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Caring is a concept that has been studied in numerous helping professions but has yet to be researched from a counseling perspective. In this qualitative research study, 13 master’s-level counseling interns were interviewed to better understand their perceptions of caring in the counseling relationship. Results suggest that these interns perceive that supporting desired outcomes, a personal capacity for caring, maintaining therapeutic conditions, mutuality in the counseling relationship, and a dynamic flow of communication are important attributes of the counseling relationship when caring is present The findings suggest further research that explores the concept of caring in the counseling relationship may be warranted. © 2002 American Counseling Association.

Gastroesophageal reflux disease can usually be successfully managed with conservative medical treatment. Anti-reflux surgery is a safe alternative when treatment fails or patients desire a more definitive treatment option. Through a case study approach, this article describes the indications for surgery, the essentials of the authors’ multi-disciplinary approach to care and the components of a well-designed education plan for a patient undergoing laparoscopic Nissen fundoplication. Although most patients do well after surgery, diligent nursing care is required before and after surgery to prevent or manage complications and ensure patients have a rapid recovery and successful outcome. © 2001 Lippincott Williams & Wilkins, Inc.

Pain is a prevailing clinical problem among older adults resulting in systemic agitation and altered quality of life. Although the possibility remains that older adults experience and report less pain, the need exists to objectively evaluate pain in order to provide the most effective pain management. Several standardized tools are available to assess pain in older adults at baseline and at subsequent, frequent intervals. Following an objective assessment, pain may be managed with pharmacologic and nonpharmacologic methods.

Societal drivers, as well as trends in education and health care, are advancing the practice doctorate in nursing. For nurse practitioner preparation, the current resurgence of interest in the practice doctorate could precipitate change that mimics the evolution from post-basic certificate to Master's level education. The National Organization of Nurse Practitioner Faculties (NONPF) is a resource for the study of the practice doctorate relative to quality nurse practitioner education. This article will offer some insights into the movement toward the practice doctorate by describing, from the NP perspective, the societal impetus for change, the historical perspective of NP and doctoral education, the 4 Ws (why, what, where, and when) of the movement, and some of the myths and realities about the practice doctorate. © 2005 Online Journal of Issues in Nursing.

As a model of care, CARELINK promotes self-care and self-management of chronic illnesses for homebound older adults no longer eligible for skilled nursing services. A case-study method is used to highlight the key constructs and outcomes related to the model. The benefits of applying the CARELINK model as a cardiac management program for home care are discussed.

Have you ever watched as care providers, be they student nurses or staff nurses, display behaviors that seem to indicate that they are becoming overwhelmed by situations in the acute care setting? Have you also observed other providers who seem to thrive on the "challenges" presented by these same situations? The same situation stimulates responses that reflect opposite ends of a continuum, the continuum of tolerance of ambiguity. The nurse educator needs to develop a greater understanding of the elements in the clinical situation (the ambiguities) that have stimulated the behavioral responses, and how an individual's level of tolerance of ambiguity influences reactions to the ambiguous situations. These understandings provide the nurse educator with the foundation for developing teaching strategies to facilitate effective management of ambiguous situations in clinical settings.

Recently published consensus statements and conference proceedings from the Cystic Fibrosis Foundation provide new direction with regard to the etiology, diagnosis, and treatment of the adult patient with cystic fibrosis (CF). Survival has improved through early diagnosis and improved treatment, and aggressive management of complications. The current state of knowledge, the most recent evidence-based treatment options, and essentials of nursing care for the adult patient with CF are outlined.

Firm up on the facts and considerations associated with acetaminophen toxicity.

Modifying the sequence, objectives, and research-based content for a nursing interventions course in a baccalaureate curriculum resulted in improved outcomes including enhancement of the evidence bases for nursing interventions. A mixed methods research study demonstrated better student preparation for clinical experiences and improved satisfaction with course content, consistency, and sequencing. Faculty reported improved integration of theory, research, and practice. Although grades were slightly lower in the new course, the positive outcomes greatly outweighed this expected finding. A foundation for improving the evidence bases for future nursing practice is guided by the curricular modifications described in this article.

Many undergraduate baccalaureate nursing programs incorporate clinical emersion courses at the end of the program. Nursing capstone courses have become increasingly important in facilitating student transition into practice. However, little is known regarding the overall effectiveness of this teaching model for students, nursing programs, and clinical agencies. Previous studies revealed conflicting results about the benefits of a senior level precepted clinical experience. In this multi-method study, the authors examined student learning outcomes, perceptions, employment choice and retention following implementation of a new capstone nursing course. Results of this study indicated that a capstone course does not necessarily significantly improve scores on achievement exams or NCLEX RN first time pass rates. Nevertheless, qualitative content analysis revealed the following themes: integration, autonomy, confidence, authority, and advocacy consistent with a perceived enhanced competence in the nursing role. Data indicated that graduates often seek employment and remain at their capstone site or within their capstone specialty.

The number of single-parent families has increased dramatically in the United States. The purpose of this study was to explore the types of family rituals present in single-parent families and their meaning within the family context. Little is known about family rituals in single-parent families, and therefore grounded theory was the qualitative research method used for this study. Unstructured face-to-face interviews were used to obtain data from a theoretical sample of seven single parents. Data analysis appropriate to the grounded theory method was utilized to identify a core variable and an emerging theory. Six types of rituals: connection, spiritual, love, recreation, celebration, and evolving were found to be used by these single-parent families as a way to facilitate family cohesion and instill family values. Applicability of the findings of this study are beneficial for nurses working with clients with diverse, changing, and complex social situations such as the single-parent family. © 2004 Sage Publications.

Purpose: To investigate the attitudes, beliefs, and concerns of pregnant and postpartum adolescents regarding breastfeeding. Study Design and Methods: Audiotaped focus groups of low-income, largely minority pregnant and postpartum adolescents were conducted and transcripts analyzed using content analysis techniques. Findings: Major themes identified were in the area of beliefs, such as They say it's healthy, or It hurts; attitudes, such as breastfeeding is the mother's choice and The baby comes first; and concerns such as privacy, and Breastfeeding leads to dependency. Clinical Implications: Adolescents can be encouraged to breastfeed, but require appropriate education beyond what they have heard from others. Myths such as pain during breastfeeding need to be addressed. Since teens want to learn but not be told what to do, active learning strategies such as guided Internet searches could be helpful to guide them into discovery of the benefits of breastfeeding. Since all the teens in this study felt that the baby comes first, emphasizing the benefits of breastfeeding for the baby should predominate educational efforts. Concerns related to physical exposure while breastfeeding can be addressed antenatally through discussing creative strategies to maintain modesty. This study suggests that, in the postpartum hospital setting, adopting a sensitive, initially hands-off' approach to supporting breastfeeding might be more well-accepted than tactile assistance, and that following the initial establishment of a milk supply, various levels of breastfeeding exclusivity should be considered as potentially acceptable infant feeding patterns.