Be still in the presence of the Lord,..

[10/12/12, 12:06 pm first published.  On 05/18/21,  added: 08/11/2011, 14 months,  after SPIRIT TRUTH was 1947/49artriii EXPUNGED THE CHIEF ARTICLE VII DAYS:ORAL COMMON 10in2 Whole Law All Prophets USDC v living indifferent thing, 1/5th senses, touch= finger,s to prove, upon police-state, DOJ investigation & creating 1302 papist/ art iii 2 kingdoms, unGLOBAL control of mind, heart commerce udhr,  that 3rdPerson/ Embryo has no criminal report;  and  on 06/08/2015, Art. VI in III judge(s)within White Star #31 are demonstrated fact in evidence, condemned by own WORD, LIFE = LAND COURT: "..SHALL BE BOUND THEREBY, ANY 'T'HING IN THE 'C'ONSTITUTION OR 'L'AWS OF ANY STATE TO THE 'C'ONTRARY NOTWITHSTANDING..", necessarily, THE PREAMBLE TO THE BILL OF COMMANDMENT V, HERITAGE, JAMES 1 [at,  .. ORALLY AND IN TRIAL COURT TRANSCRIPT GUILTY  of  's'upreme 'L'aw of the` 'L'and(=existence; Gen 1-4  [at, https://drive.google.com/file/d/1a_Qw4yTmvi1b-SmXaoVoQsNGaNhc4ICF/view?usp=sharing,  WORD, LIFE=LAND EXISTENCE CHRIST with GOD/ ADAM therefore EVE, ETERNAL SOUL, in PERFECT LOVE of FATHER = FIRST HOLY TRINITY, 1604-1611 ETERNAL SOUL= KING JAMES, 47 CLERGY, HEBREW SECOND TESTAMENT, INTERVAL 15 BOOKS SOLELY ORAL COMMON 10in2 LAWS OF THE ETERNAL GOD, THE CREATOR [at,  https://drive.google.com/file/d/1RH37-clQTOdgTwjGyrISrWFvAiyWd-14/view?usp=sharing   And at,  https://drive.google.com/file/d/1B7XO090E5CT4RBQbBE2g468I-r-QmCSF/view?usp=sharing ]

 = GEN/ PRESIDENT GEORGE WASHINGTON THE CHIEF, APOSTLE JOHN WYCLIFFE, PROPHETS WILLIAM TYNDALE, MARTIN LUTHER, 1828/ 1844 DISSERTATION ON THE ORIGIN, HISTORY AND CONNECTION [FROM GENESIS 1 ADAM Therefore EVE] LANGUAGES OF WESTERN ASIA AND EUROPE, NOAH WEBSTER, LL.D.; DR JAMES MOFFATT DIRECT TRANSLATION BIBLE, NEW RENDERING, NOT FROM ANY PREVIOUS ENGLISH VERSION [at,  https://drive.google.com/file/d/1pEha5rJw5ELfSAyhVABO1eW0RbtBX86v/view?usp=sharing

REPEATING EXACTLY WHAT THE 47 CLERGY 

" ..and wait patiently for him to act." -Psalm 37:7

on FB: Skyline Church; Pastor Jim Garlow.

Comment:
Yes! He never Fails you, but you can Him -- if you don't "Thy Will. Not Mine."  Believe-you-me, That does Take Time and Patience---doesn't it?!!!  He Is Wonderful!  So is the Holy Ghost. Actually in earthly terms only "God of The Universe" suffices -- and still falls short. Guess, just "He Is..".

That's why He Is Supreme and Necessary to our Unique in Mankind's History Nation of  "We the People" and "Consent of the Governed" -- Laws of Both Founding Documents: "1. The Spiritual is Supreme: 1. The fundamental principle underlying the traditional American philosophy is that the Spiritual is supreme--that Man [Commandment V Heritage, James 1 ( at  3rd is of Divine origin and his spiritual, or religious, nature is of supreme value and importance compared with things material.

Religious Nature

2. This governmental philosophy is, therefore, essentially religious in nature. It is uniquely American; no other people in all history have ever made this principle the basis of their governmental philosophy. The spiritual brotherhood of men under the common fatherhood of God is a concept which is basic to this American philosophy. It expresses the spiritual relationship of God to Man and, in the light thereof, of Man to Man. To forget these truths is a most heinous offense against the spirit of traditional America because the greatest sin is the lost consciousness of sin.

The fundamentally religious basis of this philosophy is the foundation of its moral code, which contemplates The Individual's moral duty as being created by God's Law: the Natural Law. The Individual's duty requires obedience to this Higher Law; while knowledge of this duty comes from conscience, which the religious-minded and morally-aware Individual feels duty-bound to heed. This philosophy asserts that there are moral absolutes: truths, such as those mentioned above, which are binding upon all Individuals at all times under all circumstances. This indicates some of the spiritual and moral values which are inherent in its concept of Individual Liberty-Responsibility.

An Indivisible Whole

3. The American philosophy, based upon this principle, is an indivisible whole and must be accepted or rejected as such. It cannot be treated piece-meal. Its fundamentals and its implicit meanings and obligations must be accepted together with its benefits.

The Individual's Self-respect

4. The concept of Man's spiritual nature, and the resulting concept of the supreme dignity and value of each Individual, provide the fundamental basis for each Individual's self-respect and the consequent mutual respect among Individual's. This self-respect as well as this mutual respect are the outgrowth of, and evidenced by, The Individual's maintenance of his God-given, unalienable rights. They are maintained by requiring that government and other Individuals respect them, as well as by his dedication to his own unceasing growth toward realization of his highest potential--spiritually, morally, intellectually, in every aspect of life. This is in order that he may merit maximum respect by self and by others..." .  Hamilton A. Long says the essential so much better in the 'Whole of our Society as Governance".   This is at,  https://babel.hathitrust.org/cgi/pt?id=mdp.39015022687787&view=1up&seq=13  First of 'Twelve Basic American Principles."

Mr. Hamilton's #12 is "The Majority -- Limited for Liberty. Read it if you haven't for therein, you will find The Wrong Decision of 'Our 1960's Watch of our 184 year-old, Posterity; and James Monroe's Opinion: "There is no maxim in my opinion which is more liable to be misapplied,  and which therefore needs elucidation than the current one that the Interest of the Majority is the is the Political Standard of Right and Wrong....In fact it is only reestablishing under another name and a more specious form, force as the measure of right..."! [at,  https://avalon.law.yale.edu/18th_century/fed12.asp ].

