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BACKGROUND: Questions, or what the physicist and learning expert Reginald Revans called "insightful inquiry," are essential to learning. People remember and use what they discover themselves. But many habits and activities in front-line workplaces of patient care have not promoted frank discussions of what we haven't figured out yet about improving care for patients. Leaders are no longer defined by having the right answers. Leaders will be the ones who have the right questions and who promote local learning with the right questions. SUGGESTIONS FOR GETTING STARTED IN COLLABORATION. The authors suggest questions to ask to get collaborative inquiry going and cite examples they have collected. The questions and examples are grouped in seven thematic categories: Listening to and appreciating others; Thinking across disciplines and roles; Sharing ideas and linking those shared ideas to execution and deployment of change; Appreciating systems and interdependencies; Using research (including local research) to inform our practices; Using methods, skills, and techniques as facilitators of collaboration; and Working across organizational boundaries.

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OBJECTIVE: To describe mothers' experiences with back transfer of their infants from a neonatal intensive-care unit (NICU) to a community hospital (CH). DESIGN: Descriptive correlational study. PARTICIPANTS: One hundred forty-three mothers whose infants were back transferred from regional NICUs to 1 of 20 Level I or Level II CHs. MAIN OUTCOME MEASURES: Quality of back transfer was measured by the NICU/CH Transfer Quality Scale developed by the investigators. Overall level of stress related to back transfer was also measured. RESULTS: More positive experiences with the NICU component of back transfer were related to fewer perceived differences in physician practice between NICUs and CH settings and fewer infant problems after transfer (R2 = 8.1%, p = .007). More positive experiences with the CH component of back transfer were related to fewer perceived differences in nursing and medical practices between settings; fewer infant problems after transfer; and more sources of pretransfer preparation (R2 = 33.4%, p < .0001). Lower levels of overall stress associated with transfer were related to fewer infant problems after transfer and greater lengths of stay in the NICU (R2 = 8.8%, p = .01). CONCLUSION: Results support the need for consistency of care and coordinated approaches to back transfer.

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This pilot study was designed to test an instrument measuring mothers' perceptions of the quality of the back-transfer experience from a neonatal intensive care unit in a tertiary medical center to a community hospital. Forty-one mothers completed a questionnaire that contained the 24-item NICU/Community Hospital Transfer Quality Scale, a 1-item measure of stress associated with the overall experience, and other variables that might affect the transfer experience. Transfer quality was strongly correlated with the overall stress of the transfer (r = .61, p < .001). That is, the higher the perceived transfer quality, the less stress the mother associated with the transfer. This instrument had a test-retest reliability of r = .82 (p < .001, n = 23) and a Chronbach's alpha of .84. Comments made by mothers indicated that communication with health care providers is a very important but sometimes inadequately addressed component of the transfer experience. Nurses can play a key role in facilitating communication between the family and health care providers in both the tertiary and community settings. Four goals for enhancing communication between parents and health care providers are described.

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Professionals in all disciplines are challenged by the proliferation of new knowledge. Nurses, too, must find cost-effective ways of ensuring that their patients are benefiting from the most current knowledge about health and illness. The methods of research dissemination to clinicians described in this article are presumed to be effective because of anecdotal reports, conference evaluations, or clinician surveys. The profession needs more sophisticated evaluations of the effectiveness of various dissemination methods. In the meantime, whether you are a researcher, an administrator, an educator, or a clinician, you have a role to play in improving research dissemination. Implement just one strategy from this article and evaluate the results. Each contribution moves nursing toward research-based practice.

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During this time when the walls that divide inpatient, outpatient, primary, tertiary, and community care are coming down, society should expect that the nursing profession will prepare and regulate advanced nursing practice for the good of patient care and society as a whole. To do so, schools with clinical practice graduate programs must create a consistent product; professional credentialing bodies must use consistent criteria to acknowledge advanced practice knowledge and expertise; and state boards of nursing must give legal recognition for advanced practice to these same nurses. Within this environment, advanced practice nurses will be prepared to serve society, even if their skills are applied in a variety of roles.

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Breastfeeding outcomes of 121 primiparas enrolled in a larger study were examined to determine the impact of cesarean delivery on time of first breastfeeding. Mothers giving birth by cesarean had a later first breastfeeding and expressed less satisfaction with the birth experience than did those who delivered vaginally. No relationships were found between delivery type and duration of breastfeeding or pain or fatigue related to breastfeeding. Time of first breastfeeding was not related to breastfeeding duration. Although some investigators have reported that mothers who have cesarean deliveries or delayed first feeding are less successful at breastfeeding, the high level of commitment to breastfeeding in this sample may have overcome the effect of perinatal events.

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Pre- and perinatal variables commonly found to predict breast-feeding duration were examined to see whether they also predicted breast-feeding problems in the first week postpartum. One hundred and twenty-eight families who prenatally committed to breast-feeding for at least 6 weeks comprised the sample. The families were randomly assigned to one of two groups: a group in which bottle feedings would be avoided in Weeks 2-6 postpartum and a group in which approximately one bottle per day would be given during the same period. Breast-feeding events most commonly experienced as problems in previous studies were also reported by mothers in this sample. Multiple regression analyses revealed that bottle use in the hospital, lower satisfaction with first breast-feeding, and group assignment were weakly predictive of the Breast-feeding Problem Score at 1 week, R2 = .154, p = .0004. The negative effect of hospital bottle use was greater for women in the bottle-restricted group than for women in the planned-bottle group.

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The Child Care Activities Scale (CCAS) and Parental Role Preference Scale (PRPS) were developed to measure parental involvement in four domains of child care: direct care, indirect care, amount of sole responsibility, and play. The CCAS measures level of involvement of each parent in 21 child care activities. The 12-item PRPS is intended to discriminate among how much parents ideally would like to participate, and how much they actually do participate in child care. The psychometric properties of both scales are presented using data from two studies. Recommendations for the future use of the scales are given.

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Efficient, cost-effective patient classification systems are an essential component of information needed for staffing projections, budgeting, productivity monitoring, and determining the cost of nursing services. Data collection on every shift is typical of GRASP-based patient classification systems. In this study, comparisons among multiple shift measurements showed that no relevant information was being gained by multiple daily assessments of patient care requirements.

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