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PubMed2007

Review of advanced nursing practice: the international literature and developing the generic features.

AIM: The aim of this article is to review the nursing literature on the notion of advanced nursing practice (ANP) and consequently provide clarifications on the concept of advanced nurse practitioner by developing its' generic features. BACKGROUND: This paper commences by critically reviewing the concept of advanced nursing practice as it is portrayed within the literature. From this review, a series of contradictions emerged in terms of definitions and roles. On further analysis of the literature the core aims and goals of the ANP are revealed. METHODS: An informative and narrative systematic literature review was undertaken, using specific inclusion and exclusion criteria. The mass of retrieved material was carefully screened and methods of data saturation were used. Consequently, the material was read, re-read and indexed as to develop seven thematic units that formed the generic features of the ANP. FINDINGS: The generic features that emerged are: (i) the use of knowledge in practice, (ii) critical thinking and analytical skills, (iii) clinical judgement and decision-making skills, (iv) professional leadership and clinical inquiry, (v) coaching and mentoring skills, (vi) research skills and (vii) changing practice. CONCLUSION: Reviewing the literature on the concept of ANP, a great variety of definitions, conceptualizations and roles emerged. Nonetheless, on a closer reading, a common goal was identified, which was the attainment of practice and professional autonomy via ANP roles for enhanced practice provision. Eventually, from the reviewed literature, seven generic features of the ANP were developed, thus providing clarification to the role and the characteristics of the ANP. RELEVANCE TO CLINICAL PRACTICE: Clarifying the confusion surrounding advanced nursing practice and gaining an in-depth understanding of its' generic features would facilitate practitioners, practice educators and clinical managers to develop those skills that would allow them or their staff or students to practise at an advanced level.

Humans↗
PubMedDate not supplied

Introducing ICN's International Classification for Nursing Practice (ICNP): a unifying framework.

Seven years ago, ICN had a vision: To establish a common language about nursing practice to describe nursing care that could be compared across borders, populations, settings and time. Today part of this vision has become a reality: the Alpha Version and a database for an International Classification for Nursing Practice (ICNP), described on the following pages, for which ICN is eliciting feedback, critique and recommendations from nurses in all settings everywhere. Below, a historical review.

Humans↗
PubMed1999

Credentialing and privileging of advanced practice nurses.

Credentialing and privileging are increasingly common administrative processes that advanced practice nurses must complete. With the intention of assuring the public of safe health care provided by qualified personnel, several federal and state organizations have developed criteria that licensed practitioners must meet. Managed care organizations are also creating credentialing and privileging guidelines for practitioners who are applying to their provider panels. Understanding the requirements of these processes is essential to advanced practice nurses establishing themselves in practice. This article explains the guidelines from federal, state, and institutional agencies and offers recommendations to practitioners as they prepare for the credentialing process. Also included are sample forms for establishing a practice agreement and a privilege-delineation request.

Contract Services↗
PubMedDate not supplied

The role of prevention in home healthcare nursing practice.

Prevention is part of nursing practice, including home healthcare. Two National Health Objectives are highlighted: prevention of breast and cervical cancer. Skilled management, under Medicare, may be one way for home healthcare staff to focus on prevention and health promotion.

Community Health Nursing↗
PubMed1985

Ethical considerations in nursing practice.

Some ethical implications for nursing practice are considered in relation to three issues: competence, honesty and obedience. Factors which contribute to conformity, obedience and authoritarianism are discussed, and respect for other people is suggested as a guiding principle for ethically acceptable conduct.

Authoritarianism↗
PubMed2003

Forensic nursing practice with asylum seekers in the USA--advocacy and international human rights: a pilot study.

In this study, the author investigated the characteristics of US asylum seekers undergoing evaluation by an advanced practice forensic nurse. Twenty-one petitioners from 14 countries, ranging in age from 17 to 53 years, were examined. All asylum seekers were evaluated, based upon US asylum granting standards for 'persecution' and 'well-founded fear of future persecution' arising from asylum seekers' race, religion, nationality, political opinion or membership in a particular social group. The methods used to persecute asylum seekers included sexual violence, physical violence, threatened physical violence, intimidation and psychological violence. These types of torture were grouped according to world region, gender, age group and the presence of forensic markers or evidence. Study limitations and forensic nursing role opportunities are discussed.

Adolescent↗
PubMed1997

The nature of expert psychiatric nurse practice: a grounded theory study.

This study examines what psychiatric nurses regard as the nature of expert psychiatric nurse practice. The study focuses on the beliefs and principles of psychiatric nurses currently working within a psychiatric unit. Using grounded theory methodology, data were coded and analysed, producing an integrated framework of expert psychiatric nurse practice comprised of four core variables: 'attitudes/philosophy', 'knowledge', 'skills' and 'roles'. It is suggested that the nature of expert psychiatric practice is an evolutionary concept and that as this practice develops the integrated theory presented will need to develop in parallel.