Attorney Hamilton, profession of Article III, wrote on page 207-, 

    "..To repeat, the Constitution cannot soundly be classified as a [Matt.15 human precept misused label..]..'religious' document; but in the foregoing respects, for example, it is intimately bound up with the recognition of the existence God and with an assumption of the profound connection with sound self-government.  ...it was a firm conviction of the 'F'ounders that religion is the basis of morality and that firm religious conviction and faith are, therefore, to sound morality among a people; just as sound morality was considered by them to be essential  to the sound character of  'I'ndividuals and of the people of a country, as the only firm basis upon which a successful self-government could be created. ..This philosophy was substantially influenced by religious leaders-- chief of all clergymen of New England---in the long course of their own  gradually developing struggle toward "Liberty and Independence" within the rhelm of religion as well as with regard to their role as citizens in the field of government: that is, independence from a country in foreign control accompanied by 'I'ndividual 'L'iberty, especially in the rhelm of conscience and all things religious--- freedom of and freedom of the 'I'ndiviual to reason and decide religious questions for himself without interference  by any superintending earthly 'A'uthority. ...There is an important consideration which needs to be kepted in mind by every generation, including especially the 'C'lergy and all others particularily interested in preserving religious liberty---freedom of conscience---in America, with the fullest protection under the Constitution. 'This is that' freedom of conscience and religion is only one aspect of the indivisible whole of 'I'ndividual 'L'iberty and must stand or fall with the other parts; it cannot be treated separately and preserved, as observed in 1776 by the Reverend John Witherspoon---President of Princeton College and a signer of The Declaration of Independence:

        "There is not a single history in which civil liberty was lost, and religious liberty preserved entire.  If therefore we yield up our temporal property, we at the same time deliver the conscience into bondage.". ...

The italics are added. Attorney Long, 100th year,1976, has written, for any youth ..A Man, A Woman, an excellent  compendium -- our PART history -- to which, right now, is the abyss .. for Reverend Witherspoon, Jan Calvin, John Locke, the RESTORATIONISTS/ CHRUCH OF CHRIST   

 

In Memory: Jet

B. +/- February 1994; D. 04/28/2012

1997 was when Jet entered our home in S.E. Escondido. A stray, he use to run around the farming, country neighborhood with his red scarf for a collar.

Jet is a black Labrador with Pit Bull Mix. He was beautiful, black with tiny white patch you see there on the right; strong, lightning fast - catch and kill a rabbit on the run; loner..or belonged to the local, rural, immigrants living on the hillside above the area's homes.  We knew these individuals were not here legally, but they helped everyone out and didn't ask for more than a chance.  Our society, absent government / union intervention, was more tolerant and remembered very well -- all the contributions these individuals offered to the world of United States Agriculture and home assistance over the years since before the 1930's.  

The loner, Jet was often at the blame for a lot of romping, chasing, gallivanting around. There were 2, long-haired, beautiful, pure-bred large dogs who were let-out to run in the neighborhood.  One day, one of those dogs did not return from the neighborhood run.  The owners put out LOST signs.  

 My big brother, Cap had passed away. Jackie, his widow, and  Dad, saw the sign.  About then, Jet appeared and not knowing anything about the LOST dog, Jackie and Dad saw Jet - a big, black dog, and gave him water and a large dog kennel.  Jet started getting 2 meals a day! 

Jackie notified the owners and they came down to the House:  "That's not the dog! He's the one who causes the problems."

Apparently, Jet would join in the chase and gallivanting with the other 2 dogs. Jet was blamed for the LOST dog.  This would be one of many mis-adventures of opinion at Jet's expense.  He was formidable. You didn't mess with him.  He could pull anyone off their feet. His skull was a virtual weapon. And if riled, hair on end; canine teeth bared,.... Jet always had plenty of space!  I gave him space.  

He loved women, babies, and children.  It was easy to see that when a puppy, Jet received a lot of Love and Care because he never changed his disposition. Dad use to adopt dogs from childhood.  It was a given that Jet would join our 4-legged family: A wonderful, Mother Cat with babies; 2 small poodles, 1 large white poodle, on 1/4 acre of land. 

Men, Jet viewed as suspect. He even had a problem with Spanish-descendant men; along with any who would attempt kick, hit, chase away, or show belligerence.  Jet kepted his distance for most, was close to Dad, and jealous of Jackie's more attention to the other dogs than him.  We moved from S.E. Escondido in 2001 to San Marcos.  Dad passed in 2002. Jet was joined by Petey, a developmentally disabled Bichon; parakeets, and fish..not counting the backyard rabbits, lizards, gophers and other ...

New neighbors included two little girls.  After a walk, Jet, Petey, and I were headed toward the house when one of the little girls came over to say 'Hi' to the dogs.  Jet wagged his tale, looked at the little girl; and as she bent down to pet him --- his head came up and the little girl got a cut on her lip.  She cried.  Jet was quiet and I took him into the house -- went over to the neighbor to check on the little girl and apologize for the accident.   "He bit her!"   I corrected, but nope "He's a dangerous dog.".  Jet kepted that reputation until I moved back to Escondido in 2011.  

Humane Society tagged Jet a couple of times for running off and scaring   some of the neighbors....but not all.   Many neighbors would get Jet's collar and bring him home --- only if I didn't get there first!  I knew Jet to be a kind, protective, loving big, tough, independent sometimes more pit bull than Lab; but more often more Lab than Pit Bull!  

As I became closer to Jet, I learned that he did know what everyone thought; that he trusted me; and that I could depend on him for even a threat of trouble.  For a few months, all the animals with me relocated to Fresno area of California.  Jet loved this area.  He romped around many areas that were open and safe for him. So Did I with some pictures on FB page!  It is beautiful country and very friendly.  I learned so much about farming; about crops and the problems of economy with government.. and the just plain hard work; as well as my Profession as RN, BSN, PHN Administrator of a Home Health Agency.

He will always be remembered by me as sensitive and intelligent. --- Wish you could have seen  Jet  as Dad became less able to manage, but still took the dogs for their walk; and when Dad was very ill and didn't make it -- that last night when he died at home.  Then, wish you could have been there as Jet with Petey, helped me after Dad had passed away.    

God gives "soul" to all animals -- especially those near and dear to each of us;...because we give the love with respect, each 'soul' within deserves.  Societal beliefs labeled Jet a trouble-maker....not Jet.  He was no more a trouble maker, than I am.  Oops! I'd better not say that!  

For society to declare sterilization for all cats and dogs, is as much an injustice as its corresponding myth that there will never be enough individuals to care for the offspring of those animals;... and deny those animals "The Soul" God has given each one of them. 

 That word "all"...is terrible!  It reigns above persons, animals, by not allowing the sacred property of conscience - both to the animals and to the persons.  It is a product of "Yes bias law" which states..society declares -- persons agree.  There is no disagreement, for to disagree would mean that there is life, liberty, and pursuit of happiness for animals as well as persons; and non-conformity to society's opinions without interference.

Jet's life is an expression of "society" v. "soul" of Each-One-Person-Accountable to God, as well as the "souls" of all animals He Created... homo sapiens being the only mammal created in God's Image with the ability to achieve righteousness.

