[Study of a practical nursing school. National Sapporo Clinic, School of Practical Nursing].
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Japan↗
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Registered nurse and registered practical nurse evaluations of their hospital practice environments and their responses to these environments.
In 2003, over 13,000 Ontario nurses were surveyed to explore how they evaluated their hospital work environments and their responses to these practice environments. The purpose of this paper is to describe and compare these nurses' evaluations and responses. Sixty-five percent of nurses who were mailed surveys completed and returned a survey. Significant differences were found between registered nurse and registered practical nurse characteristics such as mean age, full-time employment rates, mean years of nursing experience and proportion enrolled in university or college educational programs. Both groups reported weak professional practice environments; however, there were some significant differences between the evaluations by registered nurses and those of registered practical nurses. Although both groups reported weak job satisfaction and moderate levels of burnout, there were significan differences in other responses. Study findings have implications for managing and leading nurses and for strengthening human resources practices.
Acute Disease↗
A proposed expert system for nursing practice. A springboard to nursing science.
The knowledge on which nursing practice is based comes largely from traditional sources, expert nurses passing on the wisdom of their experience to novices. Nursing research, although increasing, is usually parallel to nursing practice, and its findings, at best, are implemented only after long delays. Consequently, the most effective nursing responses to a particular client problem may be undiscovered or unknown. Nursing information systems reflect the nature and usage of nursing knowledge. They offer standard care plans, but the knowledge and decision structures for individualizing care remain exclusively in the mind of the nurse. Nurses may have great freedom to enter information into the information system, but the information is rarely retrievable in a form suitable for evaluation or research. Nursing practice, and the knowledge on which it is based, could be enhanced through the use of a novel expert system. This paper describes how such a system could be developed, with examples from the authors' prototype programs. Taxonomies of data, diagnoses, objectives, and interventions would make it possible to compare patients and to determine the relative effectiveness of nursing interventions. A built-in evaluation component would provide feedback and correction. Everyday nursing practice would become a field for research, and the knowledge gained from research would immediately be fed back into practice. In its development and in its implementation, this kind of system would help to build nursing science.
Computers↗
District and practice nurses' public health practice and training needs.
In 2000, the UK government set out its plan to tackle poor health in 'Saving Lives: Our Healthier Nation'. Practice and district nurses were recognized as key health professionals in achieving the integration of health improvement into the local delivery of health care. In order to respond to these changes, North Tyneside PCT undertook a training needs and skills analysis of local practice and district nurses. Thirty practice nurses and 39 district nurses returned completed questionnaires. Practice and district nurses rated their competence as lower in public health skills than in clinical skills and also rated them of less importance. Senior practice and district nurses indicated that they perceived low value in skills required to move forward public health practice within community nursing. The findings of this study have been used to develop a 5-day training programme. The approach has relevance to those concerned with making public health a reality within community services.
Community Health Nursing↗
Changing nursing practice through a nursing journal club.
As hospitals seek to promote evidence-based nursing practice and improve the quality of bedside nursing care, formation of a nursing journal club can be one strategy to accomplish both goals.
Clinical Competence↗
The effects of a synthesis of nursing practice course on senior nursing students' self-concept and role perception.
This study investigated the effects of a Synthesis of Nursing Practice course on senior nursing students' self-concept and perception of role competencies. Seventy senior baccalaureate nursing students enrolled in the Synthesis of Nursing Practice course participated in the study during their last semester in the program. The Tennessee Self-Concept Scale was used to measure self-concept and the Slater Nursing Competencies Rating Scale was used to measure perception of role competencies. These instruments were administered at the beginning of the Synthesis of Nursing Practice course and immediately following completion of the course. A t-test was used to assess the differences between pre- and posttest group means. The study findings indicated a significant increase in the students' self-concept (p = .10) and perceived role competencies (p = .001). Implications of the findings for nursing education are discussed.
Clinical Competence↗
Kansas risk management laws and nursing practice: approaches towards compliance in reporting substandard nursing practice in acute care facilities.
This article provides a structural outline of the many basic elements needing to be considered when institutions are developing a system for review of incidents that may fall below the applicable standard of care. Details for program development need to be explored and implemented with the mindset that the process will be modified and continuously improved over time. Protecting the interest of the individual licensee, the healthcare institution and the public are important aspects that demand attention when complying with the Kansas Risk Management Laws as they pertain to nursing practice.
Ethics, Nursing↗
Using Roy's adaptation model in practice: nurses' perspectives.
Using a qualitative research methodology, the utility of the Roy adaptation model as a framework for nursing practice within a hospital setting was investigated. The level of integration of the model into practice varied among nurses. The model was generally found to be useful in focusing, organizing, and directing nurses' thoughts and actions regarding patient care, resulting in a perception of improved quality of nursing process and patient outcomes. Prior education on the Roy model and participation in professional advancement activities facilitated model integration, while lack of education and resistance to change inhibited implementation of model-based practice.
