Brand, M Colleen; Cesario, Sandra K; Symes, Lene; Montgomery, Diane
Neonatal nurse practitioners (NNPs) play an important role in caring for premature and ill infants. Currently, there is a shortage of NNPs to fill open positions. Understanding how nurses decide to become NNPs will help practicing nurse practitioners, managers, and faculty encourage and support nurses in considering the NNP role as a career choice. To describe how nurses decide to enter graduate school to become nurse practitioners. A qualitative study using semistructured interviews to explore how 11 neonatal intensive care unit nurses decided to enter graduate school to become NNPs. Key elements of specialization, discovery, career decision, and readiness were identified. Conditions leading to choosing the NNP role include working in a neonatal intensive care unit and deciding to stay in the neonatal area, discovering the NNP role, deciding to become an NNP, and readiness to enter graduate school. Important aspects of readiness are developing professional self-confidence and managing home, work, and financial obligations and selecting the NNP program. Neonatal nurse practitioners are both positive role models and mentors to nurses considering the role. Unit managers are obligated to provide nurses with opportunities to obtain leadership skills. Faculty of NNP programs must be aware of the impact NNP students and graduates have on choices of career and schools. Exploring the decision to become an NNP in more geographically diverse populations will enhance understanding how neonatal intensive care unit nurses decide to become NNPs.
Neonatal nurse practitioners (NNPs) have played a significant role in providing medical coverage to many of the country's Level III neonatal intensive care units (NICUs). Extensive education and experience are required for a nurse practitioner (NP) to become competent in caring for these critically ill newborns. The NNP can take this competence and experience and expand her role out into the community Level I nurseries. Clinical care of the infants and close communication with parents, pediatricians, and the area tertiary center provide a community service with the goal of keeping parents and babies together in the community hospital without compromising the health of the baby. The NNP service, with 24-hour nursery and delivery coverage, supports an ongoing obstetric service to the community hospital. The NNP's experience enables her to provide a neonatal service that encompasses a multitude of advanced practice nursing roles.
Pressler, Jana L; Kenner, Carole A
Neonatal nurse practitioners (NNPs) represent a high-demand specialty practice that is especially targeted for US secondary and tertiary care neonatal intensive care units (NICUs). NNPs make primary decisions about the caregiving of high-risk newborns at the time of admission, throughout hospitalization, at transfer, and at discharge that require an advanced knowledge base in neonatology as well as NICU clinical experience. NNPs prepared at the master's level are currently in very short supply, with some estimates suggesting that for each NNP who graduates, there are 80 positions open across the country. Even with the present shortage, due to the high cost of NNP education, NNP programs are diminishing and those that are remaining are not graduating a sufficient number of new NNPs each year to keep up with the demand. To add to the basic shortage problem, in 2004 the American Association of Colleges of Nursing decided that by 2015, the terminal degree for all nurse practitioners should move from the master's degree to the doctor of nursing practice (DNP) degree. That decision added a minimum of 12 months of full-time education to the advanced education requirements for nurse practitioners. What impact will the decision to require a DNP degree have on NNP specialty practice? Will even more NNP programs close because of faculty shortages of NNPs prepared at the DNP level? If a worse shortage occurs in the number of NNPs prepared to practice in NICUs, will physician assistants or other nonphysician clinicians who meet the need for advanced neonatal care providers replace NNPs? What steps, if any, can nursing take to ensure that NNP specialty practice is still needed and survives after supplementing the DNP requirement to NNP education?
Crawford, Doreen; Morris, Maryke
"Neonatal Nursing" offers a systematic approach to the nursing care of the sick newborn baby. Nursing actions and responsibilities are the focus of the text with relevant research findings, clinical applications, anatomy, physiology and pathology provided where necessary. This comprehensive text covers all areas of neonatal nursing including ethics, continuing care in the community, intranatal care, statistics and pharmokinetics so that holistic care of the infant is described. This book shou...
Cheng, Chen-Hsiu; Chen, Shih-Chien
Nurse practitioner development affirms the social value of nursing staff and promotes the professional image of nursing. As the medical environment and doctor-patient relations change, how should a nurse practitioner carry out clinical care? Apart from having foundations in medical knowledge and high-quality nursing techniques, nurse practitioners must have other clinical skills, in order to break out of their former difficult position, promote nursing competitiveness, provide a multi -dimensional service, win the people's acclamation and develop international links.
Weiland, Sandra A
This Gadamerian hermeneutic study was undertaken to understand the meaning of autonomy as interpreted by nurse practitioners (NPs) through their lived experiences of everyday practice in primary health care. A purposive sample of nine NPs practicing in primary health care was used. Network sampling achieved a broad swath of primary care NPs and practice settings. Data were collected by face-to-face interviews. Because NP autonomy is concerned with gender and marginalization, Gilligan's feminist perspective was utilized during interpretive analysis. Having Genuine NP Practice was the major theme, reflecting the participants' overall meaning of their autonomy. Practicing alone with the patient provided the context within which participants shaped the meaning of Having Genuine NP Practice. Having Genuine NP Practice had four subthemes: relationships, self-reliance, self-empowerment, and defending the NP role. The understanding of Having Genuine NP Practice will enable NPs to articulate their autonomy clearly and better influence healthcare reform. Implications for advanced practice nursing education include integrating findings into classroom discussion to prompt self-reflection of what autonomy means and socialization to the NP role. ©2014 American Association of Nurse Practitioners.
... as advanced practice nurses, or APNs) have a master's degree in nursing (MS or MSN) and board certification ... NP training emphasizes disease prevention, reduction of health risks, and thorough patient education. Like doctors, NPs are ...