Survey | This is NOT Child's Play: Our Children, Their Health, and How Nursing Can Help > WEB65

Survey | This is NOT Child's Play: Our Children, Their Health, and How Nursing Can Help > WEB65: "The 'yes' is for those practicing RN's in leadership or clinical work - specialized or not, who know the first question for IOM at RWF is: 'How did you determine that quality nsg. or med. is bad before you create at least 16 new areas for Executive Branch Government to intercede - not counting Education-Labor-DOJ-FTC - in something it has a demonstrated history of statistical errors in application of nursing theory to clinical or leadership care. Statistical in that creating a 'collective-group' for care required to one-person-in whatever multiple roles he/she occupies with relation to the Total-unique-person. In other words group-think doesn't really produce any improvement in patient care; especially when 1:1 care whether as a leader over other professionals or the implementer of care as a professional to a family with or without the pediatric-adolescent - or over the age continuum. Remember the $14.25 Trillion that represents $163,959.00/Citizen & growing!"

7. If not presented in a fair and unbiased manner, please describe.

Not a problem of the presenter. A problem of 'Group-think" that pervades nursing as it gets sucked into areas it does not belong. Because IOM at RWF starts to make changes based on "assumptions" not true in fact or in practice; everything goes down-hill. All the indoctrination regarding 'future of nursing' is lost, because nursing is defined by the inaccuracies and demands of the Executvie Branch of government force and control..along with definitions. Example: Question:"Do you think IOM/RWF Plan is realistic?". No-one has answered: "Do you think the IOM/RWF is necessary and supported by the goals of JCHA, JCAHO, Standards of Practice for virtually every specialty in nursing including acute hospital care as well as ICU_CCU; with CONTINUING involvement of all listed orgs. ...EXCEPT the increased perversion of The Executive Branch of Federal Government in a role which ignores the 'checks and balances' between the THREE Levels of government.

10. Other comments?

The Government cannot perform nursing care better than nurses can. The Dept. of Labor with the Dept. of Justice cannot measure the statistics of quality-person-to-person dynamics of coworker, leader, or caregiver in any setting. The Federal Government is incapable of "person" as a member of the species homo sapiens with cognitive skills. It comprehends group-thinking with all assumptions defined and determined BEFORE any nurse or group of nurses have any say; and it is absent any regard or recognition of the quality of person care - existing in the finest practice of medicine in the world ----- including Nursing Care and Leadership!

HAPPINESS for 1free ceu is a very interesting course...

Print Course | Happiness > CE633

Comment:

That it is a reflection of the political correctness of avoiding the word God or religion; and that the importance in the Declaration of Independence of "pursuit of Happiness" is not the word 'happiness'; but is very much the word 'pursuit'. Here is Noah Webster's definition of "pursuit": "1. A following with a view to reach, accomplish or obtain; endeavor to attain to or gain; as the pursuit of knowledge; the pursuit of happiness or pleasure; the pursuit of power, of honor, of distinction, of a phantom.

2. Proceeding; course of business or occupation; continued employment with a view to some end; as mercantile pursuits; literary pursuits.

3. Prosecution; continuance of endeavor."    And of "happiness": "The agreeable sensations which spring from the enjoyment of good; that state of a being in which his desires are gratified, by the enjoyment of pleasure without pain; felicity; but happiness usually expresses less than felicity, and felicity less than bliss. Happiness is comparative. To a person distressed with pain, relief from that pain affords happiness; in other cases we give the name happiness to positive pleasure or an excitement of agreeable sensations. Happiness therefore admits of indefinite degrees of increase in enjoyment, or gratification of desires. Perfect happiness, or pleasure unalloyed with pain, is not attainable in this life.".

The Declaration is about one person with rights from our Creator. This "evidence" while scientific is about "temporal" effects, signs, and measures,  among groups social, work, age, etc. Spiritual is about 1 person's relation to "Religion and Integrity" in relation to 'pursuing' temporal satisfactions. But the essence of spiritual is in the relationship to the definition of religion": Religion, in its most comprehensive sense, includes a belief in the being and perfections of God, in the revelation of his will to man, in man's obligation to obey his commands, in a state of reward and punishment, and in man's accountableness to God; and also true godliness or piety of life, with the practice of all moral duties. It therefore comprehends theology, as a system of doctrines or principles, as well as practical piety; for the practice of moral duties without a belief in a divine lawgiver, and without reference to his will or commands, is not religion." ["1828 American Dictionary of the English Language"].

A little nursing history comment resulting from the "Evidence-based Practice" article

Authors:

Mary Krugman, RN, PhD, FAAN
Mary Krugman, RN, PhD, FAAN, director of professional resources at the University of Colorado Hospital, is responsible for research and evidence-based practice, clinical orientation, training, and continuing education of RNs and ancillary clinical employees, along with other support programs. The author has declared no real or perceived conflicts of interest that relate to this educational activity.

Maureen Habel, RN, MA
Maureen Habel, RN, MA, is an award-winning nurse author residing in Seal Beach, Calif. The planners and author have declared no real or perceived conflicts of interest that relate to this educational activity.

Margi J. Schultz, RN, MSN, PhD, CNE
Margi J. Schultz, RN, MSN, PhD, CNE is the director of the nursing division at GateWay Community College in Phoenix, Ariz. The author has declared no real or perceived conflicts of interest that relate to this educational activity.

---

Objectives

The goal of this program is to provide nurses with information about evidence-based practice and strategies to increase evidence-based practice in their clinical work environment. After you study the information presented here, you will be able to —

• Review the concepts of evidence-based practice and the evolution of the field.
• Identify examples of evidence-based practice in clinical nursing practice.
• Examine ways a nurse can incorporate evidence into daily clinical practice.

---

Jim, a graduate nurse, is caring for ventilated patients under the guidance of his preceptor. One day, he hears nurses around him talking about a new protocol that requires brushing patients’ teeth. Since the new protocol “suddenly appeared” and requires additional care every two hours, the nurses see it as just one more extra job to do, mandated by administration. But Jim is curious. Having recently graduated with skills enabling him to search for the evidence, he retrieves articles on ventilated patients and learns that brushing patients’ teeth is one of the components of a “ventilator bundle,” an evidence-based group of interventions to help prevent ventilator-associated pneumonia.¹ At first, Jim is hesitant to show the articles to his preceptor. Will she be receptive to learning from a graduate nurse? But Jim is fortunate: His preceptor is pleased to receive the information, and his manager gives him positive feedback, asking him to present the information at a staff meeting.

