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PubMed1993

Promoting advanced practice nursing.

Meeting the goals of a reformed health care system requires the expertise of professionals, especially those with specialized knowledge and skills. In the restructured health care system, nurses prepared for advanced practice are considered to be unique and valuable providers. The effectiveness of advanced practice nurses is well documented. The use of advanced practice nurses to provide care has been limited by restrictions on their scope of practice, prescriptive authority, clinical privileging, and eligibility for reimbursement. Gaining clarity about the roles that advanced practice nurses will fulfill in the future, standardizing specialists' preparation, and removing practice barriers is imperative if advanced practice nurses are to realize their potential impact on the health care delivery system. This article discusses the current issues affecting advanced practice nurses, and provides visions of new roles for them in health care delivery.

Health Care Reform↗
PubMed1998

Realizing specialist and advanced nursing practice: a typology of innovative nursing roles.

This paper outlines the findings of the first phase of a Department of Health funded project: Realizing Specialist and Advanced Nursing Practice establishing the parameters of and identifying competencies for 'Nurse Practitioner' roles and evaluating programmes of preparation. An extensive literature review and interviews with 49 key informants was used to revise a typology of Domains of Innovative Nursing Roles which the authors had constructed. It also emerged from the key informant interviews that a substantial number of respondents considered the role of the Nurse Practitioner (NP) to be a composite of both specialist and advanced practice. Further analysis indicated that although current preparation for a 'specialist' role would meet many of the outcomes perceived necessary to prepare individuals for the NP role, something 'extra' was seen as a prerequisite for the NP. It is suggested, therefore, that there is a strong case for considering the NP role in terms of 'specialist plus', and that the typology can be helpful in considering the major emphasis within NP roles.

Attitude of Health Personnel↗
PubMed1999

Evolving trends in critical care nursing practice: results of a certification role delineation study.

BACKGROUND: In 1997, the AACN Certification Corporation, in conjunction with Professional Examination Service, undertook a role delineation study as 1 component of a large-scale, comprehensive, and systematic study of practice to update previous data. Focus groups made up of practicing critical care nurses were used to determine trends and changes in adult, pediatric, and neonatal critical care nursing practice. METHODS: Sixteen focus groups (6 adult, 5 pediatric, and 5 neonatal) used specially prepared protocols to guide discussions. Questions were designed to elicit descriptions of changes in critical care nursing practice in the preceding 5 years. Qualitative comments of the participants were analyzed across all the focus groups, rather than separately for the adult, pediatric, and neonatal focus groups. Then data for the focus groups for each patient-age range were aggregated and reviewed to abstract themes. RESULTS: Trends and changes in practice for adult, pediatric, and neonatal critical care nurses were determined. Common themes include ethical and legal issues, changes in the population of patients, psychosocial factors, and the impact of managed care. CONCLUSIONS: The results of these focus groups can be used to update the test blueprints that underlie the CCRN certification examination programs for adult, pediatric, and neonatal critical care nurses. Critical care nursing practice is changing. Specific knowledge of the changes is important for educators, managers, and clinicians. The results of this role delineation study can be used to teach, adapt systems, and validate practice.

Adult↗
PubMedDate not supplied

Reiki: a supportive therapy in nursing practice and self-care for nurses.

Reiki is a complementary, energy-based healing modality. It has ancient roots, but is uniquely suited to modern nursing practice. Reiki training offers a precise technique for tapping into healing energy, or ki, and transmitting it through touch. Reiki treatments are gently balancing and provide energy that supports the well-being of the recipient in a holistic and individualistic way. Relaxation, pain relief, physical healing, reduced emotional distress, and a deepened awareness of spiritual connection are among the benefits attributed to Reiki in anecdotes, case studies, and exploratory research, as summarized in this review of literature. Reiki is easily adaptable to nursing practice in a variety of settings, and can provide support for the practitioners of Reiki themselves, as well as benefiting those they treat with Reiki.