McDonald, Katie; Rubarth, Lori Baas; Miers, Linda J
The purpose of this study was to describe the job satisfaction of neonatal intensive care unit (NICU) nurses in the Midwestern United States. The factors explored in job satisfaction were monetary compensation (pay), job stress, caring for patients in stressful situations, level of autonomy, organizational support, level of knowledge of the specialty, work environment, staffing levels, communication with physicians, communication with neonatal nurse practitioners, interdisciplinary communication, team spirit, and the amount of required "floating" to other nursing units. Participants were 109 NICU nurses working as either staff nurses (n = 72) or advanced practice nurses (n = 37). Of the participants, 96% worked in a level 3 NICU. A descriptive, correlational design was used to study job satisfaction among NICU nurses. Nurses were recruited at 2 regional NICU conferences in 2009 and 2010. The questionnaire was a researcher-developed survey consisting of 14 questions in a Likert-type response rating 1 to 5, with an area for comments. Descriptive statistics and correlations were used to analyze the resulting data. The majority of participants were moderately satisfied overall in their current position and workplace (mean ranking = 4.07 out of 5.0). Kendall's Tau b (TB) revealed that the strongest positive correlations were between organizational support and team spirit with overall job satisfaction (TB = 0.53). : The individual factors with the highest mean scores were caring for patients in a stressful situation, level of autonomy, and communication between nurses and neonatal nurse practitioners. This indicates that our population of NICU nurses feels most satisfied caring for patients in stressful situations (m = 4.48), are satisfied with their level of autonomy (M = 4.17), and are satisfied with the interdisciplinary communication in their units (m = 4.13). Nurses in the NICU are relatively satisfied with their jobs. The small sample size (n = 109) of Midwest NICU
Healy, Patricia; Fallon, Anne
This article reviews the origins and evolution of neonatology and considers the role of the neonatal nurse within this specialty. Neonatal nurses are a vital part of the neonatal team that provides care for sick babies. The nursing care required by sick babies and their families on a neonatal unit can be variable and complex. The past century has seen significant changes in the role of the neonatal nurse. This has come about through dramatic technological developments on neonatal units, an increased understanding of neonatal physiology and pathology, changes in the education of neonatal nurses, and active and ongoing clinical research within the specialty. The resulting significant advances in neonatal care, including that provided by neonatal nurses, have made a crucial and steadfast contribution to marked improvements in neonatal outcomes.
LaMarche, Kimberley; Tullai-McGuinness, Susan
To examine the level of job satisfaction and its association with extrinsic and intrinsic job satisfaction characteristics among Canadian primary healthcare nurse practitioners (NPs). A descriptive correlational design was used to collect data on NPs' job satisfaction and on the factors that influence their job satisfaction. A convenience sample of licensed Canadian NPs was recruited from established provincial associations and special-interest groups. Data about job satisfaction were collected using two valid and reliable instruments, the Misener Nurse Practitioner Job Satisfaction Survey and the Minnesota Satisfaction Questionnaire. Descriptive statistics, Pearson correlation and regression analysis were used to describe the results. The overall job satisfaction for this sample ranged from satisfied to highly satisfied. The elements that had the most influence on overall job satisfaction were the extrinsic category of partnership/collegiality and the intrinsic category of challenge/autonomy. These findings were consistent with Herzberg's Dual Factor Theory of Job Satisfaction. The outcomes of this study will serve as a foundation for designing effective human health resource retention and recruitment strategies that will assist in enhancing the implementation and the successful preservation of the NP's role.
Shams, Marie-Lise Antoun
This study was designed to identify core journals for the nurse practitioner specialty and to determine the extent of their indexing in bibliographic databases. As part of a larger project for mapping the literature of nursing, this study followed a common methodology based on citation analysis. Four journals designated by nurse practitioners as sources for their practice information were selected. All cited references were analyzed to determine format types and publication years. Bradford's Law of Scattering was applied to identify core journals. Nine bibliographic databases were searched to estimate the index coverage of the core titles. The findings indicate that nurse practitioners rely primarily on journals (72.0%) followed by books (20.4%) for their professional knowledge. The majority of the identified core journals belong to non-nursing disciplines. This is reflected in the indexing coverage results: PubMed/MEDLINE more comprehensively indexes the core titles than CINAHL does. Nurse practitioners, as primary care providers, consult medical as well as nursing sources for their information. The implications of the citation analysis findings are significant for collection development librarians and indexing services.
Carpenter, Lindsey M; Hubbard, Grace B
The purpose of this article is to inform and educate psychiatric nurse practitioners about the pervasiveness of the rapidly increasing problem of cyberbullying. As more children and adolescents obtain access to the Internet, mobile devices, and social networking sites, the exposure to bullying in the virtual format increases. Cyberbullying is a growing public health concern and can affect mental health and school performance. Cyberbullying often results in a range of psychiatric symptoms and has been linked to suicide attempts and completions. The psychiatric nurse practitioner is uniquely prepared to provide a range of interventions for patients, families, and communities who have experienced cyberbullying. © 2014 Wiley Periodicals, Inc.
A literature review for studies of job satisfaction among nurse practitioners (NPs) suggests that the true determinants of job satisfaction have not been discovered. The purpose of this study was to determine job satisfaction among adult health NPs (ANPs) practicing in Arizona. The Misener nurse practitioner job satisfaction scale was mailed to 329 Arizona ANPs who were certified by the Arizona State Board of Nursing (47% response rate). The mean overall satisfaction score was 4.69 out of a possible score of 6.0 for very satisfied. Differences in employer type, gender, annual income, membership in professional nursing organization, or full-time versus part-time employment status did not result in significantly different scores on the job satisfaction scale in this group. A deep and sustained nursing shortage, the exodus of experienced nurses from the profession, and a projected shortage of primary care providers have generated interest among professional groups, private and government healthcare commissions, and the healthcare industry in determining what factors may influence an individual to choose and remain active in nursing practice. Researchers, educators, employers, and the healthcare industry must look beyond well-worn assumptions about job satisfaction to explore what the individual NP finds satisfying about his or her role.
Greene, Jessica; El-Banna, Majeda M; Briggs, Linda A; Park, Jeongyoung
While male nurses have been shown to earn considerably more than female nurses, there is less evidence on gender disparities in salary among nurse practitioners (NPs). This study examines whether the gender gap in NP salaries persists after controlling for differences in work setting and demographic factors. We analyzed the relationship between gender and salary (2011 pretax earnings) among 6591 NPs working as NPs at least 35 h per week, using the 2012 National Sample Survey of Nurse Practitioners. We first conducted bivariate regression analyses examining the relationship between gender and earnings, and then developed a multivariate model that controlled for individual differences in demographic and work characteristics. Male NPs earned $12,859 more than female NPs, after adjusting for individual differences in demographics and work characteristics. The gender gap was $7405 for recent NP graduates, and grew over time. Male NPs earned significantly more than female NPs across all clinical specialty areas. The gender disparities in NP salaries documented here regardless of professional seniority or clinical area should spark healthcare organizations to conduct pay equity assessments of their employees' salaries to identify and ameliorate pay inequality. ©2017 American Association of Nurse Practitioners.
