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PubMedDate not supplied

Preparing advanced practice nurses for clinical decision making in specialty practice.

Dramatic changes in the delivery of healthcare have placed an increased emphasis on developing critical thinking skills and clinical decision making abilities of nurses on both the undergraduate and graduate levels. The authors discuss teaching-learning strategies that promote clinical decision making skills of advanced practice nurses. Particular attention is paid to advanced practice nurses who are being prepared to work within specialty practice settings. An algorithm to guide educators to teach clinical decision making is presented.

Algorithms↗
PubMed1986

Teaching practice experience: linking theory to practice.

This paper analyses the relationship between the theory and practice of the art of teaching as experienced by the author during a period of teaching practice in a school of nursing. It examines such concepts as 'aims', 'objectives', 'scheme of work' and 'lesson plans' and sets these in the context of practical classroom teaching.

Curriculum↗
PubMed1996

Situating theory in practice: student views of theory-practice in Project 2000 nursing programmes.

In this paper the views of student nurses taking Project 2000 at a Scottish College of Nursing are reported. A random sample of 19 students were interviewed. The interviews focused on the relationship between the college course and the students' experiences on placement. The majority had difficulty in relating the college course to their practice, except when it came to very specific parts of the programme, for example basic medical procedures. Only a minority could integrate the broader aspects of the course to their practice, largely because there was such a long period of time between studying a topic in college and the related placement. It is tempting to see the results as supporting the situated cognition hypothesis that theory loses meaning out of context, and it is evident, even from this limited study, that the success of Project 2000, with its emphasis on the 'knowledgeable doer', could depend, to a great extent, on the careful phasing of college coursework and placement to enable students to integrate theory and practice more effectively.

Attitude of Health Personnel↗
PubMed2005

Role development and effective practice in specialist and advanced practice roles in acute hospital settings: systematic review and meta-synthesis.

AIMS: This paper reports a study whose aim was to identify and synthesize qualitative research studies reporting barriers or facilitators to role development and/or effective practice in specialist and advanced nursing roles in acute hospital settings. BACKGROUND: The number of clinical nurse specialist, nurse practitioner, advanced nurse practitioner and consultant nurse roles has grown substantially in recent years. Research has shown that nurses working in innovative roles encounter a range of barriers and facilitators to effective practice. METHODS: Systematic literature searches were undertaken, and relevant studies identified using specific inclusion and exclusion criteria. The selected studies were appraised, and their findings synthesized using Ritchie and Spencer's 'Framework' approach. RESULTS: Fourteen relevant studies were identified, mostly from the UK. They described a range of barriers and facilitators affecting specialist and advanced nursing practice. These related to the practitioner's personal characteristics and previous experience, professional and educational issues, managerial and organizational issues, relationships with other health care professionals, and resources. The factors most widely identified as important were relationships with other key personnel, and role definitions and expectations. CONCLUSIONS: Relationships with other staff groups and role ambiguity are the most important factors which hinder or facilitate the implementation of specialist and advanced nursing roles. These factors seem interlinked, and the associated problems do not appear to resolve spontaneously when staff become familiar with the new roles. In order to reduce role ambiguity and the consequent likelihood of negative responses we recommend that, when specialist and advanced nursing roles are introduced, clear role definitions and objectives are developed and communicated to relevant staff groups; these definitions and objectives should be updated as necessary.

Education, Nursing, Graduate↗
PubMed2004

Introducing the Learning Practice--III. Leadership, empowerment, protected time and reflective practice as core contextual conditions.

RATIONALE, AIMS AND OBJECTIVES: This paper is the third of three related papers exploring the ways in which the principles of Learning Organizations (LOs) could be applied in Primary Care settings at the point of service delivery. METHODS: Here we provide a systematic literature review of contextual factors that either play a key role in providing a facilitative context for a Learning Practice or manifest themselves as barriers to any Practice's attempts to develop a learning culture. RESULTS AND CONCLUSION: Core contextual conditions are identified as, first, the requirement for strong and visionary leadership. Leaders who support and develop others, ask challenging questions, are willing to be learners themselves, see possibilities and make things happen, facilitate learning environments. The second core condition is the involvement and empowerment of staff where changes grow from the willing participation of all concerned. The third prerequisite is the setting-aside of times and places for learning and reflection. This paper contributes to the wider quality improvement debate in three main ways. First, by highlighting the local contextual issues that are most likely to impact on the success or failure of a Practice's attempts to work towards a learning culture. Second, by demonstrating that the very same factors can either help or hinder depending on how they are manifest and played out in context. Third, it adds to the evidence available to support the case for LOs in health care settings.