A few short years ago, evidence-based practice was less well known, and nurses were not as prepared for or open to using data and evidence in professional practice. It’s difficult to keep up with new practice changes. Many nurses learned to function according to procedures, obtaining knowledge and technical skills from nursing instructors and textbooks. Nurses believed these methods of learning provided the most accurate information on how to care for patients. Unfortunately, the nursing profession has sometimes been reluctant to change practice even in light of research that challenges the traditional way of doing things.²

But times have changed dramatically. Now nurses know some of their most widely used techniques and information about nursing practices have been based on tradition, not evidence. All nurses can think of examples of changes in nursing care, such as no longer placing a postpartum patient on bed rest or transferring the care of many surgical patients to the outpatient arena. Evidence provided the basis for these significant practice changes, and this evidence is now available to nurses with a click of a computer mouse. Many nurses, however, still choose to seek information from colleagues rather than use the computer, with research reporting that 67% of nurses surveyed used colleagues rather than evidence in practice, 58% had never used research reports, and 82% had never used library resources for updating practice.³ Gaining knowledge of evidence-based practice and learning strategies for implementation are critical skills for changing practice in your work, whatever the setting. Nurse clinicians have hands-on experience that is invaluable in improving patient care outcomes while reducing cost.⁴

What, When, and Where

Evidence-based practice is the delivery of patient care by a provider who integrates clinical expertise with the best available evidence from systematic research.^2,4 Started by physicians in England and Canada in the 1980s and 1990s, evidence-based medicine reviews and uses the best available evidence so healthcare decisions can be made in a cost-effective way based on valid research. TheCochrane Collaboration, an international nonprofit organization supporting evidence-based practice, develops rigorous reviews of the medical research literature to promote evidence-based medicine decisions. Its reviews are based on criteria that include randomized clinical trials and outcomes evaluation to ensure providers find unbiased recommendations for practice. Evidence-based practice is now considered an essential component of high-quality health care.⁵

In the U.S., the Agency for Healthcare Research and Quality (AHRQ) has been a leader in generating evidence-based standards for healthcare providers, including publishing practice guidelines on outcomes, such as pressure ulcers and pain management. The AHRQ website offers extensive resources to both professionals and consumers.

Over the years, the focus of evidence-based practice has expanded to include not just clinical trial research, but also data on patient preferences and values.⁵ These modifications are important since research-based interventions for a patient problem are not easily implemented if the patient refuses to be treated. Nursing evidence-based practice, generated from the concepts of evidence-based medicine, continues to grow, with journals, models, and books to help nurses understand the concepts and process.

Evidence-based nursing, like evidence-based medicine, emphasizes a systematic approach to examining the evidence rather than relying on tradition and anecdotal opinions. Not all evidence in nursing and patient care practice has been systematically researched, however. Various evidence-based practice models have been developed that incorporate nonresearch sources of evidence, such as the model developed by an academic hospital that depicts current and valid research at the core, then nine other non-research sources of evidence, called practice-based evidence, such as quality data, expert nurse consensus, and benchmark data.⁶Benchmarking is the process of comparing outcomes with national standards.⁵ There continue to be many interpretations of evidence-based nursing practice and some controversy over how this movement impacts the caring, qualitative focus of nursing.⁷ Using evidence enhances caring in practice by providing the nurse with the tools to deliver safe, quality care. Implementing evidence-based practice is a major criterion for organizations seeking to achieve Magnet status for nursing excellence.²

What About Research Utilization?

Experienced nurses may know about research utilization and wonder what the difference is between research utilization and evidence-based practice. Research utilization is a more structured way of using research findings, examining outcomes in a selected area of nursing practice, reviewing the literature, and changing practice based on findings. Evidence-based practice uses a broader focus, including patient preferences and data on the costs of care, among other dimensions.⁶

While nursing now emphasizes evidence-based practice, nursing research utilization was a significant force in moving nursing research from the academic setting into the clinical environment and encouraged nurses to use research at the bedside. Important projects were undertaken to advance research in practice, including the Conduct and Utilization of Research in Nursing (CURN) project.⁸ The CURN project produced 10 research-based nursing care protocols, many of which provided the foundation for how we currently practice. One example of this practice change was the management of urinary catheters. Accepted nursing practice had been to clamp, then disconnect the urinary catheter tubing when the patient ambulated. Research showed that interrupting the closed system by this method increased the likelihood of a urinary tract infection. This landmark CURN protocol promoted change in nursing practice across the country. Research utilization brought a clinical focus to nursing research, involved staff nurses in the process, and increased clinical nursing research publications, all significant advances for our profession. As the evolution of practice-based research continues, the emphasis is now moving to multidisciplinary evidence-based practice teams, recognizing the importance of multiple disciplines working together to determine best practices in patient care.⁹

Evidence-based practice and research utilization both require a nurse to learn to search for and analyze the evidence. Nurses can learn these skills independently, in a classroom, through continuing education, through library services, or in a degree program. Practicing with guidance is an important way to gain confidence when searching and analyzing evidence. Find a peer or a mentor for support and help. A local librarian, a clinical nurse specialist, or a faculty member can serve as a coach to guide learning.

Evidence-Based Practice Examples

Jim, the graduate nurse, learned to search for the evidence in his undergraduate education and quickly located the evidence about brushing teeth of vented patients. Other clinical scenarios show why critical evidence needs to be translated into the practice environment. Translating research into practice can take up to 20 years; delays that mean patient outcomes are not improved.⁵ An example of the gap between evidence and practice, and a delay in moving knowledge to patient care, can be seen in the use of saline vs. heparin in flushing lines. In 1993, a nursing study reported evidence that saline was as effective as heparin in flushing lines, was less expensive, and had better outcomes for patients since heparin is often contraindicated for a patient’s condition.¹⁰ This study was based on original research reported a decade earlier. Even today, some hospitals do not incorporate these findings into practice.

In another example, two care variances had been detected with male catheterized patients even though nurse competencies were verified. Urology physicians were consulted to identify best practices for male catheterization procedures since evidence was limited. This evidence-based project evolved into a research project since there was so little evidence to evaluate.¹¹ Study outcomes revealed that some nursing literature contained outdated facts about male catheterization, including incorrect information on the distance to insert the catheter (6 to 8 inches when it should be 10 to 12 inches) and the incorrect assumption that residual urine return indicates that the catheter is in the bladder.

Increasingly, nursing journals are including an evidence-based or research column to help nurses keep abreast of developments in their field. Some specialty organizations also sponsor grants for members to conduct research. Nurses should keep up their membership in professional organizations to gain access to these excellent evidence-based practice resources.

Starting an Evidence-Based Work Culture

Nurses cannot assume that other healthcare professionals, including physicians, know the most recent evidence since such a large volume of data is now being disseminated. For example, when working on two of our nursing evidence-based practice projects, alcohol withdrawal preprinted order sets and a sedation assessment scale for ICU patients, we discovered that physicians often did not use the same evidence. Nurses initiated the searches for evidence, and after months of journal clubs and the examination of other sources of evidence, including benchmarking data, our collaboration resulted in evidence-based order sets. The practice teams collected pre- and post-data, demonstrating improved outcomes for patients, safer care, and increased satisfaction for staff and providers. These nurse-led evidence-based projects are now collecting follow-up data to measure how the practice changes have been sustained. How did we accomplish these projects? Our work environment fosters evidence-based practice, and nurses are encouraged to question practice. While our environment does have advanced practice nurses to support managing evidence-based practice projects, many of these steps can be carried out in any environment with clinical nurses eager to change practice in their organization.

