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PubMed1998

Negotiated care--fundamental to nursing practice.

This paper focuses on negotiation in nursing. It suggests that negotiation, in the form of negotiated care, is a key element of nursing practice in the many contexts in which it takes place. To support this statement the process of negotiated care is illustrated by three examples. These examples portray negotiated care as it occurs between nurse manager (or leader) and nurse clinicians, in an interdisciplinary context, and between nurses, other health practitioners and patients/relatives. These examples demonstrate that negotiation which is aimed at achieving quality patient care pervades nursing practice. Nevertheless, it is suggested that nurses often do not recognise the centrality of negotiation in their nursing practice, nor are its implications for long-held beliefs about the role of the nurse considered. This paper also suggests that the successful outcome of negotiation in the context of nursing is dependent on nurses' confidence in, and their ability to articulate their knowledge about, nursing practice. It also relies on their commitment to the therapeutic nature of nursing practice and nurses' awareness that their practice is an essential component to patient care. The specialist nature of negotiation in nursing care, and its fundamental role in the care process, suggests that negotiation in nursing is more accurately termed negotiated care.

Humans↗
PubMed1996

Nursing practice. Report of a WHO expert committee.

Nursing is remarkable for the scope of activities that it includes. Nursing practice involves so many things in so many places that finding a definition that includes everything and applies everywhere is no easy task. This report by the WHO Expert Committee on Nursing Practice describes the basic functions of nursing practice and how they are manifested in different socioeconomic situations. Whatever the environment, the report concludes, there are certain core elements that are the responsibility of nurses the world over. The influence that social attitudes and political and economic policies have on nursing practice is examined. The report is honest in its admission that the situation in many places is far from ideal and that in most there is clear room for improvement. Policy-makers, legislators, managers, educators, researchers, other professionals and nurses themselves have important roles to play in a comprehensive approach to the development of nursing practice proposed by the Expert Committee. The report emphasizes the importance of a well educated and highly skilled nursing workforce that is consistent in maintaining quality of care but is also responsive to change. It points the way to international standards in nursing practice and lays the foundation for new strategies to ensure that nurses will be fully equipped to meet future challenges in the delivery of health care.

Education, Nursing↗
PubMed1979

Coping with expanding nursing practice, knowledge, and technology.

Nurses utilize transcultural, transactional, systems, primary, and interdisciplinary approaches to physiological and psychosocial components of patient care. Expanded roles, as well as advances in knowledge and technology have prepared nurses for critical, specialized, primary, aerospace, and independent nursing practice. Exciting as they are, nursing's expanded roles and practices frequently contribute to the burnout and distress phenomena increasingly observed in practicing health care professionals. Causes and symptoms of the burnout distress phenomena are many and varied. Selye, Shubin, Maslach, and others adeptly identified and wrote on the phenomena as it specifically relates to nurses and the many facets of nursing practice. Rather than utilizing crisis intervention coping techniques, preventive strategies and adaptations are suggested. This paper reviews and discusses: 1. Factors associated with burnout-distress phenomena identified in professional literature; 2. Identification of factors associated with expanded roles and practice which contribute to burnout stress; 3. Identification of factors in military and civilian air ambulance and aeromedical evacuation systems which contribute to burnout stress; 4. Recommendations for strategies to prevent and cope with burnout distress factors.

Aerospace Medicine↗
PubMedDate not supplied

The integration of holistic nursing practices and complementary and alternative modalities into curricula of schools of nursing.

CONTEXT: Schools of nursing in the United States have responded to the increasing consumer use of complementary and alternative modalities and consumer demand for health professionals knowledgeable in complementary and alternative modalities by incorporating holistic nursing practices and complementary and alternative modalities into their curricula. OBJECTIVE: To determine the extent to which US schools of nursing have incorporated holistic nursing practices and complementary and alternative modalities into their curricula. DESIGN: Electronic web-based survey. SETTING: Surveys were sent to 585 US schools of nursing. PARTICIPANTS: Sample (n = 125) of deans and directors (or their designees) of Baccalaureate and higher degree US nursing programs at schools holding membership in the American Association of Colleges of Nursing (AACN). MAIN OUTCOME MEASURES: Demographics of US schools of nursing, percentages of schools who utilized the American Holistic Nurses' Association (AHNA) definition of holistic nursing practice and the Holistic Core Curriculum Guidelines, and percentage of complementary and alternative modalities incorporated into the curricula. RESULTS: Almost 60% (n = 74) of the responding schools used the definition of holistic nursing practice in their curricula and were familiar with the Holistic Nursing Core Curriculum. The majority (84.8%, n = 106) included complementary and alternative modalities in their curricula. CONCLUSIONS: The study provides preliminary evidence that US. schools of nursing are incorporating holistic nursing practices and complementary and alternative modalities into their curricula reflecting a response to increased consumer use of complementary and alternative modalities and consumer demand for health professionals who are knowledgeable about complementary and alternative modalities.

Complementary Therapies↗
PubMedDate not supplied

Opportunities for advance practice nurses in the nursing facility.

