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One of the greatest challenges new graduates confront when transitioning to practice is establishing positive relationships with experienced nurses. Nursing faculty must prepare graduates for this challenge. However, nursing faculty are often removed from everyday practice and must rely on the perceptions of those entrenched in practice in order to ground teaching endeavors in authenticity. Nurse managers are well positioned to provide knowledgeable insights to nursing faculty regarding nurse relationships. The purpose of this qualitative, descriptive study was to explore nurse managers' perceptions regarding new graduates' relationships with more experienced nurses. Researcher-participant audiotaped interviews were conducted with 13 nurse managers. A content analysis revealed that all participants believed nurse relationships were significant, that factors such as perceived inequities and stressful occurrences triggered poor relationships, that new graduates were often targeted for negative relationships, and that reasons for targeting of new graduates included prolonged dependence on experienced nurses and either over or under confidence of the new graduate. Providing a supportive, protective environment and hiring practices that promote team unity were posed as strategies that could help to prevent targeting of new graduates. Findings provide real-life, practice based information that can underpin nurse educators' teaching regarding nurse relationships and relationship building., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Aim: The purpose of this study was to understand the insights of nurse managers regarding the nurse manager role., Background: Nurse managers are vital to the success of healthcare organizations. Vacancy rates of nurse manager positions are on the rise. Recruiting and retaining qualified individuals for these positions requires an understanding of the perceptions of nurse managers regarding the role and the issues embedded in the role., Methods: A descriptive, qualitative investigation was conducted. Data were analyzed using content analysis., Findings: Although desired, role orientation, mentorship, and a strong foundational knowledge, were often lacking. Personal attributes viewed as important for success in the role included seeking opportunities and intentional self-growth. Lessons learned while in the role included the art of managing role demands and that comfort comes with time., Conclusion: Concerns regarding the preparation for, introduction to, and support in the nurse manager role highlight the need for practice changes., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To determine the association of enteral nutrition (EN) with patient preinjury and injury characteristics and outcomes for patients receiving inpatient rehabilitation after traumatic brain injury (TBI)., Design: Prospective observational study., Setting: Nine rehabilitation centers., Participants: Patients (N=1701) admitted for first full inpatient rehabilitation after TBI., Interventions: Not applicable., Main Outcome Measures: FIM at rehabilitation discharge, length of stay, weight loss, and various infections., Results: There were many significant differences in preinjury and injury characteristics between patients who received EN and patients who did not. After matching patients with a propensity score of >40% for the likely use of EN, patients receiving EN with either a standard or a high-protein formula (>20% of calories coming from protein) for >25% of their rehabilitation stay had higher FIM motor and cognitive scores at rehabilitation discharge and less weight loss than did patients with similar characteristics not receiving EN., Conclusions: For patients receiving inpatient rehabilitation after TBI and matched on a propensity score of >40% for the likely use of EN, clinicians should strongly consider, when possible, EN for ≥25% of the rehabilitation stay and especially with a formula that contains at least 20% protein rather than a standard formula., (Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Morbid obesity increases the risk of complications and allograft failure in transplant patients. Bariatric surgery is both safe and effective in patients with chronic kidney disease and end-stage renal disease, improves eligibility for transplant based on body mass index, and does not affect postoperative immunosuppressant dosing regimens. Bariatric surgery in patients with liver disease has been shown to be safe and effective, although they remain at high risk in the setting of portal hypertension. Sleeve gastrectomy may become increasingly used both pretransplant and posttransplant, as it can result in low complication rates and excellent weight loss, and retains intestinal continuity., (Copyright © 2013 Elsevier Inc. All rights reserved.)

This qualitative study explored the experiences of clinical nurse leaders (CNLs) as they implemented this new role. Twenty-four CNLs participated. Data were collected via an e-mail-distributed questionnaire. Data from open-ended questions were used to conduct a qualitative content analysis. Data were categorized according to question, key thoughts and phrases were established, and themes were determined. Findings revealed that nonsystematic role introduction was common. Two challenges to role implementation included role confusion and being overworked. The most positive aspect of the role was remaining close to the point of care. Participants noted that the overall response of the health care team to the role was positive despite participants' belief that the greatest roadblock to role success was the lack of support by nurse administrators. The support of nurse administrators and clear role expectations were viewed as essential for role sustain-ability. Understanding the experiences of CNLs as they launch this new role can provide insights for educators, administrators, CNLs, and other health care providers regarding the success and sustainability of the role. In addition, understanding the similarities between the clinical nurse specialist (CNS) role initiation in the past and the CNL role initiation today can foster the development of strategies for confronting the challenges of new role implementation., (Copyright © 2012 Elsevier Inc. All rights reserved.)