This type of data collection can and should be done by licensed practical nurses (LPNs) and licensed vocational nurses (LVNs). LPNs, or LVNs as they are known in some areas, work under the supervision of a RN or other healthcare provider. In long-term care (LTC) facilities, the RN is often immersed in managerial tasks while the LPN performs the majority of care for the residents. LPNs/LVNs are a vital part of the healthcare team in an ever-changing healthcare environment, and whether working in LTC, home care, or an acute care facility, the LPN is on the frontline to provide data that contributes to evidence-based practice.¹²

1. Identify a clinical problem or issue bothering you or other nurses. Our projects are examples of good clinical problems to tackle since all team members felt these patients were clinically challenging and exhausting to care for safely. Nurses practicing in all settings have clinical issues they find frustrating. These are often called the burning clinical question.⁷

2. Search for the evidence, using databases applicable to your problem. Some databases are by subscription only, but Medline can be accessed easily and is available at www.nlm.nih.gov/portals/healthcare.html. If you need help to search the literature and don’t have easily accessible resources, try a free online tutorial.

3. Start a journal club to analyze the evidence. Nurses on the University of Colorado Hospital medical ICU held journal club sessions to review articles on alcohol withdrawal and sedation assessment. Journal clubs are essential to keep professional practice current and to sustain the culture of evidence-based practice. Our units/services conduct journal clubs monthly or quarterly to keep up on practice changes, with clinical staff nurses taking turns learning how to lead sessions under the guidance of our CNS/educators and research nurse scientists. We started an e-mail journal to reach our float pool and off-shift nurses. There is always a way to hold a journal club! We have taught nurses about journal clubs through an online program of instruction using PowerPoint, formal classes, grand rounds, and written material.¹³ Journal clubs have the advantage of bringing together nurses from a similar specialty who have multiple views and various years of clinical experience. Participants use quantitative and qualitative critique forms to sharpen their critical thinking skills when reviewing the literature to prepare for journal club discussions. Contact a local nursing college to help conduct journal clubs if this activity seems too challenging to tackle alone in your work setting.

4. Analyze the strength of the literature. Is the evidence sufficiently reliable and valid to change practice? Decisions based on journal club review need to be based on the strength of the evidence. This can be challenging. Five key questions one expert suggests asking are —²

• Is the research relevant?
• Can the research be applied to a broader population?
• Did the intervention do more good than harm?
• What outcomes were studied?
• How large an effect did the study show, using statistical tests of significance? An account of an outcome affecting one patient, such as a case study, will have far less strength than several studies with large sample sizes. A chart (such as the one we use, with fewer levels, below) can help determine the level of evidence.^7,14

Levels of Evidence Chart
Level and Quality of Evidence	Type of Evidence
Level 1	Meta-analysis or a systematic review of multiple controlled studies or clinical trials
Level 2	Individual experimental studies with randomization
Level 3	Quasi-experimental studies, such as nonrandomized, controlled, single group, pre-post cohort, time series, or matched case-controlled studies
Level 4	Nonexperimental studies, such as comparative and correlational descriptive research, as well as qualitative studies
Level 5	Program evaluation, research utilization, quality-improvement projects, case reports (The Joint Commission’s Sentinal Event reports), or benchmarking studies (National Database of Nursing Quality Indicatorsdata, University Health SystemConsortium reports)
Level 6	Opinions of respected authorities or the opinions of expert committees, including their interpretation of nonresearch-based information. This includes textbooks and clinical product guidelines.

5. Use the strength of evidence to determine the next steps. If the evidence clearly supports a practice change, you have to decide the best method for the change process. Who are the stakeholders? Who needs to become involved to “own” the change? If it’s a nursing practice change, such as flushing lines with saline rather than heparin, nurses can initiate change using the quality improvement process in their institutions. Partners would include physicians and pharmacy. If analysis of the evidence indicates insufficient strength exists, you may need to go back and re-review the evidence or consider broadening your scope to find resources to initiate your own institutional study of the problem. We found it helpful to consult an algorithm developed by research experts to help with the next steps.¹⁵

In the case of alcohol withdrawal and the sedation scale, the evidence was clear that these were valid and reliable assessment instruments that could be implemented for safer patient care. In a different example, our nurses were interested in the issue of family presence during resuscitation procedures. The nurses reviewed research articles, but some staff were uncomfortable with having family members present during codes and other emergent procedures. We held journal clubs (many of them multidisciplinary) across our hospital to discuss the evidence. Because of the degree of controversy, we decided to conduct research by surveying nurses, physicians, and families to assess their perceptions of family presence during resuscitation. Based on our internal survey data, one unit then began to initiate the practice change as a pilot project. Our institution decided to implement this initiative as a guideline rather than a policy. Units implementing the guideline have had excellent results.¹⁶ This project demonstrates how the views of leadership influence the readiness to implement evidence, a challenge when creating an evidence-based practice environment.

6. Make the practice change. In the example of the alcohol withdrawal and sedation assessment evidence-based changes, when the preliminary nursing review of the evidence indicated sufficient strength for practice change, we formed a team, including physicians, pharmacists, and nurses, to plan practice changes. These changes included new standards of care, staff education with competency verification, and the development of preprinted medical orders. We used our hospital quality model, FOCUS-PDCA (Plan, Do, Check, Act), to implement and sustain the change.¹⁷ Evidence-based projects enhance nurses’ professional development for they not only learn about evidence-based practice directly, but also exercise leadership skills by co-leading journal clubs, writing new evidence-based nursing standards of care, collaborating with physicians and other disciplines on draft orders, holding in-services to teach peers about the practice changes, coaching staff, and conducting audits. Seeking collaborative partners to make evidence-based practice changes ensures that all team members reach consensus on the evidence and process.

Strategies to Implement Evidence-Based Practice

Activities to support evidence-based practice include forming journal clubs, conducting sessions to teach staff nurses about evidence-based practice, integrating evidence-based practice into the philosophy of nursing care and nursing job descriptions, and building policies and procedures to be evidence-based using both references and levels of evidence to document the strength of the evidence. Orientation on evidence-based practice is provided for new nursing employees, and all professional nurses complete an annual evidence-based practice skill competency. Learning how to examine the evidence is just as important as managing new equipment and deserves education and skill competencies, just like technical updates.¹⁸ We have found that working with our clinical nurses, who represent their units and services, on evidence-based champion teams, such as pain, falls, palliative care, and skin care, leads them to become champions for best practices for these clinical issues. We also disseminate an evidence-based practice newsletter to keep staff updated on evidence-based practice activities and projects.

Research shows that administrative support is key to developing a work environment that supports evidence-based practice.¹⁹ Nurse managers need to provide time and resources to encourage research utilization activities.²⁰While evidence-based activities are critical to transforming the institutional culture, the most important change needs to be your own views about research and evidence. If you think reviewing literature and other sources of evidence to implement evidence-based practice are “add-ons” to your practice, you may never fully understand or accept important practice changes. Many nurses, unfortunately, were taught that research is not part of clinical practice. Practice based on evidence is the foundation for professional nursing practice, not an activity reserved for specialists. Your actions make a difference daily in patient outcomes. Major regulatory agencies and healthcare payer groups are now examining nurse-sensitive indicators, such as pressure ulcers, falls, and restraint use, to benchmark outcomes of nursing care and possibly use this data to determine institutional reimbursement. Consumers expect that nurses will anticipate care problems to keep them safe and prevent adverse outcomes. A growing body of literature documents how nursing interventions rescue, or fail to rescue, the patient and make a difference in patient morbidity and mortality by recognizing pre-arrest conditions.^21,22 Reducing errors and keeping patients safe is a national initiative. Care needs to be delivered using evidence combined with careful patient surveillance.

