It was a normal day of work. I was going through the regular routine of a hectic morning in the NICU at the John H. Stroger Hospital. There was a mom who came to visit her baby in the crib behind me. A few minutes passed, and I turned around to greet her. I asked her if she needed any assistance and gave her a curtain to provide her privacy while doing kangaroo care with her infant. After some time, I checked on her to see if she needed anything. I was touched by the scene in front of me. The mother had the baby tucked in her shirt, and he was comfortably asleep as the mother happily smiled at him, softly whispering loving words. Although this was a normal scene in the NICU, on this particular day, I felt compelled to capture it. I immediately remembered that my unit had just purchased a new camera, which I was coincidentally testing out on this day. I decided that there was no better way to remember this moment than by taking a picture. So I grabbed the camera and asked the mother's permission. She pleasantly agreed. The picture was so beautiful that I decided to print it out and share it with the other nurses in my unit. The response was overwhelming. Everyone felt touched by this picture because it captured such a beautiful, perfect moment shared between a mother and her infant.

Multidisciplinary management of the acute cardiac patient, for decades, has been driven by best practices, treatment algorithms, and research-based protocols. As nurses continue to develop and implement evidence-based care, they must ensure that the essence of nursing is not lost in the process. In this article, strategies for the development of evidence-based practice guidelines for acute cardiac patients using standardized nursing language are provided.

In general, most, but not necessarily all, patients want truthfulness about their health. Available evidence indicates that truth-telling practices and preferences are, to an extent, a cultural artefact. It is the case that practices among nurses and doctors have moved towards more honest and truthful disclosure to their patients. It is interesting that arguments both for and against truth-telling are established in terms of autonomy and physical and psychological harm. In the literature reviewed here, there is also the view that truth-telling is essential because it is an intrinsic good, while it is argued against on the grounds of the uncertainty principle. Based on this review, it is recommended that practitioners ought to ask patients and patients' families what informational requirements are preferred, and research should continue into truth-telling in clinical practice, particularly to discover its very nature as a cultural artefact, and the other conditions and contexts in which truth-telling may not be preferred.

An important treatment goal for pediatric nephrology caregivers is the optimization of a child's capacity for normal growth and development. However, the physiologic and metabolic derangements associated with chronic kidney disease (CKD) significantly alter these processes, creating important challenges in the care of affected children. Evidence-based clinical practice guidelines support early recognition and treatment of CKD-related complications to improve growth and development and, ultimately, quality of life for children with this chronic condition.

Clinical practice guidelines (CPGs) should consist of treatment recommendations that assist hand therapists in providing high-quality cost-effective care to specific patients based on the highest level of available evidence. This requires CPGs to be developed using a rigorous process based on evidence, appraisal of both original studies and expert opinion, and a process for multiple reviewers to evaluate the draft CPG. This study identified CPGs relevant to hand therapy and then evaluated their quality using the AGREE quality assessment tool. The majority of guidelines were not evidence-based and were of extremely low quality. Two guidelines were produced using a rigorous process that emphasized comparative clinical trials. These were able to provide only a single treatment recommendation, that ultrasound is effective for calcific tendinitis of the shoulder. Hand therapists need to move away from opinion- or clinic-based protocols and toward more evidence-based treatment guidelines. However, the value of treatment guidelines must be tested, not assumed, regardless of the development process.

BACKGROUND: The Royal Australian and New Zealand College of Psychiatrists is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority METHOD: For these guidelines, the CPG team reviewed the treatment outcome literature (including meta-analyses) and consulted with practitioners and consumers. TREATMENT RECOMMENDATIONS: This guideline provides evidence-based recommendations for the management of bipolar disorder by phase of illness, that is acute mania, mixed episodes and bipolar depression, and the prophylaxis of such episodes. It specifies the roles of various mood-stabilizing medications and of psychological treatments such as cognitive therapy and psycho-education.

