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PubMed1987

Raising standards of clinical practice--the fundamental issue of effective nursing practice.

The proposition put forward in this paper is that standards of nursing practice can only be assured if the profession is able to find ways of responding to the intuitions and gut reactions of its practitioners. Rather than deny them, nurses have to know how to test and thus legitimize them. Such a validation process demands more clinically based nursing research projects and the proliferation of arrangements such as clinical nursing practice units. It is further argued that by linking the intuitive and rational aspects of nursing in this way the profession is in a better position not only to fulfil its societal obligations but also to build up its own knowledge and skills.

Clinical Competence↗
PubMedDate not supplied

The baccalaureate degree in nursing as an entry-level requirement for professional nursing practice.

The education of professional nurses must take place in institutions of higher learning with a bachelor of science in nursing degree required for beginning professional practice. Nurses educated in these academic settings should be socialized as professionals with a philosophical and value system that is compatible with this role. This education should be flexible, diverse, and directed toward providing the nurse with a solid base for general, professional nursing practice. Nursing as a profession is a social institution and must present itself as a strong, unified profession to survive the inevitable changes occurring on the health care front. By tracing the evolution of the entry-into-practice dilemma, a systems archetype and two mental models that currently drive nursing and jeopardize its potential to meet the demands of the emerging health care market are identified. The authors offer a high-leverage solution to the entry-into-practice dilemma that they believe will strengthen the nursing profession.

American Nurses' Association↗
PubMed2006

Redesign of the model of nursing practice in an acute care ward: nurses' experiences.

OBJECTIVE: to describe nurses' experiences of the change associated with redesign of the model of nursing practice in an acute care ward in the preparatory and implementation phases. DESIGN: descriptive case study SETTING: a surgical ward in an acute care hospital in Greater Western Sydney SUBJECTS: fourteen registered and six enrolled nurses working on the surgical ward volunteered to be interviewed, eight in the preparatory phase and twelve six months into the implementation phase MAIN OUTCOME MEASURE: descriptions of nurses' experiences in the preparatory phase and six months into the implementation phase of the redesigned nursing practice model RESULTS: many nurses felt apprehensive in the preparatory phase, however, six months into implementation phase their willingness to trial the model was evident. Negativity pervaded both phases, as did their concerns for the quality of care being given. In the preparatory phase nurses described the clinical activities coordinator (CAC) role as having potential to be beneficial and this was realised to some degree six months into implementation phase. A preference for registered nurses over enrolled nurses as a dominant component of the staff was evident in both phases CONCLUSIONS: the struggle with the change that nurses experienced suggests redesign needs to be a more collaborative process involving strong communication and supportive education so nurses can empower themselves within the change.

Australia↗
PubMed2000

Watson's philosophy, science, and theory of human caring as a conceptual framework for guiding community health nursing practice.

Criticisms of existing nursing theories in relation to community health nursing practice are that they focus on individuals and have been developed primarily for practice within the context of infirmity and disease, making them inadequate to guide community health nursing practice. Despite being developed for individuals, Watson's theory is proposed as a nursing framework that is philosophically congruent with contemporary global approaches to community health and health promotion. An overview of her theory identifies the centrality of caring, holism, and ecology in the theory as it has evolved over the past 20 years. Concepts developed for individual-nurse interactions are extrapolated to the community in a discussion of the suitability of the theory to guide community health nursing practice. A community assessment tool based on Watson's theory is provided.

Community Health Nursing↗
PubMed1998

An advanced practice nurse--nurse researcher collaborative model.

The advanced practice nurse (APN)--nurse researcher collaborative model proposed in this article emerged through an APN and a nurse researcher working together on a pilot research study and a project to describe advanced nursing practice in the outpatient setting. The model demonstrates how, through the observation and discussion of practice and research, the needs of both the NR and the APN are identified. Further discussion identifies outcomes important for each professional role as well as for the discipline of nursing. Results of such collaboration include practice-relevant nursing research, research-based practice, and more reflective APNs and nurse researchers.

Ambulatory Care↗
PubMedDate not supplied

Levels of performance for intravenous nursing practice.

Intravenous nurses function at different levels of performance based on their experience, educational background, desire for autonomy, acceptance of accountability and responsibility, and commitment. Levels of practice for the IV nurse have been developed to delineate competency, proficiency, and expertise. These levels can be used to define areas of weakness, to complement achievement, and to inspire IV nurses to reach for higher goals in their professional practice.

