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Rationale, Aims, and Objectives: Valid and reliable instruments for measuring are needed. To add knowledge to the subject of tools of evidence-based practice (EBP) evaluation in mainland China, the present study aims to translate the Quick-EBP-VIK into Chinese, which is an instrument for the assessment of nurses' value, knowledge, and implementation of EBP, and to evaluate the metric characteristics of the Chinese version., Methods: In this methodological study, a total sample of 402 nurses from mainland China was applied. Construct validity was evaluated by using factor analysis and further supported through known-group validity. A panel of experts examined the content validity. Internal consistency was determined using composite reliability and Cronbach alpha. The intraclass correlation coefficient (ICC) was calculated to assess test-retest reliability., Results: The exploratory factor analysis revealed a three-factor structure model same to the original instrument. The confirmatory factor analysis showed a good fit model with a comparative fit index of 0.957 and a root mean square error of approximation of 0.065. Significant differences were found in the item means of the tool between nurses who received EBP training and those who had not, which supported the known-group validity. The Cronbach alpha and composite reliability for the three subscales were all higher than 0.70. The ICC ranged from 0.569 to 0.928 for the three subscales and from 0.494 to 0.903 for the items included in the instrument., Conclusion: The Chinese version of the Quick-EBP-VIK has evidence of acceptable reliability and validity and can be used to measure value, knowledge, and implementation of EBP for Chinese nurses., (© 2018 John Wiley & Sons, Ltd.)

The Nursing and Midwifery Council is a 4-country regulator. Our remit covers Wales, Scotland, Northern Ireland and England, which is reflected in the membership of our council and many of our activities.

Purpose: To describe the presence or absence of key components of hospital pressure ulcer (PU) prevention programs in 6 acute care hospitals., Design: Multisite comparative case study., Subjects and Setting: Using purposeful selection based on PU rates (high vs low) and hospital size, 6 hospitals within the Veterans Health Administration health care system were invited to participate. Key informant interviews (n = 48) were conducted in each of the 6 participating hospitals among individuals playing key roles in PU prevention: senior nursing leadership (n = 9), nurse manager (n = 7), wound care specialist (n = 6), frontline RNs (n = 26)., Methods: Qualitative data were collected during face-to-face, semistructured interviews. Interview protocols were tailored to each interviewee's role with a core set of common questions covering 3 major content areas: (1) practice environment (eg, policies and wound care specialists), (2) current prevention practices (eg, conduct of PU risk assessment and skin inspection), and (3) barriers to PU prevention. We conducted structured coding of 5 key components of PU prevention programs and cross-case analysis to identify patterns in operationalization and implementation of program components across hospitals based on facility size and PU rates (low vs high)., Results: All hospitals had implemented all PU prevention program components. Component operationalization varied considerably across hospitals. Wound care specialists were integral to the operationalization of the 4 other program components examined; however, staffing levels and work assignments of wound care specialists varied widely. Patterns emerged among hospitals with low and high PU rates with respect to wound care specialist staffing, data monitoring, and staff education., Conclusion: We found hospital-level variations in PU prevention programs. Wound care specialist staffing may represent a potential point of leverage in achieving other PU program components, particularly performance monitoring and staff education.

Background: In previous studies, deficiencies in nursing students' medication competence have been highlighted. However, the focus of research has been limited especially to medication calculation competence and factors associated with it. In order to develop undergraduate nursing education and research, an understanding of the individual and learning environmental factors associated with medication competence from a broader approach is warranted. Our aim was therefore to evaluate the theoretical, practical and decision-making competence of nursing students and to identify factors associated with their medication competence at the beginning and end of their education., Methods: We used a descriptive, correlational study design with a structured instrument including a set of potential associated factors, knowledge test, medication calculation test and patient vignettes. The participants were nursing students at the beginning (n = 328) and at the end of their education (n = 338). Data were analyzed statistically., Results: In the evaluation of theoretical medication competence, the students' mean score over the semesters was 72 % correct answers in a knowledge test. In the evaluation of practical medication competence, the mean score was 74 % correct answers in a medication calculation test. In the evaluation of decision-making competence, the mean score was 57 % correct answers on deciding the best action in the situation given in patient vignettes. At the end of their education, students were able to solve patient vignettes significantly better. Individual factors were most evidently associated with medication competence. At the beginning of their education, students' previous academic success had a stronger association with medication competence. However, at the end of the education students' abilities in self-regulated learning and study motivation were more significant factors., Conclusion: The core elements of medication competence are significantly interrelated, highlighting the need to provide integrated and comprehensive medication education throughout the undergraduate education. Students' learning style is associated with medication competence. There is a need for methods to identify and support students having difficulties to self-regulate their learning. To increase the safety of medication care of patients, research focusing on the development of effective teaching methods is needed. This study produced information for future nursing education research in this field, especially for interventional studies.

