[The role of nursing practice in clinical nursing education].
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This article explores whether the nurse practitioner continues to utilize his/her nursing skills in the expanded role. Eight important nursing actions or attitudes are defined to describe practitioner nursing performance.
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This article traces the roots and history of nurse-midwifery in the United States in order to demonstrate the reality of midwifery as a profession in its own right. From its beginnings in the late 1920s, the profession has gradually evolved from its clear roots in nursing to an identity of its own expressed through its professional organization, the American College of Nurse-Midwives. A review of other countries' experiences with midwifery reflect much of the U.S. process and results. The future challenge for both professions is to determine how they can exist in harmony, recognizing that they are complementary roles.
Advanced practice nursing, since its inception in the early 1960s, has constantly changed in an effort to establish standardized core graduate education, specialization of practice, and autonomy, now common in the 1990s. Nurse practitioners, nurse midwives, and certified registered nurse anesthetists have followed in the footsteps of the clinical nurse specialist by enhancing their practice through advanced education. Nurses in these advanced areas are graduating from established programs with a master's of science in nursing and a specialty in their chosen field. The pediatric critical care nurse practitioner is one such specialty. This article highlights the results of a national survey that described pediatric critical care nurse practitioner practice over a broad geographic area. With change as a constant, nurses will look to the future of advanced practice roles, which are ever changing, and continue to provide safe, quality care to patients.
In an environment characterized by a projected over-supply of primary care providers and a public seeking higher quality, cost-effective care, advanced practice nurses will be measured not only by their comparative value in delivering conventional primary care, but also by the uniqueness of their contributions to health outcomes. These value-added skills, distinctive to nursing practice at all levels, include health education, disease prevention, health promotion, community resource access, and partnerships with patients. Government, private payors, and national and state regulators all authorize increasingly independent practice by advanced practice nurses. When advanced practice nurses assume such fully accountable primary care roles, their title and certification should be distinctive to that level of practice. A Doctor of Nursing Practice (DNP) degree would signal to the public that nurses--at their highest practice competency--are at the same level as other health professionals holding doctorates (such as MD, DDS, or PharmD).
There are several intervention classifications for nursing practice. Yet, their relevancy and clarity for international use has not been evaluated. Thus, the paper presents a review of 4 major nursing intervention classifications (Saba's Home Health Care Classifications, Omaha's Intervention Scheme, Grobe's Nursing Intervention Lexicon & Taxonomy, and the International Classification for Nursing Practice) for Korean nursing practice. A simple comparison procedure utilized to determine the relevancy and clarity of each overall scheme and specific elements. The findings showed that general concepts for the top level of all the classifications were both relevant and clear. However, specific elements of lower levels became less clear and relevant because of the lack of definitions and cultural differences. In particular, interventions related to psycho-social and environmental components appeared to be either unclear or non-relevant for Korean nursing practice while interventions related to physiological components were found to be very relevant and clear. In conclusion, multiple levels of hierarchical intervention schemes and the absence of definitions impede clarity of intervention classifications. In addition, for international use, an intervention classification needs to be sensitive to cultural relevancy in its elements.
Since 1965, the controversial question of what level of educational preparation is appropriate and necessary for entry into nursing practice has been discussed. No consensus has been reached by the members of the nursing profession as a whole. The opinions of occupational health nurses toward the requirement for initial registered nurse licensure and entry into occupational health nursing practice was assessed. The study revealed occupational health nurses generally supported their respective basic programs for initial licensure and entry into occupational health nursing.
Public health nursing is recognized as an important and critical component of the public health workforce, and today, it makes up the largest single category of public health professionals, according to the U.S. Department of Health and Human Services. Preparation of generalist public health nurses with the knowledge base, skills, and training to effectively respond to public health challenges is essential. The County of Los Angeles Department of Health Services, Public Health Nursing Section, in response to this need, implemented the Public Health Nursing Practice Manual to provide public health nurses with interventions and guidelines to articulate their role and practice as outlined by the framework of the Public Health Nursing Practice Model developed by Los Angeles County. Identification and development of new methods to support the practice of nursing is imperative in facilitating a more sophisticated and expanded level of practice, as well as providing a means of improving, protecting, and enhancing the quality of health for all people. The Public Health Nursing Practice Manual is an effective tool to monitor performance improvement and provide standardization of the generalist public health nurse practicing in Los Angeles County.
The Academic Nursing Home Care Unit of the West Los Angeles Veterans Administration Medical Center developed standards of gerontological/long term care (LTC) nursing practice. The standards can be used by nurses who practice in LTC settings and who care for the diverse needs of patients who are elderly or who have chronic illnesses: medical, psychiatric, or both. The standards describe how the philosophy, mission, and goals of the facility should be translated into action, and they supply a framework for evaluating the quality of nursing care.
Identifying, developing, and incorporating nursing's unique ontological and epistemological perspective into advanced practice nursing practice places priority on delivering care based on research-derived knowledge. Without a clear distinction of our metatheoretical space, we risk blindly adopting the practice values of other disciplines, which may not necessarily reflect those of nursing. A lack of focus may lead current advanced practice nursing curricula and emerging doctorate of nursing practice programs to mirror the logical positivist paradigm and perspective of medicine. This article presents an ontological perspective for advanced practice nursing education, practice, and research.
Evidence-based practice is emerging as a widely accepted paradigm for contemporary professional nursing practice. Institutions and providers of healthcare services are adopting this framework to guide the structure, process, and outcomes of patient care delivery. Advanced practice nurses are ideally prepared and positioned within healthcare delivery systems to champion the integration of this practice as a model for evidence-based patient care. This article highlights opportunities and suggests strategies for advanced practice nurses to serve as catalysts for optimizing patient care through evidence-based practice.
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