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Background: A doctoral degree, either a PhD or equivalent, is the academic credential required for an academic nurse educator position in a university setting; however, the lack of formal teaching courses in doctoral programs contradict the belief that these graduates are proficient in teaching. As a result, many PhD prepared individuals are not ready to meet the demands of teaching. Methods: An integrative literature review was undertaken. Four electronic databases were searched including the Cumulative Index to Nursing & Allied Health Literature (CINAHL), PubMed, Educational Resources Information Center (ERIC) and ProQuest. Date range and type of peer-reviewed literature was not specified. Results: Conditions and factors that influenced or impacted on academic nurse educators' roles and continue to perpetuate insufficient pedagogical preparation include the requirement of a research focused PhD, lack of mentorship in doctoral programs and the influence of epistemic cultures (including institutional emphasis and reward system). Other factors that have impacted the academic nurse educator's role are society's demand for highly educated nurses that have increased the required credential, the assumption that all nurses are considered natural teachers, and a lack of consensus on the practice of the scholarship of teaching. Conclusions: Despite recommendations from nursing licensing bodies and a major US national nursing education study, little has been done to address the issue of formal pedagogical preparation in doctoral (PhD) nursing programs. There is an expectation of academic nurse educators to deliver quality nursing education yet, have very little or no formal pedagogical preparation for this role. While PhD programs remain research-intensive, the PhD degree remains a requirement for a role in which teaching is the major responsibility. [ABSTRACT FROM AUTHOR]

Objective: Critical illness affects health systems globally, but low- and middle-income countries (LMICs) bear a disproportionate burden. Due to a paucity of data, the capacity to care for critically ill patients in LMICs is largely unknown. Haiti has the lowest health indices in the Western Hemisphere. In this study, we report results of the first known nationwide survey of critical care capacity in Haiti. Design: Nationwide, cross-sectional survey of Haitian hospitals in 2017–2018. Setting: Haiti. Subjects: All Haitian health facilities with at least six hospital beds. Interventions: Electronic- and paper-based survey. Results: Of 51 health facilities identified, 39 (76.5%) from all ten Haitian administrative departments completed the survey, reporting 124 reported ICU beds nationally. Of facilities without an ICU, 20 (83.3%) care for critically ill patients in the emergency department. There is capacity to ventilate 62 patients nationally within ICUs and six patients outside of the ICU. One-third of facilities with ICUs report formal critical care training for their physicians. Only five facilities met criteria for a Level 1 ICU as defined by the World Federation of Societies of Intensive and Critical Care Medicine. Self-identified barriers to providing more effective critical care services include lack of physical space for critically ill patients, lack of equipment, and few formally trained physicians and nurses. Conclusions: Despite a high demand for critical care services in Haiti, current capacity remains insufficient to meet need. A significant amount of critical care in Haiti is provided outside of the ICU, highlighting the important overlap between emergency and critical care medicine in LMICs. Many ICUs in Haiti lack basic components for critical care delivery. Streamlining critical care services through protocol development, education, and training may improve important clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: This study reports on physicians’ experiences with chronic pain management. For over a decade prescription opioids have been a primary treatment for chronic pain in North America. However, the current opioid epidemic has complicated long-standing practices for chronic pain management which historically involved prescribing pain medication. Caring for patients with chronic pain occurs within a context in which a growing proportion of patients suffer from chronic rather than acute conditions alongside rising social inequities. Methods: Our team undertook an ethnographic approach known as institutional ethnography in the province of Ontario, Canada in order to explore the social organization of chronic pain management from the standpoint of primary care physicians. This paper reports on a subset of this study data, specifically interviews with 19 primary care clinicians and 8 nurses supplemented by 40 hours of observations. The clinicians in our sample were largely primary care physicians and nurses working in urban, rural and Northern settings. Findings: In their reflections on providing care for patients with chronic pain, many providers describe being most challenged by the work involved in helping patients who also struggled with poverty, mental health and addiction. These frustrations were often complicated by concerns that they could lose their license for inappropriate prescribing, thus shifting their work from providing treatment and care to policing their patients for malingering and opioid abuse. Interpretation: Our findings show that care providers find the treatment of patients with chronic pain–especially those patients also experiencing poverty–to be challenging at best, and at worst frustrating and overwhelming. In many instances, their narratives suggested experiences of depersonalization, loss of job satisfaction and emotional exhaustion in relation to providing care for these patients, key dimensions of burnout. In essence, the work that they performed in relation to their patients’ social rather than medical needs seems to contribute to these experiences. Their experiences were further exacerbated by the fact that restricting and reducing opioid dosing in patients with chronic pain has become a major focus of care provision. [ABSTRACT FROM AUTHOR]