Transitioning from a department to a school of nursing creates an environment that is more conducive to attracting qualified faculty and enhancing program growth to meet the projected nursing workforce needs. A comprehensive review of the literature revealed limited research to guide nursing programs considering this transition. This qualitative study explored the conditions and outcomes associated with successful or unsuccessful attempts to transition from a department to school of nursing from the perspective of 10 deans affiliated with the American Association of Colleges of Nursing (AACN). Meleis' transitions theory (2010) guided this study in its exploration of facilitating and inhibiting conditions. With institutional review board approval and participant permission, interviews were conducted in-person or by telephone, audio-recorded, and transcribed verbatim. Transcripts were independently reviewed and coded for emerging themes. Content analysis revealed the following themes: titles matter, support is essential, voice at the table, buy-in or dissension, it just brings nursing to totally different level, think differently, and legitimizing your position. For these deans, consideration of the facilitating and inhibiting conditions is critical in determining whether decisions are favorable and in support of the transition. Developing an understanding from the experiences of these 10 deans offers guidance to nursing academic administrators who are contemplating transitioning from a department to a school of nursing. Future research is needed to explore conditions relative to faculty governance and infrastructure, examine the experiences of those undergoing transitions, and expand study findings to develop a self-study guide for programs in assessing their readiness for such a transition., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: We examined the evaluations given by nurses to obstetrics and gynecology residents to estimate whether gender bias was evident., Background: Women receive more negative feedback and evaluations than men-from both sexes. Some suggest that, to be successful in traditionally male roles such as surgeon, women must manifest a warmth-related (communal) rather than competence-related (agentic) demeanor. Compared with male residents, female residents experience more interpersonal difficulties and less help from female nurses. We examined feedback provided to residents by female nurses., Methods: We examined Professional Associate Questionnaires (2006-2014) using a mixed-methods design. We compared scores per training year by gender using Mann-Whitney and linear regression adjusting for resident and nurse cohorts. Using grounded theory analysis, we developed a coding system for blinded comments based on principles of effective feedback, medical learners' evaluation, and impression management. χ examined the proportions of negative and positive and communal and agentic comments between genders., Results: We examined 2,202 evaluations: 397 (18%) for 10 men and 1,805 (82%) for 34 women. Twenty-three compliments (eg, "Great resident!") were excluded. Evaluations per training year varied: men n=77-134; women n=384-482. Postgraduate year (PGY)-1, PGY-2, and PGY-4 women had lower mean ratings (P<.035); when adjusted, the difference remained significant in PGY-2 (MWomen=1.5±0.6 compared with MMen=1.7±0.5; P=.001). Postgraduate year-1 women received disproportionately fewer positive and more negative agentic comments than PGY-1 men (positive=17.3% compared with 40%, negative=17.3% compared with 3.3%, respectively; P=.041)., Conclusion: Evidence of gender bias in evaluations emerged; albeit subtle, women received harsher feedback as lower-level residents than men. Training in effective evaluation and gender bias management is warranted.

Aim: The Creighton Competency Evaluation Instrument (CCEI) was modified from an existing instrument, the Creighton Simulation Evaluation Instrument, for use in the National Council of States Boards of Nursing National Simulation Study (NCSBN NSS)., Background: The CCEI was developed for the NCSBN NSS for use as the evaluation instrument for both simulation and traditional clinical experiences in associate and baccalaureate nursing programs., Method: Five nursing programs assisted with reliability and validity testing of the CCEI. Using a standardized validation questionnaire, faculty rated the CCEI on its ability to accurately measure student performance and clinical competency. Videos scripted at three levels of performance were used to test reliability., Results: Content validity ranged from 3.78 to 3.89 on a four-point Likert-like scale. Cronbach's alpha was > .90 when used to score three different levels of simulation performance., Conclusion: The CCEI is useful for evaluating both the simulation and traditional clinical environments.

