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PubMed1998

Clinical exemplars describing expert staff nursing practices.

AIM: This study was undertaken to identify and describe expert staff nursing practices in a large teaching hospital in south-western USA. BACKGROUND: Differentiation of the skill level of staff nurses is important for assuring safe, quality care. In the current atmosphere of corporate, downsizing, shortened hospital stays, cross training and continued high staff nurse turnover rates, it is of critical importance to identify and describe the essential contributions of expert nursing practice and to recognize and reward nurses according to their skill level. METHOD: Clinical situation interviews and participant observations were conducted using the interpretative phenomenological research approach. Narrative data were obtained and analysed systematically in multiple stages to identify and describe recurring meanings, themes, exemplars and constitutive patterns. FINDINGS: The final stage of data analysis involved interpretation of the narrative text using Benner's (1984) 'domains and competencies of nursing practice' as a framework. These competencies were validated in this study and 16 new competencies were identified. CONCLUSIONS: Expert staff nursing practices described in this project are not behaviours commonly defined as organizational expectations in performance appraisals for staff nurses. These practices need to be incorporated into position descriptions, performance appraisals and clinical ladders to recognize, foster and acknowledge the significance of expert nursing practice.

Clinical Competence↗
PubMed1999

Stages of change theory and the nicotine-dependent client: direction for decision making in nursing practice.

Clinical practice is the basic purpose of nursing. Nursing's evolving professional development calls for the application of theory to direct decision making in nursing practice. Therefore, in an attempt to bridge what has been described as the "theory-practice gap," the author demonstrates how Prochaska and DiClemente's stages of change theory is relevant to nursing practice. According to Prochaska and DiClemente, behavioral change, such as smoking cessation, involves a process of five identified stages: precontemplation, contemplation, preparation, action, and maintenance. The author discusses each stage of change and the framework it provides for decision making in nursing practice. The concept of relapse is described and highlighted as a valuable learning experience. Finally, using the criteria set by Chinn and Kramer, systematic evaluation of the stages of change theory pinpoints strengths and discusses integration of the theory into nursing practice.

Adaptation, Psychological↗
PubMedDate not supplied

Use 'em or lose 'em: the licensed practical nurse.

This article examines the process our gastroenterology unit has undergone in redesigning and enhancing the role of the licensed practical nurse. Within the department, there had existed some dissatisfaction among the licensed practical nurses regarding their role. The unit norm was to use these nurses as healthcare technicians or associates in the procedure and reprocessing rooms. The licensed practical nurses struggled with the restriction of their role and the unit reexamined the appropriate usage of licensed practical nurses. In this article, a literature review has been provided along with a description of the process of developing orientation tools and training of the licensed practical nurses to new roles. Barriers to staff acceptance has also been highlighted. Enhancement of the licensed practical nurse role has had a positive impact on our unit. This practice change has improved the job satisfaction of the licensed practical nurse as well as provided greater unit flexibility and improved teamwork within the department. Alice, a licensed practical nurse (LPN) with 30 years of experience, joined the gastrointestinal (GI) department 7 years ago. She recently corrected my introduction of her as "the tech" by explaining to our patient that: "I am a licensed nurse who will assist the doctor." This simple statement made me realize that Alice was actually a nurse! This initiated the exciting and somewhat painful process of reevaluating our use of staff, individual staff skills and competencies, and staffing patterns within our GI unit.

Clinical Competence↗
PubMed2005

Practice nurses and older people: a case management approach to care.

AIM: This paper reports on aspects of a study designed to answer the research questions: (i) To what extent do practice nurses use the five cyclical elements of a case management approach when caring for people aged over 75 years? (ii) What determines or deters practice nurses' use of the cyclical elements of a case management approach in caring for older people? BACKGROUND: Case management is an approach that uses a cyclical process of assessment, planning, implementation, monitoring and evaluation to provide systematic proactive care to people with complex health and social care needs. In England, specialist practice nurse case managers for older people have been piloted in ten primary care trusts and the posts are to be implemented nationally by 2008. No baseline work has, however, considered the applicability of developing the existing generalist practice nurse workforce. METHOD: A 26-item structured postal questionnaire was used to explore both practice nurses' use of a case management approach when working with older people, and what factors influenced the care provided. A random sample of 500 practice nurses was selected from the Royal College of Nursing Practice Nurse Association member database. RESULTS: A 45% response rate was achieved. Practice nurses assessed, planned and implemented care, but reviewing medication opportunistically and evaluating the care were uncommon. A case management approach was significantly (P = 0.005) more likely to be used in on-going management activities than in one-off treatment room care. Practice nurses with postregistration education in district nursing were significantly (P = 0.016) more likely to refer patients to social care services. Lack of time and the central role of the general practitioner were the main reasons for not incorporating case management into practice. CONCLUSIONS. The extent to which practice nurses used elements of a case management approach was highly variable and influenced by individual professional expertise, the nature of the consultation and the practice nurse's position in the general practice.