This qualitative study explored second degree prelicensure master's graduates' attraction to the nursing profession, views on nursing, and thoughts regarding their contribution to nursing. Fourteen individuals participated from a cohort of master's students enrolled in a second degree program with a Clinical Nurse Leader focus. Data were collected through researcher-participant interviews. The researchers categorized data according to interview questions using constant comparison. Within each category, central themes emerged. Findings revealed that participants were drawn to nursing because of the opportunities and the caring nature of nursing. Participants felt prepared and excited to start a second career despite having to overcome challenges. They believed that their previous education enhanced their communication abilities and broadened their views; however, they encountered difficulties integrating previously held perspectives into a nursing worldview. They found poor nurse-to-nurse relationships among some experienced nurses and the difficulty of nursing education surprising. The opportunity to help others and the people for whom they provided care were the two features the participants most liked about nursing. Understanding such insights is important to continue to attract individuals from other careers to nursing. Findings highlight the important contributions that these individuals bring to the profession., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Older adults with macular degeneration use multiple driving strategies. A secondary analysis focused on driving strategies was conducted on data from two studies that had explored the experience of visual impairment in older adults diagnosed with macular degeneration. Findings revealed 24 driving strategies. Twelve categories emerged, reflecting two themes: (1) strategies used while performing the task of driving and (2) strategies used to continue driving. By understanding these strategies, nurses can assess the conditions under which these older adults drive and the risks taken. Findings guide nurses to counsel and educate older adults regarding driving.

Dissemination of research findings and effective clinical innovations is key to the growth and development of the nursing profession. Several avenues exist for the dissemination of information. One forum for communication that has gained increased recognition over the past decade is the poster presentation. Poster presentations are often a significant part of regional, national, and international nursing conferences. Although posters are frequently used to disseminate information to the nursing community, little is reported about actual poster presenters' experiences with preparation and presentation of their posters. The purpose of this article is to present insights derived from information shared by poster presenters regarding the poster preparation and presentation process. Such insights derived from the personal experiences of poster presenters may assist others to efficiently and effectively prepare and present scholarly posters that disseminate information to the nursing community., (Copyright 2001 by W.B. Saunders Company)

As the Councils move toward the new millennium, efforts to improve outcomes for patients with renal disease will be at the forefront. Each council has established a commitment to improving the quality of life for these individuals. Toward this goal, the CNNT, the CRN, and the CNSW will each propose programs to the NKF for improving the knowledge and skills of the professionals within these councils, promoting research within the respective scope of these professions, and working together to bring a better understanding of the issues confronted by the patients and the professionals as well. As an example of the combined effort of the Councils, the first joint project of the century will be to bring the communications packages of each council under a common framework by joining the newsletters of each council. It is an exciting time to be part of the NKF. As a professional in the renal community, being a part of the CNNT, the CRN, or the CNSW offers a professional enrichment and opportunities to participate in making lives better for those with renal disease.

The characteristics of rejection and rejection response have not been systematically described in renal transplant recipients. The Efficacy Endpoints Conference Database contains characteristics from 953 episodes of rejection occurring at 19 North American, European, and Australian transplant centers. This database was used to profile renal transplant rejection episodes treated with primary steroid therapy, primary antilymphocyte antibody therapy, and rescue antilymphocyte antibody therapy. Primary steroid therapy was used in 88% of the rejection episodes. A successful response was more common in recipients without fever (72% v 61%; P < 0.004), in recipients experiencing less than a Banff Grade III rejection (92% v 75%; P = 0.009), and was more likely associated with graft function at 1 year following the rejection than rejection episodes that failed steroid therapy (89% v 82%; P = 0.013). Steroid success was statistically identifiable by day 2 of therapy and clinically useful by day 3; serum creatinine on these days of therapy is shown as a ratio of the rejection creatinine (102% v 112% day 1, success v failure, P< 0.002; 104% v122% day 2, success v failure, P < 0.0001; 105% v125% day 3, success vfailure, P < 0.0001). Response to primary antilymphocyte antibody therapy reached significance at day 5 of therapy when serum creatinine decreased below the rejection creatinine level in antilymphocyte successes but remained at or above the rejection creatinine in those who failed the therapy (90% v 135%; P < 0.01). For rescue antilymphocyte antibody therapy, a response was evident after 5 days of therapy (approximately day 9 to 10 of rejection) when serum creatinine began to decline and continued lower throughout the 10-day course of antilymphocyte antibody therapy (day 14 to 15 of rejection; serum creatinine 3.0 mg/dL v 4.4 mg/dL for success v failure; P < 0.004). Serum creatinine was lower throughout the first year following therapy in each success group (steroids, antilymphocyte antibody therapy as primary or as rescue), and a greater percentage of failures of any of the three therapies resulted in graft loss. Interestingly, 1-year graft survival was not different in the patients who were treated with antilymphocyte antibody therapy as primary than those who received these antirejection agents as rescue therapy (81% and 84%, respectively). The Efficacy Endpoints Conference Database provides an essential tool for profiling acute rejection in renal transplantation and should lead to improved evaluation of rejection therapies.

