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PubMed2005

Two models of mistake-making in professional practice: moving out of the closet.

Nurses make mistakes in practice despite the culturally based expectation of perfection. Such a disparity between reality and expectation calls members of the profession to question the current attitudes toward mistakes in practice. Two explanatory models of the origin of mistakes are presented. The Perfectibility Model holds that any error or harm is caused by an individual practitioner's lack of knowledge or motivation. The Faulty Systems Model offers a broader explanation of human error. I conclude that a Faulty Systems Model is more comprehensive and more effective for managing mistakes. Integrating the Faulty Systems Model into practice and education can result in more ethically fitting responses to errors and ultimately better outcomes for nurses, institutions and patients.

Attitude of Health Personnel↗
PubMed2004

Moving forward? Complementary and alternative practitioners seeking self-regulation.

Complementary and alternative medicine (CAM) occupations continue to struggle towards achieving professional status, especially in the form of statutory regulation. Many consider professional status a worthwhile goal for CAM occupations, yet it is a process fraught with tensions. In this paper we present in-depth interview data from the leaders of three CAM groups (naturopaths, traditional Chinese medicine practitioners acupuncturists, and homeopaths) in Ontario, Canada that demonstrate four main strategies used by these groups to professionalize. The strategies discussed are related to how the knowledge base of each group is organised and transmitted. These strategies include: improving educational standards, improving practice standards, engaging in peer-reviewed research and increasing group cohesion. At the core of these strategies is the demarcation of who is qualified to practice, and a signalling to 'outsiders', such as medicine and the government, that practitioners are qualified and legitimate. Across the three groups, the leaders referred to the inclusion of medical science as a basis for distinguishing between 'science' and 'non-science' as well as who should practice and who should not. We highlight how internal battles over the infusion of medical science into the knowledge base are part of the process for establishing legitimacy for the three CAM groups in our study. We end with a brief discussion of the implications of these internal battles over medical science knowledge for the future of CAM groups.

Attitude of Health Personnel↗
PubMed1994

Professionalization--theoretical analysis of the implications for nursing practice.

The aim of the present paper is to examine ideas of professionalization, and to explore in what way they might give directions for the development of nursing practice. An examination of the literature on professionalization in social science reveals that the existing ideas of professionalization may be divided into two paradigms, denominated naïve paradigm and cynical paradigm. Both paradigms have been criticized on the grounds of being idealistic and ahistoric. A contemporary view has developed from this criticism, oriented towards the historical and social contexts of professions. The implications for nursing practice of this view brings into focus the development of nursing practice in relation to the public and the tradition of nursing. This view of professionalization contributes to a contemporary view of nursing practice, and an expanded idea of professionalization is discussed.

Humans↗
PubMed2000

Empowerment of nursing as a socially significant profession in Vietnam.

PURPOSE: To describe nursing education and practice in Vietnam, and strategies that support empowerment of nursing as a socially significant profession for that country. DESIGN: The Jones-Meleis health empowerment model was used as a framework to examine barriers and identify strategies that support empowerment. METHODS: Fieldwork, interviews, and participation-observation in collaborative partnerships with the Ministry of Health, the national nurses association, and schools of nursing in Vietnam. FINDINGS: Nurses in Vietnam are eagerly poised to make significant and essential contributions to the well-being of society. CONCLUSIONS: Baccalaureate and master's degree nursing curricula taught by nurses are necessary for professionalization of nursing practice in Vietnam.

Humans↗
PubMed2002

Revisioning nursing scholarship.

PURPOSE: To propose a universal model of nursing scholarship that (a) indicates the importance of professional practice disciplines, (b) incorporates the synthesis of intellectual pursuit with social change, and (c) is holistic in its design. ORGANIZING CONSTRUCT: Scholarship, traditionally viewed as part of or generated in the university enterprise, must be an expectation in all settings in which a community of scholars from both discipline and practice can and do coexist. METHODS: Review and synthesis of the literature on scholarship, nursing scholarship, nursing as a practice discipline. FINDINGS: The history, culture, and intellectual property of nursing comprise an appropriate basis for adopting a universal holistic model of scholarship built upon a set of universal assumptions about nursing scholarship. As a discipline and a profession, nursing should include four connected domains in a universal holistic model of scholarship: knowing, teaching, practice, and service. CONCLUSIONS: Confirmation of this universal holistic model of scholarship can contribute significantly to a larger nursing identity. Use of universal holistic model of nursing scholarship indicates responsibility of the nursing profession collectively and all nurses individually. Additional work is needed to understand how a universal holistic model of nursing scholarship evolves across cultures, domains, and work settings.

Humans↗
PubMed2004

Development and psychometric evaluation of the Professional Practice Environment (PPE) scale.