Holistic Health↗
PubMedDate not supplied

General practice nurses' knowledge of alcohol use and misuse: a questionnaire survey.

Nurses in general practice (termed practice nurses) are an under-utilized resource for the detection and management of patients with alcohol misuse. However, little is known about their knowledge and attitudes towards alcohol use and misuse. We therefore conducted a postal questionnaire survey of 132 practice nurses in Liverpool (UK). The results of our survey (response rate 77%) show that a knowledge and skills gap exists in the delivery of effective advice on alcohol-related issues. Indeed, our results suggest that only one in two women and one in three men are receiving correct advice on sensible limits of alcohol consumption, this despite the fact that alcohol histories are taken. Further training was requested by most nurses to develop their screening and health promotion roles, and to become involved in the management of patients with alcohol-related problems in primary care. We suggest practice nurses should be encouraged to become involved in screening for, and management of, alcohol-related problems. However, it is important to ensure that the nurses receive appropriate training and have adequate back-up facilities from doctors and other workers involved in the care of patients with alcohol-related problems.

Alcoholism↗
PubMed1990

Advanced nursing practice.

Advanced OR nursing practice is emerging and the roles, responsibilities, relationships, and rewards are spread over preoperative, operative, and postoperative work units. The roles of the nurse in advanced practice are multidimensional: clinical, collegial, educative, investigatory, and administrative. Though the primary allegiance of the ANP is to nursing, she has a commitment and the skills to work collaboratively with other nurses and disciplines on the surgery team.

Ambulatory Surgical Procedures↗
PubMed2002

[Developing and establishing an expanded and more comprehensive HIV/AIDS nursing practice].

Developing and establishing an advanced nursing practice is an essential step toward future-oriented nursing care. An action research process was initiated to establish advanced nursing practice at the HIV clinic of the outpatient department at the University Hospital Basel with the goal to offer advanced nursing care to patients. Participatory action research allows generating knowledge about a social system while at the same time tempts to promote social change. The most important goal is to constantly analyse, improve, and evaluate nursing care for patients and family caregivers. Advanced nursing practice in HIV/AIDS is based on solid knowledge regarding the illness and current therapies. Central concepts are caring, clinical experiences, evidence based practice, and patient preferences. Through a systematic step-by-step process, the nurses at the HIV clinic are being better educated and more experienced in these concepts. An essential aspect of advanced nursing practice is the specialization of each nurse in a self selected topic within HIV/AIDS care. These nurses now offer new services such as medication management and adherence support, health maintenance and prevention, and symptom management. This ongoing process of learning while establishing advanced nursing practice in HIV/AIDS, enables the nurses to face future changes in health care in a proactive way.

Acquired Immunodeficiency Syndrome↗
PubMed1976

Eighteen months general practice experience with urban practice nurses.

Experience working with practice nurses under the present urban practice nurse scheme is described very briefly. Financial matters are touched on briefly, as are points for and against the scheme. The personal conclusions reached with regard to patient acceptance, opportunities to practise a more preventive type of medicine and the relief of excessive pressures on the doctor, appear to make the continuance and extension of the scheme well worthwhile.

Community Health Nursing↗
PubMedDate not supplied

Conceptual systems of undergraduate nursing students as compared with university students at large and practicing nurses.

Phase I of a longitudinal study compared characteristics of abstractness-concreteness of junior-level baccalaureate nursing students at the University of Colorado with characteristics of practicing nurses and other college students. Three measurement instruments were used: Harvey's Conceptual Systems Test, the Role Survey, and the Self-Esteem Questionnaire. Nursing students were found to be more abstract than practicing nurses; no difference was found on abstractness-concreteness between nursing and the other students. More nursing students than practicing nurses or other students were found to have a need for structure and order. And, nursing students showed higher overall expanded role orientation than practicing nurses. Phases II and III of the study will examine nursing students' changes in abstractness-concreteness during the second and third years of study.