Working necessarily with Likert scales to measure Nursing Outcomes Classification (NOC) outcomes has the advantage of unification, but also presents difficulty in reducing the rating from 1 to 5, especially when the research is qualitative and thus includes the use of words and expressions, as well as observations and perceptions. What exactly does a score of 2 or 3 mean with regard to the NOC Health beliefs? In this paper, we make a number of different proposals for operationalizing concepts and transforming them to numbers; however, it should be noted that such proposals always end in a quantitative analysis. Thus, we propose the use of emic/etic qualitative observations for psychosocial and cultural indicators, following ethnographic principles. Basic and applied research on nursing languages must have correct methodological foundations and seek to satisfy the same criteria of methodological suitability as any other research.

Introduction: To date, there has been little documentation of how practice-based midwifery networks in the United States might influence the transfer and development of knowledge in childbearing and women's health care. The first phase of this participatory action research project was to conduct a qualitative study with a community of midwifery practices to understand their perspectives on evidence-based practice and how an organized network could facilitate their work., Methods: Midwives within the community of interest were invited by letter or e-mail to participate in individual or small group interviews about knowledge transfer, primary concerns of evidence-based practice, and potential for a midwifery practice-based research network. Participatory action research strategies and organizational ethnographic approaches to data collection were used to guide qualitative interviews., Results: Eight midwifery practices enrolled in the study with 23 midwives participating in interviews. They attended births at 2 hospitals in the community. Two broad areas of discourse about evidence-based practice were identified: 1) challenges from influential persons, finances and resources, and the cultural perception of midwifery, and 2) strategies to foster best practice in the face of those challenges. The midwives believed a research network could be useful in learning collectively about their practices and in the support of their work., Discussion: Evidence-based practice is a goal but also has many challenges in everyday implementation. Practice-based research networks hold promise to support clinicians to examine the evidence and form strong coalitions to foster best clinical practice. The second phase of this study will work with this community of midwives to explore collective strategies to examine and improve practice., (© 2012 by the American College of Nurse-Midwives.)

Triage decision making and prioritizing nursing care are essential nursing skills in all clinical settings. The purpose of this study was to evaluate the psychometric properties of the Triage Decision Making Inventory in a sample of Navy and civilian nurses with diverse clinical specialties and years of clinical experience. Establishing reliability and validity allows staff development educators to evaluate training strategies that promote confidence in decision making among nurses of all specialty practices.

Credentialing is an umbrella term that encompasses several categories, many of which have an impact when considering professional development for registered nurses. This column identifies select categories within the credentialing domain., (Copyright 2012, SLACK Incorporated.)

There is a correlation between patient safety and nursing orientation. The authors discuss a mixed-method study that supports the efficacy of using a competency-based process to assess knowledge and judgment skills of registered nurses in a community hospital. This assessment is the backbone of the competency-based orientation.

The aim of the study was to evaluate the effect of an on-line, medication calculation education and testing programme. The outcome measures were medication calculation proficiency and self efficacy. This quasi-experimental study involved the administration of questionnaires before and after nurses completed annual medication calculation testing. The study was conducted in two hospitals in south-east Queensland, Australia, which provide a variety of clinical services including obstetrics, paediatrics, ambulatory, mental health, acute and critical care and community services. Participants were registered nurses (RNs) and enrolled nurses with a medication endorsement (EN(Med)) working as clinicians (n=107). Data pertaining to success rate, number of test attempts, self-efficacy, medication calculation error rates and nurses' satisfaction with the programme were collected. Medication calculation scores at first test attempt showed improvement following one year of access to the programme. Two of the self-efficacy subscales improved over time and nurses reported satisfaction with the online programme. Results of this study may facilitate the continuation and expansion of medication calculation and administration education to improve nursing knowledge, inform practise and directly improve patient safety., (Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.)

There was failure to respond to nurses' demands for clinical information system quality that upholds nursing care as clinical information system quality was not measured in a systematic manner. This study identified measures of clinical information system quality by a literature review and used a multimethod approach combining questionnaire, interview, and observation to evaluate the quality of a clinical information system. The study participants were 20 nurses using a clinical information system. Quantitative data were analyzed for tool assessment and item mean values. Qualitative data were transcribed. A set of the criteria was used to integrate quantitative and qualitative data. Results show that the nurses' responses fell into the range of the quality measures included in the tool. Integration of quantitative and qualitative data showed that quality measures facilitated or disrupted nurses' performance on a clinical information system. Nurses' perceptions of and demands for quality in a clinical information system were identified. In conclusion, this study supports a multimethod approach for evaluating the quality of a clinical information system in the complex dynamics of clinical information system implementation. The identified quality dimensions and measures will serve as a foundation to evaluate the quality of a clinical information system. The criteria employed to integrate multiple data were very useful for this study.