Aims To synthesize evidence and knowledge from published research about nurses' experiences of nurse-patient relationships with adult patients in general, acute inpatient hospital settings. Background While primary research on nurses' experiences has been reported, it has not been previously synthesized. Design Meta-ethnography. Data sources Published literature from Australia, Europe, and North America, written in English between January 1999-October 2009 was identified from databases: CINAHL, Medline, British Nursing Index and Psyc INFO. Review methods Qualitative studies describing nurses' experiences of the nurse-patient relationship in acute hospital settings were reviewed and synthesized using the meta-ethnographic method. Results Sixteen primary studies (18 papers) were appraised as high quality and met the inclusion criteria. The findings show that while nurses aspire to develop therapeutic relationships with patients, the organizational setting at a unit level is strongly associated with nurses' capacity to build and sustain these relationships. The organizational conditions of critical care settings appear best suited to forming therapeutic relationships, while nurses working on general wards are more likely to report moral distress resulting from delivering unsatisfactory care. General ward nurses can then withdraw from attempting to emotionally engage with patients. Conclusion The findings of this meta-ethnography draw together the evidence from several qualitative studies and articulate how the organizational setting at a unit level can strongly influence nurses' capacity to build and sustain therapeutic relationships with patients. Service improvements need to focus on how to optimize the organizational conditions that support nurses in their relational work with patients. [ABSTRACT FROM AUTHOR]

Aim: The current vs desired brand position of the nursing profession is examined using brand theory. Background: The nursing brand has a long and revered image with various stakeholder groups. However, the current image frequently represents nurses as caring advocates rather than Influential Leaders who deliver, manage and administer health care services. Evaluation: Recent quantitative field research describes perceptions of nurses' current vs desired brand position. A perceptual map illustrated a gap on the axes of Patient‐Centered Caregivers and Leaders in Healthcare. Empirical literature provided the foundation for prescriptive advice, which could address potential threats and opportunities for the brand. Key Issue: Brand theory is used to describe how nurses' current image seems at odds with nurses' role in contemporary society. The largest gap on the perceptual map was on the 'Leadership Axis', suggesting more effort is needed to change perceptions of the essential leadership role of nurses in various health care systems. Implications for Nursing Management: The nursing profession needs to implement branding strategies, which close the gap between the current and desired brand positions. The central brand position of nurses as leaders should thread throughout practice, education, research and professional associations for effective brand repositioning to occur. [ABSTRACT FROM AUTHOR]

Aim: This study aims to synthesize the factors associated with nurse emigration from lower and middle‐income countries. Design: Integrative review. Methods: An in‐depth search of registries and five databases yielded 9466 records. Using the PRISMA guidelines, 11 were chosen after screening by two authors independently. The mixed methods appraisal tool (MMAT) was used to assess the risk of bias. Results: The destination countries were Europe and North America, with an inclination for nurse migration of 14.3%–85%. Emigration factors were poor salary, working conditions, poor quality healthcare infrastructure; outdated healthcare technologies, lack of employment opportunities, younger age, relationship status (single), living environment, social pressure, urban residence, work experience, insecurity, high crime rates, political corruption and foreign language skills. Public Contribution: Healthcare authorities and nursing leaders must implement practical measures to minimize nurse emigration. [ABSTRACT FROM AUTHOR]