Attitude of Health Personnel↗
PubMedDate not supplied

HIV and pregnancy: considerations for nursing practice.

This article describes current nursing practice for pregnant women with HIV. In the United States, the number of new cases of HIV continues to rise in women of childbearing age. Women often learn of their HIV status when a pregnancy involves them in the healthcare delivery system. Since the manifestation of the disease in 1981, there have been significant advances in treatment, and now, among pregnant women testing positive for HIV, the risk of perinatal transmission can be decreased to 1% with pharmacologic intervention. Yet, HIV disease poses many new challenges to the woman testing positive who is considering pregnancy or who is already pregnant. The progression of the symptoms of AIDS is similar to the common symptoms of pregnancy; the HIV medications may also cause these symptoms. Adherence to the HIV medication regime is necessary for ongoing viral suppression, for missed doses can initiate drug resistance and the whole categories of antiretroviral drugs may become ineffective. Additionally, the HIV stigma continues to impact those infected and interferes with the access to healthcare. HIV poses a major challenge for the nurse caring for the childbearing woman.

Anti-HIV Agents↗
PubMed2003

Translating clinical tools in nursing practice.

BACKGROUND: The widespread use of clinical tools in nursing practice reflects their usefulness in guiding patient care, evaluating treatment effectiveness and conducting audit. Cultural awareness and the provision of culturally competent care is a high priority for nurses in the United Kingdom (UK), given patterns of increasing ethnic diversity. However, meeting the individual needs of patients can be difficult when language barriers hinder communication. One way to address these difficulties is to translate existing clinical tools. AIM: The aim of this paper is to appraise the potential for, and limitations of, translating clinical tools for use in nursing practice. DISCUSSION: Drawing on a range of studies from the disciplines of health and social science, this review describes and discusses some key considerations relevant to translating clinical tools in nursing. These considerations include the need to ensure cultural equivalence, lack of familiarity with clinical tool formats in some cultures and its impact on responses, and low literacy levels in some populations. CONCLUSION: Clinical tools provide benefits in identifying patients' problems, guiding patient care, and evaluating treatments and interventions. Translating these tools can help to bridge the language gap that hinders good communication between nurses and patients. Translated clinical tools can be of acceptable cultural equivalence and validity if high quality translation methodologies are employed, together with an awareness of culturally relevant issues when interpreting the information gained from the tools.

Communication Barriers↗
PubMedDate not supplied

Development of a comprehensive examination to evaluate licensed practical nurses' cognitive knowledge of intravenous therapy administration.

In this article, the authors describe the systematic and collaborative processes used by a group of nursing educators to develop a comprehensive exam to evaluate licensed practical nurses' cognitive knowledge of intravenous therapy practice. The examination was written to meet the new requirements mandated by the State of Florida Board of Nursing related to the expanded role of the licensed practical nurse. After statistical analysis and test revision, the examination would eventually be a challenge examination for those licensed practical nurses who had acquired this knowledge previously.

Educational Measurement↗
PubMed1994

Correctional nursing practice.

This study explored the nature and problems of nursing practice in correctional settings using qualitative field research methodology. Data were collected through participant observation at three men's state prisons and one city jail and included informal interviews and conversations of varying length and depth with 40 nursing staff members. Data analysis was accomplished through the constant comparative methodology and dimension analysis of grounded theory. Custody personnel's recognition, evaluation, and acceptance of judicially mandated health care varied across settings and formed a toleration continuum with two types (contentious and considered) located at polar ends and a third (acknowledged) in a central position. Correctional nurses' conceptions of nursing were categorized as limited, expanded, or other-directed. The three types of toleration provided differing contexts for correctional nursing practice. Interactions between custody and health care staff occurring within each toleration scene differentially influenced the degree to which the three conceptions of nursing prevailed.

Data Collection↗
PubMed1997

Nursing practice in war zones and wisdom acquired.

The purpose of this study was to describe nursing practice in war zones and skills nurses had acquired through their work. A descriptive design was used. The sample included 39 nurses who had worked in different areas of conflict around the world for two Norwegian humanitarian organizations. A questionnaire was designed to collect both quantitative and qualitative data. The results seem to indicate that the nurses were well prepared for this particular work. The nursing practice consisted of nursing victims of war and supervision/teaching of local nurses. The nurses had positive experiences from their work. The nurses acquired personal and professional skills from their work in war zones, but the results seem to indicate that their Norwegian employers just to a certain degree took advantage of these skills.