The role of the LPN/LVN in evidence-based care is especially evident in the examples related to pressure ulcers, fall, and safety issues. The LPN/LVN is often the first to recognize signs of impaired skin integrity, confusion, incontinence, and other issues that affect the safety of the patient. The LPN must observe, record, and report changes that may have a significant impact on patient outcomes. In fact, data collection is one of the primary roles of the LPN/LVN. It’s the responsibility of the LPN/LVN to participate in the development of policy change and new protocols to meet the needs of all patients. LPNs/LVNs are an integral part of the healthcare team and should participate in the change process that occurs with evidence-based nursing care.²³

Patients depend on us to deliver the best care possible. Nurses need to assume accountability for practice by continually learning to fulfill our professional responsibilities. Basing practice on evidence is essential for safe nursing practice and the future of our profession.

Gannett Education guarantees the content of this educational activity is free from bias.

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References

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1. Grap MJ, Munro CL. Preventing ventilator-associated pneumonia: Evidence-based care. Crit Care Nurs Clin North Am.2004;16(3):349-358.

2. Koehn ML, Lehman K. Nurses’ perceptions of evidence-based practice. J Adv Nurs. 2008;62(2):209-215.

3. Pravikoff DS, Tanner AB, Pierce ST. Readiness of U.S. nurses for evidence-based practice. Am J Nurs. 2005;105(9):40-51.

4. Menez JA. Research in evidence-based nursing practice. Acad Medsurg Nurs Official Newslet. 2007;16(4).

5. Burns N, Grove SK. Understanding Nursing Research: Building an Evidence-Based Practice. 4^th ed. St. Louis, MO: Mosby Elsevier; 2007:498-529.

6. Goode CJ. What constitutes the ‘evidence’ in evidence-based practice? Appl Nurs Res. 2000;13(4):222-225.

7. Messear DC, Tanner CA. Evidence-based practice. In: Joel LA. Advanced Practice Nursing: Essentials for Role Development. 2nd ed. Philadelphia: PA Davis; 2009:244-259.

8. Michigan Nurses Association. Conduct and Utilization of Research in Nursing Project. New York, NY: Grune & Stratton;1981-1982.

9. Porter-O’Grady T, Alexander DR, Blaylock J, Minkara N, Surel D. Constructing a team model: creating a foundation for evidence-based teams. Nurs Adm Q. 2006;30(3):211-220.

10. Goode CJ, Kleiber C, Titler M, et al. Improving practice through research: the case of heparin vs. saline for peripheral intermittent infusion devices. Medsurg Nurs. 1993;2(1):23-27.

11. Daneshgari F, Krugman M, Bahn A, Lee RS. Evidence-based multidisciplinary practice: improving the safety and standards of male bladder catheterization. Medsurg Nurs. 2002;11(5):236-241.

12. Crecelius CA. LPNs in long-term care. Licensed practical nurse or least prepared nurse? American Medical Directors Association Web site. http://www.amda.com/publications/caring/october2004/lpns.cfm?printPage=1. Published

October 2004. Accessed June 23, 2010. 

13. Oman KS, Krugman M, Fink R, eds. Nursing Research Secrets. Philadelphia, PA: Hanley & Belfus: 2003.

14. Oman KS, Duran C, Fink R. Evidence-based policy and procedures: an algorithm for success. J Nurs Adm. 2008;38(1):47-51.

15. Titler MG, Kleiber C, Steelman VJ, et al. The Iowa Model of Evidence-Based Practice to Promote Quality Care. Crit Care Nurs Clin North Am. 2001;13(4):497-509.

16. Duran CR, Oman KS, Abel JJ, Koziel VM, Szymanski D. Attitudes toward and beliefs about family presence: a survey of healthcare providers, patients’ families, and patients. Am J Crit Care. 2007;16(3):270-290.

17. Hospital Corporation of America. Continual Improvement Handbook. Nashville, TN: Executive Learning Inc; 1993.

18. Krugman M. Evidence-based practice: the role of staff development. J Nurs Staff Dev. 2003;19(6):279-285.

19. Hutchinson AM, Johnston L. Beyond the BARRIERS scale: commonly reported barriers to research use. J Nurs Adm. 2006;36(4):189-199.

20. McClosky DJ. Nurses’ perceptions of research utilization in a corporate healthcare system. J Nurs Scholarsh. 2008;40(1):39-45.

21. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288(16):1987-1993.

22. Ashcraft AS. Differentiating between pre-arrest and failure-to-rescue. Medsurg Nurs. 2004;13(4):211-215.

23. Nursing Practice Standards for the Licensed Practical/Vocation Nurse. National Federation of Licensed Practical Nurses Web site.http://www.nflpn.org/about.html. Published October 2003. Accessed June 23, 2010.

COMMENT:
Being a diploma grad.[1971], who went on for BSN-PHN[1983], with a few courses toward Masters; research was very much a part of my Hospital-based program diploma with hours spent at UCLA Medical Library.

At Mt. St. Mary's College of "The Roy Adaptation Model" of nursing care; unless you read, researched, applied, and evaluated your practice role in every setting; you would not have graduated from the program. This is back in the early '80's.

Another aspect, not recognized is that when a RN recognized a patient-care problem; suchas insertion of a foley catheter in a male patient, and asked urologist for the patient, the physician wasn't a resource for change - even when knowing that change was needed.  Literature searches while readily available and extensive from the 70's, weren't easy to implement clinically...not because of lack of clinical Research and Development information so much, as "if you don't follow the policy and procedure"; then you were 'liable to be written-up'; or the institution might lose their JCHO or JCAHO Accreditation; and it is 'the Policy and Procedure' which is the 'Basis of Law' in malpractice cases.

RN's, especially the group of leaders who taught and lead the 70 through pretty much to date, though many are retiring now; knew exactly what the 5W's and H of their profession.  That #4 question with its answer is very disagreeable to this 38 year practicing, home health nurse! There isn't a good choice among the choices because of the error in the basis of the article.

It is important to separate didactic from clinical in nursing education and thinking, and to not forget - The Art of Patient Care - was also integral, so that nurses learned from instructors and texts is true; but the "67% learn from their peers" is too low a percent for the nursing years, roughly referred to; plus the co-developing of computers and software which did not arrive in 'nursing' until well into the mid-90's. Learning nursing practice in acute and homecare, probably occurred 80 to 95%, via mentor programs, of the time because Art and Science were both involved.