Freed, Gary L; Dunham, Kelly M; Martyn, Kristy; Martin, Jean; Moran, Lauren M; Spera, Laura
The demand for hiring pediatric nurse practitioners (PNPs) is strong. However, the number of newly educated PNPs has remained relatively flat during the past several years. Understanding the rationale and timing for the decision to pursue this profession is essential to having a positive impact on increasing the future workforce. A mail survey of all new PNPs certified between January 2009 and July 2011 (N = 1040) was conducted. The response rate was 79.9%. Nearly half of all respondents (45%, N = 314) reported that they work in outpatient general pediatrics, 26% (N = 184) in outpatient subspecialty pediatrics, and 22% (N = 152) in inpatient settings. More than one third (36%, N = 253) spend most of their time in a private practice. Forty percent (N = 307) reported that they decided to pursue education as an advanced practice nurse while in practice as a registered nurse (RN), and 38% (N = 289) made the decision before pursuing RN education. Efforts to increase the PNP pipeline will need to be directed both to students during their RN education and to creating opportunities for current RNs to pursue advanced practice nurse education that is focused on children. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.
Fontenot, Holly B; Hawkins, Joellen W; Weiss, Josie A
The purpose of this study was to explicate the concept of cognitive dissonance as experienced and reported by nurse practitioner (NP) faculty members. Responses from NP faculty members to an online survey about their experiences with cognitive dissonance. The respondents detailed their experiences with cognitive dissonance, citing differences between expectations for which they are rewarded and those for which they are paid. Expecting all faculty members to excel in practice, research, teaching, and service may create unrealistic workloads for NP faculty members. Examining expectations and considering creation of a clinical track for faculty who practice may be options administrators of NP programs might explore. ©2012 The Author(s) Journal compilation ©2012 American Academy of Nurse Practitioners.
Sharp, Dayle B; Monsivais, Diane
To describe difficulties associated with the business-related aspects of practice in role transition of rural nurse practitioners (NPs), and to give practice implications. This focused ethnographic study derived data from semi-structured interviews. Participants provided information about rural NP practice ownership and barriers. The sample consisted of 24 rural NPs living throughout the United States. The majority were 51-60 years of age (45%) and females (93%) who had been in rural practice for 1 to over 20 years. NP social entrepreneurs experience difficulties related to scope of practice, business skills, and role conflict. To decrease barriers for NP clinic ownership and management, NPs need to receive education related to financing a rural practice, legal/regulatory practices, strategic planning, leadership, and clinic management. ©2014 American Association of Nurse Practitioners.
O'Rourke, Nancy C; Crawford, Sybil L; Morris, Nancy S; Pulcini, Joyce
Twenty-eight states have laws and regulations limiting the ability of nurse practitioners (NPs) to practice to the full extent of their education and training, thereby preventing patients from fully accessing NP services. Revisions to state laws and regulations require NPs to engage in the political process. Understanding the political engagement of NPs may facilitate the efforts of nurse leaders and nursing organizations to promote change in state rules and regulations. The purpose of this study was to describe the political efficacy and political participation of U.S. NPs and gain insight into factors associated with political interest and engagement. In the fall of 2015, we mailed a survey to 2,020 NPs randomly chosen from the American Academy of Nurse Practitioners' database and 632 responded (31% response rate). Participants completed the Trust in Government (external political efficacy) and the Political Efficacy (internal political efficacy) scales, and a demographic form. Overall, NPs have low political efficacy. Older age ( p≤.001), health policy mentoring ( p≤.001), and specific education on health policy ( p≤.001) were all positively associated with internal political efficacy and political participation. External political efficacy was not significantly associated with any of the study variables. Political activities of NPs are largely limited to voting and contacting legislators. Identifying factors that engage NPs in grassroots political activities and the broader political arena is warranted, particularly with current initiatives to make changes to state laws and regulations that limit their practice.
Messmer, P R; Parchment, Y
Mary Grant Seacole was born in 1805, in Kingston, Jamaica, to a Jamaican doctress (medicine woman) and a Scottish naval officer. Later Seacole became a doctress, nursing British soldiers during epidemics of cholera, dysentery, and yellow fever in Jamaica, Cuba, and Panama. After refusals by both the British government and Florence Nightingale to be allowed to practice in Scutari, she financed her own way to the scene of the Crimean War and then established the British Hotel to serve both the comfort and medical needs of the wounded soldiers. At night, Seacole worked side by side with Nightingale at Scutari as a volunteer nurse. Seacole's fame grew proportionately after she was seen helping wounded soldiers on the battlefields even while the battles were still raging. Seacole died on May 14, 1881, in London. One hundred years later, many members of the London black community, a few members of the Nurses Association of Jamaica and the Friends of Mary Seacole marched to her grave, honoring her as one of the greatest women of all times. Mary Grant Seacole rose above the barriers of racial prejudice and demonstrated the determinism, compassion, and caring that have became the hallmark of nurse practitioners.
Gallagher, S M
Being good at what you do is not enough. Despite strong evidence that the nurse practitioner delivers cost-efficient and outcome-based care, few consumers really understand the nurse practitioner's scope of practice. With the current rapidly changing status of health care, the nurse practitioner is presented with many opportunities. Strategies that ensure survival and growth are critical to longevity. Marketing strategies can offer solutions to these challenges. The 4 P's of marketing are discussed as an approach to promote the role of the nurse practitioner.
Kleinpell, Ruth; Kapu, April N
Evaluating the impact of nurse practitioner (NP) practice has become a priority area of focus for demonstrating outcomes. A number of quality measures are available to enable practice-specific evaluation of NP roles and initiatives. This article reviews sources of quality measures that can be used to facilitate quantifying the outcomes of NP practice as part of an overall evaluation agenda. National resources and published literature on NP quality measures were reviewed. Various resources and toolkits exist to assist NPs in identifying outcomes of practice using quality measures. The need to demonstrate outcomes of NP practice remains an ongoing priority area regardless of the clinical practice setting. A variety of sources of quality measures exist that can be used to showcase the effect of NP care. The use of quality measures can be effectively integrated into evaluation of NP role and NP-directed initiatives to demonstrate impact, and enhance the conduct of an NP outcomes assessment. The use of organizational, NP-specific, and national-related quality measures can help to showcase how NP care improves the quality, safety, and costs of health care. ©2017 American Association of Nurse Practitioners.
Wing, D M
Changes in health care reimbursement practices have affected the way in which primary health care is provided. To be successful, nurse practitioners must have a proficient understanding of basic business functions, including accounting, finance, economics, marketing, and reimbursement practices. Yet, many graduates of nurse practitioner programs are not adequately prepared to make fundamental business decisions. Therefore, it is essential that nurse practitioner faculty provide learning experiences on primary practice business. Because the preceptor experience is an integral aspect of nurse practitioner education, a business preceptorship provides students with pragmatic knowledge of the clinical practice within a business framework. The University of Indianapolis School of Nursing offers a nurse practitioner business preceptorship. The implementation, challenges, and positive outcomes of the course are discussed in this article.
