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The shift to community-based practice presents challenges to traditional nursing education. One such challenge is that of student safety. The authors discuss the continuing efforts to develop an instrument to assess student perceptions of threats in the community as well the findings of a pilot study. Analysis of the data indicates that the Environmental Comfort Scale III is valid, reliable, and easy to administer and interpret.

A patient is successfully resuscitated after a trauma or serious illness. It is increasingly common for such a patient to report having experienced a feeling of calm and peace, a feeling of being separated from the body, and/or a sense of moving through a dark tunnel ending at a bright light. Such experiences are known as near death experiences. What are critical care nurses to make of such accounts reported to them by their patients? This article explores critical care nurses' interests in, knowledge of, and attitudes towards the near death experience, and it identifies nursing interventions that critical care nurses can use during and after the patient experiences near death.

Improvement of the health of the nation demands that we prepare nurses to deliver care to those within our urban settings. Yet students frequently are uncomfortable visiting clients in urban settings. Our initial efforts were to refine the Environmental Comfort Scale (Carter, Carroll, & Hayes, 1994), an instrument developed to measure comfort levels in various urban scenarios. This article reports the results of this instrument refinement as well as the inductive process leading to the initial conceptualization of a model that addresses threats to safety. These threats, in turn, generate fear of nursing in community-based settings. The study participants were 120 volunteer junior students in a baccalaureate nursing program. The Environmental Comfort Scale II was administered to students at the beginning of an orientation session prior to their initial clinical nursing course. The instrument consisted of 15 items: 3 demographic items, 11 items asking students to rate their level of comfort and of fear in relation to various urban situations, and 1 open-ended question. Analysis of data led to conceptualization of two factors that could influence comfort levels in the urban environment. The first factor was personal-emotional (affective) and the second factor was cognitive (objective). The interaction and interdependency of these two factors led to the creation of a model.

A state's decision to institute mandatory continuing education has ramifications for individuals involved in staff development and inservice education. In collaboration with the University of Delaware College of Nursing along with the Medical Center of Delaware, the Delaware Nurses' Association in 1990 assessed the continuing education needs and interests of a convenience sample of 547 registered nurse Delaware Nurses' Association members. Analysis of the data revealed a variety of interests within practice, education, administration, and research. The most preferred method of acquiring continuing education was attendance at a live conference, with part-day morning programs favored by a majority of the sample. Consequently, staff development and inservice educators are challenged with meeting the needs of the organization and the individual employee in an era of diminishing resources.

In October 1902, Lina Lavanche Rogers began her work in the New York City schools as the first school nurse in the United States. The purpose of this research was to examine the evolution of school nursing as it exemplifies development of a public health nursing specialty. Historiographic methodology was used. Primary sources included materials written by pioneers in school nursing. Secondary sources included journals, books, newspapers, biographical materials, and unpublished materials from the archives of health care and educational institutions and agencies. Public health nurses in 1902 had a model for practice that was considerably more independent and interdependent than that characterizing the practice of hospital nurses. From its origins in public health nursing, the role of the school nurse shrunk in many school systems to that of dispenser of bandages and aspirins, only to return once more to an advanced practice model. HIV, tuberculosis, sexually transmitted diseases, addiction, and violence have returned and/or replaced the contagious diseases of 1902 and the early years of school nursing. New immigrants, poverty, homelessness, and lack of primary care offer challenges to school nurses to meet the needs of schoolchildren and their families in the 1900s.

Cities, formerly the hub of cultural activities and entertainment, are now more often associated with crime statistics and poverty. Students' emotional comfort and safety must therefore be prime considerations in planning community-based nursing education. This study piloted an instrument that promises to be useful in labeling situations that affect an individual's comfort level in an urban setting. Questions that guided the study included: (1) Does the Environmental Comfort Scale (ECS) score vary with the respondents' residential zone (urban = 1, suburban = 2, rural = 3)? (2) Is the instrument (Environmental Comfort [Fear] Scale) reliable? A one-shot, one-group, pre-experimental design was employed. Participants were self-selected from a junior baccalaureate nursing class (N = 79) that was a predominantly suburban-bred, relatively privileged population. The ECS contained nine specific environmental-situation items that could be construed as potentially threatening to safety. Respondents were to indicate on a five-point Likert scale the extent to which they would be fearful in each situation; 1 = least fearful and 5 = most fearful. Findings showed practically no difference in responses by residential zone and suggest a need for item refinement and a need to lengthen the tool to improve alpha coefficients. Further, the increasing demand for measurable outcomes underscores the need for continued work on instruments to produce such data. The deinstitutionalization of health care from contained grounds to uncontained community-based settings makes it imperative that nursing education attend to the challenges of safety education.

This study reports on the effectiveness of the attributional approach for evaluating outcomes of bicultural nurse-client interactions. Data for retrospective analysis were drawn from junior baccalaureate nursing students' (N = 16) self-evaluations of a one-to-one experience with a low-income, elderly, minority, urban resident. This data collection site, a wellness center in the resident/participant's high-rise apartment building, was ideal because of the relative control of variables that tend to raise caregiver anxiety and confound outcomes of nurse-client bicultural interactions in community-based settings. Faculty found the attributional tool to have major advantages involving the students' preconceived ideas and plans for person growth. Multicultural population trends and expanding community-based nursing practice needs make it imperative that barriers in bicultural situations be addressed.

Laboratory test results are a valuable source of information. Nurses need to assess laboratory test results as part of the physical assessment of their patients. Comparison of laboratory test results and changes with abnormal physical findings provides the basis for changes in the nursing care plan. Progressive monitoring of laboratory results and prompt interventions might lessen the seriousness of the health problem. In acute care units, the initial group of laboratory tests serves as a baseline for assessing additional test results. Several reference values should be remembered, particularly the electrolytes (potassium, sodium, and calcium), glucose, BUN, creatinine, and albumin. Specific group profiles assist in identifying and in monitoring the patient's health status. Incorporating laboratory test results into the plan and evaluation of care will result in safer and more effective patient care. Referring to laboratory test findings and comparing them with physical assessment findings are required for the delivery of professional nursing care.