Career Mobility↗
PubMed2000

An evaluation of the management of patients with sore throats by practice nurses and GPs.

BACKGROUND: Practice nurses are increasingly involved in the management of minor illnesses in primary care. However, there has been little work published that evaluates the quality of the service they offer to patients. In our practice (semi-rural, 14,000 patients) a nursing triage system for minor illnesses has been established since 1992. AIM: To compare the quality of management of sore throats by practice nurses and general practitioners (GPs) in a routine nursing triage system. METHOD: An observational study assessing all patients over the age of two years presenting over a six-month period (February-August 1997) to either the practice nurse or GP with a sore throat as the chief presenting complaint. Patients were followed up at five to seven days by a researcher and recovery rates, analgesic requirements, reconsultation rates, and satisfaction rates were recorded. Patients who were still symptomatic at five to seven days were followed up again at 28 days and outcomes recorded. RESULTS: A total of 44% of patients consulted the practice nurse and 56% consulted the GP. Severity of presenting illness was similar in the two groups. The number of patients whose sore throats had settled, reconsultation rates, antibiotic prescription, and dissatisfaction rates were the same for both groups. However, the patients consulting the nurse had a more favourable outcome on indices such as patients' perception of being back to normal health (64% versus 53%) and median number of days for the sore throat to settle (four versus five). Nurses tended to see younger patients (mean age = 22.5 years versus 28.3 years) and more patients seeing the practice nurse recalled receiving advice about home remedies (76% versus 54%). CONCLUSION: Practice nurses can establish a safe and effective service for treatment of sore throats in a time-restricted triage system.

Adult↗
PubMedDate not supplied

Transcultural nursing practice described by registered nurses and baccalaureate nursing students.

Using Leininger's Theory of Culture Care Diversity and Universality as a framework, this research examined transcultural practices of nurses and students. A survey was administered to a convenience sample of registered nurses and senior baccalaureate students with 767 usable questionnaires returned. Neither group expressed confidence in their ability to care for culturally-diverse patients. Registered nurses (RNs) reported assessing cultural factors and modifying practices more frequently than did students. Respondents reported their beliefs about transcultural nursing were influenced by being with people of other cultures, their own personal values, and education. Analysis of the open-ended questions revealed two major themes. First, both nurses and students perceive an overwhelming need for transcultural nursing. Second, nurses and students respond to cultural challenges by modifying their care. Modifications are based on language and communication, pain perception and relief, religious and spiritual dimensions, gender and family roles, and other values. Results suggest that nurses and students are aware of culture, recognize that culture influences the care they provide, and modify their health teaching and nursing care based on culture. The use of a conceptual framework to help make modifications in care was not mentioned.

Adult↗
PubMed1998

Demonstrating the value of the advanced practice nurse: an evaluation model.

Advanced practice nurses are challenged to assess comprehensively the value of their role and the impact of their practice. Value is defined as quality divided by cost. The correlations among the structure, strategies of care (process), and their objectives (outcome) are key to the assessment of the quality of care and the impact of the advanced practice nurse's role. Advanced practice nurses are challenged to provide high quality care for a competitive or decreased cost. For the profession of nursing, outcomes are the result of interventions based on the nurse's clinical judgment and theoretical, practical, or scientific knowledge. An evaluation model is presented that comprehensively measures the impact of advanced practice nurses on patients and families, and an example is presented. Using the model will give credibility and validity to the APNs' positive impact on the quality and financial outcomes of care for each patient and for entire patient populations.

Humans↗
PubMed1994

Nurses' knowledge of and attitudes towards sexuality and the relationship of these with nursing practice.

Issues concerning sex and sexuality are relevant to nursing practice. The objective of this study was to determine the relationship between knowledge of and attitude towards sexuality, and nursing practice. Nursing practice in this case was defined as the discussion of sexuality with the patient, with particular reference to taking a sexual history on admission to the ward. A multi-choice questionnaire with sections establishing demographic details and nursing practice, and including the Sex, Knowledge and Attitude Test (SKAT), was administered to 357 registered general nurses (RGNs). Results show a relationship between knowledge and attitude but no relationship between either of these and the nursing practice scale. However, a slight but significant correlation between receiving teaching about sexual history taking and questioning patients about sexuality on admission suggests that nursing practice and knowledge are weakly related. There is evidence that factors other than those within the scope of this study influence all three independent variables, and these are discussed. The implications of the study suggest the need for an improvement in nurse education regarding sexuality at all stages of training.

