Nursing shortages within American hospitals are in part associated with problematic work environments. Scholarship related to work environments is multidisciplinary and has been conducted using traditional and constructivist approaches to science and knowledge development. Nursing research related to nurses' work environments in hospitals is often conceptualized around variables such as job satisfaction, professional practice environment, and job stress. Macro-level variables associated with political, economic, and social aspects of the work environment have received less attention. Philosophical issues are considered. Person-Environment Congruence Theory is proposed as a framework capable of addressing environmental incongruence in hospital nursing work environments. Implications for theory and research using the framework are described.

Staff RNs in the sampled units wanted a significantly higher level of EC. They rated their WRS moderately high and the contribution of the physical environment to it as moderate. A moderately negative relationship was found between EC and WRS. EC may be a useful construct in research that attempts to improve hospital nursing work environments.

Dermatitis is a distressing symptom of radiation therapy, and current care guidelines often lack evidence. Using an evidence-based practice (EBP) model, a multidisciplinary group in an academic medical center reviewed the literature to create departmental patient education materials related to skin care that were grounded in evidence. Recommendations not supported by evidence from randomized, controlled trials were viewed within a stress-reduction framework. Until evidence related to the prevention and treatment of radiation dermatitis is more fully developed, skin care recommendations for patients with cancer who receive radiation may need to be based on evidence and theory. In addition, care for patients with radiation dermatitis should encompass strategies aimed at physical and psychosocial stressors.

Future research could explore both empirical and contextual aspects of acute dying processes. Nurses are in a position to develop useful knowledge about acute dying processes in cancer.

The purpose of this exploratory study was to examine the end-of-life (EOL) care rendered to patients and families within a large midwestern academic medical center during a recent one-year period. An investigator-developed audit tool was used to review the final hospitalization records of 100 patients. Data were collected regarding demographic variables, final hospitalization, medical diagnoses and histories, and documented end-of-life care. Major findings included a majority of deaths occurring within medical services on critical care units, a frequent short length of stay, a majority of Do Not Resuscitate or Withdrawal of Support orders being written 1-3 days prior to death, an unstable health status prior to admission, and presence of at least one significant chronic illness in the past medical history. Findings are being used to address EOL care related issues within the institution.