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Strategic directions for nursing research in tobacco dependence.

Tobacco use continues to be the leading cause of preventable death in the United States, causing approximately 440,000 deaths a year. Even with significant progress in the last decades, there are over 45 million smokers in the United States. Despite the efficacy of nurses in providing tobacco cessation interventions, nursing research in this area has been minimal. The purpose of this presentation is to summarize the recommendations for focusing and fostering nursing research in tobacco cessation from 42 researchers, clinicians, educators, and representatives from the Agency for Healthcare Research and Quality (AHRQ), the National Cancer Institute (NCI), the Joint Commission on Accreditation of Healthcare Organizations, and from nursing organizations who attended a 1-day invitational conference. This conference evolved from the work of the Tobacco Free Nurses Initiative in promoting the role of nursing in tobacco control and in response to the recognition of potential contributions to the field from nursing research. Sponsored by AHRQ and the NCI, the conference included formal presentations, and small and large group discussions around tobacco cessation research, resulting in consensus statements about a research agenda. Participants recommended strategies for new approaches in nursing research on tobacco dependence and cessation; strategies for seizing opportunities and confronting challenges in building nursing research in the field; and enhancing utilization of research findings into clinical practice. This agenda provides direction for growing nursing research in tobacco cessation, breaking down barriers to research, and supporting efforts for increasing utilization of evidence-based findings in clinical practice.

Health Promotion↗
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Nursing research and treatment of tobacco dependence: state of the science.

Tobacco use is considered to be the single most preventable cause of premature morbidity and mortality among men and women. It is well documented that tobacco cessation reduces the burden of disease significantly and is cost effective. Efficacious therapy for tobacco dependence exists, and nurses have been shown to be effective tobacco cessation interventionists. Given the large number of nurses in the United States, nurses can influence national health objectives of reduced tobacco use significantly and help to decrease the number of adults at risk for tobacco-attributable disease and death. The objectives of this presentation are to (a) describe the scientific evidence for tobacco cessation interventions, based on the U.S. clinical practice guideline Treating Tobacco Use and Dependence; (b) present the meta-analytic findings of the efficacy of nursing interventions for smoking cessation; (c) discuss barriers to nursing research and tobacco interventions; and (d) provide future directions for nursing intervention research.

Evidence-Based Medicine↗
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Nursing research in smoking cessation: a listing of the literature, 1996-2005.

A listing of publications related to nurses and tobacco is posted on the Tobacco Free Nurses Web site (www.tobaccofreenurses.org). For this conference, a chronological listing of the numbers and type of data-based articles that focused on nursing involvement in tobacco cessation published since 1996, the year of the first publication of the Agency for Health Care Policy and Research, Clinical Practice Guideline #18, through 2005 was developed. One hundred and seventy-five data-based papers that met the criteria, that is, the paper focused on smoking cessation and involved nurses, were identified. Most (88%) articles were exclusively focused on cessation. Research designs included experimental (38%), quasi-experimental (24%), descriptive-quantitative (25%), descriptive-qualitative (8%), meta-analyses (2%), and secondary analyses and systematic reviews (each 1%). The number of articles that focused on nursing involvement in tobacco cessation has increased eight fold in the past 10 years, from less than 5 articles published in 1996 to more than 40 published in 2005. The minority (35%) of data-based articles that focused on nurses and tobacco cessation were published in nursing journals.

Bibliometrics↗
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The softer side of technology: how IT helps nursing care.

Few would argue the efficiencies made possible by technology. However, technology goes beyond efficiency in healthcare, to actually help nurses provide better care. This article will examine the historical relationship among nursing, caring, and technology while explaining how technology reinforces--rather than destroys--the unique and intangible quality of caring in nursing.

Attitude of Health Personnel↗
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Patient and nurse safety: how information technology makes a difference.

The Institute of Medicine's landmark report asserted medical error is seldom the fault of individuals, but the result of faulty healthcare policy/procedure systems. Numerous studies have shown that information technology can shore up weak systems. For nursing, information technology plays a key role in protecting patients by eliminating nursing mistakes and protecting nurses by reducing their negative exposure. However, managing information technology is a function of managing the people who use it. This article examines critical issues that impact patient and nurse safety, both physical and professional. It discusses the importance of eliminating the culture of blame, the requirements of process change, how to implement technology in harmony with the organization and the significance of vision.

Automation↗
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From Tele-ed to Telehealth: the need for IT ubiquity in nursing.

Although numerous studies have shown that information technology (IT) improves care, makes the workplace better for clinicians, and reduces costs, healthcare-especially nursing-has been slow to adopt it for a variety of reasons. However, because of a worsening nursing shortage, couples with increasing healthcare costs and administrative overhead, nursing demands that IT become not only common, but pervasive, playing a role in every aspect of nursing, from recruitment and education, to patient care. This article will examine the several potential applications of IT to nursing and their benefits, challenges to widespread IT adoption, and the importance of IT ubiquity to the very viability of the profession.

Attitude of Health Personnel↗
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Evidence-based practice: how nursing administration makes IT happen.

As the voice of and advocate for nurses, nursing administration should assume the leadership position in the development of evidence-based practice models. One of its most important tasks is to advocate for ubiquitous information technology (IT) to support these models. This article examines evidence-based nursing and the importance of IT to its development and growth. It explains the role of nursing administration in guiding IT implementation, as well as key issues that must be examined in system selection and development.