Progress in transplantation therapeutics requires validation from multicenter trials in which enrollment criteria and endpoint definitions have been standardized. A database of acute rejection was established from 19 North American, European, and Australian transplant centers and included parameters on rejection diagnosis and treatment of 50 consecutive rejection episodes from each center. Patient demographics, induction and maintenance immunosuppressive therapies, antirejection agents (drug, dose, duration), clinical signs (decrease in urine volume, presence of fever of > or =38.5 degrees C), serum creatinine concentration (nadir, at rejection, daily during antirejection therapy to 15 days, and days 30, 90, 180, and 365 after rejection date), rejection biopsy findings, morbidity, recurrence of rejection, and renal function at 1 year were recorded for 953 rejection episodes. From these data, three definitions were proposed. Acute rejection was defined as an immunologic process resulting in a serum creatinine increase of > or =0.4 mg/dL, with or without clinical signs, and should include a biopsy confirmation that has been standardized to the Banff criteria. Corticosteroid-resistant rejection was defined as a rejection episode in which a minimum of 250 to 1000 mg of methylprednisolone administered as initial therapy fails to result in stabilization or reduction of the serum creatinine after 3 days of corticosteroid treatment. Successful response to therapy was defined as a serum creatinine level < or =110% of the serum creatinine on the day of the rejection diagnosis and a return of the serum creatinine to or below the rejection creatinine level by 5 days of therapy with maintenance of this response for a minimum of 30 days. The work represented in the Efficacy Endpoints Database provides a step toward improving definitions in clinical trials. Continuity in clinical trial design should lead to improvements in evaluation of outcomes and, thereby have an effect on clinical practice.

An international database of rejection episodes and their characteristics with regard to definition and follow-up parameters was developed to improve the approach to protocol development for clinical trials. Nineteen North American, European, and Australian centers uniformly reported on 50 consecutive transplant rejection episodes. Data collected included patient demographic parameters, induction and maintenance immunosuppression therapies, rejection agents (drug, dose, duration), clinical signs (50% decrease in urine, fever), serum creatinine (nadir, at rejection, daily during antirejection therapy to 15 days, and days 30, 90, 180, and 365 after rejection date), histopathological findings, morbidity, recurrence of rejection, and function at 1 year. The centers contributed a total of 953 presumed rejection episodes, of which 842 were confirmed as acute rejection episodes. The majority of cases were first rejections (81%), and rejection occurred 119 +/- 345 days following transplantation. The Banff Schema of histological grading was used in 38% of biopsy-proven rejection episodes (2% Borderline, 42% Grade I, 38% Grade II, 18% Grade III). Only 30% of all rejections showed clinical signs that were most likely to occur in Grade III rejection episodes (P < 0.006). The serum creatinine response was well below the rejection creatinine level by day 15 following initiation of antirejection therapy in the majority of cases. A significant number of the cases (34%) reported in this database experienced a recurrent rejection approximately 85 days following the first rejection. Graft survival 1 year following the rejection episode was good (83%). These findings will facilitate development of clinical trial design and beneficially impact approaches to antirejection therapies for kidney allograft recipients.

We evaluated 20 hemodialysis patients who had been treated with erythropoietin (Epo). All patients had hemoglobin levels below 8.5 g/dL. They were randomized to receive either Epo (100 U/kg) or placebo three times per week for 12 weeks. All patients on Epo had a significant (P less than 0.001) elevation of hematocrit levels (19.7% v 35.7%). They also had a significant (P less than 0.05) increase in midweek predialysis blood urea nitrogen (BUN) levels, 27.8 versus 29.6 mmol/L (78 v 83 mg/dL), and serum phosphorus, 1.8 versus 2.1 mm/L (5.7 v 6.6 mg/dL). Protein catabolic rate also increased significantly (P less than 0.05). No changes were seen in the levels of serum creatinine and potassium, but episodes of hyperkalemia were more frequent in patients on Epo. No changes were seen in patients on placebo. When hematocrit increased, the clearance of blood-water for urea decreased 9%, and the clearance of creatinine, potassium, and phosphorus decreased 15%. Patients on Epo increased both their appetite and protein intake. More frequent episodes of hyperkalemia and elevated phosphorus level resulted from a combination of increased intake and decreased dialyzer clearance. We may need blood-water clearance to calculate Kt/V.