Oncology nurses should be aware of cancer patients considered at higher risk for suicide. Systematic screening for suicidal ideation and behavior may identify cancer patients at high risk and facilitate appropriate mental health evaluation and treatment.

In a nursing home case study using observation and interview data, we described two mental models that guided certified nurse assistants (CNAs) in resident care. The Golden Rule guided CNAs to respond to residents as they would want someone to do for them. Mother wit guided CNAs to treat residents as they would treat their own children. These mental models engendered self-control and affection. We found limits to the models in that they led to actions such as infantalization and misinterpretations about potentially undiagnosed conditions such as depression or pain. Further, we found that CNAs were isolated from clinicians; little resident information was exchanged. We suggest ways to alter CNA mental models to give them a better basis for action and strategies for connecting NIH Public Access CNAs and clinical professionals to improve information flow about residents. Study results highlight a critical need for registered nurses (RNs) to be involved in frontline care.

Complexity science teaches that relationships among health care providers are key to our understanding of how quality care emerges. The authors sought to compare the effects of differing patterns of medicine-nursing communication on the quality of information flow, cognitive diversity, self-organization, and innovation in nursing homes. Two facilities participated in 6-month case studies using field observations, shadowing, and depth interviews. In one facility, the dominant pattern of communication was a vertical "chain of command" between care providers, characterized by thin connections and limited information exchange. This pattern limited cognitive diversity and innovation in clinical problem solving. The second facility used an open communication pattern between medical and frontline staff. The authors saw higher levels of information flow, cognitive diversity, innovation, and self-organization, although tempered by staff turnover. The patterns of communication between care providers in nursing facilities have an important impact on their ability to provide quality, innovative care.