Attitude of Health Personnel↗
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A comparison of teaching strategies for integrating information technology into clinical nursing education.

As health care becomes more information-intensive and diverse, there is a need to integrate information technology (IT) into clinical education. Little is known, however, about how to design instructional strategies for integrating information technology into clinical nursing education. This article outlines the instructional strategies used by faculty in five nursing programs who taught students to use a point-of-care information technology system. The article also reports students' computer acceptance and summarizes IT clinical teaching recommendations.

Adult↗
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An innovative clinical practicum to teach evidence-based practice.

A clinical practicum was successfully implemented for RN to BSN students to apply evidence-based practice to actual clinical problems affecting nursing practice. The author describes how this practicum was implemented and the requisite resources and support systems. This senior-level capstone course enabled students to understand and value a lifelong learning approach to evidence-based practice.

Attitude of Health Personnel↗
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The times they are a changing: effects of online nursing documentation systems.

Safe patient care is at the front line when delivering patient care. Point-of-care online nursing documentation is presented as a possible solution. With the implementation of online nursing documentation, questions arise if this technology will improve the quality of nursing documentation as well as end user satisfaction. Five research articles are critiqued and it is concluded that overall online nursing documentation systems would be beneficial in improving documentation requirements and end user satisfaction and help influence how nursing is practiced.

Attitude of Health Personnel↗
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Organizational and cultural changes for providing safe patient care.

OBJECTIVE: To describe an approach and experience with fostering a culture of patient safety. METHODS: (1) Organizational Change-The Department of Medicine established a patient safety committee (PSC) and charged it with reviewing adverse events. (2) Cultural Change-PSC sponsors and participants work to promote a culture of collaboration, study, learning, and prevention versus a culture of blame. (3) Collaboration-The PSC includes chief residents and members from medical informatics, nursing, pharmacy, quality assurance, risk management, and utilization management. (4) Evolution-The duties of the PSC progressed from merely learning from adverse event reports to implementing patient safety and quality improvement projects. (5) Standardization-The PSC uses standard definitions and procedures when reviewing cases of adverse events, and when conducting patient safety and quality improvement projects. RESULTS: (1) Developed an online adverse event reporting system, shortening the average report collection time by 2 days and increasing the number of adverse events reported. (2) Established a model for change using (a) safety rounds with residents, (b) e-mail safety alerts, and, in some cases, (c) decision alerts using electronic order entry. These changes in culture and capability led to improvements in care and improved financial results. CONCLUSIONS: Senior management support of a culture of learning and prevention and an organizational structure that promotes collaboration has provided an environment in which patient safety initiatives can flourish by providing not only safer and higher quality patient care but also a positive financial return on investment.

Decision Support Systems, Clinical↗
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Implementing a Web-based information resource at an inner-city community church: lessons learned.

The objective of this project was to develop and implement electronic access to HIV/AIDS information resources at Glide Memorial Church in San Francisco, CA. This involved developing tailored Web-based access to the relevant information for the Glide Clinic patients. In addition, the project deployed workstations in 2 clinic areas and provided support to clinic patients as they learned to access the information resources. This article describes the experience with information retrieval in a clinic setting for underserved patients, including lessons learned, effective strategies, and anecdotes of effect on patients. Required nursing informatics competencies in this particular area are also addressed.

Attitude to Health↗
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Data mining as a tool for research and knowledge development in nursing.

The ability to collect and store data has grown at a dramatic rate in all disciplines over the past two decades. Healthcare has been no exception. The shift toward evidence-based practice and outcomes research presents significant opportunities and challenges to extract meaningful information from massive amounts of clinical data to transform it into the best available knowledge to guide nursing practice. Data mining, a step in the process of Knowledge Discovery in Databases, is a method of unearthing information from large data sets. Built upon statistical analysis, artificial intelligence, and machine learning technologies, data mining can analyze massive amounts of data and provide useful and interesting information about patterns and relationships that exist within the data that might otherwise be missed. As domain experts, nurse researchers are in ideal positions to use this proven technology to transform the information that is available in existing data repositories into useful and understandable knowledge to guide nursing practice and for active interdisciplinary collaboration and research.

Algorithms↗
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Concept development of nursing information: a study of nurses working in critical care.

This article proposes a definition of nursing information. Nurses use information to plan, implement, and evaluate patient care. They seek information from colleagues, books, electronic sources, and equipment, and give information to multiple audiences. Even with the pervasiveness of information in nursing practice, there has been little research aimed at developing a definition of nursing information. This study was undertaken to start filling that gap. The Hybrid Model of Concept Development served as the study design. This model consists of three phases: theoretical, fieldwork, and final analytical. In the theoretical phase, a working definition of nursing information was developed. The fieldwork phase involved observations and interviews of 13 expert nurses working in a critical care unit. The qualitative data obtained from the fieldwork phase were analyzed to refine and extend the working definition. Previously identified categories in the definition--context, form, communication, and value--were validated in the analysis. New categories--multidimensionality, intervening/doing, and power--emerged during the final analytical phase, and the definition was revised to include this new knowledge. The utility of the definition of nursing information and its impact on nursing practice, information technology, and theory development is discussed.

Attitude of Health Personnel↗