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PubMed1999

What constitutes a nursing practical skill?

Practical nursing skills ensure patients' physical comfort, hygiene, and safe medical treatment. The learning, performance, or significance of nursing practical skills are seldom a theme in theoretical and philosophical debate or the topic of research within nursing. This might be due to a long-standing behavioristic tradition in nursing of viewing nursing practical skills in a simplistic way, only as correctly sequenced motor movement. The purpose of this article is to bring forth an argument for a broader understanding of the constitution of nursing practical skills. This argument is substantiated by a review of past and present conceptualizations of nursing practical skills as well as by philosophical reflections on the value of practical skills in the nursing profession. Nursing practical skills embrace dimensions of performance, intention, and nursing "disciplined" understanding.

Art↗
PubMedDate not supplied

Educating advanced practice nurses for practice reality.

The complexity of the current health care environment ethically mandates advanced practice nursing (APN) educators to prepare graduates with a clear understanding of APN roles and professional and regulatory issues for them to make a reasonable transition to the marketplace. Integrating both clinical content needed for APN practice and APN role issues can be a difficult balance. This article describes critical role content needed in APN programs and offers a variety of teaching strategies. Recommendations regarding the timing and placement of role content in the graduate curriculum also are offered. Although there is no one right way to build APN role content into graduate coursework, some approaches are preferable to others.

Adaptation, Psychological↗
PubMed1994

Connections: a contextual model for holistic nursing practice.

Nursing is a holistic practice in which the science and technology of curing is cradled by the art of human caring within a healing context. Caring is the human capacity to connect with another from a place of compassion and unconditional support in the process of growth and actualizing one's potential in the face of human challenge. Healing reflects the process of one's search for wholeness in the ultimate expression of one's unique being. This wisdom is multidisciplinary and interconnecting, integrating the multidimensional aspects of the human process engaged in the art and science of healing.

Empathy↗
PubMedDate not supplied

A framework for advanced practice nursing.

The empirical and expository literatures about advanced nursing practice have lacked a broad, comprehensive, conceptual framework to organize and guide substantive work. Such a framework is needed during the development of health care policy, educational curricula, role descriptions, and research agendas for this arena of practice. The framework proposed in this article represents an integrative synthesis of previous work on advanced nursing practice. The proposed framework is based on the definition of advanced practice nursing as professional health care activities that (1) focus on clinical services rendered at the nurse-client interface, (2) use a nursing orientation, (3) have a defined but dynamic and evolving scope, and (4) are based on competencies that are acquired through graduate nursing education. Advanced practice nursing is comprised of activities in the domains of advanced clinical practice, health care systems management, and professional involvement in broad health care discourse.

Curriculum↗
PubMed1976

The application of psychotherapeutic conceptual models in nursing practice.

Nurses, in order for their practice to be at a scientific level, need to consciously apply laws of change and stability of human behavior that have been identified by the behavioral sciences--especially psychotherapeutic theories. These are separated into several conceptual models which are organized around assumptions of the etiology of human behavior based on scientific observation and experimentation. They differ in emphasis and manipulation of the psychic elements of magic, faith, adaptation, and intellect. The beginning practitioner will probably find applying concepts from one model at a time most effective. She should base her choice on the congruence of the assumptions and emphasis of the models and her nursing assessment of the problem and her own philosophy of nursing. Her resulting choices of nursing intervention using a psychotherapeutic model should yield predictable goal attainment.

Education, Nursing↗
PubMedDate not supplied

Sexuality: a challenge for nursing practice.

Nursing has made significant progress towards individualised, holistic patient care. Yet caring for patients who have concerns about sexuality and body image remains a challenge, despite considerable literature on the subject. This article explores reasons for this and suggests learning exercises to enable nurses to examine their own attitudes to body image and sexuality.

Attitude of Health Personnel↗
PubMed2005

Applying a quality use of medicines framework to using essential oils in nursing practice.