Full Text Available Jacqueline Fong,1,2 Thomas Buckley,2 Andrew Cashin3 1St George Hospital, Kogarah, 2Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia; 3School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia Background: Internationally, the delivery of care provided by nurses and midwives has undergone a significant change due to a variety of interrelated factors, including economic circumstances, a diminishing number of medical providers, the unavailability of adequate health care services in underserved and rural areas, and growing specialization among the professions. One solution to the challenges of care delivery has been the introduction of nurse practitioners (NPs and the authorization of NPs to prescribe medicines. Aim: The aim of this paper was to review the current international literature related to NP prescribing and compare the findings to the Australian context. The review focuses on literature from the United States, Canada, Europe, Australia, and New Zealand. Methods: Databases were searched from January 2000 to January 2015. The following keywords: “nurse practitioner”, “advanced nurse”, “advanced practice nurse”, “prescri*”, “Australia”, “United States America”, “UK”, “New Zealand”, “Canada”, “Europe”, “drug prescri*”, “prescri* authority”, and “prescri* legislation” were used. Findings: NPs tend to prescribe in differing contexts of practice to provide care in underserved populations and require good systems literacy to practice across complex systems. The key themes identified internationally related to NP prescribing relate to barriers to prescribing, confidence in prescribing, and the unique role of NPs in prescribing medicines, eg, the high prevalence of prescribing pain medicines in several countries, including Australia. Conclusion: Across all countries reviewed, there appears a need for further research into the organizational and
Xue, Ying; Tuttle, Jane
Nurse practitioners are increasingly being integrated into primary care delivery to help meet the growing demand for primary care. It is therefore important to understand nurse practitioners' productivity in primary care practice. We examined nurse practitioners' clinical productivity in regard to number of patients seen per week, whether they had a patient panel, and patient panel size. We further investigated practice characteristics associated with their clinical productivity. We conducted cross-sectional analysis of the 2012 National Sample Survey of Nurse Practitioners. The sample included full-time primary care nurse practitioners in ambulatory settings. Multivariable survey regression analyses were performed to examine the relationship between practice characteristics and nurse practitioners' clinical productivity. Primary care nurse practitioners in ambulatory settings saw an average of 80 patients per week (95% confidence interval [CI]: 79-82), and 64% of them had their own patient panel. The average patient panel size was 567 (95% CI: 522-612). Nurse practitioners who had their own patient panel spent a similar percent of time on patient care and documentation as those who did not. However, those with a patient panel were more likely to provide a range of clinical services to most patients. Nurse practitioners' clinical productivity was associated with several modifiable practice characteristics such as practice autonomy and billing and payment policies. The estimated number of patients seen in a typical week by nurse practitioners is comparable to that by primary care physicians reported in the literature. However, they had a significantly smaller patient panel. Nurse practitioners' clinical productivity can be further improved. Copyright © 2016 Elsevier Inc. All rights reserved.
Pop, Rodica S
Nursing philosophy is the foundation of nurse practitioner (NP) training. However, NP practice is based on the medical care model. Thus, the necessity of mediating between these two approaches is often problematic for new NPs who are transitioning into their new roles. Mentoring has been used successfully to facilitate role transition and role understanding for nurses, NPs, and physicians. However, mentoring has been rarely studied in NPs. The purpose of this study was to develop a theory of mentoring for new NPs in a hospital setting. Grounded theory methodology was used. The sampling approach was initially purposive and was then shifted to theoretical to ensure the collection of meaningful data. Semistructuredinterviews were recorded and transcribed into Word documents for analysis. The three-phase analysis developed by Corbin and Strauss was initiated after the second interview. Sixteen participants (eight mentors and eight mentees) were interviewed between February and June 2011. The core category that emerged from the data was "defining self," and the main categories were forming the relationship, developing the relationship, and mentoring outcomes. A well-designed formal mentoring program may greatly improve the transition of NPs into a new role. The theory generated by the data from these study participants provides clearly defined categories that may be operationally defined and utilized to develop evaluation tools for mentoring programs.
The paper presents an overview of a multi-dimensional, prospective, comparative 5-year audit of the quality of the neonatal care provided by a maternity unit in the UK delivering 2000 babies a year, where all neonatal care after 1995 was provided by advanced neonatal nurse practitioners, in relation to that provided by a range of other medically staffed comparator units. The audit includes 11 separate comparative studies supervised by a panel of independent external advisors. Data on intrapartum and neonatal mortality is reported. A review of resuscitation at birth, and a two-tier confidential inquiry into sentinel events in six units were carried out. The reliability of the routine predischarge neonatal examination was studied and, in particular, the recognition of congenital heart disease. A review of the quality of postdischarge letters was undertaken alongside an interview survey to elicit parental views on care provision. An audit of all hospital readmissions within 28 days of birth is reported. Other areas of study include management of staff stress, perceived adequacy of the training of nurse practitioners coming into post, and an assessment of unit costs. Intrapartum and neonatal death among women with a singleton pregnancy originally booked for delivery in Ashington fell 39% between 1991-1995 and 1996-2000 (5.12 vs. 3.11 deaths per 1000 births); the decline for the whole region was 27% (4.10 vs. 2.99). By all other indicators the quality of care in the nurse-managed unit was as good as, or better than, that in the medically staffed comparator units. An appropriately trained, stable team with a store of experience can deliver cot-side care of a higher quality than staff rostered to this task for a few months to gain experience, and this is probably more important than their medical or nursing background. Factors limiting the on-site availability of medical staff with paediatric expertise do not need to dictate the future disposition of maternity services.
Jones, L C; Guberski, T D; Soeken, K L
The purpose of this article is to examine the relationships of individual nurse practitioners' perceptions of the leadership climate in their organizations and self-reported formal and informal leadership behaviors. The nine climate dimensions (Structure, Responsibility, Reward, Perceived Support of Risk Taking, Warmth, Support, Standard Setting, Conflict, and Identity) identified by Litwin and Stringer in 1968 were used to predict five leadership dimensions (Meeting Organizational Needs, Managing Resources, Leadership Competence, Task Accomplishment, and Communications). Demographic variables of age, educational level, and percent of time spent performing administrative functions were forced as a first step in each multiple regression analysis and used to explain a significant amount of variance in all but one analysis. All leadership dimensions were predicted by at least one organizational climate dimension: (1) Meeting Organizational Needs by Risk and Reward; (2) Managing Resources by Risk and Structure; (3) Leadership Competence by Risk and Standards; (4) Task Accomplishment by Structure, Risk, and Standards; and (5) Communication by Rewards.