"Accepted nursing practice had been to clamp, then disconnect urine catheter tubing when patients ambulated." dates from before 1978. This distorts nursing history, which in itself parallels some of the most wonderful advances in medicine in history: 1940 through and including the first ICU at Hollywood Presbyterian in 1970 +/- a couple of years.

The hurry-up and wait approach to teaching "evidenced-based practice" was also a bit of Canada and England's (I was in England in '83)answer to 'Continuing Quality Improvement' which had many names, and was part of US Practice before approximately 1988. Adding "patient preference, cost data, + other" doesn't do justice in terms of differentiating nursing research before "evidence-based practice". Many, if not most, thoughtful, practicing profession RN's have always used self-propelled-learning via all the professional journals with peer work - most certainly if they came from Mt. St. Mary's College BSN-PHN Program.

TODAY'S LESSON: My Love Adventures...Chapter 11

                                                      

QUARTO 1609

 SHAKESPEARE'S SONNETS103

A Lack what pouerty my Muſe brings forth, That hauing ſuch a skope to ſhow her pride, The argument all bare is of more worth Then when it hath my added praiſe beſide. Oh blame me not if I no more can write! Looke in your glaſſe and there appeares a face, That ouer-goes my blunt inuention quite, Dulling my lines,and doing me diſgrace. Were it not ſinfull then ſtriuing to mend, To mar the ſubiect that before was well, For to no other paſſe my verſes tend, Then of your graces and your gifts to tell.   And more,much more then in my verſe can ſit,   Your owne glaſſe ſhowes you,when you looke in it.* (www.shakespeares-sonnets.com) but try to read out loud. It takes practice - several times, before its whit and beauty come forth....   Another example of the problems of translation - which after you try, you can read the more modern way, and learn what the richness of vocabulary and grammar can offer any writing from using the original!  The glass is your face-understanding.
Last Night, All I did when Ron walked by for the 3rd time (maybe 4th), was grab his sleeve and say "Here!" in a sort-of, command voice.  He opened his arms, and i could have walked-in; but I'm never fast enough to catch- these efforts, all to quickly their gone! Later, I walked around looking for him, found the Christmas Present left on a table; then found him across the room.  Oh, yea, and while watching and listening to the beautiful "Saint Cecilia Christmas Celebration" lighted candles on head of Saint Cecilia with two escorts in front and in back; Ron had a pretty, young blond next to him.[I had mentioned, in one of my invitations for fun things, that I was female and sensitive to such things!]. After the Swedish Christmas Celebration, I walked over to him, anyway, and just stood there. He kept talking to whoever he was talking to; and his guard, Greg from Oceanside wandered by; pretty much as soon as the group behind Ron and facing me, shook my hand and introduced each other; Ron and his conversation walked away. For me, failed again (#13 or 14) time. Upset, of course!  Tried to decide to try again - but after above; pretty useless. On both our parts, some of the above is part of a pattern, too well known to both of us.  I left. He has been more than a little patient, when I asked him to come somewhere, usually public; he does - always.  And dating back to 2002 said; and, at least up until now, "Cathy, you can write anything you want to me.",  I have. My writing has improved tremendously; and now I have an audience -- mostly on FB; but probably elsewhere. He has been most kind and patient over the short, sporadic encounters [Ron wouldn't like that word!], since around 2000. There are too many events to go into here.  I just said this because of two sides to every coin... Today's Lesson from last night:  While all of the above was going on: Paul came up to me for the 4th time at different events and said "I didn't get to read your latest before coming, what did you go after..?"  Answered "Senate and the attack on Bush tax. I really went after them! Clarified 'Pyrrhic for Paul". Then, Jeff said "That's a pretty watch-band."  I told him it cost $8.00 at Big Lots. That I had several other bands to go with it from a much more expensive watch - stolen because the band only snaps"...showing him how it; and my mind - works:-)! That was after all of us in the audience sang "Silent Night" together; with my new choir voice, people seem to like. Jeff said "It (watchband) is very attractive." Because, with Ralph, the above, and other friends, I don't act the way I do with Ron. I'm pretty sure I didn't act at all. It wasn't part of my life, so I never thought about it - short and square in body and mind; before Ron came into my life!  Back in October, Brother Mike, Ward Mission Leader, had been helping me perform a family history for my mother and father. This less than 72 hours before "Temple Night". Temple, first time, arrival suppose to be 8:45. I get there at 9:30; and Mike stayed with me until about 12:15 am, as he guided me through the process to have my mother and my father baptized and confirmed. During the time, while waiting, I told Mike, I got lost, couldn't see street signs because of my glasses which are wrong prescription; and besides I had fallen, right the the street, bounced my nose and had a ..."You have a black-eye, and your nose is a little swollen"..I was also a little upset, because I forgot to bring a change of clothes to baptize my Mother - so one of the younger members performed it for me; but Mike made sure I could watch close by! I confirmed my mother; Mike confirmed my father. We spoke of how fast things happened; and that I was unsure of my actions, in the opportunity for Everlasting Life of both my parents. Mike didn't so much reassure me as he did remind me of what Baptism and Confirmation represent to Jesus and every individual, in heaven, on this, and any other Globe in the Universe. We just talked with Mike making sure I was OK and getting to know me.  In the 3 months of membership in LDS, I have learned more about: God, the Father, His Son, Jesus, most recently, The Holy Ghost; The King James Version of the Bible (400 years young-Anniversary)* - because God's word is changed with each translation & with word, language changes** -  and "The Book of Mormon" with "Doctrine and Covenants" and "Pearl of Great Price" - All of which are exactly what they say they are. Mike saw me through both a very upsetting, emotional and rewarding time. His concern was polite and very much as a friend helping someone in need...or not..because even though politics are a 'no-no'; I have been able to explain, why Both our Founding Documents have Nothing whatever to do with politics: 100% "Religion and Morality" with "Inner Power" of the Individual protected from "External Power" of a government; which happens to be in power, at this moment in history, not only, in America; but also, the World over!  If this kind of government wins-out, the "Dark Ages" are going to look like "A Comedy of Errors", in comparison!! Human Nature is entirely capable of considerable darkness of mind and spirit of each and every individual, walking the face of the globe; - Lucifer, almost looks kind - a deception he is most proud of attracting!! After the above journey learning about feeling love for another,  Ron is still the most important person to me for all he has done to help me understand the idea of "relationship" which he said, way back; he didn't want any part of because he liked to take off & land whenever and wherever he was needed or wanted to go. I answered that I wouldn't be interfering with that, anyway.  I had been [e-mailing to reader]; writing to us older folk, about many, many things political, international, and loving - pretty much in that order. One time, I knocked on his door, and he didn't have his shirt on - it was a 90 degree day. We hit a silent part of the conversation...he started to, kind of, smiled, his really nice smile...and I realized that I was red in the face!  Some of you may not remember 'red in the face' -- this is not a comparison, complaint, or wrong-thing to any person on any of life's journeys -- just my thing because I was about 63; but did not, by any means consider myself an old maid. Uneducated, but not old!!. I knew from FB, before he changed it, Ron's birthdate. It's quite a difference in numbers...which goes to show, the unimportant nature of numbers; until human nature takes over using them! Anyway, I knew Ron liked me - not all the way to an encounter, just liked. It is hard to keep to the point because I keep defending my feelings and talking about events to justify my feelings -- never to have a conversation, anything like the above; but with enough, interchanges - non-verbally - to fill a book of its own.  [Although, Mike is exceptional; but then that's why 'Latter Day Saints'! I get to be one too! And we know what we mean - each individual - of us - in many countries of the world. One LDS called it "The Republic of God" and that is probably correct.  It is absolutely parallel to the founding of the United States of America, some 47 years later, The Mormon Religion.] The Lesson:  I am who I am, the glass is my face, and my muse is showing such pride, I'm attempting to mend, but with Ron's gifts and graces to show; and my attempts to understand friendship without physical expression of love; mix with maybe(!?); but genuinely, with all the love a caring friend can offer someone, who doesn't always see gifts as love. * and the lessons become submerged by human nature - not by: "The Way, The Truth, and The Light"; **best example is the word "Religion" - look-up in Noah Webster's "American Dictionary of the English Language", then try any Dic. )

