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PubMed1994

A survey of practicing nurses' research interests and activities.

We conducted a survey of 279 practicing nurses' research attitudes, past and current research activities, and research resources. Levels of practice included staff nurses, nurse managers, and advanced practice nurses. Three factors were identified from a 15-item research attitudes scale: research value, confidence, and perceived support. Significant differences were found for research value and confidence among three levels of clinical practice. Advanced practice nurses reported higher research value and confidence than did staff nurses and nurse managers. Most respondents reported using research findings in practice, but only a small percentage were conducting research. Factors related to research conduct and use differed. Suggestions are offered for methods to increase the value of research by practicing nurses.

Adult↗
PubMed2000

Prescribing patterns of advanced practice nurses: contrasting psychiatric mental health CNS and NP practice.

Advanced practice nurses (APNs) play a key role in delivering health care and increasingly include prescriptive authority in their practices. To date, few systematic studies have investigated APN prescribing patterns. The purpose of this investigation was to explore the prescriptive practice of APNs, assess differences in prescriptive patterns by specialty, and determine barriers to prescriptive practice. Fifty-one percent (n = 1352) of 2,651 nurse practitioners (NPs) and psychiatric clinical nurse specialists (CNSs) in Massachusetts responded to a self-administered survey; 59% had incorporated prescriptive authority. Identified barriers included fees, the process of obtaining prescriptive authority, and lack of physician supervision. Significantly more psychiatric CNSs than NPs had difficulty obtaining physician supervisors. Prescriptive authority is integral to advanced practice, but differences in ability to implement this in practice exist among specialties.

Adult↗
PubMed2002

The importance of research to school nurses and school nursing practice.

Historically, school nursing has not documented sufficiently the health issues in schools, nor has it prioritized these issues for school nursing interventions or evaluated the effectiveness of nursing interventions. The National Association of School Nurses (NASN) is strongly committed to the advancement of children's health. Thus, NASN is developing an infrastructure to support research that articulates the health conditions affecting children's school success and the contributions of school nursing to children's health and academic success. In 1999, NASN participated with the National Center for School Health and the National Nursing Coalition for School Health at a Research Summit to set a school nursing research agenda. Needs and issues were identified for future research activities. The primary outcome was the identification that school nurses must practice the standards of care pertaining to research. These standards specify that clinicians be informed about, supportive of, and participate in the conduct and use of research.

Humans↗
PubMedDate not supplied

Employing a practice nurse: what sort of GP?

The general practitioners employing all 102 nurses known to be practising as practice nurses in the Republic of Ireland were sent a questionnaire for completion anonymously. A response rate of 51% was obtained. Practices employing practice nurses were found to be mostly single handed (28/52) in a town/rural setting (39/52) and participating in the General Medical Services (GMS) Scheme (49/51)*. A substantial minority of practices (16/51)* derived more than 75% of their income from the GMS. Eighty five percent of practices felt that their practice "gained or would gain financially" through the employment of a practice nurse. (* = one non-respondent)

Employment↗
PubMedDate not supplied

Standards of holistic nursing practice as guidelines for quality undergraduate nursing curricula.

The accreditation criteria of the Commission for Collegiate Nursing Education (CCNE) direct faculty to select nationally developed standards for professional practice to guide curricula and to articulate curriculum outcomes. Recently, the CCNE proposed that all undergraduate programs should adopt the American Association of Colleges of Nursing (AACN) Essentials of Baccalaureate Education as one set of national standards for undergraduate and prelicensure programs. Standards of Holistic Nursing Practice, developed by the American Holistic Nurses' Association, is an additional set of standards that assists in defining quality for undergraduate nursing education. Standards of Holistic Nursing shares major concepts with Essentials; however, it accentuates the concepts of nurse self-care, articulated nursing theory as a foundation for practice, managing the care environment to promote healing, and care of the environment as essential to professional practice. These standards do not change the care being provided by professional nurses adhering to nursing theory and current evidence, but they do raise awareness and change emphasis of practice to reflect a holistic perspective. Used together, Standards and Essentials provide complementary guidelines for curricula-preparing professional nurses to care for client and self.

Accreditation↗
PubMedDate not supplied

Licensed practical nurses in critical care areas: intensive care unit nurses' perceptions about the role.

OBJECTIVE: The purpose of this study was to determine critical care nurses' perceptions about the reintroduction of the licensed practical nurse into critical care areas. DESIGN: A qualitative research design was used, with focus groups used as the method for data collection. SETTING: A large midwestern university-affiliated medical center. SUBJECTS: Registered nurses (RNs) and licensed practical nurses (LPNs) employed in the medical center's critical care units. PROCEDURES: RNs and LPNs were interviewed separately in groups of 3 to 8 members. Open-ended questioning was used to collect information about nurses' perceptions concerning the reintroduction of the LPN role into critical care units. Data were analyzed for themes within and across groups. RESULTS: Registered nurses were unprepared for reintroduction of the role and were unsure of legal versus hospital-directed restrictions on LPN practice. LPNs were frequently placed in situations in which they assumed patient assignments outside those described in job descriptions or unit standards. CONCLUSION: When LPNs are reintroduced into critical care units, clear descriptions of roles and responsibilities are needed as is orientation of RNs to the roles of delegator and resource nurse.

