Previous attempts to build comprehensive clinical decision support systems have disregarded important theoretical considerations hindering the success of these projects. Grounding a Decision Support System in a theoretical model of novice nurse decision-making will strengthen the utility and acceptance of the Decision Support System. Additionally, a conceptualization of novice nurse development is an asset to nurse educators, managers and scientists interested in improving clinical decision-making.

Attending to key areas of influence in the interaction process facilitates the achievement of desired outcomes in symptom management--accurate diagnosis, symptom relief, and agreement on a course of action. The dominance of chronic illness in health care, and the centrality of the symptom experience underscores the value of sensitizing nurses to these issues.

These strategies will assist scientists and practitioners interested in determining the best evidence to support clinical decision support systems.

The vast majority of people will suffer presbycusis during the aging process. This hearing loss has potential social consequences, which place these individuals at risk for loneliness. Nurses need to encourage thorough audiological examination and follow through on recommendations to improve hearing. The use of hearing aids needs to be encouraged. A suggested model of interaction among variables influencing loneliness identifies areas amenable to nursing intervention. Frequency of significant interaction and motivation to engage in interactions represent two important variables that influence loneliness.

Nurses' reasoning skills are of interest to nurse researchers, managers, clinicians, educators and students. Recent emphasis on critical thinking has raised important questions regarding the modes of reasoning necessary for practice and appropriate measures to improve nurses' cognitive skills. This paper analyses critical thinking and diagnostic reasoning. A longitudinal framework for promoting both modes of reasoning, beginning with nursing students through to experienced clinicians, is proposed as a model worth testing in nurse samples.