a capillary dressing and semi-permeable film dressing.

Jackie Lisle British journal of community nursing 10/2002;

We are using TAP blocks more and more for pediatric surgical cases and this has included neonatal surgery up to and including adolescents. TAP blocks last about 4 hours whereas a caudal block as used in infants/toddlers will last much longer (approx. 8 hours)

I completed my doctoral research and published it in the Alternative and Complementary Therapies Journal in April 2014. My study used diffused essential lemon oil during an exam with nursing students and it significantly reduced their cognitive test anxiety scores post intervention. Please let me know if you'd like additional information on my work. Thank you!

Dear Jennifer, thanks for your wonderful contribution and indeed it is a good way to go.

We use IPC in all our patients who undergo pneumonectomy for five days postoperatively, combined with enoxoparin for six weeks. The rationale is to prevent (mostly fatal) embolic events in the unique remaining lung. This procedure is now in place for six years and we had no such events in this timeframe. (it is of course an event that is rare, but before we used ICP, major embolic events were seen in about 1% of pneumonectomy patients; we do 40+ pneumonectomies a year, so calculating the odds it seems an improvement).

For the use: the first three days the IPC is running 24/24, when the patient is fully mobilized the IPC is only used during the night. Most patients complain, not of discomfort wearing them, but from the noise the pumps make.

This is of course a totally different population from stroke patients, but we feel it works

Also, refer to research by Amit Gefen from Israel. He studies the seated population.

My experience with students is they need to be prompted to ensure they cover all aspects of their area of study. Placing the patient as the core focus, then asking the student to use prompts such (For example):

Physical - What is the condition, clinical signs, symptoms etc

Psychological - How does the condition impact on self concept

Social - How does the condition impact on the patient/family social interactions

Cultural - Do the cultural beliefs of the patient have an impact on any of the other prompts and how may clinical decisions be impacted by these beliefs

Professional - What potential clinical interventions could be made? What frames the decision making process? Are there any legal or ethical issues that need to be taken into account?

This approach seems to stop the student over focusing on one aspect and prompts a greater realization of the holistic impacts of the decision making process.

In your specific case, "existing patient records" randomization is not a real issue. Make sure that in your work you describe, with detail, how you gained access to the data. Another key issue is how you formulate the problem, make sure that yours is clearly stated.

Randomization would be central if you were studying health people. as I understand you are studying a diseased population.

I oversee the end-of-life and postmortem practice of a trauma hospital in a high-risk, inner city community of Los Angeles. We devote particular attention to the needs of our over-sized patients and the unique challenges they bring to their famlies when they die. As most of my families have little if any resources to provide a traditional funeral, much less the added funerary expenses involved with larger persons, we developed a protocol for maintaining their dignity, preservation, and privacy that mirrors the care of patients with a lesser habitus (we call our expired patients 'patients' after they die,because they are stil in our care). We have a cooling protocol if they are unabe to be placed in traditional morgue drawer the first 24-30 hours after death; we have contracted with a local mortuary with a room refrigeration system to hold them after that window, especially if the family needs a bit more time. We do not charge the families for this service.

Families appreciate having referrals to mortuaries who offer emotional support and reduced rates, knowing cremation is often their only option. It took time and patience to put it all in place -i.e. shaping the use of language and behavior, artfully crafting step-by-step instructions, and partnering with the funeral homes. The driving force behind the practice is love and acceptance - of the living and the dying, of the small and the not-so-small. If you have any questions, jet me an e-mail.

In my opinion the nursing education is not simply to raise awareness of rules and procedures, but to help learning how to get in touch with the cognitive and emotional processes present in places of care and that are started by caring of the patient.

We teachers should think of a training of health professionals that recognized the ethical and epistemological roots of nursing, putting at the center of caring enhancement of human relationship between nurse and patient.

The evolution of scientific knowledge takes place within different contexts of practice in relation to life stories, so nursing student has the need to deepen the emotional dimension of the experience of fragility and pain.