Purpose: Grant funding from the American Academy of Nurse Practitioners Foundation was used to develop a community asthma education initiative for patients at Access Carroll. This initiative provided asthma education and supplies to current patients seen at the free healthcare clinic. While the focus was on patient education, the majority of funds were used to purchase supplies, including bronchodilators, spacer devices, nebulizers, and peak flow meters., Data Sources: Using an asthma self-management and symptom control questionnaire, data were collected before and after the asthma education program., Conclusions: While on a small scale, this project was deemed successful by increasing patient asthma treatment awareness, improving patient quality of life, and reducing emergency department visits for the patients at Access Carroll., Implications for Practice: Using specific tools to assess asthma treatment knowledge and current self-perception of asthma control can help healthcare professionals quantify patients' symptoms and specify areas of augmentation in asthma understanding., (©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.)

Aim: This paper reports on the implementation of a competency assessment tool for registered general agency nurses working in an acute paediatric setting, using a change management framework., Background: The increased number of registered general agency nurses working in an acute children's hospital alerted concerns around their competency in working with children. These concerns were initially raised via informal complaints about 'near misses', parental dissatisfaction, perceived competency weaknesses and rising cost associated with their use., Method: [Young's (2009) Journal of Organisational Change, 22, 524-548] nine-stage change framework was used to guide the implementation of the competency assessment tool within a paediatric acute care setting., Implications for Nursing Management: The ongoing success of the initiative, from a nurse manager's perspective, relies on structured communication with the agency provider before employing competent agency nurses. Sustainability of the change will depend on nurse managers' persistence in attending the concerns of those resisting the change while simultaneously supporting those championing the change. These key communication and supporting roles highlight the pivotal role held by nurse managers, as gate keepers, in safe-guarding children while in hospital. Leadership qualities of nurse managers will also be challenged in continuing to manage and drive the change where resistance might prevail., (© 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.)

Both accredited and approved continuing nursing education providers can be challenged by requirements related to using faculty who have relationships with commercial entities, or when managing commercial support or sponsorship. This column presents case studies that can be used to further an understanding of the guidelines for disclosure and for commercial support that comply with the provision of continuing nursing education activities., (Copyright 2011, SLACK Incorporated.)

Objective: To assess the current distribution and training patterns of pediatric nurse practitioners (PNPs)., Study Design: Secondary data analysis from the National Association of Pediatric Nurse Practitioners and the 2008 US Census Bureau were used to estimate the distribution of PNPs per 100,000 children. Data on nurse practitioner (NP) graduation and specialty education programs were obtained from the American Association of Colleges of Nursing., Results: PNPs have the greatest concentration in the New England and mid-Atlantic regions and a narrow band of Midwestern states. States that allow PNPs to practice or prescribe independently do not consistently have a higher density of PNPs per child population. There has been a slight decrease in the proportion of programs that offer PNP training. In the last decade, the proportion of NP graduates pursuing family nurse practitioner education has increased, and the proportion pursuing PNP education has decreased., Conclusion: Workforce planning for the health care of children will require improved methods of assessment of the role of PNPs and the volume of care they provide. Increased use of PNPs in pediatrics will likely require greater effort at recruitment of NPs into the PNP specialty., (Copyright (c) 2010 Mosby, Inc. All rights reserved.)

Random assignment of participants to experimental and comparison treatments is believed to enhance the comparability of the study groups on baseline characteristics. Despite its benefits, random assignment presents threats to validity. It ignores participants' treatment preferences. If not accounted for when participants are allocated to treatments, preferences influence enrolment in the study, representativeness of the accrued sample, attrition, adherence to treatment, and outcomes. This methodological article describes the mechanisms underlying the influence of treatment preferences on the external and internal validity of an intervention evaluation study. The authors present empirical evidence to support the points of discussion. They describe alternative research designs that account for treatment preferences, for use in future nursing intervention research.