This essay argues that the British Army's North American general hospital and an increasingly large and diverse group of army women became not only connected but dependent on one another during the Seven Years' War. This relationship derived from the army's reorganization of its medical services in a way that intentionally predicated the hospital's operation and success on army women working for it, particularly as nurses. Both the medical staff and women attached to regular and provincial regiments realized benefits from this linkage; the hospital was able to cope with increasingly large numbers of patients, and women found that serving as nurses provided them with reliable access to regimental provisioning and security. Yet hospital personnel also increasingly had to regulate army women on behalf of the regiments, while women working for the hospital faced heightened dangers of illness, military attack, enemy capture, and death. [ABSTRACT FROM AUTHOR]

The impact of managed care on nurses’ workplace learning and teaching This paper examines the impact of managed care on the informal learning process for nurses in a major US-based health organisation. Through the analysis of focus group data we report the nurses’ view of the effect recent changes have had on the nurse/patient/care relationship. Managed care, our research indicates, has transformed the learning milieus for nurses with two effects. First, nurses have seen their need for informal learning increase while the time and context for that learning has diminished. Second, the process of teaching patients and families has also been adversely affected even as managed care creates the need for more patient education. We report the analysis of the data collected at group interviews involving nurses working in both hospital and community settings of a leading US-based HMO. All interviews took place during September of 1997 at various sites in California. This study is part of a larger Social Science Research Council of Canada funded investigation into managed care in the US and Canada. [ABSTRACT FROM AUTHOR]

Background: Non‐pharmacologic interventions might be effective to reduce the incidence of delirium in pediatric intensive care units (PICU). Aim: To explore expert opinions and generate informed consensus decisions regarding the content of a non‐pharmacologic delirium bundle to manage delirium in PICU patients. Study design: A two‐round online Delphi study was conducted from February to April 2021. PICU experts (nurses, physicians, researchers, physical therapists, play specialists, and occupational therapists) located in Europe, North America, South America, Asia, and Australia participated. Results: We developed a questionnaire based on the outcomes of a comprehensive literature search in the domains: 1) cognition support; 2) sleep support; and 3) physical activity support. Under these domains, we listed 11 strategies to promote support with 61 interventions. Participants rated the feasibility of each intervention on a 9‐point Likert scale (ranging from 1 strongly disagree to 9 strongly agree). A disagreement index and panel median were calculated to determine the level of agreement among experts. In the second round, participants reassessed the revised statements and ranked the interventions in each domain in order of importance for age groups: 0–2, 3–5, and 6–18 years of age. During the first Delphi round, 53 of 74 (72%) questionnaires were completed, and in the second round 45 of 74 (61%) were completed. Five of the highest ranked interventions across the age groups were: 1) developing a daily routine, 2) adjusting light exposure according to the time of day, 3) scheduling time for sleep, 4) providing eyeglasses and hearing aids if appropriate, 5) encouraging parental presence. Conclusions: Based on expert consensus, we developed an age‐specific non‐pharmacologic delirium bundle of interventions to manage delirium in PICU patients. Relevance to Clinical Practice: An age‐specific Non‐Pharmacological Delirium bundle is now ready to be tested in the PICU and will hopefully reduce pediatric delirium. [ABSTRACT FROM AUTHOR]

Aims: The aim was to assess the current literature investigating health activism within nursing practice. Design: This was a scoping review of the literature utilizing the updated Levac et al.'s framework. Data Source/Review Methods: A search of the CINAHL, PubMed, Scopus and Allied Health databases was conducted for peer‐reviewed, English research published between January 2000 and April 2021. Results: Thirty‐one articles met the criteria for inclusion in this study. The included research in nursing and health activism was heterogeneous in topic and method and primarily conducted in North America. Four themes resulted from the inductive thematic analysis: (1) Doing Health Activism, (2) Facilitators to Engaging in Health Activism, (3) Barriers to Health Activism Engagement and (4) Limited Education. Activism was not consistently defined and the term was used interchangeably with advocacy. Conclusion: There is a gap between nursing scope of practice, and education and skills in health activism. There is limited research regarding health activism and what constitutes as health activism. There is an opportunity to improve health activism awareness and skills within the nursing profession and undergraduate education and to produce nursing research on health activism. Impact Health activism is integral to the nursing role, however, evidence suggests nurses lack confidence to engage in activism as practice. This is important for nurses across the world and in all care specialities. [ABSTRACT FROM AUTHOR]