Humans↗
PubMed2004

Educating advanced practice nurses for collaborative practice in the multidisciplinary provider team.

PURPOSE: To describe the use of a clinical decision-making work sheet as a tool to teach communication skills to advanced practice nurse (APN) students. Achievement of competencies in communication and documentation that utilize language and communication strategies that are shared with other health professionals promotes effective collaborative practice among members of the multidisciplinary provider team. DATA SOURCES: Review of the recent Institute of Medicine report on health professions education and other health professional literature. CONCLUSIONS: The Clinical Decision-Making Work Sheet helps APN students effectively communicate in real-world clinical settings. The clinical work sheet allows nurse practitioner students to communicate more effectively and efficiently, using a vocabulary that is shared with other members of the multidisciplinary health care provider team. Use of the tool in students' clinical-rotation settings facilitates effective application and refinement of the clinical decision-making skills that students learned in the advanced health assessment course. IMPLICATIONS FOR PRACTICE: Faculty have the responsibility to assist nurses as they transition from traditional nursing to APN roles. The work sheet facilitates learning the common language for data collection, clinical decision making, documentation, and reporting that is shared with other health professionals. Using the tool, students learn to efficiently organize information that supports communication and documentation that enhances their clinical problem-solving skills. Case presentation and documentation using the work sheet provide a basis for preceptor and student interaction and for student evaluation.

Communication↗
PubMedDate not supplied

How and why to study the practice content of a practice-based research network.

BACKGROUND: We describe the rationale, methods, and important lessons learned from doing a practice content study in a new practice-based research network (PBRN). METHODS: We performed a modified replication of the National Ambulatory Medical Care Survey (NAMCS) in the Kentucky Ambulatory Network (KAN). Network clinicians had input into focused modifications of the NAMCS protocol, including addition of data fields of special interest to them. Cross-sectional sampling of patient visits was done for a 1-year period, with each practice collecting data during 2 separate weeks. We used selected results to illustrate lessons learned and the value of this endeavor. RESULTS: Twenty-three KAN clinicians helped recruit 33 of their colleagues, and these 56 community-based primary care clinicians collected data on 2,228 office visits. Patient demographics (except race) and the top 10 diagnoses were similar to US NAMCS data. One third of visits addressed 3 or more diagnoses, and one fourth of the visits involved 4 or more medications. The top 10 primary diagnoses represented only one third of all primary diagnoses. Seventy percent of adult patients were either overweight (30%) or obese (40%). Rates of counseling on diet or exercise rose with increases in body mass index. CONCLUSION: This study helped us establish and activate our new PBRN, increasing its membership in the process. The descriptive data gained will stimulate, guide, and support our future research activities.

Cross-Sectional Studies↗
PubMed2006

Incorporating anti-IgE (omalizumab) therapy into pulmonary medicine practice: practice management implications.

Despite aggressive therapy, many asthma patients cannot achieve optimal control, and it is recognized that a small number of patients, generally those with severe persistent asthma, are the most difficult to control and are responsible for a large segment of the costs of asthma. These patients demonstrate a need for additional therapeutic options to achieve enhanced asthma control. Omalizumab should be considered a second-line therapy for patients with moderate-to-severe persistent allergic asthma not fully controlled on standard therapy. This article should not be considered a complete guide to incorporating this therapy into practice but serve as an introduction and a basic review of the practice management aspects of therapy for physicians practicing in the United States.

Antibodies, Anti-Idiotypic↗
PubMed1994

Using cost-effectiveness analysis for formulary decision making: from theory into practice.

The growth of expenditures on healthcare and pharmaceutical products is a concern to third-party payers because of the absence of market discipline (price signals that consumers face). Cost-effectiveness analysis is a method that allows third-party payers to systematically make judgements about the 'value for money' of these products. It moves beyond simple unit price comparisons of alternate interventions/products to consider the full stream of relevant cost and benefits. As formulary committees begin to adopt the systematic use of cost-effectiveness analyses to inform the debate, the exercise will move from an academic to a more practical application. This transition will require several important changes including defining the purpose of cost-effectiveness analysis, measurement of outcomes and data, format of reports, and contractual arrangements between the pharmaceutical industry and analysts. As more 'real world' experience is gained in the practical application of cost-effectiveness analysis, the quality of data will improve as will its value as an aid to decision making.