Aged↗
PubMed1997

A controlled comparison of the ability of practice nurses to detect psychological distress in patients who attend their clinics.

This study aimed to compare the ability of practice nurses in two groups of general practices to detect psychological distress in patients attending their clinics. Practice nurses in Britain are employed directly by general practitioners (GPs) and carry out their duties mainly in treatment rooms in GP's practices. The number of practice nurses has increased rapidly since the mid-1970s; recent estimates put the total between about 15000 and 18000. Most psychiatric disorders that come to medical attention do so initially within a primary care setting. In Britain, 98% of the population is registered with a GP and 70% of these people will consult their doctor in a given year. In the early 1990s the WHO found a 24% prevalence of current mental disorder in users of general health care. A further 9% of patients had significant and/or disabling symptoms but did not reach the threshold criteria for a confirmed diagnosis of mental disorder. Although published reports of surveys of practice nurses have shown varying degrees of involvement in mental health care, it is thought to be important that they become agents of detection of mental health problems because these nurses are in contact with a wide range of vulnerable people. Armstrong (1994) found that informants in a survey thought that practice nurses needed additional training in three main areas of mental health care: recognition followed by appropriate referral and on-going care of people with depression and anxiety; primary prevention of depression; and care in the community for people with serious long-term mental illness. The study briefly reported here measured practice nurses' detection of mental health problems. Results showed that practice nurses detect about 23% of those identified as cases using the General Health Questionnaire (GHQ). Testing of agreement between nurses and patients using Cohen's (1960) kappa showed a low level of agreement between nurses and patients concerning psychological distress.

Attitude of Health Personnel↗
PubMed2005

Exploring the relationship between nursing protocols and nursing practice in an Irish intensive care unit.

Nursing practice no longer relies on tradition or ritual; instead, it is based on research and empirical evidence. The emphasis on evidence-based nursing, as well as standardization of nursing practice, has resulted in the production of policies, protocols and guidelines aimed at directing numerous aspects of nursing care. The aim of this study was to explore the relationship between these documents and actual nursing practice. To this end, this descriptive study employed a case study approach to examine the experiences of nurses in an Irish intensive care unit with a protocol on endotracheal tube suctioning. Focus group interviews of 17 nurses in six focus groups provided a significant insight into the experiences of these nurses in relation to policies, protocols and guidelines. Analysis of the data afforded some highly relevant findings, including the fact that nurses adapt clinical protocols as they see fit, thus demonstrating the importance that they place on their own professional judgement and autonomy.

Attitude of Health Personnel↗
PubMed1992

The Nursing Practice Personnel Data Set. Implications for professional practice systems.

Existing data about nursing practice personnel has been found to be fragmented, incomplete, and non-uniform. These shortcomings can severely hamper administrative decision making related to professional practice systems in general, and differentiated pay and practice models in particular. The Nursing Personnel Practice Data Set (NPPDS) is designed to remedy these deficiencies by providing available, accessible, reliable, and comparable data about nursing personnel. The authors describe elements of the NPPDS and discuss implementation aims.

Career Mobility↗
PubMed2001

Practice nursing: an evaluation of a training practice initiative.

Globally, health care is moving towards a primary care approach. In the UK initiatives for nurses wishing to gain experience in primary and community care may be crucial with the advent of Primary Care Groups (PCGs) and Primary Care Trusts (PCTs). This paper outlines an initiative in practice nursing, developed as a pilot study by a Health Authority. The training practice initiative was aimed at nurses returning to practice and offered them an experiential and supportive career pathway into primary care. The evaluation (carried out over 1 year), highlighted that those primarily involved in the initiative--the trainees, educators and general practitioners--felt it had been successful, especially in relation to professional development issues. The funding bodies for the initiative, who previously had concerns over the recruitment and retention of practice nurses, were also optimistic that the support networks which developed as a result of the initiative had raised morale. The paper suggests several educational, organizational and professional issues which arose from the evaluation exercise. Further, it suggests how this initiative, in an extended form, could provide an effective basis for the training and development of nursing staff in PCGs/PCTs.