PURPOSE: To describe the Professional Practice Environment (PPE) scale, its conceptual development and psychometric evaluation, and its uses in measuring eight characteristics of the professional practice environment in an acute care setting. DESIGN AND METHODS: The 38-item PPE Scale was validated on a sample of 849 professional practice staff at the Massachusetts General Hospital in Boston. Psychometric analysis included: item analysis, principal components analysis (PCA) with varimax rotation and Kaiser normalization, and internal consistency reliability using Cronbach's alpha coefficient. FINDINGS: Eight components were shown, confirming the original conceptually derived model's structure and accounting for 61% of explained variance. Cronbach's alpha coefficients for the eight PPE subscales ranged from .78 to .88. CONCLUSIONS: Findings showed the 38-item PPE Scale was reliable and valid for use in health outcomes research to examine the professional practice environment of staff working in acute care settings.

Acute Disease↗
PubMedDate not supplied

Nursing in the next millennium. Leadership skills for surviving and thriving.

Consider the following case study: The setting is an acute care facility with a large obstetrical service delivery (6,000 babies annually.) The year was 1989. A nurse leader had been appointed manager of Women's Services. Major job responsibilities included staffing, hiring, employee performance evaluations, developing policies and protocols, and managing daily operations issues. The reimbursement for the patient population was more than 50 percent fee for service.

Forecasting↗
PubMed1994

Intrapartal nursing care: research into practice.

One of the nursing profession's major goals is to advance the ideal of research-based nursing practice. Much has been written during the past decade about the difficulties inherent in achieving the goal of applying research findings to practice. With the increasing national interest in promoting optimal women's health care reforms, one area that should receive renewed interest is that of intrapartal nursing care in the hospital setting. In particular, second stage labor management is supported by considerable research, much of it conducted by nurses, that has not been incorporated into mainstream nursing care. This article discusses the issues surrounding research utilization within the context of nursing practice today, particularly in relation to existing barriers. Using intrapartal nursing care as a focal point to examine these issues, implications for a stronger emphasis on an empirical basis for practice are be identified. Recommendations for approaches to facilitate the process of research utilization by maternity nurse clinicians also is delineated.

Clinical Nursing Research↗
PubMedDate not supplied

The challenge of accountability in nursing.

The authors examine the literature on accountability in nursing and analyze the following questions: What is meant by accountability in nursing? To whom are nurses accountable? For what should nurses be held accountable? Finally, the implications of accountability for the nursing profession are explored. In order for nursing to grow and develop as a profession based on sound theoretical foundations, nurses need to examine what it means to be truly accountable. The authors point out that accountability is a complex issue that requires nurses to examine their practice relative to the needs of healthcare consumers, their relationships with other healthcare professional, and the increasingly critical role of nursing in the healthcare system.

Education, Nursing↗
PubMedDate not supplied

What is in a name: the case of nursing.

The purpose of this paper is to create a debate on whether the name "nursing" has any influence on how the nursing profession is perceived today by other healthcare professionals and the general public the nursing profession serves. A quantum leap is being suggested by the authors, as only a paradigm shift could change the world's mindset on nursing and its recognition as a profession. A change in name is what the authors see as a way of changing the unflattering perception of nurses and enhancing its status to the level of respectability of other healthcare professions.

Attitude of Health Personnel↗
PubMed2004

Educational strategies to enhance placement and retention of nurse practitioners in rural Arkansas.

PURPOSE: To examine the factors and incentives enhancing nurse practitioners' (NPs') long-term employment in rural areas. DATA SOURCE: The participants were 121 master's prepared or higher educated NPs located in rural Arkansas. A survey about role preparation and employment factors was mailed to the participants. CONCLUSIONS: We found that 10% of all respondents were not currently employed in the role of an NP. The majority of rural-employed NPs had didactic content focusing on rural-practice opportunities and engaged in rural practicums while in graduate school. Rural NPs were much more likely to have graduated from research-intensive universities. Nearly 90% of NPs reported they were somewhat to very well prepared for practice in rural Arkansas. IMPLICATIONS FOR EDUCATION: The shortage of health care providers remains one of the most irresolvable problems in the U.S. health care delivery system. Compounding the shortage is the unequal distribution of health care practitioners in rural areas. Evidence indicates that NP students engaged in rural clinical practicums were more likely to practice in rural areas. In light of this information, nurse educators should expand the NP educational process beyond rurally located practicums to deliver the entire educational process to the NP students' rural homes.

Adult↗
PubMed2004

What is the nature of nurse practitioners' lived experiences interacting with patients?