Lowe, Grainne; Plummer, Virginia; Boyd, Leanne
The aim of this qualitative research was to explore perceptions of organisational change related to the integration of nurse practitioners from key nursing stakeholders. The ongoing delivery of effective and efficient patient services is reliant upon the development and sustainability of nurse practitioner roles. Examination of the factors contributing to the underutilization of nurse practitioner roles is crucial to inform future management policies. A change management theory is used to reveal the complexity involved. Qualitative interviews were undertaken using a purposive sampling strategy of key stakeholders. Thematic analysis was undertaken and key themes were correlated to the theoretical framework. The results confirm the benefits of nurse practitioner roles, but suggest organisational structures and embedded professional cultures present barriers to full role optimization. Complicated policy processes are creating barriers to the integration of nurse practitioner roles. The findings increase understanding of the links between strategic planning, human resource management, professional and organisational cultures, governance and politics in change management. Effective leadership drives the change process through the ability to align key components necessary for success. Sustainability of nurse practitioners relies on recognition of their full potential in the health care team. The results of this study highlight the importance of management and leadership in the promotion of advanced nursing skills and experience to better meet patient outcomes. The findings reinforce the potential of nurse practitioners to deliver patient centred, timely and efficient health care. © 2018 John Wiley & Sons Ltd.
Hsu, Hsiu-Ying; Chang, Shu-Chen; Chang, Ai-Ling; Chen, Shiah-Lian
Critical thinking disposition (CTD) is crucial for nurse practitioners who face complex patient care scenarios. This study explored the CTD of nurse practitioners and related factors. The study was a cross-sectional descriptive design. A purposive sample was recruited from a medical center and its hospital branches in central Taiwan. A structured questionnaire was used to collect data from 210 nurse practitioners. The participants obtained the highest average score on systematicity and analyticity. CTD had a significant positive correlation with fundamental knowledge readiness, professional knowledge readiness, and confidence in making clinical decisions. Professional knowledge readiness, education level, and on-the-job training predicted the score of the participants on overall CTD. On-the-job training and education level may influence the CTD of nurse practitioners. Providing formal or on-the-job continuing education training to nurse practitioners may help enhance their CTD. J Contin Educ Nurs. 2017;48(9):425-430. Copyright 2017, SLACK Incorporated.
Weiland, Sandra A
To examine factors that influence the ability of nurse practitioners (NPs) to practice as independent primary care providers. Extensive literature search on CINAHL, OVID, MEDLINE, Internet journal sources, and professional association Web sites. The legal authority for NPs to practice independently is recognized; however, the ability to put that authority into practice is undermined by the historical failure of political, professional, and social entities to recognize NPs as providers capable of providing primary care autonomously. Nonrecognition is responsible for complex reimbursement policies (both federal and state) that economically and professionally restrain the NP role; hence, NPs remain in a financially dependent relationship despite 40 years of proven safe practice. NPs must articulate their independence as practitioners more vociferously in order to meet society's healthcare requirements, as well as to attain professional fulfillment and forge collegial relationships. NPs will never be seen as members of a profession by either themselves or others without the practicality of independence and autonomy. Although legal independence is a fact, real practice independence in the pragmatic sense is contingent upon reimbursement. Without fiscal sustainability, practice independence is an impossibility. And, without professional autonomy, NPs will have only an employee's voice in the dynamic healthcare system in which they are really key players in providing healthcare services to the poor and undeserved populations.
Strandås, Maria; Fredriksen, Sven-Tore D
Neonatal nurses report a great deal of ethical challenges in their everyday work. Seemingly trivial everyday choices nurses make are no more value-neutral than life-and-death choices. Everyday ethical challenges should also be recognized as ethical dilemmas in clinical practice. The purpose of this study is to investigate which types of ethical challenges neonatal nurses experience in their day-to-day care for critically ill newborns. Data were collected through semi-structured qualitative in-depth interviews. Phenomenological-hermeneutic analysis was applied to interpret the data. Six nurses from neonatal intensive care units at two Norwegian hospitals were interviewed on-site. The study is designed to comply with Ethical Guidelines for Nursing Research in the Nordic Countries and the Helsinki declaration. Findings suggest that nurses experience a diverse range of everyday ethical challenges related to challenging interactions with parents and colleagues, emotional strain, protecting the vulnerable infant, finding the balance between sensitivity and authority, ensuring continuity of treatment, and miscommunication and professional disagreement. A major finding in this study is how different agents involved in caring for the newborn experience their realities differently. When these realities collide, ethical challenges arise. Findings suggest that acting in the best interests of the child becomes more difficult in situations involving many agents with different perceptions of reality. The study presents new aspects which increases knowledge and understanding of the reality of nursing in a neonatal intensive care unit, while also demanding increased research in this field of care. © The Author(s) 2014.
Wyatt, Tami H; Krauskopf, Patricia B; Gaylord, Nan M; Ward, Andrew; Huffstutler-Hawkins, Shelley; Goodwin, Linda
New technologies give nurse academicians the opportunity to incorporate innovative teaching-learning strategies into the nursing curricula. Mobile technology for learning, or m-learning, has considerable potential for the nursing classroom but lacks sufficient empirical evidence to support its use. Based on Mayer's multimedia learning theory, the effect of using cooperative and interactive m-learning techniques in enhancing classroom and clinical learning was explored. The relationship between m-learning and students' learning styles was determined through a multimethod educational research study involving nurse practitioner students at two mid-Atlantic universities. During the 16-month period, nurse practitioner students and their faculty used personal digital assistants (PDAs) to participate in various m-learning activities. Findings from focus group and survey responses concluded that PDAs, specifically the Pocket PC, are useful reference tools in the clinical setting and that all students, regardless of learning style, benefited from using PDAs. It was also demonstrated that connecting students with classmates and other nurse practitioner students at distant universities created a cooperative learning community providing additional support and knowledge acquisition. The authors concluded that in order to successfully prepare nurse practitioner graduates with the skills necessary to function in the present and future health care system, nurse practitioner faculty must be creative and innovative, incorporating various revolutionary technologies into their nurse practitioner curricula.
Nolan, C M; Conway, L G; Litteer, T B; Peterson-Sweeney, K; Richardson, K; Smith, S W; Stoler, P M
As competition within the health care field increases, marketing strategies are becoming more important for all members of the health care team, including nurse practitioners. The purpose of this research was to identify marketing strategies being used by nurse practitioners in New York state. A total of 285 practitioners responded to a survey containing questions related to marketing techniques traditionally used in the business world: service differentiation, market segmentation and practice promotion. A majority of respondents did not report using many of the marketing strategies contained in the survey, although most nurse practitioners did report identifying themselves as primary care providers in one-on-one interactions with clients. Significantly higher marketing scores were found for nurse practitioners who attended a workshop or seminar on marketing strategies, had three or more years of experience, or who practiced in private outpatient settings.