Background: Hospitalisation of a child is a unique opportunity for health staff to offer smoking cessation support; that is screening for carer smoking status, discussing cessation and providing interventions to carers who smoke. This has the potential to reduce the child's exposure to second-hand smoke, and in turn tobacco related illnesses in children. However, these interventions are not always offered in paediatric wards. The aim of this study was to explore the provision and prioritisation of smoking cessation support to patient carers in a paediatric ward with a high proportion of Aboriginal patients and carers in a regional area of Australia's Northern Territory. Methods: This is a qualitative descriptive study of data collected through semi-structured interviews with 19 health staff. The interviews were audio recorded and transcribed verbatim. Thematic analysis was performed on the transcripts. Results: We found low prioritisation of addressing carer smoking due to, a lack of systems and procedures to screen for smoking and provide quitting advice and unclear systems for providing more detailed cessation support to carers. Staff were demotivated by the lack of clear referral pathways. There were gaps in skills and knowledge, and health staff expressed a need for training opportunities in smoking cessation. Conclusion: Health staff perceived they would provide more cessation support if there was a systematic approach with evidence-based resources for smoking cessation. These resources would include guidelines and clinical record systems with screening tools, clear action plans and referral pathways to guide clinical practice. Health staff requested support to identify existing training opportunities on smoking cessation. [ABSTRACT FROM AUTHOR]

Aim: To determine if smart alarm‐guided treatment of respiratory depression using the Integrated Pulmonary Index is an effective way to implement capnography during nurse‐administered sedation. Design: Parallel cluster‐randomized trial. Methods: Nurses will be randomized to use capnography with or without the Integrated Pulmonary Index enabled. Capnography alarm performance will be compared between nurses using capnography alone or with the Integrated Pulmonary Index enabled. The target sample size is 400 adult patients scheduled for elective procedures with nurse‐administered sedation. The primary outcome is the number of seconds in an alert condition state without an intervention being applied. Secondary outcomes are alarm burden, number of appropriate alarms, number of inappropriate alarms, total duration of alert conditions, choice of alarm settings and adverse sedation events. This study has been funded since April 2021. Discussion Implementing capnography into practice for respiratory monitoring during nurse‐administered sedation is considered a high priority. The Integrated Pulmonary Index shows promise as a strategy to optimize the implementation of capnography for respiratory monitoring during nurse‐administered sedation. If it is found in this study that using the Integrated Pulmonary Index improves the nursing management of physiologically abnormal states during nurse‐administered sedation, it would provide the high‐level evidence needed to support broader use of this 'smart alarm' strategy for respiratory monitoring in practice. Impact With advances in medical technology continuing to expand the indications for minimally invasive surgical techniques, the use of nurse‐administered sedation during medical procedures is likely to expand in the future. The findings may be applied to other populations receiving nurse‐administered sedation during medical procedures. Results from this study will help translate the usage of smart alarm‐guided treatment of respiratory depression during procedural sedation. Trial registration: NCT05068700. [ABSTRACT FROM AUTHOR]

The impact of managed care on nurses’ workplace learning and teaching This paper examines the impact of managed care on the informal learning process for nurses in a major US-based health organisation. Through the analysis of focus group data we report the nurses’ view of the effect recent changes have had on the nurse/patient/care relationship. Managed care, our research indicates, has transformed the learning milieus for nurses with two effects. First, nurses have seen their need for informal learning increase while the time and context for that learning has diminished. Second, the process of teaching patients and families has also been adversely affected even as managed care creates the need for more patient education. We report the analysis of the data collected at group interviews involving nurses working in both hospital and community settings of a leading US-based HMO. All interviews took place during September of 1997 at various sites in California. This study is part of a larger Social Science Research Council of Canada funded investigation into managed care in the US and Canada. [ABSTRACT FROM AUTHOR]

The article focuses on outbreak of epidemics and pandemics including Ebola, Severe Acute Respiratory Syndrome (SARS) and Coronavirus (COVID-19) and mentions implementation of lockdown of Hubei province. Topics discussed including nursing informatics community responding to crisis and lessons learned, reduction of impact of the disease on the country's healthcare system and e-learning technologies to ensure nursing students.