Nurses are increasingly incorporating complementary therapies into their practices. Aromatherapy is one of the most popular therapies. The basis of aromatherapy is essential oils, which are chemically active substances with a long history of safe traditional use and a growing evidence base to support their use in nursing care. In Australia, essential oils are classified and regulated under the same policies as conventional medicines such as the National Medicines Policy and the Quality Use of Medicines (QUM) framework applies. QUM is a framework for selecting and using medicines safely and effectively if medicines are indicated. The key elements of QUM are a systems-based approach to using medicines based on relevant evidence, partnerships, and informed client consent. Clients are placed at the centre of a QUM medication management process, which is consistent with holistic care. Applying a QUM approach to essential oil use, Quality Use of Essential Oils (QUEO), involves developing effective systems for managing essential oils from an holistic perspective that includes structured assessment and diagnostic processes to enable effective essential oil prescribing and outcome monitoring. In a QUEO approach, essential oils are integrated into the client's overall medication regimen and care plan rather than being used as 'add-ons'. Adopting QUEO is consistent with the current national focus on the quality use of therapeutic substances, increases the profile of aromatherapy in nursing care and provides important information to guide future aromatherapy practices.

Aromatherapy↗
PubMedDate not supplied

[Drug surveillance project based on nursing practice].

Nurses can play a very important role in reporting adverse drug reactions (ADRs) or adverse events, thus producing information that complement information already available. The role of reporting improves the safety of drugs, alerting about new hazards and recommending new practices to be followed. Current reporting practices fall short of these objectives and nurses rarely play an active role in reporting. A proposal for a research project on nursing drug surveillance is presented. The aims of the project are: A. To produce an epidemiology of ADRs and their attributability to drugs, therapies and procedures, focusing on specific populations: children, elderly, intensive care patients and patients with medical, infectious and neurological problems. B. To describe the strategies for preventing and treating ADRs. C. To make a register of "classic" ADRs such as bone fractures and gastrointestinal bleedings. D. To monitor the hospitalisations potentially attributable to an unsatisfactory management of chronic treatments. The project will involve mainly nurses and will combine quantitative and qualitative methods.

Adverse Drug Reaction Reporting Systems↗
PubMed2005

Telemedicine: benefits to advanced practice nursing and the communities they serve.

PURPOSE: To review the use of telemedicine in a variety of advanced nursing practice settings, its contribution in expanding the service and role of the nurse practitioner, and the regulatory issues of reimbursement and licensure. DATA SOURCES: Literature review of relevant journals, research articles, case examples, and web searches. CONCLUSIONS: Although telemedicine has been utilized for many years, it has historically been used primarily by physicians. In recent years, telemedicine has been demonstrating its growing potential in advanced nursing practice in terms of economy, efficacy, and quality of care. When used appropriately, telemedicine complements advanced nursing practice in cost-effective ways and improves healthcare access to the populations served. IMPLICATIONS FOR PRACTICE: Incorporating telemedicine into the advanced nursing practice can be rewarding for both clinicians and their patients. Because of the high variability that exists among state regulations and payer reimbursements, clinicians are advised to verify their respective Board of Nursing Examiners, State, and payers' policies prior to investing in the establishment of telemedicine in practice.

Facility Regulation and Control↗
PubMed1996

Negotiating the role of the practice nurse in general practice.

The debate about the role of the practice nurse is not only about practice nursing per se, but raises broader issues about the organization of primary health care. Two related issues emerge as significant: the role of the practice nurse in providing primary health care; and the effective use of the practice nurse resource in the 'new' National Health Service. This paper, by drawing on material from a qualitative study, specifically examines the type of work performed by practice nurses and the factors that influence this. The responses of practice nurses, general practitioners, Family Health Service Authority (FHSA) advisers, community nurse purchasers and managers of community nursing provider units suggest that a consensus on the future development of practice nursing is unlikely. The different stakeholders emphasized different issues, reflecting their own priorities and backgrounds. Practice nurses' accounts of the future, for example, focused on professional issues. General practitioners stressed the importance of role development which met their General Medical Service responsibilities. Purchasing agencies, provider units and FHSAs adopted a wider perspective and were more concerned to develop an effective and integrated primary health care service. The tensions generated by their different interests and perspectives, and the subsequent organizational and policy initiatives that emerge, will provide the context in which the role of practice nurses will be negotiated.