How to get everyone to eat vegetables...

First the cook of the house has to learn additions to "Staples" or basic food kept in refrigerator, freezer, or cupboard:
Assume 'Staples' beginnings hasn't changed, that much, from the history of food preparation; possibly except for herbs, seasonings unique to every Nation, and now readily available:

For everyone to enjoy vegetables - any of them - here are some 'staples' to keep on hand by purchasing whenever the markets run specials with the 'rider' shop price/oz even in its a 4# container of strawberries:
FRUIT:  Fresh Blueberries, raspberries, blackberries, cranberries. Fresh, frozen, or canned with 'No added sugar' apricots, peaches, pears, mandarin oranges, fruit cocktail, figs, dates. From your tree(s) - Citrus: Remember frozen with skins on = frozen juice or pulp for smoothies, lime or lemonade, grapefuit, tangelo, lemon (or Meyer), orange (navel, valencia (best juice).blood orange which is 'red' orange taking a little longer to ripen for sweetness.*
HERBS - SEASONINGS:  Nutmeg, Cinnamon, "Mixed-up Salt", non-salt herb blendings, multi-flavored pepper, cloves, cumin. Best is to buy the ones that come with a grinder on top.
CEREALS, FLOUR, PACKAGED: Jiffy, Red Barn Mills, PASTA:  Cereals in the farm-fresh produce stores with Bulk Bins or Barrels.  Mixed grain-seed cereals are a wealth of Nutrition- BUT not sweetened with sugar. Honey is good because of its other benefits. Splenda is more expensive; but Much Better to keep Carbohydrate's Grams down; there is no difference in flavor.  When cereals are bought in 'name' packages, you receive much less quantity/oz, than when you buy in bulk, but unfortunately some farm producer markets have discover the difference and raised the price in bins; which only means shop to compare price/oz for cereal. When bin markets notice they don't sell their bin's contents; they will change their pricing.  They won't sweeten with Splenda because of cost. Since that is the measure, why not leave out the sugar or reduce it? Anyway, point being the Natural Grains are among the best sources of  multivitamins. Pasta, especially whole grain, is another 'staple' when kept cooked because it also goes in veggies, scrambled eggs, any casserole. When you make spaghetti, make more pasta than will be eaten.  Flavor the pasta water, return to pan and add garlic, butter, seasonings of choice;  and keep in refrigerator for 10 days or less

DRIED Whatever is grown: figs, dates, apricots, beans etc. Don't forget mushrooms: Now all varieties are frozen and are terrific with anything!
VEGETABLES: A great idea is to chop-up carrots, celery, small amount onion(whatever kind), jicama, radishes, tomatoes, squashes, walnuts, almonds, pecans (when on sale) - Just enough for 2-4 days or probably 2 cups. Keep in container for: scrambled eggs, tuna-chicken-macaroni-any cold salad, vegetables, gravy.  All of the above allows imagination. Problem, you might imagine something delicious, but forget what you did.  That could be very unpopular with your family:-( !  
MEATS, CHEESE, including CREAM CHEESE: Do include the sandwich meats because these also go into scrambled eggs, vegetables, quick sandwiches, home 'macNcheese' (better than Kraft), grilled cheese using Olive Oil & butter.
FOR GETTING EVERYONE TO EAT VEGETABLES:
To Frozen Vegetables - Any:  Sprinkle with Nutmeg (One of the forms of pepper); salt or whatever you use - no change; pepper is OK too.  What is Different is the Nutmeg, with or without Cinnamon, Plus choosing one of the following: Blueberries, Raspberries, grapefruit sections. Probably any of the above fruits, but I have only tried the blueberries with Nutmeg.  Don't forget to add 1 or 2 serving tablespoons from chopped veggies.

Try It, You and Everyone Will Like It!

Food-dinner is family sharing at its best---even with crying, complaining, etc---talking about government as our nation with politics; talking about the family finances with the kids role in decision making and with allowances the method of learning to save for saving purposes - for something wanted - for planning - for purchasing. Playing 20 questions with school topics of history, spelling, etc. Then monopoly, card games for math, statistics of chance, strategy by remembering what has been played, and chess - because there is no substitute for the analogy of life with all its generalities including the protecting and losing of queen, knight, bishop and even pawn!  Don't forget, we are mammals; and we all learn about life when young - through games - as well as through the choices required of Boy & Girl Scout, Sports, Art and Sunday School and taking life's journeys together! No family member, including teenager, should be excused - even adult work is not an excuse.  If night-shift worker, then Breakfast is the Family Meal.

*Sweet is the reason fast-foods are popular and probably the reason children don't receive enough protein - as well as non-cooking adults. That is because Carbohydrate Foods = no cooking, just eat and run. Protein in grow and development is Essential to mental, nerve, cognition in growing brains and brains grown with the prime important source = Red Meat for its iron and B12 plus other B vitamins, muscle-bone growth. The other popularity is the spices of Mexican food with the way cheeses are blended and melted. When you discover how easy a smoothy is to make at home, you won't spend your hard earned $3-4 on one at a store.

Top of the stove cooking is Fast Food At Home!

Normally, with above staples; most meals take about 20-25 min. - not even when a roast is barbecued or prepared on Sunday, of the number of #'s for Sun. meal + 2 to 4 meals through the week.  This idea goes for single people as well as families with any number of children to any age adult.  Another rider is adults teaching children nutrition, while never calling it that:  Simply, to any child old enough to say no:  Tommy, Sally or whoever - You do not know if you don't like a food, Until You Take 6 teaspoon-fulls or 8 plastic spoons.  No Soft Drink with Meal. Only Milk - growing = don't worry about fat when Tommy or Sally spend 4-6hours/day outside - moving.  Your the parent: mean what you say and say what you mean!
 
Talk about Scramble vs Omelet or Foccacia next time....