With the advent of continuous antiretroviral therapy, HIV has become a complex chronic, rather than acute, condition. The Chronic Care Model (CCM) provides an integrated approach to the delivery of care for people with chronic conditions that could therefore be applied to the delivery of care for people living with HIV. Our objective was to assess the alignment of HIV care settings with the CCM. We conducted a mixed methods study to explore structures, organization and care processes of Canadian HIV care settings. The quantitative results of phase one are published elsewhere. For phase two, we conducted semi-structured interviews with key informants from 12 HIV care settings across Canada. Irrespective of composition of the care setting or its location, HIV care in Canada is well aligned with several components of the CCM, most prominently in the areas of linkage to community resources and delivery system design with inter-professional team-based care. We propose the need for improvements in the availability of electronic clinical information systems and self-management support services to support better care delivery and health outcomes among people living with HIV in Canada. [ABSTRACT FROM AUTHOR]

In this essay, I advance an argument against the expansion and acceptance of postmodern metaphysical antirealist ideologies in the development of nursing theory in North America. I suggest mystical theoretical explanations of care, the rejection of empirical epistemology, and a return to divinity in nursing represent an intellectual dead end, as these ideas do little to help resolve real-world health issues and also negate the need for the academic discrimination of bad ideas. I examine some of the philosophical foundations of nursing theory and deconstruct some of the more preternatural theories that have become established as the dominant conventional wisdom in the academy. It is argued that this can be characterized as a form of self-deception, and overall has had a negative impact on advancement of the nursing profession and public health care. Reasons behind the widespread acceptance of these irrational theoretical stances in nursing and the ongoing support for mystical therapeutic interventions are explored. [ABSTRACT FROM AUTHOR]

Aim To synthesize knowledge, attitudes and experiences of health professionals about Female Genital Mutilation. Background Despite the World Health Organization campaigning to stop FGM, and it being illegal in many countries, the practice remains common in some countries and cultures. Migration has contributed to the growth of this practice in countries where it was not previously carried out. Design Mixed-method synthesis. Data sources Search of ten electronic databases: 2006-2014. Manual scanning of reference lists and summary feeds from international organizations such as WHO, UN and UNICEF. Review methods Thematic synthesis comparing country of origin where the practice was common with country of residence where migrant women affected by the practice reside. 17 included descriptive, quantitative, qualitative studies and grey literature studies in English or Spanish. Results Seven themes were developed: Ignorance of FGM practice and its consequences; Lack of adherence to FGM protocols and guidelines; Socially constructed acceptance of FGM; Ignorance of legislation and legal status of FGM; Condoning, sanctioning or supporting FGM; Lack of information and training; Nurses and Midwives as key to protecting and supporting girls and women Conclusions Although some nurses and midwives are in the forefront of eradicating FGM this is counterbalanced by health professionals (including nurses and midwives) who condone, sanction or support the practice with some calling for medicalization of FGM as a legitimate procedure. Girls at risk need better protection and women affected need more competent and cultural care from health professionals. Health and legal systems, professional regulation and governance, and professional training require strengthening to eradicate FGM, prevent the medicalization of FGM as an acceptable procedure, and to better manage the lifelong consequences for affected girls and women. [ABSTRACT FROM AUTHOR]