Adult↗
PubMed1988

Description and evaluation of a course for practice nurses.

There is increasing awareness of the needs of practice nurses for continuing education and both the report of the community nursing review and the government's white paper Promoting better health have stressed this. A course for practice nurses is described in which the curriculum was based on previous research into their requirements. An evaluation of the course demonstrated changes in the attitude towards the work of the practitioner and an overall increase in confidence of the group. Perceptions of the course and the relevance of the content were also measured. The cost of the course is given and the future direction of training discussed.

Adult↗
PubMed1999

Do advanced practice nurses and physician assistants benefit small rural hospitals?

Advanced practice nurses and physician assistants have offered small, rural hospitals an alternative to scarce primary care physicians for 30 years. This paper uses survey data from 285 small rural hospitals and case studies of 36 of these hospitals to answer questions about the extent to which advanced practice nurses and physician assistants provide primary care in small, rural hospitals, the benefits that might bring to the hospitals as well as the reactions of the public. The study used survey data collected as part of an evaluation of 285 hospitals, which received a Rural Health Care Transition grant from the Health Care Financing Administration in 1993 and 1994. Most of the hospitals used the practitioners; 70 percent used nurse practitioners; 30 percent used physician assistants; and 20 percent used both. There were some negative reactions to the use of the practitioners, but, overall, there was acceptance and benefits to the hospitals in the form of reduced recruitment costs, increased revenues and increased service offerings. These practitioners are beneficial to rural hospitals, and mechanisms to encourage their acceptance should be developed and implemented.

Data Collection↗
PubMed1998

Mentoring and self-efficacy for advanced nursing practice: a philosophical approach for nurse practitioner preceptors.

Nurse practitioners (NPs), frequently called upon by graduate schools of nursing to be preceptors for NP students, are asked to play an active role in the socialization of these students as capable primary care providers. Much is expected of the preceptor in the typical short-term clinical preceptorship with little guidance available to her or him. A mentoring model of clinical education, while representing a longer-term commitment for preceptors than usual precepting arrangements, may ultimately be a more effective model for student learning and more satisfying for the preceptor than currently practiced models. Eastern philosophical principles, very much in harmony with valued nursing approaches to relationships, can provide a framework for examining mentoring as a strategy for promotion of self-efficacy for advanced practice that can be of benefit to both the NP preceptor and the NP neophyte.

Clinical Competence↗
PubMed1999

Expert public health nursing practice: a complex tapestry.

The research outlined in this paper used Heideggerian phenomenology, as interpreted and utilised by Benner (1984) to examine the phenomenon of expert public health nursing practice within a New Zealand community health setting. Narrative interviews were conducted with eight identified expert practitioners who are currently practising in this speciality area. Data analysis led to the identification and description of themes which were supported by paradigm cases and exemplars. Four key themes were identified which captured the essence of the phenomenon of expert public health nursing practice as this was revealed in the practice of the research participants. The themes describe the finely tuned recognition and assessment skills demonstrated by these nurses; their ability to form, sustain and close relationships with clients over time; the skillful coaching undertaken with clients; and the way in which they coped with the dark side of their work with integrity and courage. It was recognised that neither the themes nor the various threads described within each theme exist in isolation from each other. Each theme is closely interrelated with others, and integrated into the complex tapestry of expert public health nursing practice that emerged in this study. Although the research findings supported much of what is reported in other published studies that have explored both expert and public health nursing practice, differences were apparent. This suggests that nurses should be cautious about using models or concepts developed in contexts that are often vastly different to the New Zealand nursing scene, without carefully evaluating their relevance.

Clinical Competence↗
PubMed1993

Toward a nursing practice research method.

This article promotes a structure for nursing research in which the primary feature is the nurse researcher-as-clinician in a collaborative relationship with the client-as-subject. Elements of a theoretical rationale for blending the roles of clinician and researcher in an essentially qualitative methodology are developed. A nursing practice research method is conceptualized not as merely a technical activity with a focus on narrative data, but also as an explicit recognition of research as practice with an emphasis on intersubjectivity and dialogue in the research process as constitutive of reality. Research and knowledge development are thus envisioned as taking place from within the nursing situation and contingent on the quality of the nurse-client relationship. The nurse and client are recognized as the authors of the nursing-research situation in which meanings of health experiences are explored and chosen, and opportunities for enhanced quality of life are presented to both. Nurse and client each lend a unique perspective in the shared nursing-research situation. Regardless of the facticities of the client's medical status, both nurse and client have the potential for positive growth and change when these unique perspectives of nurse and client are joined. The proposed nursing practice research methodology capitalizes on these features of the practice situation, and thus, speaks directly to the concerns of the clinician.

Clinical Competence↗