Community Health Nursing↗
PubMed2005

Effectiveness of education and problem solving work group on nursing practices to prevent needlestick and sharp injury.

OBJECTIVES: To examine the effect of an education program and problem solving work group on nursing practices for prevention of needlestick and sharp injury. MATERIAL AND METHOD: A quasi-experimental study design with a control group was conducted at the emergency and labor rooms in Sermngam Hospital, Lampang. All healthcare workers (HCWs) in the emergency and labor room were randomly assigned to the experimental and control group from April 17, 2002 to September 3, 2002. Data collection included demographics, a participatory problem solving plan, and safety nursing practice observation recording form. The present study was divided into a two months observation period, followed by a one month intervention period and a two month post-intervention observation period. Interventions included education and posters to promote safe nursing practices, peer reminders to avoid unsafe nursing practices, providing devices for recapping needles and small-sized trays to facilitate one-handed recapping, and making a hole in the lid of a sharp container Nursing practices on prevention of needlestick and sharp injury were prospectively monitored. RESULTS: Twelve HCWs (12/24; 50%) were randomly assigned to the experimental group and 12 (12/24; 50%) were assigned to the control group. There was no difference with respects to demographic and safety nursing practices on prevention of needlestick and sharp injury during the pre-interventional period among these groups. Compared to the pre-interventional period, significant improvement on safety nursing practices for all nursing practice categories were observed in the experimental group after the intervention (P=0.001). Compared to the control group, all safety nursing practice categories were performed more often in the experimental group (p=0.001). CONCLUSION: The educational and problem solving work group on nursing practices to prevent needlestick and sharp injury were effective and should be considered as an intervention to reduce needlestick and sharp injury in emergency and labor rooms at Sermngarm Hospital.

Adult↗
PubMed2005

Development of advanced practice nurses in South Korea.

In Korea, since the first specialized areas of nursing were first recognized in 1973, 10 areas have been established by the Medicine Law, 2003: public health, anesthesia, mental health, home care nursing, gerontological nursing, critical care nursing, industrial nursing, hospice, emergency nursing, and infection control. Education for advanced practice nurses is the MSN level curriculum requiring 33 credit semester hours or more. However, there are several problems to be solved and challenges to be overcome before offering advanced nursing practice to the population. Those tasks and their plausible solutions were discussed in the article.

Korea↗
PubMed1995

Who is the advanced practice nurse?

Challenges and opportunities for Advanced Practice Nurses are explored during the paradigm shift in health care. Role development is presented from a historical perspective, and current role activities are discussed related to accountabilities for care management. Advanced Practice Nurses with practitioner skills of care management coupled with a nursing framework for practice can deliver cost-effective primary care in a variety of settings.

Humans↗
PubMed1998

The circle of caring: a transformative model of advanced practice nursing.

This article presents a new and original approach to advanced practice nursing. A transformative model, the Circle of Caring is described. Using a template that builds on both nursing and medicine, this model provides a synthesized approach to practice. The traditional medical model is reviewed, as well as the evolution of the nursing process. In response to changing societal need, the scope of nursing practice is constantly challenged and expanded. New elements of practice emerge. In an effort to clarify and elaborate the current realities of advanced practice nursing, the Circle of Caring was conceptualized. Components of traditional medical practice are combined with elements of traditional nursing practice; both are situated in an elemental nursing model of caring. Although a linear representation, the Circle of Caring encompasses process pieces taken in part from a theory of caring (Boykin & Schoenhofer, 1993; Mayerhoff, 1971). An underlying purpose of this model is to highlight in a concrete way the inclusion of nursing's voice in the new and emerging--and rapidly changing--healthcare system. It is theorized that this approach to practice will yield more positive outcomes for patients, families, and communities.

Empathy↗
PubMed1995

Utilization of advanced practice nurses in healthcare systems and multispecialty group practice.

Cost-effective strategies for delivering primary care require the appropriate mix of healthcare providers. The authors define the scope of practice for the advanced practice nurse. Results of a nationwide survey of 26 large healthcare systems and multispecialty group practices are presented. Findings from these practice settings are contrasted with those previously reported in the literature. Implications for the future are discussed.

Cost-Benefit Analysis↗