lodewijckx c., sermeus w., panella m., deneckere s., leigheb f., troosters t., boto p.a., mendes r.v., decramer m. & vanhaecht k. (2012) Quality indicators for in-hospital management of exacerbation of chronic obstructive pulmonary disease: results of an international Delphi study. Journal of Advanced Nursing 69(2), 348-362. doi: 10.1111/j.1365-2648.2012.06013.x Abstract Aim. To report a Delphi study that was conducted to select process and outcome indicators that are relevant to study quality of care and impact of care pathways for patients hospitalized with exacerbation of chronic obstructive pulmonary disease. Background. Management of patients hospitalized with exacerbation of chronic obstructive pulmonary disease is suboptimal and outcomes are poor. To evaluate the impact of care pathways properly, relevant indicators need to be selected. Design. Delphi study. Methods. The study was conducted over 4 months in 2008, with 35 experts out of 15 countries, including 19 medical doctors, 8 nurses and 8 physiotherapists. Participants were asked to rate, for 72 process and 21 outcome indicators, the relevance for follow-up in care pathways for in-hospital management of exacerbation of chronic obstructive pulmonary disease. Consensus (agreement by at least 75% of the participants) that an indicator is relevant for follow-up was sought in two rounds. Results. Consensus was reached for 26 of 72 process indicators (36·1%) and 10 of 21 outcome indicators (47·6%). Highest consensus levels were found for the process indicators regarding oxygen therapy (100%), pulmonary rehabilitation (100%) and patient education (94·5-88·6%) and for the outcome indicators concerning understanding of therapy (91·4-85·7%) and self-management (88·6-88·2%). Conclusion. The selected indicators appear to be sensitive for improvement. Therefore, researchers and clinicians that want to study and improve the care for patients hospitalized with exacerbation of chronic obstructive pulmonary disease should primarily focus on these indicators. [ABSTRACT FROM AUTHOR]

This article examines the flows of physicians and nurses from African countries to Europe and North America using available data sets. It offers a geographic perspective of the magnitude and flow of these skilled health care professionals and highlights positive and negative impacts of the flows on Africa’s development. The article further discusses the coercive and ‘carrot and stick’ strategies that African governments have employed during the past two decades in attempts to stem the tide of the flows of its health care professionals. It concludes by noting that while Africa can do nothing about the pull factors, it can mitigate the push factors by creating conducive working environments to help retain its health care professionals. [ABSTRACT FROM PUBLISHER]

To review relevant literature on expert practice in nursing to assess common characteristics across the breadth of nursing specialties and work settings. An integrative literature search was conducted with inclusion criteria: (a) primary studies of how clinical staff nurses develop and demonstrate expert practice; (b) subjects from variety of specialties, employment settings, and countries of origin; and (c) studies of clinical staff nurses and not nurses in advanced practice roles. Literature published between 1996 and 2009 was reviewed using MEDLINE and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) using the key words 'nursing,''expert,' and 'practice.' The characteristics of expert practice as explicated across a variety of specialty areas of practice and international settings included the following: knowing the patient, intuitive knowledge, reflective practice, risk taking, and skilled know-how. Involvement and engagement of the expert nurse with her or his patients underpin these characteristics. Themes were illustrated in a star model of nursing expert practice surrounded by support and grounded in emotional involvement. Expert practice develops as nurses gain experience in a specialized practice setting, reflect on and learn from their experience, and develop meaningful relationships with their patients, families, and colleagues. The findings provide an understanding of expert nursing practice that can serve as a foundation for efforts to transfer knowledge from expert nurses to less expert nurses in all practice settings to reduce the expertise gap that is now widening. [ABSTRACT FROM AUTHOR]

To provide an inclusive understanding of nurses' responses to suicide and suicidal patients that can benefit nursing practice and guide research. The question was 'What is a critical interpretive synthesis of accumulated nursing research on nurses' responses to suicide and suicidal patients?' Various studies address nurses' responses to suicide and suicidal patients. An understanding of accumulated research-based literature about nurses' responses to suicide and suicidal patients may guide nurses to care for suicidal patients in ways that facilitate suicide prevention and recovery. The design is reflexive and iterative. A Critical Interpretive Synthesis was conducted, which comprised of six phases: formulating the review question, searching the literature, sampling, determining quality, extracting data and conducting an interpretive synthesis. Qualitative content analysis and systematic review of literature was included in these phases. The results report the review question, literature review strategies, purposive sample (26 full-text studies published in peer reviewed journals, 1988-July 2009, conducted mostly in Europe and North American), quality determinants, data extraction into themes and an interpretive synthesis of four key concepts, i.e. critical reflection, attitudes, complex knowledge/professional role responsibilities, desire for support services/resources. This understanding of accumulated research-based literature enhances contextual, conceptual and methodological perspectives. Contextually, gaps exist in international research. Conceptually, the four key concepts can serve as a useful guide for nurses to understand their own and other nurses' responses to caring for suicidal patients in various settings. Methodologically, the Critical Interpretive Synthesis approach moved a small body of knowledge that varied in quality measures beyond an aggregate understanding. Understanding nurses' responses to suicide and suicidal patients may guide nurses to care for suicidal patients in ways that facilitate suicide prevention and recovery, thus addressing the urgent work of suicide prevention in the world. [ABSTRACT FROM AUTHOR]