Attitude of Health Personnel↗
PubMed2002

The need for a new advanced nursing practice role for Australian adult critical care settings.

The current deficit of knowledge related to advanced nursing practice in Australian adult critical care settings presents a barrier to future role development. This paper reports the findings of one theme identified by a research study that explored issues related to the potential for a new advanced nursing practice role for these settings. The qualitative approach of focus group methodology was used to collect data from a purposive sample of regional Queensland critical care nurses (n = 26). Thematic content analysis of the data identified concepts that progressively contributed to five major themes. This paper will report the findings related to the theme that there is a need for a new advanced nursing practice role for adult critical care settings. Participants perceived that nurses are already practising at advanced levels that may predetermine a new role. There was believed to be a need for recognition of and legal sanction for critical care nurses' present practices that extend beyond the current scope of nursing practice. Participants proposed that critical care nurses may be more competent than inexperienced medical personnel in this environment and participants wanted consistent levels of autonomy for advanced practices. The current career structure was seen to be a failure and many participants perceived the lack of opportunities for critical care nurses to advance up the clinical career pathway as problematic in recruitment and retention issues. The findings of this study provide new information that makes an important contribution to further exploration of advanced nursing practice role development for Australian adult critical care settings.

Adult↗
PubMed2003

The challenge of providing family-centred care during air transport: an example of reflection on action in nursing practice.

This article explores reflection with regard to the nursing practice of a transport nurse in caring for ill newborn patients and their family. It examines the issue of reflective nursing practice, institutional obstacles, and angst in promoting the model of family-centred care, as it applies to newborn infants being transported for tertiary care to a hospital some distance away from the family's home community. Reflective practice is explored as an epistemological link between practice and research, locating one nurse's clinical experience in reflection and subsequent action, through clarification of thought-provoking issues and generation of research questions.

Adaptation, Psychological↗
PubMed2001

Time to think: temporal considerations in nursing practice and research.

UNLABELLED: AIMS OF THE STUDY/PAPER: To explore the meaning of nursing time, both as it is represented in the literature and interpreted within nursing practice. To explore how nursing time may be better conceptualized through exploring non-nursing literature and the use of theory derivation. BACKGROUND/RATIONALE: The dynamic of time is one of the most important influences upon nursing behaviour, yet temporal issues have attracted very little attention in the literature regarding nursing practice, theory and research. DESIGN/METHOD: In the course of this literature review an attempt is made, via the process of theory derivation, to clarify the meaning of 'nursing time', and how nursing time is valued and perceived by others. RESULTS/FINDINGS: The literature reveals misconceptions and a lack of value of nursing time, possibly indicative of the dominance of linear models of time (such as clock and calendar time), and the historical ascendancy of medicine and the positivistic sciences over nursing. It is proposed here that nurses exist and practice within nonlinear, complex and parallel temporal worlds; these are considered by examining research data that illustrates a moment in nursing time. Exploring this moment gives an opportunity to introduce some terms and concepts that may be useful in the future conceptualization of nursing time. CONCLUSIONS: It is recommended that attention to such factors as the complex temporal dynamics inherent within health care in general, and nursing in particular, should be considered within the domains of nursing practice and research. This may help in distinguishing the fundamental identity and nature of nursing within health care and health care professions.

Humans↗
PubMed2004

Online, directed journaling in community health advanced practice nursing clinical education.

The sharing of experiences in advanced practice nursing clinical courses allows for application of core principals to different facets of practice, with the potential to promote discussions beyond the course objectives, create opportunities for mentoring, foster critical thinking, and facilitate change and socialization into advanced practice. A pilot test of online, directed journaling, an innovative sharing and reflection strategy, was incorporated in a two-quarter community health advanced practice nursing clinical course in an attempt to enhance clinical learning. Six female graduate nursing students completed the journaling. A 10-item evaluation measure demonstrated that the online journaling strategy was highly effective and valuable for the students. An assessment of the journaling entries found multiple examples of discussion, mentoring, critical thinking, and socialization. Innovative online strategies should become the standard for sharing in advanced practice nursing education.

Adult↗
PubMed1998

Nursing practice models: implications for information system design.