Adult↗
PubMedDate not supplied

Evidence-based nursing practice: are we there yet?

The volume of evidence for nursing practice has increased as a result of research and scientific discoveries. Yet we are still struggling with the dilemma of how to get evidence into nursing practice. Estimates are that it takes 20 years before innovations are fully put into use. Research is one type of knowledge to be used in practice. Nursing and patient care would benefit from moving more toward knowledge based on research and evidence. This article reviews barriers to and facilitators of using evidence in nursing practice and discusses a model for promoting the systematic use of evidence in practice. The author also offers suggestions for increasing the evidence base of nursing practice. Using evidence in nursing practice is important for all nurses, but requires more that the attention of the individual nurse.

Diffusion of Innovation↗
PubMed2003

Enhancing evidence-based practice--a controlled vocabulary for nursing practice and research.

Evidence-based practice requires flexible systems for information retrieval. Search processes in electronic databases must be based on terms, which are familiar to professionals and describe accurately the problem to be solved. The paper describes the process of evolving a controlled nursing vocabulary for indexing and information retrieval purposes. The vocabulary is based on terms of the Medline thesaurus the medical subject headings (MeSH) by National Library of Medicine and the International Classification for Nursing Practice by the International Council of Nurses. The created vocabulary consists of 10 themes central to nursing domain. The content was compiled using Delphi technique. The expert panel had four rounds and at the first stage the vocabulary consists of 558 terms. The validity of the vocabulary has been tested for indexing nursing research and based on the validation the expert panel has made some changes for the hierarchy and content. The vocabulary will be added as an independent theme to the Finnish thesaurus the FinMeSH.

Clinical Nursing Research↗
PubMed2003

Careful nursing: a model for contemporary nursing practice.

BACKGROUND: Careful nursing, a system of nursing developed in Ireland by Catherine McAuley in the early years of the 19th century and used by Irish nurses at the Crimean war, has been described as Ireland's legacy to nursing. Although records of careful nursing have been preserved, it has received little attention in the nursing literature. AIM: The purpose of this study was to conduct a preliminary content analysis of the mainly primary source historical documentation of the careful nursing system and present it within the structure of a contemporary conceptual model of nursing. METHODS: The documents describing the careful nursing system were studied and re-studied to gain understanding of the philosophical assumptions underlying careful nursing and of the thinking, attitudes, actions and practice of the nurses. Content relating to the four central nursing concepts was identified and summarized. RESULTS: Careful nursing definitions of person, environment, health and nursing are presented. Ten key concepts of careful nursing practice are identified as disinterested love, contagious calmness, creation of a restorative environment, 'perfect' skill in fostering safety and comfort, nursing interventions, health education, participatory-authoritative management, trustworthy collaboration, power derived from service and nurses' care for themselves. The spiritual dimension of human life and the spiritual in nursing emerge as important characteristics of the model. CONCLUSIONS: The results of this preliminary analysis require further verification and critical examination. However, the careful nursing model illuminates important aspects of professional nursing and could be further developed to conceptualize and guide nursing practice.

Delivery of Health Care↗
PubMed1985

The relationship between nursing theory and nursing practice.

During the past two decades, redefinition of many of the beliefs and assumptions which underly nursing appears to have contributed to an increasing divergence between nursing theory and nursing practice. Nurses who are theorists and educationalists, and nurses who are engaged in nursing practice tend to use different vocabularies, to have differing perceptions of patients and of nursing, and to value different kinds of nursing knowledge. Some of the divergences between nursing theory and nursing practice are considered, and suggestions made about how theory and practice might be reconciled.

Communication↗
PubMed1999

Assisted dying and nursing practice.