As the demand for cultural awareness in the provision of nursing care continues to increase, nursing programs must develop creative and effective teaching strategies and curricula to address this need. The evaluation of a five year, funded, North American nursing exchange project developed and implemented by six partner universities in Canada, Mexico and the United States of America is described in this article. The project was designed to enable nursing students to increase cultural awareness, redefine their role relationships with nurses from the partner countries, and increase knowledge regarding the health care systems and role of the nurse in those countries. Findings provide evidence that teaching nursing through a prism of cultural awareness, using both a jointly taught online course and student and faculty exchanges across the three countries is an effective strategy to increase the level of cultural awareness in nursing students. [ABSTRACT FROM AUTHOR]

To identify which characteristics, wisdom, and skills are essential in becoming an effective Native American nurse leader. This will lead to the development of a curriculum suitable for Native American nurses. Design: A qualitative, descriptive design was used for this study. Focus groups were conducted in Polson, Montana. A total of 67 Native and non-Native nurses participated. Sixty-seven percent of them were members of Indian tribes. Data were content analyzed using Spradley's ethnographic methodology. Findings: Three domains of analysis emerged: point of reference for the leader (individual, family, community), what a leader is (self-actualized, wise, experienced, political, bicultural, recognized quiet presence, humble, spiritual, and visionary), and what a leader does (mentors, role models, communicates, listens, demonstrates values, mobilizes, and inspires). Discussion: Native nurse leaders lead differently. Thus, a leadership curriculum suitable for Native nurses may lead to increased work productivity and therefore improved patient care for Native Americans. [ABSTRACT FROM AUTHOR]

Nursing education strives to develop critical thinking through emphasis on process, inquiry, and reasoning. Although North American nursing education programs have recommended integrating the critical thinking construct into the conceptual framework that supports undergraduate nursing programs, critical thinking is still ambiguously and inconsistently applied within the profession. The research described in this article explored the development of thinking in five newly graduated baccalaureate RNs by accompanying them on the conceptual, theoretical, and practical evolutionary journey of their first 6 months in nursing practice and explicating their knowledge development over time, offering insights into the role of undergraduate education in teaching, and fostering critical thinking as an approach to nursing practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although there is a developing body of literature dealing with cultural care issues there is a continuing need for research based knowledge of how nurses work within a multicultural population in providing culturally competent care. Nurses' experiences with Vietnamese clients can contribute to the knowledge of how to provide cultural care. PURPOSE: The purpose of this 1997 study was to investigate what North American nurses learned from their work with Vietnamese clients. METHOD: A grounded theory approach was employed. A purposive sample of 27 Registered Nurses, who work with Vietnamese clients in North America, in acute care, community, and clinic settings were interviewed using a semi-structured format. Following ethical approval, an explanation of the study, and data collection, data were analysed using dimensional analysis. Verifiability, adequacy of the findings, and empirical grounding of the theory was established through use of the constant comparative method as well as review of the research method and the study results by selected participants in the study and a nursing expert. FINDINGS: The action process of cultural discovery was found as the most fruitful explanation of nurses' experiences. Properties of cultural discovery were learning to see them, seeing a common humanity, and learning to see how they see health. The condition of cultural discovery was making a connection with the consequences of learning how to provide sensitive care and a changed nurse. CONCLUSIONS: Nurses can learn to become more culturally competent in their care for Vietnamese clients. Nurses learned to be more aware of the differences among people of different cultures as well as recognizing common elements among different groups. They learned to broaden and redevelop their concept of health and to respect the social adjustments that the Vietnamese were making. [ABSTRACT FROM AUTHOR]