Advance practice nurses (APNs) have emerged as valuable members of the nursing facility interdisciplinary team. They function in a variety of roles, including clinical care, administration, nursing consultation, and education. Positive outcomes in key indicators of care and reduction in costs to the healthcare systems have been attributed to their practice. Barriers to implementation of the role include regulatory issues, facility resistance, and difficulty adapting to the environment. Facilitation of the role is enhanced by collegial relationships and role negotiation. There is strength in the APN-physician collaborative model. The APN is likely to concentrate on prevention, restoration, maintenance, and palliative care, allowing the physician to concentrate on complex medical problems. There is a need for APN practices to identify APN-sensitive outcomes, collect and analyze data, and disseminate findings.

Certification↗
PubMed1996

Systems energetics: holistic model for advanced practice nursing.

The advanced practice nurse is faced with constant and unrelenting change. Learning ways to not only view change as healthy, but also incorporate this into practice every day can be very difficult. Systems Energetics is a holistic, natural health model. Working with nature's natural cycles, your body and common sense, Systems Energetics helps balance kinetic and potential energy in healthy, life-fulfilling ways.

Holistic Nursing↗
PubMedDate not supplied

Using role theory concepts to understand transitions from hospital-based nursing practice to home care nursing.

BACKGROUND: The phenomena experienced by professional nurses who make practice-based career changes are seldom addressed in the literature. Nurses changing from a hospital-based practice to a home health care setting report feelings of anxiety, incompetency, and lack of the necessary skills to care for clients in the home. METHOD: An integrative review of the literature on role theory can provide the conceptual understanding of the transitional experience of nurses whose roles change when they move from hospital-based practice to a home health care setting. RESULTS: A model of the role transition process is helpful in identifying the transition experienced by nurses new to the home health care setting. Experiences during the initial transition period are critical in shaping the nurse's understanding of the role. CONCLUSION: Educators can play a key part in assisting novice home health care nurses with role enactment by developing comprehensive orientation and education programs aimed at minimizing role strain.

Attitude of Health Personnel↗
PubMed1998

Women users' views on the role and value of the practice nurse.

Aspects of the views of women aged 16-65 years on practice nurses in the primary health care setting are explored. The extent to which women consult practice nurses and the reasons for consultation are first identified. Women's assessments of practice nurses are then examined. The findings are from a 3-year research project where 1251 women completed a postal questionnaire and 70 women were interviewed in depth about issues concerning women's perceptions and experiences of both general practitioners (GPs) and practice nurses. Two thirds of the sample had consulted the practice nurse; 22% about specific women's health issues (including 13% for cervical screening). For most women's health issues, more women expressed a preference to be seen by a general practitioner (GP) than a practice nurse, except for breast examination among women aged 49 to 65 years where 57% expressed a preference for a practice nurse compared with 43% for a GP. Women gave similarly positive evaluations of the approachability of practice nurses and GPs. Positive views of practice nurses were high among older women, women who saw practice nurses in well-women clinics and women who saw practice nurses in relation to women's health issues. Among women who had not consulted a practice nurse, there was both a lack of awareness of the level and range of expertise of practice nurses, and a perception that in the main they offered only minor routine services. Health promotion, disease prevention and family planning do not appear to feature centrally in women's expectations of services provided by the practice nurse.

Journal Article↗
PubMed2000

Factors impacting on shared care working relationships between practice nurses and general practitioners: a literature review.

Practice nurses have worked in general practice for many years yet little is known or published in Australia about their work. Recent health care reforms in Australia, particularly the establishment of the Divisions of General Practice and various best-practice innovations linked to the National GP Strategy have seen an increase in the role of practice nurses. Despite this GPs in Australia are cautious about the role of practice nurses. Much of this caution arises from reform in general practice in Britain particularly the establishment of fund-holding for general practice. This article reviews the literature on practice nurses in Britain and Australia within the framework of the health reforms in general practice in both countries.

Adult↗
PubMedDate not supplied

Critique of transcultural practices in end-of-life clinical nursing practice.

TOPIC: Transcultural nursing practices for terminally ill patients. PURPOSE: To examine several criticisms of transcultural nursing theory in end-of-life care. SOURCES: Published literature and interviews with nurses. CONCLUSIONS: Nurses often encounter barriers that impede their ability to provide ideal end-of-life care.

Adult↗
PubMed2000

Reflective practice and its role in mental health nurses' practice development: a year-long study.

The study reported in this paper lasted over a year, and identifies a conceptual framework of nursing practice based upon a relationship-building process. It also identifies six characteristics of nursing roles inherent within the practice of mental health nurses on a Nursing Development Unit. The paper presents a structure and process of reflection for nursing practice as illustrated by the work of a group of nurses working in a NDU. The purpose of the study was to help them better understand their work with patients. The findings from the study are used to explore how the nurses described and implemented individualized, patient-focused care. This care was based upon the ability of the nurse to communicate well and to build a relationship with a patient, bound within a context of change.

Humans↗
PubMed2003

Development and testing of the theory of collaborative decision-making in nursing practice for triads.