Use of physical restraint in acute care psychiatry has been, and continues to be, a controversial issue. For this reason, a study was conducted in 1996 that examined nurses' decision making related to the use of physical restraint with aggressive psychiatric patients. An instrument, the Moylan Assessment of Progressive Aggression Tool (MAPAT), was developed for this purpose. Information relating to this instrument has not been previously published. It is currently in use in an ongoing research study by the author. A description of the process of the development of the MAPAT is provided here, along with the validity and reliability of the instrument, and implications for potential use in research, training, and education.

A randomized controlled trial of a nurse-delivered coping and communication support (CCS) intervention tailored to the preferences of middle-aged and older patients with advanced cancer and their family caregivers is tested for its value in improving outcomes for quality cancer care. An intervention study must be reliably delivered to estimate the accuracy of findings or make valid conclusions about the outcomes of research. The purpose of this article was to describe methodology for ensuring treatment fidelity in this patient-centered CCS intervention. Fidelity is maximized by ensuring that the CCS intervention is congruent with relevant theory, standardizing training and interventionist competence, and monitoring intervention delivery and documentation. We address unique challenges arising from using individualized interventions that preserve autonomy of the individual and are responsive to shifts in patients' needs and preferences over time. The challenge of nursing research on patient preference and coping communication requires both rigorous measurement of interventionist adherence to the intervention protocol and flexibility to allow for changing needs of patients and family caregivers.

Background: In a study to establish the interrater reliability of the Irish Nursing Minimum Data Set (I-NMDS) for mental health difficulties relating to the choice of reliability test statistic were encountered., Objectives: The objective of this paper is to highlight the difficulties associated with testing interrater reliability for an ordinal scale using a relatively homogenous sample and the recommended kw statistic., Method: One pair of mental health nurses completed the I-NMDS for mental health for a total of 30 clients attending a mental health day centre over a two-week period. Data was analysed using the kw and percentage agreement statistics., Results: A total of 34 of the 38 I-NMDS for mental health variables with lower than acceptable levels of kw reliability scores achieved acceptable levels of reliability according to their percentage agreement scores., Conclusion: The study findings implied that, due to the homogeneity of the sample, low variability within the data resulted in the 'base rate problem' associated with the use of kw statistic. Conclusions point to the interpretation of kw in tandem with percentage agreement scores. Suggestions that kw scores were low due to chance agreement and that one should strive to use a study sample with known variability are queried.

Aim: This paper is a report of an evaluation of cognitive continuum theory and identification of revisions required for application to clinical judgement and decision-making in nursing., Background: The importance of nurses' developing and applying sound clinical judgement is reflected in an international classification of nursing practice. Cognitive continuum theory synthesizes rival and complementary approaches to decision theory in an accessible format, which has been applied in medicine, and various nursing scholars have advocated its use to enhance the effectiveness of nurses' clinical judgement and decision-making., Method: Parse's structure and process criteria are applied in critiquing the relevance of cognitive continuum theory to nursing., Findings: Cognitive continuum theory illustrates how different judgement tasks are suited to different thought processes and how matching the two can optimize decision-making. However, existing modes of inquiry applied to medicine emphasize experimental research, ignoring many alternative approaches used in nursing. A revised version of the cognitive continuum is developed, incorporating examples of nursing judgements and decisions, a broader evidence base, an ethical dimension, and evaluative competence criteria., Conclusion: The revised cognitive continuum promotes awareness of the nature and the variety of patient-centred judgement tasks and decisions in nursing, how to select the most suitable intervention tactic from available options, and the fallibility of all forms of human judgement from intuitive/experiential to analytic/rational. Hence, it is recommended for use as an educational tool and practice guide to facilitate theory development and the practice of judgement and decision-making in nursing.

The quality of care in nursing homes has improved over the last 2 decades; however serious problems persist. Although staffing levels are a primary concern, studies show that ineffective management structures may be a contributing factor to poor quality care. Evidence suggests that the complexity of work performed within the organization is an important consideration in developing effective management structures. The purpose of this article is to describe the development and initial testing of an instrument to measure the complexity of nursing work in nursing homes. A sample of 168 nursing personnel (RNs, LPNs, CNAs) from 7 nursing homes participated in the study. The results of measures to determine the reliability and validity were generally acceptable for a new scale. A modified version of the original scale can be used to provide scientific evidence on which to base the design of management structures in nursing homes.

