BACKGROUND: Identifying the learning needs of employees and evaluating the results of staff development offerings are essential elements of the responsibilities of the staff development educator. High patient acuity, the shortage of critical care nurses, and rapidly changing technology within the critical care environment demand the provision of staff development offerings that are appropriate for the learning needs of critical care nurses and the evaluation of the effect of programs on critical care nursing practice. OBJECTIVE: The purposes of this descriptive, correlational study were to compare the ability of a knowledge test, a self-evaluation tool, and computerized clinical simulations to discriminate between nurses with varied levels of knowledge and experience, and to compare the learning needs identified from the three types of evaluative instruments. METHODS: Each subject (n = 142) completed the Basic Knowledge Assessment Tool for Critical Care, Cardiovascular Self-Evaluation Tool, and four computerized clinical simulations. RESULTS: Both the Basic Knowledge Assessment Tool and the Cardiovascular Self-Evaluation Tool discriminated between experienced/inexperienced and Advanced Cardiac Life Support-certified/noncertified critical care nurses. The computerized clinical simulations discriminated according to Advanced Cardiac Life Support certification, but not between experienced and inexperienced critical care nurses. The computerized clinical simulations identified more specific learning needs than did the Basic Knowledge Assessment Tool or Cardiovascular Self-Evaluation Tool. CONCLUSIONS: The evidence for discriminant validity, adequate internal consistency reliability, and ease of administration supports the continued use of these two tools as methods for critical care staff development needs assessment and evaluation. In addition, the study findings support the use of computerized clinical simulations as an adjunct to other needs assessment and evaluation methods in nursing staff development.
BACKGROUND AND METHODS: The descriptive, correlational study examined patients' perceptions of pulmonary problems and nursing interventions in a sample (n = 201) of persons living with AIDS hospitalized for Pneumocystis carinii. Additionally, the study assessed differences in physiological variables, patient symptoms, and functional status based on the type of problems identified: dyspnea, pulmonary problems without dyspnea, and nonpulmonary problems. RESULTS: A total of 601 problems was identified including 61 instances of dyspnea and 83 reports of other pulmonary problems. The remainder of the problems was nonpulmonary. Nursing interventions associated with dyspnea and pulmonary problems other than dyspnea were mainly broadly defined interventions such as oxygen and medication administration. When patients were placed into three groups based on identification of dyspnea, pulmonary problems without dyspnea, or only nonpulmonary problems, there were no differences between groups in functional status or patient symptoms of pain, nausea, or fatigue as measured by the Quality Audit Marker. CONCLUSIONS: This study demonstrated that hospitalized patients with Pneumocystis carinii present with a broad array of problems. Contrary to expectations, dyspnea was not ubiquitous but was reported by less than one-third of this sample. When dyspnea was present there were few independent nursing interventions that patients identified. Studies are needed to test effective strategies for the nursing management of dyspnea and a large variety of other patient problems associated with HIV infection.