PURPOSE: To illuminate the nature of the lived experiences of nurse practitioners (NPs) interacting with patients, to discover the essential meanings of those lived experiences, and to articulate a structure gleaned from the essential meanings. DATA SOURCES: Six NPs provided concrete descriptions of their experiences interacting with patients. Data were collected and analyzed using a descriptive, phenomenological method of inquiry. CONCLUSIONS: The data revealed eight essential meanings for interacting with patients: openness, connection, concern, respect, reciprocity, competence, time, and professional identity. The nature of NPs' lived experiences interacting with patients is an authentic attending to health-related concerns, originating and enduring within the context of an intersubjective relationship. Through the dialogues that evolve within the context of intersubjective relationships, both NPs and patients become more as persons, amenable to understanding the meanings each has assigned to his or her life-world situations, regardless of the outcomes of any health-related interventions. IMPLICATIONS FOR PRACTICE: The NPs in this study valued the relationships that ensued from their interactions with patients. From these relationships they derived both personal and professional growth. Intersubjective relating is the "art of nursing" for the participants in this study.

Adult↗
PubMed2006

Prescribing trends by nurse practitioners and physician assistants in the United States.

PURPOSE: As an important step in analyzing the role of nurse practitioners (NPs) and physician assistants (PAs), we examined their prescribing behavior. The intent is to study the characteristics of providers and patients, and the type of prescriptions written by NPs and PAs in primary care and to compare these activities to physicians. DATA SOURCES: The National Ambulatory Medical Care Survey (NAMCS) database was examined for prescriptions written by primary care clinicians (family and general medicine, internal medicine, and general pediatrics). A representative sample of 88,346 primary care visits over a 6-year period (1997-2002) was analyzed in which a prescription was written by an NP, a PA, or a physician in an urban or rural setting. CONCLUSIONS: The characteristics of all the patients seen were similar for geographical region of visit, age, and gender, but differed by ethnicity and race. An NP or a PA was the provider of record for 5% of the primary care visits in the NAMCS database. The three clinician types were likely to write at least one prescription for 70% of all visits, and the mean number of prescriptions was 1.3-1.5 per visit (range 0-5) depending on the provider. PAs were more likely to prescribe a controlled substance for a visit than a physician or an NP (19.5%, 12.4%, 10.9%, respectively). Only in nonmetropolitan settings did differences emerge. In rural areas, NPs wrote significantly more prescriptions than physicians and PAs. IMPLICATIONS FOR PRACTICE: We suggest that NPs and PAs may provide a role that is similar to that of physicians in primary care based on prescribing behavior. The prescribing behavior of PAs and NPs parallels that of physicians by the number of medications per visit, the types of therapeutic classes, and the type of patient. However, in nonmetropolitan areas, prescribing differences emerge between the three types of providers that bear further exploration.

Adult↗
PubMed1984

School nurses: improve the reception and sharpen the image.

Many educators and community members misunderstand the present-day school nurses. These nurses' roles encompass a much broader range of health-related activities than did their predecessors' roles. Continued education and professional autonomy have enabled school nurses to direct their attention to primary and secondary prevention and to the maintenance of health. By utilizing a systems approach, school nurses can plan strategies that promote visibility and clarify their images. The outcome could result in better understanding and cooperation between the nurses and other school personnel, resulting in an ultimate benefit to children. The organization of a city school district's health service program and the functions of some of its team members are described. Pertinent statistics regarding the district and the nurses working within it are provided. Examples are given of typical school nurses experiences and responsibilities. Numerous suggestions are made for establishing networks with those persons having formal and informal power in order to achieve visibility and credibility. Some of the suggestions include participation at parent association meetings, presidents' council, teacher-faculty meetings, community council meetings and spreading the message via school and local newspapers.

New York City↗
PubMed2005

Perceived barriers to nurse practitioner practice in rural settings.

CONTEXT: Rural residents experience the same incidence of acute illness as urban populations and have higher levels of chronic illness. Overall, access to adequate rural health care is limited. Nurse practitioners (NPs) have been identified as safe, cost-effective providers in meeting these challenges in rural settings. PURPOSE: This replication study was conducted to examine NP perceptions of barriers to rural practice in Minnesota. Findings were compared to earlier studies to examine issues that have persisted over time. METHODS: A Barriers to Practice checklist was mailed to NPs from the database of the Board of Nursing of a midwestern state. Rural NPs (n = 191) identified and described barriers to practice and rated the overall restrictiveness of their practice. FINDINGS: Barriers to practice were perceived to be prevalent. Persisting barriers continued to stand in the way of full utilization of NP roles. Lack of understanding of NP roles on the part of the public and other health professionals has been particularly problematic over time. Key issues in 2001 were low salaries, lack of adequate office space, and a limited peer network. Perceived restrictiveness of the practice climate, gauged as somewhat restrictive, remained unchanged between 1996 and 2001. CONCLUSIONS: NPs have an excellent history of meeting rural primary health care needs. Enhancing the NP work environment could prove instrumental to retaining these professionals in the work force and thereby contribute to improved access and quality of care in underserved rural communities.

Adult↗