Adaptation, Psychological↗
Advancing nursing practice: acute care nurse practitioners meet challenges at and beyond the health care horizon.
Preparation of advanced practice nurses (APNs) with acute care skills relevant to today's health care environment is a challenge faced by nurse educators, care providers, professional organizations, and regulatory agencies. The acute care nurse practitioner (ACNP) is prepared to provide multidimensional, risk-appropriate management of medically vulnerable patients with serious illness in a variety of settings. ACNPs conduct comprehensive health assessments, order and interpret diagnostic tests, diagnose and manage health problems and disease-related symptoms, prescribe and evaluate drugs and treatments, and coordinate care during setting transitions. Working independently and collaboratively the ACNP enhances access to care and quality of care for patients and families through cost-effective, outcome-oriented practice. This article describes health care market factors fostering ACNP practice, ACNP practice domain, the University of Washington ACNP program, and collaborative contributions from educators, care providers, professional organizations, and regulatory groups needed to implement the role.
Acute Disease↗
Advanced practice nurses: change agents for clinical practice.
The article presents the role of advanced practice nurses as change agents in the clinical setting. Research utilization is needed to shape and form the basis of nursing practice. As change agents, the advanced practice nurses in one institution established a research-based minimal stimulation protocol for the very low-birth weight infant and implemented it using a video presentation. Knowledge of change theory, research utilization, and video production was necessary in making this project a success.
Clinical Nursing Research↗
Standards of perioperative nursing practice: using the revised standards. From the Committee on Nursing Practices.
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Nursing Process↗
The Nursing Assistant to Licensed Practical Nurse Program: a collaborative career ladder experience.
The Department of Veterans Affairs (VA) is committed to providing cost-effective, quality care to veterans. Given an aging veteran population and common, multiple co-morbid illnesses, the needs of the typical patient cared for within the VA system are complex. Thus, caregivers meeting these needs require additional nursing education. To ensure the staff will have the skills necessary to care for patients experiencing more complex illnesses, the Battle Creek VA Medical Center (VAMC) designed a program giving experienced nursing assistants the opportunity to enroll in a nursing program leading to practical nurse licensure. The Nursing Assistant to Licensed Practical Nurse Program has been established by developing a collaborative agreement with an affiliating educational institution, defining the selection criteria, helping to prepare funding requests, developing a mentoring program, coordinating with Human Resources and Fiscal Services, and outlining the service obligation. After the first year of this program, the VAMC and the academic institution consider it a successful collaborative effort.
Career Mobility↗
[Statistical study of the problems in practical nursing. Exerpts of the White Paper on practical nursing].
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Japan↗
Educating advanced practice nurses for collaborative practice in the multidisciplinary provider team.
PURPOSE: To describe the use of a clinical decision-making work sheet as a tool to teach communication skills to advanced practice nurse (APN) students. Achievement of competencies in communication and documentation that utilize language and communication strategies that are shared with other health professionals promotes effective collaborative practice among members of the multidisciplinary provider team. DATA SOURCES: Review of the recent Institute of Medicine report on health professions education and other health professional literature. CONCLUSIONS: The Clinical Decision-Making Work Sheet helps APN students effectively communicate in real-world clinical settings. The clinical work sheet allows nurse practitioner students to communicate more effectively and efficiently, using a vocabulary that is shared with other members of the multidisciplinary health care provider team. Use of the tool in students' clinical-rotation settings facilitates effective application and refinement of the clinical decision-making skills that students learned in the advanced health assessment course. IMPLICATIONS FOR PRACTICE: Faculty have the responsibility to assist nurses as they transition from traditional nursing to APN roles. The work sheet facilitates learning the common language for data collection, clinical decision making, documentation, and reporting that is shared with other health professionals. Using the tool, students learn to efficiently organize information that supports communication and documentation that enhances their clinical problem-solving skills. Case presentation and documentation using the work sheet provide a basis for preceptor and student interaction and for student evaluation.
Communication↗
Better care in nursing homes: advanced practice nurses' strategies for improving staff use of protocols.
This article describes a set of strategies used by gerontologic advanced practice nurses (GAPNs) in three nursing homes to integrate the use of protocols into the daily care of residents. The protocols were developed as part of a larger study on the quality of care in nursing homes carried out by nurse researchers at the University of Minnesota and funded by the National Institute of Nursing Research (R01-NR03490). The GAPNs worked regularly with nursing home staff to incorporate aspects of protocols into daily care routines for residents with four specific problems common in elderly residents of nursing homes: pressure ulcers, incontinence, depression, and aggressive behavior. Outcomes of the larger study showed that residents with these four problems had better outcomes in the homes in which care was planned by the GAPNs using protocols that were integrated into the daily routines of staff.