Cost-Benefit Analysis↗
PubMed2004

Mortality in general practice--an analysis of 841 deaths during a two-year period in 17 Dutch practices.

PURPOSE: To gain insight into how general practitioners (GPs) determine the cause of death and record it on the death certificate for patients who die at home. METHOD: During 1998 and 1999, the number of patient deaths, as well as the cause and place of death, were registered for 17 general practices. RESULTS: A total of 841 patients died during the two-year study period: an average of 25 patients per practice, per year. 53.8% at home, 34.6% in hospital, 8.7% in a nursing home, and 2.8% elsewhere. When compared with national figures, the number of deaths due to neoplasms were similar, whereas there were clear differences when causes for sudden death were compared with the information obtained from the National Central Bureau of Statistics (CBS). Heart disease (19%) was registered less often, and cerebrovascular accidents (45%) more frequently. There were 57 (6.7%) deaths due to unnatural causes, 23 (2.6%) of which were due to euthanasia, which were all reported according to the law, requiring no further action. Autopsies were obtained in 3% of all deaths. CONCLUSION: Especially in cases of sudden death, determining the cause of death is guesswork. During medical school and continuing education, attention should be given to the completion of registration information. The Central Bureau of Statistics would be able to give more and better feedback to the physicians. A case is made for maintaining a death registry in each general practice. A death register is a means of reflection and for improving quality of care.

Adult↗
PubMed2001

Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment.

The relationship between spirituality and medicine has been the focus of considerable interest in recent years. Studies suggest that many patients believe spirituality plays an important role in their lives, that there is a positive correlation between a patient's spirituality or religious commitment and health outcomes, and that patients would like physicians to consider these factors in their medical care. A spiritual assessment as part of a medical encounter is a practical first step in incorporating consideration of a patient's spirituality into medical practice. The HOPE questions provide a formal tool that may be used in this process. The HOPE concepts for discussion are as follows: H--sources of hope, strength, comfort, meaning, peace, love and connection; O--the role of organized religion for the patient; P--personal spirituality and practices; E--effects on medical care and end-of-life decisions.

Humans↗
PubMed2001

Evaluation of sexually transmitted disease control practices for male patients with urethritis at a large group practice affiliated with a managed care organization--Massachusetts, 1995-1997.

Effective management for sexually transmitted diseases (STDs) depends on appropriate testing, treatment, partner management, and complete and timely reporting of positive STD tests (1). Testing can ensure appropriate treatment of initial or recurrent infections and identification of drug-resistant pathogens, appropriate treatment can reduce risk for complications and development of drug resistance, and complete and timely reporting of positive test results by laboratories and STD cases by health-care providers to health departments can facilitate rapid sex partner notification and outbreak detection. By 1998, private providers, including those affiliated with commercial or Medicaid managed care organizations (MCOs) (2,3) were caring for approximately 70% of persons with chlamydia and 55% of persons with gonorrhea. To assess the quality of STD care at a MCO-affiliated multisite facility, the testing, treatment, and reporting practices of gonorrhea- and chlamydia-associated urethritis in male patients were evaluated. This report summarizes the evaluation, which indicated that the providers tested most men with urethritis symptoms, prescribed CDC-recommended therapy to all patients, and reported most laboratory-confirmed chlamydia and gonorrhea cases of urethritis to the state health department. Several interventions introduced at this large group practice may have encouraged these favorable STD practices.

Adult↗
PubMed2002

[Nursing practice in home care: social-demographic profile and professional practice].