Haut, Cathy; Madden, Maureen
Acute care nurse practitioners, prepared as providers for a variety of populations of patients, continue to make substantial contributions to health care. Evidence indicates shorter stays, higher satisfaction among patients, increased work efficiency, and higher quality outcomes when acute care nurse practitioners are part of unit- or service-based provider teams. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education outlines detailed guidelines for matching nurse practitioners' education with certification and practice by using a population-focused algorithm. Despite national support for the model, nurse practitioners and employers continue to struggle with finding the right fit. Nurse practitioners often use their interest and previous nursing experience to apply for an available position, and hospitals may not understand preparation or regulations related to matching the appropriate provider to the work environment. Evidence and regulatory guidelines indicate appropriate providers for population-focused positions. This article presents history and recommendations for hiring acute care nurse practitioners as providers for different populations of patients. ©2015 American Association of Critical-Care Nurses.
Klutz, Diane L
To inform nurse practitioners (NPs) about the issues related to tort reform and its relationship to malpractice insurance costs. Current journals, newspapers, professional newsletters, and Internet sites. NPs are paying more for their malpractice premiums, and many are losing their places of employment as clinics close due to the increased cost of premiums. One method proposed for curbing the flow of monies spent on premiums and litigation is tort law reform. California serves as an example; its Medical Injury Compensation Reform Act (MICRA) tort reform law was passed 25 years ago, and it has maintained stable malpractice premiums. Other states have proposed similar laws, but some have not had similar success. To curb litigation costs, not only should tort laws be reformed, but NPs and physicians should keep abreast of current practice standards in order to provide quality medical care. Like physicians, NPs are affected directly by tort laws. These laws hold NPs accountable at the same level as physicians. In addition, many states limit NPs' practice to delegation of authority by a physician. Liability is therefore transferred from the NP to the physician and vice versa in cases of injury or wrongful act. In addition, many NPs are finding it increasingly difficult to locate insurers who will write policies for medical liability.
To examine overall job satisfaction and its association with extrinsic and intrinsic characteristics of job satisfaction among nurse practitioners at the chosen practice site. The objectives were to identify relevant retention and recruitment strategies, from the nurse practitioners perspective, by examining (1) what role aspects are most satisfying, and (2) approaches for successful, professional development and integration in the role. Supportive professional practice environments are particularly important to nurses' satisfaction with their work and the quality of patient care provided. Hence, research that examines nurse practitioners practice implications and barriers in today's healthcare system is essential. A descriptive-correlational design using survey methodology. A nonprobability sample of convenience was used. The outcome measures were: The Misener Nurse Practitioner Job Satisfaction Scale and two investigator-developed surveys. Participants expressed dissatisfaction with professional and monetary recognition, assertive influence, administrative support and collegial relationships. Interaction of subscale factors on overall job satisfaction and demographic survey findings has important implications for health administrators and nurse practitioners in similar organisations. Stakeholders in healthcare milieus need to be fully engaged in the redesign of the American healthcare system heeding the recommendations of the Institute of Medicine to provide safer health systems to the public. By doing this, issues related to frustration by nurse practitioners related to job satisfaction will be addressed. The need for cooperation, participation, collaboration and instrumental communication are essential in the delivery of safe, quality patient care. A better understanding of intrinsic professional rewards needs to be learned by nurse practitioners who want to seek professional satisfaction and engage in the survival and growth of the profession. Nurse
Wagener, J. Mark; Carter, Glenna
The development, operating principles, and users' evaluations of a broad based gynecologic program emphasizing effective birth control on a university campus are discussed. A major feature explored is the use of nurse practitioners as the primary service providers. (JMF)
This article presents a comprehensive assessment model for pediatric nurse practitioner (PNP) practice that integrates familiar elements of the classical medical history, Gordon's Functional Health Patterns, and developmental fields into one system. This model drives the diagnostic reasoning process toward consideration of a broad range of disease, daily living (nursing diagnosis), and developmental diagnoses, which represents PNP practice better than the medical model does.
Tarlier, Denise S; Browne, Annette J
Remote Nursing Certified Practice (RNCP) was introduced in 2010 to regulate nursing practice in remote, largely First Nations communities in British Columbia, Canada. These are communities that often experience profound health and health-care inequities. Typically nurses are the main health-care providers. Using a critical social justice lens, the authors explore the clinical and ethical implications of RNCP in terms of access to equitable, high-quality primary health care.They examine the fit between the level and scope of health services provided by registered nurses working under RNCP and the health needs of remote First Nations communities. In doing so, they draw comparisons between nurse practitioners (NPs) and outpost nurses working in NP roles who historically were employed to provide health care in these communities.The authors conclude by calling for nursing regulations that support equitable, high-quality primary care for all British Columbians.
Phillips, Robert L; Harper, Doreen C; Wakefield, Mary; Green, Larry A; Fryer, George E
Nurse practitioners have evolved into a large and flexible workforce. Far too often, nurse practitioner and physician professional organizations do not work together but rather expend considerable effort jousting in policy arenas. Turf battles interfere with joint advocacy for needed health system change and delay development of interdisciplinary teams that could help patients. A combined, consistent effort is urgently needed for studying, training, and deploying a collaborative, integrated workforce aimed at improving the health care system of tomorrow. The country can ill afford doctors and nurses who ignore one another's capabilities and fail to maximize each other's contributions cost-effectively.
Lawson, Thomas N
Diagnostic reasoning is often used colloquially to describe the process by which nurse practitioners and physicians come to the correct diagnosis, but a rich definition and description of this process has been lacking in the nursing literature. A literature review was conducted with theoretical sampling seeking conceptual insight into diagnostic reasoning. Four common themes emerged: Cognitive Biases and Debiasing Strategies, the Dual Process Theory, Diagnostic Error, and Patient Harm. Relevant cognitive biases are discussed, followed by debiasing strategies and application of the dual process theory to reduce diagnostic error and harm. The accuracy of diagnostic reasoning of nurse practitioners may be improved by incorporating these items into nurse practitioner education and practice. [J Nurs Educ. 2018;57(4):203-208.]. Copyright 2018, SLACK Incorporated.