Adult↗
PubMed2000

Occupational health surveillance, screening, and prevention activities in occupational health nursing practice.

Occupational health nursing practice is broad and encompasses surveillance, screening, and prevention activities as part of the scope of practice. While there has been some controversy about who is responsible for these activities, it is clear occupational health nurses play a pivotal role in overseeing, managing, implementing, and evaluating these programs. In fact, recent OSHA standards have included broad language that permits licensed health care professionals acting within their legal scope of practice to conduct medical and health surveillance activities. While the contributions of occupational health nurses are well documented, little is known about the degree and emphasis in practice related to surveillance, screening, and prevention programs. This study examined the scope of independent and interdependent practice by occupational health nurses related to these activities and found 71% of occupational health nurses had overall responsibility for program management, and the majority performed surveillance, screening, and prevention functions as independent practice. Physician supervision for any of these activities ranged from only 0% to 8% in reporting. The results of this study validate the independent functioning in scope of occupational health nursing practice related to surveillance, screening, and prevention activities while recognizing the contributions all providers make to a healthy work force.

Cross-Sectional Studies↗
PubMedDate not supplied

Computers in nursing practice. A comparison of the attitudes of nurses and nursing students.

This study was undertaken to compare the attitudes of nurses and nursing students toward computer use in nursing practice and to clarify factors that influence these attitudes. Three factors within the student sample were examined: changes over time, prior experience with computers, and attitudes toward technology in general. Second, the attitudes of the nursing students were compared with those of a sample of practicing nurses. Finally, the multidimensional structure of Stronge's attitude scale was analyzed. A total of 353 sophomore nursing students and 358 staff nurses participated in the study. The analysis produced a refined 17-item attitude scale composed of three identifiable subscales: computers and patient care, computers and personal security, and general attitude. It was found that students had less experience with computers than the investigators had anticipated, and there was little change over three successive cohorts of students. However, in general, students' attitudes toward computer use in nursing were positive, and the more computer experience students had, the more positive their attitudes. The attitudes of the practicing nurses also were generally positive, but differences between students and nurses were observed.

Attitude to Computers↗
PubMedDate not supplied

Impact of the RCT proposal on specialty nursing practice.

The nursing shortage is clearly the major human resource challenge facing our practice today. According to the American Medical Association (AMA), the RCT plan is intended to be an innovative solution to the shortage of bedside personnel and will prove to be timely, cost-effective and efficient. The impact of this proposal and others involving the use of clinically assistive personnel in health care facilities today is a concern for all nurses. The author addresses the latest solutions to the nursing shortage and the effect of such programs on the specialty of intravenous nursing.

Allied Health Personnel↗
PubMed1994

Cancer patients' hopes and expectations of nursing practice in Stockholm--patients' descriptions and nursing discourse.

Although nursing literature on 'caring' has proliferated in recent years, relatively little empirical data exists about which aspects of nursing practice are those recognized and valued by patients. The purpose of the qualitative study presented here is to explore the manner in which one group of Swedish patients describe and explain the domain of nursing. The data presented derives from interviews with persons diagnosed with cancer during 1987 at one general hospital in the greater Stockholm area. Forty-six patients were interviewed in 1988-89, and 20 of these survivors were interviewed again in 1992. The domain of nursing practice 'expected' by the patients was seen to be defined positively, both by what nurses 'are' and 'do', as well as negatively, by what they do not do. It was found that the patient--nurse contact, as described by these patients, was between an individual patient and a nursing collective. Finally, the need for local rather than global criteria for evaluating nursing care is discussed.

Attitude to Health↗
PubMed1984

A model for advanced nursing practice.

What is advanced nursing practice? How can the nurse administrator decide when to employ advanced nurse practitioners? The author suggests a way for differentiating basic from advanced nursing practice. She also identifies conditions that may influence decisions about employing advanced nurse practitioners. Examples of application to situations are provided.

Clinical Competence↗