OBJECTIVES: To characterise the Andalusian nurses providing home care (HC), to describe the activities developed, to define the components of nursing practice and to identify differences between the care of terminal cancer, of AIDS patients, of elderly people with dementia and of patients who had undergone more serious out-patient surgery. DESIGN: Cross-sectional descriptive study using a postal questionnaire. SETTING: Primary care centres in Andalusia. PARTICIPANTS: 348 PC nurses working in home care. Multi-stage sampling, proportional by provinces. MAIN MEASUREMENTS: Social-demographic and work characteristics, nursing activity in the home, type and frequency of activities performed in the care of each kind of patient and use of protocols. RESULTS: 61.14% reply rate. 65.5% were women, with mean age of 39.7 and averaging 10 years of PC experience. Mean number of patients attended was 10.5 per week, and mean time was 20.7 minutes. 90.1% had attended cancer patients, 16.7% AIDS patients, 83.3% elderly people with dementia, and 87.2% patients discharged early. In all cases the most commonly developed item was the technical one, followed by preventive/health promotion and psycho-social. Except in the case of evaluation of physiological needs, in all the other activities the frequency of the item was in function of the pathology of the patient (P<.05). Nursing practice in the home of terminal cancer patients and of elderly people with dementia only differs in the handling of emotional problems in both patient and carer, and in the preventive item (P<.05). 60% of the sample said they used no protocol in home care. CONCLUSIONS: The most common activities in care of home care patients are giving treatment, dressings, bandages, and monitoring of the vital constants, followed by assessment of physiological needs. Nursing practice does not seem to be fully conditioned by the pathology, but rather in function of groups of patients with similar needs and problems. Most Andalusian home-care nurses use no protocol in caring for these four classes of patient.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Bridging the "theory-practice gap" in renal nursing: establishing a renal professional practice model. Experiences of the Adam Linton Dialysis Unit.

The renal program (RP) at the London Health Sciences Centre (LHSC) chose to implement a professional practice model (PPM). This paper examines the implementation and maintenance issues of the renal professional practice model (RPPM) at the Adam Linton Dialysis Unit (ALU), one unit of several dialysis units affiliated with the LHSC RP. The discussion includes primary nursing as the care delivery system for the RPPM. Attention is paid to experiences post program transfer--when the renal programs from St. Joseph's Health Centre and LHSC merged. The final focus of this paper is on the practical experiences of nurses at the ALU while using this model. Included are: Systems in place to support the success of this model. How leadership and staff contributed to the model's success. How this model might have improved patient outcomes. How this model could enhance both patient and staff satisfaction.

Clinical Nursing Research↗
PubMedDate not supplied

Practical gloving and handwashing regime for dental practice.

The debate concerning the re-use of gloves in dental practice continues, despite the fact that recent guidelines on cross-infection control recommend that a new pair of gloves should be used for each patient. Whichever policy for glove use is adopted, it is important to take the maximum possible precautions in hand care. This paper presents a practical regimen for hand/glove washing which is simple, quick and effective. The importance of establishing a hand-care regimen in dental practice is emphasised.

Cross Infection↗
PubMed2006

Activities performed by acute and critical care advanced practice nurses: American Association of Critical-Care Nurses Study of Practice.

BACKGROUND: Accreditation standards for certification programs require use of a testing mechanism that is job-related and based on the knowledge and skills needed to function in the discipline. OBJECTIVES: To describe critical care advanced practice by revising descriptors to encompass the work of both acute care nurse practitioners and clinical nurse specialists and to explore differences in the practice of clinical nurse specialists and acute care nurse practitioners. METHODS: A national task force of subject matter experts was appointed to create a comprehensive delineation of the work of critical care nurses. A survey was designed to collect validation data on 65 advanced practice activities, organized by the 8 nurse competencies of the American Association of Critical-Care Nurses Synergy Model for Patient Care, and an experience inventory. Activities were rated on how critical they were to optimizing patients' outcomes, how often they were performed, and toward which sphere of influence they were directed. How much time nurses devoted to specific care problems was analyzed. Frequency ratings were compared between clinical nurse specialists and acute care nurse practitioners. RESULTS: Both groups of nurses encountered all items on the experience inventory. Clinical nurse specialists were more experienced than acute care nurse practitioners. The largest difference was that clinical nurse specialists rated as more critical activities involving clinical judgment and clinical inquiry whereas acute care nurse practitioners focused primarily on clinical judgment. CONCLUSIONS: Certification initiatives should reflect differences between clinical nurse specialists and acute care nurse practitioners.

Certification↗
PubMed1995

Medication dispensing in pediatric office practice. Committee on Practice and Ambulatory Medicine, American Academy of Pediatrics.

The changing practice of dispensing medication in pediatric offices needs ongoing evaluation to determine the extent to which patients' and practice's needs are being met. Research should assess the extent to which in-office dispensing enhances patient compliance and patient education or whether it increases or decreases patient medication errors. Pediatricians choosing to dispense medication should monitor such research carefully, review state and federal laws periodically, and evaluate recommendations from professional organizations. The American Academy of Pediatrics holds that the practice of medication dispensing is acceptable and appropriate provided that it is legally permissible and that it is structured primarily to serve the best interests of the patient.

Drug Prescriptions↗