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Introduction of an evidence-based practice change, such as hourly rounding, can be difficult in the hospital setting. This study used ethnographic methods to examine problems with the implementation of hourly rounding on 2 similar inpatient units at our hospital. Results indicate that careful planning, communication, implementation, and evaluation are required for successful implementation of a nursing practice change.

The rising population of older Americans with advanced illness challenges current care delivery models. We use the metaphor of advanced illness as a difficult journey and propose a specific role, that of the "OACIS NP [nurse practitioner]," who helps provide a place of refuge during this journey. "OACIS" is an acronym for Optimizing Advanced Complex Illness Support, a program to provide home-based palliative medical care. The 4 pillars of this collaborative model for advanced nursing care include care coordination, medical management, psychosocial support, and education. We make the case for this expanded role for nurse practitioners who specialize in palliative care.

Staff response to patient call bells is a communication issue that influences patient assessment of care quality and satisfaction. An ethnographic, grounded theory approach was used to examine nurses and nursing support staff perspectives about call bell use on single- versus double-patient-room units. We used the dance metaphor to describe differences in staff behaviors related to answering call bells on the 2 units in the study. Unit culture as exemplified by an enhanced call bell system and a relationship-centered leadership style were associated with a well- choreographed call bell answering process that promoted safety and patient satisfaction.

Rapid assessment was used to evaluate a noise problem on a busy, high-traffic, high-acuity medical/surgical telemetry unit over a 4-week period. Six sources of environmental noise were identified including conversational noise, noise from doors, noise from housekeeping activities, noise from the pneumatic message tube station, hallway noise, and miscellaneous noise. Our study also demonstrates the value of rapid-assessment methodology for the evaluation of clinical problems such as noise.