Although the design of the study we undertook was randomized, the groups were statistically similar, the intervention was based on evidence of previous efficacy, and the treatment was delivered exactly as planned, this pilot study on an intervention to promote motivation for weight loss in new mothers failed to produce an effect. A closer examination using criteria for intervention fidelity revealed a number of weaknesses. Both treatment integrity and differentiation merit careful consideration in intervention design.

This article presents an overview of the first phase of a study to determine the contextual indicators that enable or hinder evidence-based continence care and management. The main focus of the article is to provide an insight into the value of understanding practice 'context' and its impact on the provision of person-centred continence care.

Aim: To involve as many parents as possible in evaluating the services provided to their child while an inpatient on a children's surgical ward and to obtain information to improve patient care, facilities and the clinical environment., Method: 180 questionnaires were distributed over a nine month period to parents of inpatients in a children's surgical ward prior to discharge. 100 of these were returned. The questionnaire focused on nursing and medical care, the ward environment, play and parent facilities., Results: A number of parents were dissatisfied with the noise level on the ward in contrast to the large number who asked for more televisions. A large percentage of respondents were satisfied with the nursing care they received and always felt involved in their child's care., Conclusion: The questionnaire succeeded in highlighting problem areas on the ward so that changes could be implemented, including the introduction of a quiet time. Good practice was also highlighted allowing for praise within these areas.

Aim: To test the validity of The Newcastle Satisfaction with Nursing Scales as measures of patient satisfaction with nursing care in an inpatient postpartum unit., Background: The Newcastle Satisfaction with Nursing Scales (Experience of Nursing Care Scale and Satisfaction with Nursing Care Scale) were developed to measure the satisfaction of medical-surgical inpatients with nursing care., Methods: The Newcastle Satisfaction with Nursing Scales were administered by interviewers to 189 postpartum women prior to hospital discharge. We tested the construct validity of the scales by making five a priori predictions: mothers who were more satisfied would be more likely to have one nurse caring for them and to recommend the postpartum unit to a friend. We also predicted that the Experience of Nursing Care and Satisfaction with Nursing Care Scales would be positively correlated with each other, with a global question about satisfaction with nursing care, and with a global question about satisfaction with overall postpartum stay., Results: Four of the five a priori predictions were supported by the data. The mean Newcastle Satisfaction with Nursing Scale scores of mothers who would recommend the unit to a friend were higher (more satisfied) than those who would not (P < 0.001). The Experience of Nursing Care Scale and Satisfaction with Nursing Care Scale were positively and significantly correlated with each other (r = 0.9, P < 0.001). There was a positive and significant correlation between the scales and global ratings of nursing care (Experience Scale r = 0.79, P < 0.001; Satisfaction Scale r = 0.82, P < 0.001) and overall postpartum stay (Experience Scale r = 0.64, P < 0.001; Satisfaction Scale r = 0.68, P < 0.001)., Conclusion: The Newcastle Satisfaction with Nursing Scales are valid measures of maternal satisfaction with inpatient postpartum nursing care.

Background: Nursing care provided at night has a different purpose and objective to that provided during the day. A review of the literature does not reveal any scientifically tested research instruments for evaluating and comparing the nurse's assessment of nursing care with the patient's perception at night., Aims and Objectives: The aim of this study was to develop and test an instrument for evaluating nursing care and to compare nurses' assessments with patients' perceptions of nursing care provided at night., Design: The study was carried out in two phases; the first had an explorative design and the second an evaluative and comparative design. The Night Nursing Care Instrument (NNCI) included two questionnaires; one for nurses and one for patients. These questionnaires were developed from a nursing framework and covered the following three areas: 'nursing interventions', 'medical interventions' and 'evaluation'., Methods: Nurses (n = 40) on night duty on a medical ward at a central hospital in southern Sweden were consecutively selected, to participate in the study. The patients (n = 80) were selected by means of convenience sampling. In order to achieve construct validity, factor analysis of each individual area was carried out. Reliability in terms of internal consistency was tested by Cronbach's alpha., Results: The overall NNCI had acceptable reliability and validity. There was no statistically significant difference between nurses' assessments and patients' perceptions in any of the three areas of 'nursing interventions', 'medical interventions' or 'evaluation'. The patients rated night nursing care as satisfactory for the majority of the items., Relevance to Clinical Practice: These findings demonstrate that it is possible to create a short instrument with acceptable reliability and validity, which is easy to use in clinical practice. The results also show that night nurses need to improve their ability to assess patients' needs during the night to increase the quality of night nursing care.