PURPOSE: Nurses' views are often solicited about physician-assisted dying, a concept that incorporates both assisted suicide and active euthanasia. Yet nurses are rarely asked about their own clinical experience of assisted dying. The literature indicates that many nurses experience difficulty distinguishing professionally sanctioned end-of-life interventions from those that are not. In this article the investigator explores the social, legal, and political roots of assistance in dying, and critically examines the profession's position on nurse participation in assisted dying and the research regarding nurse-assisted dying. SCOPE: The bioethics and nursing literature was reviewed from 1990 to 1999. The databases used were the Cumulative Index to Nursing and Allied Health Literature and Medline. CONCLUSIONS: The complex nature of caring for highly symptomatic dying patients, and the difficulty some nurses experience in distinguishing a moral difference between hastening and assisting death, strongly indicate a need for additional nursing research that does not use a forced answer.

Attitude of Health Personnel↗
PubMed1999

Is practical nursing experience necessary in administration, education, and research?

Because nursing is a practice discipline involving a relationship between nurse and client based on moral commitments of nurse to client, it is critically important that nurse administrators, educators, and researchers have experienced that relationship in practice. Nurse administrators need that basis to found a vision of nursing required to lead and guide. Nurse educators need to have experienced nursing practice to engage nursing students in praxis, that act of reflection and action. Nurse researchers need to have practiced nursing to identify critical areas of focus in nursing practice and to give meaning to the interpretation of findings. The author urges greater convergence and clarity in identifying the nonnegotiables of nursing's art and science, including the importance of nursing practice as foundational to nursing work.

Clinical Competence↗
PubMed2004

Diabetes care: practice nurse roles, attitudes and concerns.

BACKGROUND: Practice nurses (PNs) are the largest group of nurses providing primary care for patients with diabetes in New Zealand, and changes in the health system are likely to have a substantial effect on their roles. To inform the development of a new primary health care nursing structure and evaluate the new role associated with this, it will be important to have data on current practice nurse roles. AIMS: The aim of this paper is to report a study to compare the diabetes-related work roles, training and attitudes of practice nurses in New Zealand surveyed in 1990 and 1999, to consider whether barriers to practice nurse diabetes care changed through that decade, and whether ongoing barriers will be addressed by current changes in primary care. METHODS: Questionnaires were mailed to all 146 PNs in South Auckland in 1990 and to all 180 in 1999, asking about personal and practice descriptions, practice organization, time spent with patients with diabetes, screening practices, components of care undertaken by practice nurses, difficulties and barriers to good practice, training in diabetes and need for further education. The 1999 questionnaire also asked about nurse prescribing and influence on patient quality of life. RESULTS: More nurses surveyed in 1999 had postregistration diabetes training than those in 1990, although most of those surveyed in both years wanted further training. In 1999, nurses looked after more patients with diabetes, without spending more time on diabetes care than nurses in 1990. Nevertheless, they reported increased involvement in the more complex areas of diabetes care. Respondents in 1999 were no more likely than those in 1990 to adjust treatment, and gave a full range of opinion for and against proposals to allow nurse prescribing. The relatively low response rate to the 1990 survey may lead to an underestimate of changes between 1990 and 1999. CONCLUSIONS: Developments in New Zealand primary care are likely to increase the role of primary health care nurses in diabetes. Research and evaluation is required to ascertain whether this increasing role translates into improved outcomes for patients.

Attitude of Health Personnel↗
PubMedDate not supplied

Taking a sexual health history: the role of the practice nurse.

Nurses working in general practice (GP) settings are generally multiskilled and competent practitioners who come into contact with a huge cross-section of patients. These patients frequently present with a combination of health problems/needs. The practice nurse is often the first person with whom the patient comes into contact and/or consults. Practice nurses therefore have an important role to play in promoting health, including sexual health. This article examines the conclusions of Jewitt's (1995) work which explored the development of sexual history taking in GP settings. The pivotal role of the practice nurse is highlighted and the importance of taking a sexual health history is discussed. The obstacles and barriers faced by practice nurses when taking a sexual health history are outlined. Recommendations for practice are discussed, and a check list is presented that will enable practice nurses to consider their invaluable input into the holistic care of patients in more detail.

Health Promotion↗