Anicia, we have some basic data from a study we did at one of our customer sites with some alarm data from a PedsICU. I am happy to share it with you. paul.mcgurgan@excel-medical.com

Evidenced based knowledge (EBK) is generated from scientific research while practice-based is knowledge (PBK) gained over time by means of practice (i.e. like apprenticeship).

If you notice, most apprentice know what they do but they do not understand the science or scientific rationale behind what they do. EBK makes a person to understand the science behind the practice. In this way (i.e. with EBK one is open to thinking outside the box, and can also apply the science to other situations.

Scientific reasoning affects practice. It makes practice flexible but PBK makes practice rigid as the technician cannot figure out another way of doing things other than what he has learnt through practice.

In my experience as faculty and dean in the college of nursing the prescribed number of hours and days allotted for related clinical experience as prescribed in the curriculum are adequate to meet the desired learning outcomes. We have competency appraisal course with 12 units (6 hours/week in 36 weeks). The competency appraisal course is offered in fourth year level of BS Nursing. On going clinical competence appraisal is being done during the entire semester.

Strategic curriculum planning is a good suggestion to address clinical formative evaluation and other related matters.

I don't know any questionnaires about this topic, however I suggest to check pulse oximetry to avoid fluid overload in haemodialysis patients. Indeed fluid overload is life threatening only if it impairs pulmonary gas exchange and hence decreases pulse oximetry. On the contrary leg edema is not life threatening and does not impair gas exchange.

At our facility, we use the Braden scale daily on every patient. A score of 9 or below gets an automatic consult to the wound care nurse who assesses the pt for treatment and preventative measures. Prevention is the key. It is a good tool for identifying at risk patients.

Plus this article to relate.

Alex:

There are several such reviews, including three Cochrane joint systematic reviews (SR) and meta-analyses [1,2,3], another joint SR/MA [4], two additional SRs [5,6], and three additional meta-analyses [7,8,9].

Note that there are over a dozen more non-systematic literature or narrative reviews that you may also find useful to consult; although not strictly systematic, nonetheless they are solid and comprehensive literature reviews on general and special issues relating to PDPH.

Good luck on your own research.

SR/MA on PDPH (Post-dural Puncture Headaches):

1. Arevalo-Rodriguez I, Ciapponi A, Munoz L, Roqué i Figuls M, Bonfill Cosp X. Posture and fluids for preventing post-dural puncture headache. Cochrane Database Syst Rev 2013; 7:CD009199.

2. Basurto Ona X, Uriona Tuma SM, Martínez García L, Solà I, Bonfill Cosp X. Drug therapy for preventing post-dural puncture headache. Cochrane Database Syst Rev 2013; 2:CD001792.

3. Boonmak P, Boonmak S. Epidural blood patching for preventing and treating post-dural puncture headache. Cochrane Database Syst Rev 2010; (1):CD001791.

4. Bradbury CL, Singh SI, Badder SR, Wakely LJ, Jones PM. Prevention of post-dural puncture headache in parturients: a systematic review and meta-analysis. Acta Anaesthesiol Scand 2013; 57(4):417-30.

5. Apfel CC, Saxena A, Cakmakkaya OS, Gaiser R, George E, Radke O. Prevention of postdural puncture headache after accidental dural puncture: a quantitative systematic review. Br J Anaesth 2010; 105(3):255-63.

6. Wu CL, Rowlingson AJ, Cohen SR, et al. Gender and post-dural puncture headache. Anesthesiology 2006; 105(3):613-8.

7. Richman JM, Joe EM, Cohen SR, et al. Bevel direction and postdural puncture headache: a meta-analysis. Neurologist 2006; 12(4):224-8.

8. Choi PT, Galinski SE, Takeuchi L, Lucas S, Tamayo C, Jadad AR. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anaesth 2003; 50(5):460-9.