Aged↗
Sexual health and the practice nurse: a survey of reported practice and attitudes.
BACKGROUND: Practice nurses have an important role in the provision of sexual health services in general practice. AIM: This study set out to determine practice nurses' reported practice and training in sexual health, attitudes towards sexual health, barriers to discussing sexual health with patients, and training needs. METHOD: A confidential self-administered postal questionnaire survey was sent to all 298 practice nurses in one English health district (Leicestershire). RESULTS: Completed questionnaires were returned by 234 practice nurses (response rate 79%). Most nurses routinely offered well-person checks (90%), cervical smears (89%), travel clinics (83%), saw women with genito-urinary symptoms (77%) and offered family planning advice (54%). Only a minority of nurses (13%) offered specific teenage health clinics. Sexual health issues were always discussed in a majority of consultations when giving family planning advice (65%) and in women with genito-urinary symptoms (58%). Most practice nurses (62%) had undertaken at least one course dealing with sexual health issues in the last 5 years. Uptake of training was, however, significantly lower in certain groups of nurses. An analysis of the attitude statements suggested that nurses were more comfortable discussing sexual health issues with female patients and teenagers than with male patients and those of different sexual orientations. Nurses who had received training reported more positive attitudes towards discussing sexual health issues with patients. CONCLUSION: Practice nurses offer a wide range of services in which the need to be able to take a sexual history and offer appropriate advice is important. There is scope to improve the provision of sexual health services by nurses in general practice, particularly in relation to services for teenagers.
Adolescent↗
Documentation and outcomes of advanced nursing practice.
PURPOSE/OBJECTIVES: To review literature related to documentation and evaluation of the competency of advanced practice nurses (APNs) and outline consensus findings specific to this area from the State-of-the-Knowledge Conference on Advanced Practice in Oncology Nursing. DATA SOURCES: Published articles in professional journals and written summations from the conference. DATA SYNTHESIS: Documentation and evaluation of APN competency is characterized by continued questioning about optimum approaches and methods. The literature to date has offered suggestions to initiate evaluation in APN practice. When documenting and evaluating APN competency, quality enhancement efforts and indices of cost-effectiveness must be considered. To expand APN practice opportunities, documentation and evaluation must be considered as a desired and necessary quantification of practice and not just as extra work. Efforts to promote this way of thinking will enhance marketability of the APN role in cancer care. CONCLUSION: Little research of APN outcomes exists. To counter this paucity, ONS and other organizations need to develop theoretical models to support outcomes documentation, which, in turn, enhances political and organizational savvy and promotes a viable future for APNs. NURSING IMPLICATIONS: Improved documentation of nursing interventions is required to justify the necessity and effectiveness of the APN role. In the ever-changing arena of health and cancer care, oncology APNs must ensure their positions in both existing and evolving marketplaces though efficient documentation and evaluation.
Clinical Competence↗
How can the practice nurse be more involved in the care of the chronically ill? The perspectives of GPs, patients and practice nurses.
BACKGROUND: A well established "midlevel" of patient care, such as nurse practitioners and/or physician assistants, exits in many countries like the US, Canada, and Australia. In Germany, however there is only one kind of profession assisting the physician in practices, the practice nurse. Little is known about the present involvement of practice nurses in patients' care in Germany and about the attitudes of GPs, assistants and patients concerning an increased involvement. The aim of our study was to get qualitative information on the extent to which practice nurses are currently involved in the treatment of patients and about possibilities of increased involvement as well as on barriers of increased involvement. METHODS: We performed qualitative, semi-structured interviews with 20 GPs, 20 practice nurses and 20 patients in the Heidelberg area. The interviews were digitally recorded, transcribed and content-analysed with ATLAS.ti. RESULTS: Practice nurses are only marginally involved in the treatment of patients. GPs as well as patients were very sceptical about increased involvement in care. Patients were sceptical about nurses' professional background and feared a worsening of the patient doctor relationship. GPs also complained about the nurses' deficient education concerning medical knowledge. They feared a lack of time as well as a missing reimbursement for the efforts of an increased involvement. Practice nurses were mostly willing to be more involved, regarding it as an appreciation of their role. Important barriers were lack of time, overload with administrative work, and a lack of professional knowledge. CONCLUSION: Practice nurses were only little involved in patient care. GPs were more sceptical than patients regarding an increased involvement. One possible area, accepted by all interviewed groups, was patient education as for instance dietary counselling. New treatment approaches as the chronic care model will require a team approach which currently only marginally exists in the German health care system. Better medical education of practice nurses is indispensable, but GPs also have to accept that they cannot fulfil the requirement of future care alone.
Adult↗