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Increasing the visibility of patient fatigue.

OBJECTIVES: To describe the process used by our cancer center to assess staff knowledge and attitudes about cancer-related fatigue, and to change clinical practice of fatigue assessment and management. DATA SOURCES: Review articles, research studies, guidelines, and questionnaires. CONCLUSIONS: Change in clinical practice occurs slowly. One major change that occurred was the inclusion of a fatigue question in the Daily Patient Care Record. This inclusion signified a commitment by the institution to address this under-reported and under-treated symptom. IMPLICATIONS FOR NURSING PRACTICE: Professionals challenged to pursue practice change must be passionate, persistent, and patient. A multidisciplinary effort is needed to support change.

Cancer Care Facilities↗

A response to Mapou.

Mapou (1988) has suggested that detection of brain damage has become an irrelevant task for neuropsychology, and that neuropsychological assessment should be used to generate profiles of cognitive function useful for sophisticated diagnosis and rehabilitation. While agreeing the latter considerations are important and germane, we affirm that the detection of brain damage remains an important task for neuropsychology. This affirmation is based on considerations of the nature of brain damage, the development and validation of neuropsychological tests, the utilization of neuropsychological assessment in current practice and the appropriate professional practice of clinical neuropsychology.

Aged↗

Problem-knowledge coupling: a tool for physical therapy clinical practice.

The purposes of this article are 1) to summarize the development, function, and philosophy of the Problem-Knowledge Coupler (PKC), a computerized tool that is designed to aid the clinical decision-making process in medical practice, and 2) to speculate on the value this system has in meeting clinical practice, needs and addressing professional practice issues in physical therapy. The evolution of the PKC system from its origins in the problem-oriented system of medical care is described, and the philosophy of problem-knowledge coupling is contrasted to the basic philosophy of traditional clinical medical practice and never computerized expert decision-support systems. We suggest that problem-knowledge coupling could be a useful tool in physical therapy because it improves the collection and synthesis of patient information and uses the unique nature of individual patient problems coupled with the clinical literature as the bases for clinical practice decisions.

Decision Making, Computer-Assisted↗

Defining the role of the pediatric critical care nurse practitioner in a tertiary care center.

OBJECTIVE: To describe the development and implementation of a pediatric critical care nurse practitioner role in a tertiary academic pediatric intensive care unit. DATA SOURCES: Selected relevant articles from the literature. DATA EXTRACTION/SYNTHESIS: Over the past two decades, the role of critical care nurse practitioners in neonatal and adult settings has developed. More recently, the role has emerged in the setting of pediatric critical care. Literature to date focuses on implementation of the nurse practitioner role in neonatal and adult critical care units, with limited publications on the role in the pediatric critical care arena. In addition, information on the practice of critical care nurse practitioners in tertiary care centers is lacking. We therefore, sought to describe the design, implementation, scope of practice, and outcomes to date of a pediatric nurse practitioner program in our pediatric critical care unit. CONCLUSIONS: A pediatric critical care nurse practitioner role can be implemented successfully in a tertiary center's pediatric intensive care unit. However, before integration of the pediatric critical care nurse practitioner into the health care team, definition of entry level requirements and the overall role with respect to scope of practice, daily operations, and professional practice is essential. Future endeavors should include evaluation of the impact of the pediatric critical care nurse practitioner on patient outcomes in the tertiary care center.

Child↗

Defining neurosurgical and neurological nursing practice: establishing our clinical parameters, part I.

We have examined the education and practice roles of various professional and allied health personnel necessary for providing optimal care to a specialized group of patients, in this case, the neurosurgical/neurological patient group. One needs to investigate these factors in order to plan for effective economic utilization of such personnel in the health care system. The primary goal of all health care providers is quality patient care services, yet secondary concerns cannot be overlooked if we are to accomplish this ultimate goal. Prohibitive health care costs for those we serve and escalating educational costs to become competent to render such services mandate that we choose the most advantageous use of available resource personnel. Placing professionals in appropriate positions which allow them to apply their education and clinical strengths in the care of patients will not only promote excellence in patient care but also excellence in each professional practice role.

Education, Nursing↗