There have been several changes to healthcare services in the UK over recent years, with rising NHS costs and increasing demands on healthcare professionals to deliver high-quality care. Simultaneously, public inquiries have identified suboptimal leadership throughout the NHS, which has been linked to a lack of clear leadership across the healthcare professions. In nursing, the role of the advanced nurse practitioner is regarded as a solution to this leadership challenge. This article examines the background to the development of the advanced nurse practitioner role. It also explores the various factors that may affect nurse leadership and the role of the advanced nurse practitioner, including professional identity, gender, nursing's strategic influence, clinical outcomes, and recruitment and retention. The article concludes that while advanced nurse practitioners can positively influence clinical outcomes and cost efficiency, they must also be adequately prepared to undertake a leadership role. © 2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.
Nurse-physician relationships remain, for the most part, hierarchical in nature. A hierarchical structure allows the person at the top, most notably the physician, the highest level of authority and power for decision making. Other health care providers are delegated various tasks related to the medical plan of care. One role of nonmedical health care providers, including nurses, is to support the medical plan of care and increase the productivity of physicians. Medical centers have house staff, usually interns and residents, who work collaboratively with the attending physicians in care delivery. At one medical center, a shortage of medical house staff for internal medicine prompted the development and evaluation of an alternative service. The alternative service utilized master prepared, certified nurse practitioners on a nonteaching service to provide care for selected types of medical patients. Physicians consulted with nurse practitioners, but retained decision-making authority concerning patient admission to the service. This paper describes the development and evaluation of an alternative service based on a collaborative practice model and the role of nurse practitioners working under such a model. Discussion includes suggestions for process guideline development for organizations that want to improve collaborative practice relationships between unit nursing staff, nurse practitioners, and physicians.
Crigger, Nancy; Barnes, Kristen; Junko, Autumn; Rahal, Sarah; Sheek, Casey
This paper reports on a study conducted to describe family nurse practitioners' perceptions towards and participation in pharmaceutical marketing and to explore the relationships among related variables. The pharmaceutical industry's intense global marketing strategies have resulted in widespread concern in healthcare professionals and professional groups, sectors of the public in many countries, and in the World Health Organization. Research on healthcare providers' participation in pharmaceutical marketing indicates that these relationships are conflicts of interests and compromise healthcare providers' prescribing practices and trust. Nursing, as a discipline, appears to be slow to address the impact of pharmaceutical marketing on nursing practice. Questionnaires about perceptions and participation in pharmaceutical marketing were completed by a random sample of 84 licensed family nurse practitioners in the United States of America in 2007. Family nurse practitioners viewed pharmaceutical company marketing uncritically as educational and beneficial. They also perceived other providers but not themselves as influenced by pharmaceutical marketing. The findings supported those found in previous research with nurses and physicians. Lack of education, participation in marketing and psychological and social responses may impede family nurse practitioners' ability to respond critically and appropriately to marketing strategies and the conflict of interest it creates.
Smeltzer, Suzanne C; Blunt, Elizabeth; Marozsan, Heather; Wetzel-Effinger, Lisa
To examine the integration of disability-content in a national sample of nurse practitioner curricula. Responses of National Organization of Nurse Practitioner Faculties (NONPF) members to an online 34-item survey designed to assess disability-related content included in nurse practitioner (NP) curricula; populations of people with disabilities addressed; models of disability; and resources used to teach about disability, facilitators and barriers to inclusion of disability, and respondents' assessment of the adequacy of coverage of disability in their programs. A survey used previously to assess integration of disability content in undergraduate nursing programs was modified to make it relevant to NP curricula. Nursing faculty and people with disability validated the survey to ensure its completeness and sensitivity to the disability community. Participating programs represent 111 (33.6%) NP programs. Lack of disability-related content reported by NP faculty in the majority of programs suggests that there is considerable room for improvement in efforts to address this often vulnerable population. Because people with disabilities can be found in any setting where health care is provided, all NPs need to be prepared to care for people with disabilities across the life span. Strategies need to be developed and implemented to increase the awareness of NP faculty about the health issues of people with disabilities and integration of disability-related content without disrupting existing overloaded NP curricula. © 2014 American Association of Nurse Practitioners.
Seo, Kumsook; Kim, Miyoung
Despite nurse practitioners' (NPs) professional identity having important implications for the confirmation of nursing practice characteristics, few studies have examined the professional identity of NPs overlaid with the immigrant experience. The aim of this study was to explore the career characteristics of Korean nurse immigrants who became NPs in the United States. Seven Korean NPs in the United States underwent in-depth interviews from August 2013 to May 2015. Content analysis was employed for data analysis. Five themes were identified regarding their professional identity as NPs: patient-centered thinking, responsibility for patient care, dedicated life, diligence, and feelings of achievement. Of these, patient-centered thinking appeared to be the overriding theme. The findings add to nursing knowledge about immigrant nurses and their abilities and striving to develop into new roles in nursing. The participants focused on listening, interpersonal relationships, and education in patient care, which helped differentiate their roles from those of other healthcare professionals. Nurse managers should consider the study findings when making policies to assist immigrant nurses to acculturate into practice, and there is a need for the development of educational materials to guide and promote the NPs' professional role. ©2017 American Association of Nurse Practitioners.
Johnson, Janet; Brennan, Mary; Musil, Carol M; Fitzpatrick, Joyce J
Nurse practitioners (NPs) deliver a wide array of healthcare services in a variety of settings. The purpose of this study was to examine the practice patterns and organizational commitment of inpatient NPs. A quantitative design was used with a convenience sample (n = 183) of NPs who attended the American Association of Nurse Practitioners (AANP) national conference. The NPs were asked to complete a demographic questionnaire, the Practice Patterns of Acute Nurse Practitioners tool and the Organizational Commitment Questionnaire. Over 85% of inpatient practice time consists of direct and indirect patient care activities. The remaining nonclinical activities of education, research, and administration were less evident in the NP's workweek. This indicates that the major role of inpatient NPs continues to be management of acutely ill patients. Moderate commitment was noted in the Organizational Commitment Questionnaire. Supportive hospital/nursing leadership should acknowledge the value of the clinical and nonclinical roles of inpatient NPs as they can contribute to the operational effectiveness of their organization. By fostering the organizational commitment behaviors of identification, loyalty, and involvement, management can reap the benefits of these professionally dedicated providers. ©2015 American Association of Nurse Practitioners.
Hall, Elisabeth O C; Kronborg, Hanne; Aagaard, Hanne
To investigate the lived experiences of neonatal nurses, that is, what it is like to be a neonatal nurse after developmental care is introduced in the unit.......To investigate the lived experiences of neonatal nurses, that is, what it is like to be a neonatal nurse after developmental care is introduced in the unit....