Nursing practice models (NPMs) describe the structural and contextual features of nursing practice environments. They offer direction in the design of information systems. Eleven factors describing NPMs emerged from a modified Delphi process: continuity of care, participation in management, collaboration, leadership, learning environment, nurse's role, staffing, communication, specialization, orientation of temporary staff, and group commitment. These factors provide nurse administrators with specific features of the clinical practice environment that IS applications should support.

Health Facility Environment↗
PubMed2005

Nursing practice as bricoleur activity: a concept explored.

The debates concerning the nature of nursing practice are often rooted in tensions between artistic, scientific and magical/mythical practice. It is within this context that the case is argued for considering that nursing practice involves bricoleur activity. This stance, which is derived from the work of Levi-Strauss, conceives elements of nursing practice as an embodied, bricoleur practice where practitioners draw on the 'shards and fragments' of the situation-at-hand to resolve the needs of the individual patient for whom they care. This conceptualisation of nursing practice will be analysed with a particular emphasis on its implication for nursing epistemology, pedagogy and praxis. The evidence to support this argument is drawn from empirical work that investigated nurses' use of intuition, the work of Levi-Strauss, and issues in nursing epistemology and ontology. The paper itself is written from the perspective of a bricoleur who uses 'bits and pieces' from the domains of nursing, philosophy, psychology, education, sociology and anthropology.

Adaptation, Psychological↗
PubMed2005

Advanced nursing practice: policy, education and role development.

AIMS AND OBJECTIVES: This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice. BACKGROUND: The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required. CONCLUSION: The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community. RELEVANCE TO CLINICAL PRACTICE: In a rapidly changing people-centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research.

Accreditation↗
PubMed2006

Development of the Family Nursing Practice Scale.

This article describes the development and testing of the Family Nursing Practice Scale (FNPS). This self-report questionnaire is designed to measure perceived changes in family nursing practice including attitudes toward working with families, critical appraisal of their family nursing practice and reciprocity in the nurse-family relationship. Categories were derived from a needs assessment, competence as effective application of knowledge and skill and theoretical foundations for family assessment and intervention. Psychometric testing (content, construct validity, internal consistency, and test-retest reliability) was undertaken with 140 psychiatric nurses in Hong Kong. Practice appraisal and nurse-family relationships accounted for 56.4% of the variance. Cronbach's alpha reliability coefficients were .88 and .73 for the two subscales, respectively, and .86 for the scale overall. Test-retest reliability ranged from .62 to .93 on the individual items. The results provide preliminary evidence of the reliability and validity of the FNPS. The instrument provides quantitative and qualitative evaluation components.

Adult↗
PubMed2003

Identification of psychological morbidity in older people in primary care by practice nurses.

Older people with psychological morbidity generally first present to health services in primary care, where they are increasingly seen by primary care nurses. In order to evaluate primary care nurses' identification of psychological morbidity, 190 older patients attending eight practice nurses completed the General Health Questionnaire (GHQ) and the practice nurses made an assessment as to the presence or absence of psychological problems. The practice nurses identified only 26% of probable cases of psychological morbidity identified by the GHQ. Their threshold for identification was high, rating only 12% of patients as experiencing psychological problems compared to 29% probable cases identified by the GHQ, and their accuracy was low (kappa for agreement between GHQ and nurse ratings = 0.23). Likelihood of identification depended on length and type of visit. The findings suggest that it may be unrealistic to expect practice nurses, without additional training and reorganisation of their work, to identify more than a minority of older patients with psychological morbidity in the course of their routine work.

Aged↗
PubMed2006

Amorphous practice: nursing in a remote Indigenous community of Australia.

Nurses are key providers of health care in remote Indigenous communities throughout Australia. Evidence of nurses' actual practice and the outcomes of their care for clients in this context, however, is lacking. This exploratory research describes how nursing is practised in a remote Aboriginal community and reveals many anomalies. The overall theme, termed amorphous practice, defines the changeable character of practice from nurse to nurse and from situation to situation. The themes underlying amorphous practice are termed detachment, diffusion, and beyond the nursing domain. Each theme is described by way of its characteristics, the strategies nurses use to deal with the situation, and the consequences. The significance of these findings raise concerns for the accountability of nursing and most of all for the rights of Indigenous people in remote areas to basic standards of safe health care.

Health Services, Indigenous↗
PubMed1998

Nursing practice draws upon several different ways of knowing.

This paper explores the proposition that nursing practice draws upon several different ways of knowing. It highlights difficulties often faced by practising nurses in defining what they do and hence what it is that constitutes nursing practice. Following formal definition and analysis of sources of literature regarding nursing knowledge, issues such as the origins of knowledge and the sources of nursing knowledge are addressed. The types of knowledge required to enhance nursing practice are discussed, focusing upon future opportunities and innovations in the generation of knowledge for nursing. Finally, recommendations are made regarding the way forward for nurses endeavouring to communicate the complexities of nursing practice.

Health Knowledge, Attitudes, Practice↗