Background: We reviewed psycho-educational intervention studies that were designed to reduce interdialytic weight gain (IDWG) in adult hemodialysis patients. Our goals were to critique research methods, describe the effectiveness of tested interventions, and make recommendations for future research., Methods: Medline, PsychInfo, and the Cumulative Index to Nursing and Applied Health (CINAHL) databases were searched to identify empirical work. Each study was evaluated in terms of sample, design, theoretical framework, intervention delivery, and outcome., Results: Nine studies were reviewed. Self-monitoring appears to be a promising strategy to be considered to reduce IDWG. Theory was not usually used to guide interventions, designs generally had control groups, interventions were delivered individually, more than one intervention was delivered at a time, the duration of the intervention varied greatly, there was no long-term follow-up, IDWG was the only outcome, and IDWG was operationalized in different ways., Conclusions: Theoretical models and methodological rigor are needed to guide future research. Specific recommendations on design, measurement, and conceptual issues are offered to enhance the effectiveness of future research.

The implementation of Diagnosis Related Groups (DRGs) as the payment system for hospital work requires to optimise the processes and the use of resources while maintaining the quality of care. To achieve these goals hospitals implement clinical pathways. The systematic structure of these pathways was developed in the industrial context during the 1950s. This history led to the assumption that a process begins and ends in a previously-planned most linear motion. This assumption creates various problems. First of all, the conditions of the situation and the individual's personal needs are ignored. Both aspects are relevant for the quality of care as well as for the calculation of the expenditures. Another problem is the disregard of communicative understanding, the core of nursing. As a result of these problems, the contradictory goals satisfying the rationale and communicative needs conflict. This situation creates the risk of the functional-orientated orders of the clinical pathways determining the relationship between the nurse and the patient. The next risk is that the patient will only be a marginal part of the process. In addition, the nurses may loose their caring competence. Despite these arguments, the use of clinical pathways can be well supported. For the pathway to be successful, the stipulation that remains important is for the system to allow flexibility. To achieve this flexibility, one must utilize assessment instruments. The steps of the intervention process have to be guided by the results of the assessment along with the outcome. The art of professional nursing should successfully combine the clinical pathway with the patient's individual needs.

Aims and Objectives: To describe the current scientific evidence in the field of diagnostics and treatment of pain, malodour and exudate from pressure ulcers and to give recommendations for practice, based on these findings., Background: Patients with pressure ulcers are confronted with symptoms of chronic wounds and impaired wound healing. Assessment and treatment of these symptoms have received very little attention., Design: Systematic literature review., Methods: Medline, CINAHL, and Cochrane, were searched for studies on pain, malodour and exudate in patients with pressure ulcers., Results: The McGill Pain Questionnaire, the Visual Analogue Scale and the Faces Rating Scale are useful instruments to assess pressure ulcer related pain. Strong evidence was found to support a positive effect of (dia)morphine. Some evidence was found to support a positive effect of benzydamine gel and Eutectic Mixture of Local Anaesthetic-cream. Wound malodour is subjectively assessed. In a laboratory study, it is proved that activated charcoal is capable of absorbing gas molecules causing malodour. At present, no studies are available on the odour-absorbing capacity of activated charcoal dressings in pressure ulcer patients. Exudate is a symptom of impaired wound healing. The Pressure Sore Status Tool is a valid and reliable instrument for assessing the wound healing process. There is a possible indication that hydrocolloid positively influences healing time because the absorption of exudates is more effective., Conclusion: Little sound research has been performed on wound-related complaints in patients with pressure ulcers. Nevertheless several recommendations could be made on the present state of the art., Relevance to Clinical Practice: Regarding pressure ulcer related pain, this review supports the intervention of local pain relieve in patients with pressure ulcers. Regarding pressure ulcer related odour and exudates, this study identifies the gaps in evidence and research.

A systematic analysis of the research literature on skeletal pin site care was conducted, and the opinions of an expert panel were obtained. Four specific recommendations for skeletal pin site care are offered, with explicit discussions of the level of research support and/or expert panel support for each. Discussion of other pin site care issues is provided, and characteristics of the research base regarding skeletal pin site care are described.