9. Choi PT, Galinski SE, Lucas S, Takeuchi L, Jadad AR. Examining the evidence in anesthesia literature: a survey and evaluation of obstetrical postdural puncture headache reports. Can J Anaesth 2002; 49(1):49-56.

Concept mapping is the graphic illustration of concepts and relationship of concepts in a topic. It is an inductive teaching-learning process. Attached is sample concept map of topics in pediatric nursing

Interrelatedness of learning objectives, related learning experience, clinical practice environment, and evaluation tool; required competence of the nursing students; and teaching competence and nursing skills of the clinical instructor influence nursing students in clinical setting

I agree with Chika Ugochukwu recommending the use of Nursing process to provide individualized holistic care. In addition, nursing care should be holistic regardless of the method of nursing care. The body, mind and spirit are intertwined and inseparable.

I believe that being empathetic is one of the indicators of being emotionally intelligent. Empathy requires that one understands the needs of others, as if they were his/hers. Putting oneself in the place of others is an art. Moreover, feeling of others without getting too much involved to the degree that one cannot be of value in helping others is not an easy task. In short, emotional EI is using ones emotions in a constructive manner and relate to people in the most appropriate way.

Benner & Wrubel actually responded to Edwards' article, please see Benner, P., & Wrubel, J. (2001). Response to: Edwards S.D. (2001) Benner and Wrubel on caring in nursing. Journal of Advanced Nursing 33(2), 16-171. Journal of Advanced Nursing, 33(2), 172-4.

Talking about autonomy of nurses is an old as well as ever new topic. In my opinion autonomy is not given but instead it is gained. Proving to hospital managers and other health care personnel that you are competent and are doing your job in the best possible way is important to gain confidence and independence. In addition nurse managers and leaders either facilitate or inhibit the autonomy of nurses. Being assertive and defending the nurses' rights and empowering nurses are important to gain autonomy.

Hi Laura,

This is an area that can create a lot of angst for clinicians in understanding what the family and patient require in providing support, education and promoting well-being of the patient, but also recognizing what stage of grief and loss cycle the family may be experiencing. The ability to roll with resistance and change is an important analogy as mental and general healthcare clinicians, we want to provide patient and family centered care while trying to maintain a family systems perspective. Often as we know this takes a multidisciplinary and consistent approach to assist the family and patient in understanding the path to recovery and the available treatment and therapy options.

I hope these articles may be of some help:

What evidence and guidelines exists on how best to resolve conflict through education and patient/family collaboration in plan of care for recovery?

Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004–2005

Collaborative Communication in Pediatric Palliative Care: A Foundation for Problem-Solving and Decision-Making. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2151773/

Implementing Team Approaches in Primary and Tertiary Care Settings: Applications from the Rehabilitation Context.

Given et al (2001). Family Support in Advanced Cancer http://onlinelibrary.wiley.com/doi/10.3322/canjclin.51.4.213/pdf

Consumer-oriented interventions for evidence-based

prescribing and medicines use: an overview of systematic

reviews (Review)

Sorry about the long entry, but hope this is some help.

James

Dear Myfanwy,

in my opinion it could be useful to "train" nurses in order to care about "bad-news communicating"; everyday we see doctors that maybe are not so empathyc or have not enough time to explain, answer etc. with family members of a patient.

Although this kind of work has always been linked with the figure of the doctor, I really think that a nurse can do this job and can do it better, because the point is that a nurse has the competence to speak clearly and professionally but has also a "strict relation" with the patient, so a nurse can be more empathyc with families.

In my University, both medicine and nursering courses have lessons about this, although I think it's more something you "have inside" and you understand when you practice in hospital.

Best regards

Hi Alex,

In the USA, New York State has something called comfort care homes. They are terrific alternative for many people who may not have the resources to die in their own home but prefer a home like setting. The homes are non-profit and rely heavily on volunteers and philanthropic support. Patients are eligible if they have an estimated prognosis of 3 months or less.

Sally