OBJECTIVE: To compare thermal stability during the first bath of newborns bathed by maternal-child nurses in a newborn nursery with thermal stability of newborns bathed by parents at the maternal bedside. DESIGN: A randomized clinical controlled trial. SETTING: A tertiary care hospital in western Canada. PARTICIPANTS: Participants (N = 111) were full-term newborns born vaginally. INTERVENTIONS: The experimental treatment was the parent bathing the newborn under nursing supervision at the bedside in the first few hours of birth; the standard treatment was a nurse bathing the newborn in an admission nursery. MAIN OUTCOME MEASURES: The main outcome measure was newborn heat loss occurring from bathing as assessed by changes in aural temperatures, which were taken before, during, and following bathing. RESULTS: There was no difference in temperature change between newborns bathed by a nurse and those bathed by a parent (F = 0.595, df = 1, p =.442). A return to normal thermal ranges takes approximately an hour. CONCLUSION: Heat loss experienced by newborns during bathing is significant and is not associated with who bathes the newborn or where the bath takes place.

BACKGROUND: The method of skin-to-skin contact (kangaroo care [KC]) has shown physiologic, cognitive, and emotional gains for preterm infants; however, KC has not been studied adequately in term newborns. AIMS: To evaluate the effect of KC, used shortly after delivery, on the neurobehavioral responses of the healthy newborn. STUDY DESIGN: A randomized, controlled trial using a table of random numbers. After consent, the mothers were assigned to 1 of 2 groups: KC shortly after delivery or a no-treatment standard care (control group). SUBJECTS: Included were 47 healthy mother-infant pairs. KC began at 15 to 20 minutes after delivery and lasted for 1 hour. Control infants and KC infants were brought to the nursery 15 to 20 and 75 to 80 minutes after birth, respectively. RESULTS: During a 1-hour-long observation, starting at 4 hours postnatally, the KC infants slept longer, were mostly in a quiet sleep state, exhibited more flexor movements and postures, and showed less extensor movements. CONCLUSIONS: KC seems to influence state organization and motor system modulation of the newborn infant shortly after delivery. The significance of our findings for supportive transition from the womb to the extrauterine environment is discussed. Medical and nursing staff may be well advised to provide this kind of care shortly after birth.

goodman p., mackey m.c.& tavakoli A.S.(2004) Journal of Advanced Nursing46(2), 212-219 Factors related to childbirth satisfactionBackground. A woman's satisfaction with the childbirth experience may have immediate and long-term effects on her health and her relationship with her infant, but there is a lack of current research in this area. Aim. This paper reports a study to examine multiple factors for their association with components of childbirth satisfaction and with the total childbirth experience. Method. A correlational descriptive study was conducted with 60 low-risk postpartum women, aged 18-46 years, with uneventful vaginal deliveries of healthy full-term infants at two medical centres in the south-eastern United States. The Labor Agentry Scale, McGill Pain Questionnaire and Mackey Childbirth Satisfaction Rating Scale and a background questionnaire were completed by women. Obstetrical data were collected from the medical record. Findings. Personal control was a statistically significant predictor of total childbirth satisfaction (P = 0.0045) and with the subscale components of satisfaction (self, partner, baby, nurse, physician and overall). In addition, having expectations for labour and delivery met was a significant predictor of satisfaction with own performance during childbirth. Conclusions. Personal control during childbirth was an important factor related to the women's satisfaction with the childbirth experience. Helping women to increase their personal control during labour and birth may increase the women's childbirth satisfaction.

PURPOSE/OBJECTIVES: To review historical and current research data on prevention and treatment of acute radiation dermatitis. DATA SOURCES: 18 research trials and 1 case report published from 1967-2001 and 1 unpublished research trial from 1972. DATA SYNTHESIS: Washing the skin with mild soap and water and the hair with mild shampoo is safe during radiation therapy. Biafine (Medix Pharmaceuticals, Inc., Largo, FL), chamomile cream, almond ointment, topical vitamin C, and gentian violet have not been proven effective and should not be used. Transparent, hydrocolloid, and hydrogel dressings have been beneficial, as have sucralfate cream and corticosteroid cream. Aloe vera may be beneficial and is not harmful. CONCLUSIONS: The existing scientific data are lacking in quantity and quality. The current body of evidence is unable to provide clinicians with comprehensive guidelines for prevention and management of acute radiation dermatitis. IMPLICATIONS FOR NURSING: Nurse clinicians and nurse scientists must partner to conduct further research to add to the limited resources about the prevention and management of acute radiation dermatitis and develop comprehensive evidence-based clinical practice guidelines.