BACKGROUND: Although nurses depend heavily on informal family caregivers to provide care to clients and to be involved in care planning and decision-making, no nursing theories that include the client, the caregiver, and the nurse were available to guide collaborative care planning and decision-making. AIM: The purpose of this paper is to describe the construction and initial testing of the theory of collaborative decision-making in nursing practice for a triad. The theory represents an extension of Kim's theory of collaborative decision-making in nursing practice. Kim's theory was developed to describe and explain collaborative decision-making in a dyad (client and nurse). The inclusion of a third person (family caregiver) in the theory required the addition of concepts about the caregiver, coalition formation, and nurse and caregiver outcomes. The expansion of Kim's dyadic theory to a triadic theory was achieved by means of a modified version of the theory derivation process described by Walker and Avant. CONCLUSIONS: The theory of collaborative decision-making in nursing practice for a triad can be used to guide further research and clinical practice. The theory provides a framework for researchers who are interested in studying the effects of collaboration regarding decision-making among nurses, family caregivers, and clients. The initial testing of the new theory in home health care nursing revealed variety in the nature of the client-caregiver-nurse relationships, the many processes used by the nurses in proceeding with the home visits, a multitude of decisions considered and different collaborative, noncollaborative, and coalition-forming interactions. The limited evidence of the empirical adequacy of the theory precludes development of definitive guidelines for clinical practice at this time. More studies are required before clinical practice guidelines can be developed.

Caregivers↗
PubMed1990

Gerontological research. Is it useful for nursing practice?

The potential usefulness to gerontological nursing practice of nursing as well as non-nursing research was studied. The empirical phase of nursing research was also compared with that of medical, behavioral science, and multidisciplinary research. Although the quantity of nursing research reviewed was small, nearly 80% was judged to be potentially useful to the practice of gerontological nursing. About one third of the non-nursing research was judged potentially useful. These findings are relevant to all nurses, indicating the value on non-nursing as well as nursing research to nursing practice. Overall, the design of nursing research compared favorably to the design of non-nursing research.

Geriatric Nursing↗
PubMedDate not supplied

Values influencing nursing practice: responses from neonatal nurses.

PURPOSE: An analysis of narrative comments from neonatal nurses to illustrate the values that motivate behavior in the practice setting. DESIGN: A descriptive study using content analysis of written, narrative text data. PARTICIPANTS: A self-selected subsample (N = 97) of a larger random sample of the membership of the National Association of Neonatal Nurses (NANN). MAIN OUTCOME MEASURES: The application of philosophical concepts of human relationships, patient need, keeping promises, human dignity, and unrestricting circumstances in the neonatal care setting. RESULTS: Individual participants made cognitive choices related to the application of conceptual ideals of the profession to the practice setting. However, there was a lack of congruence between what the individual nurse believes is important or good and the behavior enacted in the practice setting. CONCLUSION: As a discipline, nursing needs to identify and implement strategies that support proactive accountable nursing practice consistent with the philosophical foundation of the profession.

Adult↗
PubMed1998

The evolving role of advanced practice nurses in surgery.

Health care reform has created many opportunities for advanced practice nurses and for OR nurses who want to go beyond traditional circulating and scrub roles. This article will briefly differentiate between expanded and advanced nursing practice and offer a definition and conceptual model for the surgical arena. Literature will be reviewed related to development, evaluation, and practice issues of the emerging role of the surgical advanced practice nurse.

Certification↗
PubMed1989

Hallmarks of success in nursing practice.

Four hallmarks of success in nursing practice are identified and discussed. The hallmarks are the use of conceptual models to guide nursing practice, the development of classification systems, the establishment of formal linkages between nursing education and nursing service, and the recognition of clinical scholars and clinical scholarship. Two innovations in nursing practice are identified that could become future hallmarks of success: alternative nursing care delivery systems and collaborative practice.

Clinical Nursing Research↗
PubMed2001

Skilled nursing practice -- a qualitative study of the elements of nursing.

An understanding of skilled nursing practice has implications for the identity of nursing in service delivery, and for the learning environment of the developing nurse. Here I report a qualitative study, largely reliant on ethnography, which became a journey of exploration through accounts and descriptions given by nurses in a number of different practice settings. This journey is founded in an understanding of what I have called a phenomenological and psychosocial tradition, recognising the importance of a postmodern influence, which is in tension with a scientific and behavioural tradition. The emergence of four domains of skilled nursing practice in a contextualised narrative would seem to offer justification of assumptions concerning the value of embedded knowledge and intuitive clinical judgement in nursing practice, and lay a foundation for a qualitative study of the developing nurse.

Adaptation, Psychological↗
PubMedDate not supplied

Role of the nurse teacher in advanced nursing practice.

Education and experience are the foundations on which practitioners should base their clinical judgment and broaden the scope of their professional practice. PREP has secured a professional market for nurse education, the viability of which depends on closer collaboration between nursing education and nursing practice. Nurse teachers who are committed to practice are in a strong position to assist the development of practitioners, and work towards research-based practice. This article examines the role of the nurse teacher in the domain of advanced nursing practice.

Clinical Competence↗