Exploring critical-care nurses' perceptions about critical thinking /

The influx of nurses to the critical-care environment is continuous. In many workplaces, the nurses who are new to critical care are also newly graduated nurses. These new critical-care nurses and their critical-care nursing colleagues, who may have worked in critical care for many years, need to demonstrate expert judgment in order to optimize the potential for positive patient outcomes. The purpose of this study was to explore critical-care nurses' perceptions about critical thinking and expert nursing judgment. Using grounded theory research design, I collected data from 1 1 critical-care nurses through focus groups, an interview, and postparticipation questionnaires. I have articulated a Critical-thinking Modelfor Expert Nursing Judgment. The educational model is directly relevant to practicing critical-care nurses and nursing leaders who guide critical-care nursing practice. The Critical-thinking Modelfor Expert Nursing Judgment contributes to educational theory by objectifying the substantive topic of critical thinking and expert judgment. The model has broad applicability within the domain of education and specific applicability within the domain of nursing education.

Opioid poisoning and availability of specialized medical care in Ontario, 2002-2006

The prescription of opioid analgesics has risen sharply in North America over the past two decades. This increase has been accompanied by a rise in overdoses. The present study draws on administrative data collected from emergency department contacts to describe the epidemiology of opioid overdose in Ontario b~tween 2002 and 2006 and to examine the role of regional variation in availability of specialist care. The number of poisonings increased from 1250 (10.9 per 100,000) in FY2002 to 1816 (15.2 per 100,000) in FY2005. Local concentration of specialist physicians was significantly associated with the incidence of opioid overdose, inversely at most levels of availability, but positively at very high levels. Regional variation in incidence was also associated with demographics, median family income, and the rate of other drug poisonings. Policy options for limiting opioid-related harms are limited, but improvements in monitoring and clinical management may prove valuable.