Attitude of Health Personnel↗
PubMed1995

Regulation of advanced nursing practice: Part Two--Certification.

PURPOSE/OBJECTIVE: To present an overview of issues related to the use of advanced practice nursing (APN) certification. DATA SOURCES: Published articles, position papers, and colleague experiences. DATA SYNTHESIS: Certification is used for credentialing APNs at the state level, and in some states, it is a requirement for second licensure. Presently, a great deal of variability exists in the purposes and procedures related to certification processes, thus devaluing its use. CONCLUSION: The lack of consistency among certifying agencies and the lack of documented impact of certified advanced nursing practice can negatively affect the value placed on certification as an advanced practice credential. In the current climate of increased regulation, nursing must maintain control of practice regulation. IMPLICATIONS FOR NURSING PRACTICE: Inconsistencies between states and among nursing organizations can negatively affect the mobility and career flexibility of APNs. The evaluation of outcomes related to certified advanced nursing practice must be a research priority in the current climate. Collaboration among specialty organizations also must occur to increase the credibility of certification as a nursing credential.

Certification↗
PubMed2004

Environmental elements affecting the decision-making process in nursing practice.

BACKGROUND: In their practice nurses constantly make decisions in a dynamic context including complex situations. Besides affecting elements related to the decision-maker and the task itself, the setting where the decision-making process takes place are of decisive importance to the quality of the decision-making outcome. AIM: The aim of this study was to explore environmental elements related to the decision-making process in nursing practice. METHODS: Six expert nurses, from three Swedish nursing settings, participated voluntarily in the study, which were designed of participated observations in everyday nursing practice. Permission to carry out the study was given by the clinics and an ethical committee. A content analysis was used to analyse the field notes where themes emerged which were found to be environmental elements affecting decision-making process of nurses. CONCLUSIONS: The most striking theme, environmental elements, included the sub-themes interruptions and the work procedures are presented in this report. The implications of environmental elements, are discussed from a perspective of nurses' competence, where the elements could be seen as a facilitator or as a hindrance to developing nursing competence. It were concluded that environmental elements have to be well considered before knowledge can be reached about decision-making in practice. RELEVANCE TO CLINICAL PRACTICE: Interpersonal and technological interruptions were features highlighted in the study, features which could jeopardize the decision-making outcome. Therefore, it is of greatest importance that nurses learn to use decision-making strategies to guarantee patient care security and patient care quality.

Decision Making↗
PubMed1995

Training and education in practice nursing: the perspectives of the practice nurse, employing general practitioner and Family Health Service Authority.

Continuing training and education, although fundamental to the development of practice nursing, is subject to considerable debate. This paper, by drawing on material from a national qualitative study funded by the Department of Health and Welsh Office, explores the role of continuing training and education from the perspectives of practice nurses, general practitioners, representatives from Family Health Service Authorities (FHSAs), commissioners of community nursing services and managers of community nursing provider units. The paper demonstrates how practice nurses make use of a variety of education and training opportunities and do not seem particularly disadvantaged in their training pathways. Problems, however, have began to emerge. The informal arrangements covering training and education have been felt by many practice nurses, to leave them in a potentially needs might not be so easily accommodated. More generally, the paper concludes that debates about training and education cannot take place without referring to the type of work it is appropriate for a practice nurse to perform. The role expected of general medical services and the general development of primary health care provision, therefore, will influence practice nurses' training and educational needs.

Education, Nursing, Continuing↗