The transition from registered nurse (RN) to nurse practitioner (NP) is often a stressful career change. Data are lacking on the factors affecting NP role transition. This study examined the relationships between NP role transition, prior RN experience, and a formal orientation. From a sample of 352 NPs, only a formal orientation contributed significantly to the regression model indicating a positive relationship with NP role transition (b = 6.24, p < .001). Knowledge of the factors that expl...
Kelly, N R; Mathews, M
The nurse who graduates from a nurse practitioner program leaves a comfort zone of nursing practice to enter a new position where feelings of insecurity and stress are common. Because the role of the nurse practitioner (NP) continues to evolve and is influenced by many environmental issues, the preparation of the NP by the academic institution needs to be assessed on a frequent basis. The purpose of this research was to obtain a better understanding of the transitional phase to the first position as NP after graduation. The perceptions of preparation, gains, losses, barriers, facilitators, and strategies for adjustment were explored. A qualitative approach using focus groups was developed in which 21 recent NP graduates from a large university participated in one of four focus groups. Peer debriefing and participant verification were techniques used to ensure credibility and trustworthiness of the data and subsequent analysis. The themes identified were: loss of personal control of time and privacy; changes and losses in relationships; feelings of isolation and uncertainty in establishing the NP role; and a special bonding with clients. Although the participants perceived they were adequately prepared for their role, they also described feelings of guilt and uncertainty from not knowing information they believed they should know. They concluded that they functioned differently than the physician as well as other nurses and found it necessary to distance themselves from the role of other health care providers. This study has implications for colleagues, academic institutions, and the individual nurse practitioner.
Lopatina, Elena; Donald, Faith; DiCenso, Alba; Martin-Misener, Ruth; Kilpatrick, Kelley; Bryant-Lukosius, Denise; Carter, Nancy; Reid, Kim; Marshall, Deborah A
Advanced practice nurses (e.g., nurse practitioners and clinical nurse specialists) have been introduced internationally to increase access to high quality care and to tackle increasing health care expenditures. While randomised controlled trials and systematic reviews have demonstrated the effectiveness of nurse practitioner and clinical nurse specialist roles, their cost-effectiveness has been challenged. The poor quality of economic evaluations of these roles to date raises the question of whether current economic evaluation guidelines are adequate when examining their cost-effectiveness. To examine whether current guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles. Our methodological review was informed by a qualitative synthesis of four sources of information: 1) narrative review of literature reviews and discussion papers on economic evaluation of advanced practice nursing roles; 2) quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials; 3) review of guidelines for economic evaluation; and, 4) input from an expert panel. The narrative literature review revealed several challenges in economic evaluations of advanced practice nursing roles (e.g., complexity of the roles, variability in models and practice settings where the roles are implemented, and impact on outcomes that are difficult to measure). The quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials identified methodological limitations of these studies. When we applied the Guidelines for the Economic Evaluation of Health Technologies: Canada to the identified challenges and limitations, discussed those with experts and qualitatively synthesized all findings, we concluded that standard guidelines for economic evaluation are appropriate for economic
Poghosyan, Lusine; Chaplin, William F; Shaffer, Jonathan A
Favorable organizational climate in primary care settings is necessary to expand the nurse practitioner (NP) workforce and promote their practice. Only one NP-specific tool, the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), measures NP organizational climate. We confirmed NP-PCOCQ's factor structure and established its predictive validity. A crosssectional survey design was used to collect data from 314 NPs in Massachusetts in 2012. Confirmatory factor analysis and regression models were used. The 4-factor model characterized NP-PCOCQ. The NP-PCOCQ score predicted job satisfaction (beta = .36; p organizational climate in their clinics. Further testing of NP-PCOCQ is needed.
Burman, Mary E.
Directors of family nurse practitioner education programs (n=141) reported inclusion of some complementary/alternative medicine content (CAM), most commonly interviewing patients about CAM, critical thinking, evidence-based medicine, laws, ethics, and spiritual/cultural beliefs. Definition of CAM was medically, not holistically based. More faculty…
Martin-Misener, Ruth; Kilpatrick, Kelley; Donald, Faith; Bryant-Lukosius, Denise; Rayner, Jennifer; Valaitis, Ruta; Carter, Nancy; Miller, Patricia A; Landry, Véronique; Harbman, Patricia; Charbonneau-Smith, Renee; McKinlay, R James; Ziegler, Erin; Boesveld, Sarah; Lamb, Alyson
To identify recommendations for determining patient panel/caseload size for nurse practitioners in community-based primary health care settings. Scoping review of the international published and grey literature. The search included electronic databases, international professional and governmental websites, contact with experts, and hand searches of reference lists. Eligible papers had to (a) address caseload or patient panels for nurse practitioners in community-based primary health care settings serving an all-ages population; and (b) be published in English or French between January 2000 and July 2014. Level one testing included title and abstract screening by two team members. Relevant papers were retained for full text review in level two testing, and reviewed by two team members. A third reviewer acted as a tiebreaker. Data were extracted using a structured extraction form by one team member and verified by a second member. Descriptive statistics were estimated. Content analysis was used for qualitative data. We identified 111 peer-reviewed articles and grey literature documents. Most of the papers were published in Canada and the United States after 2010. Current methods to determine panel/caseload size use large administrative databases, provider work hours and the average number of patient visits. Most of the papers addressing the topic of patient panel/caseload size in community-based primary health care were descriptive. The average number of patients seen by nurse practitioners per day varied considerably within and between countries; an average of 9-15 patients per day was common. Patient characteristics (e.g., age, gender) and health conditions (e.g., multiple chronic conditions) appear to influence patient panel/caseload size. Very few studies used validated tools to classify patient acuity levels or disease burden scores. The measurement of productivity and the determination of panel/caseload size is complex. Current metrics may not capture
Gallagher, Katie; Marlow, Neil; Edgley, Alison; Porock, Davina
The paper is a report of a study of the attitudes of neonatal nurses towards extremely preterm infants. Alongside advancing survival at extremely preterm gestational ages, ethical debates concerning the provision of invasive care have proliferated in light of the high morbidity. Despite nurses being the healthcare professionals who work closest with the infant and their family, their potential influence is usually ignored when determining how parents come to decisions about future care for their extremely premature infant. A Q methodology was employed to explore the attitudes of neonatal nurses towards caring for extremely preterm infants. Data were collected between 2007 and 2008 and analysed using PQMethod and Card Content Analysis. Thirty-six nurses from six neonatal units in the United Kingdom participated. Although there was consensus around the professional role of the nurse, when faced with the complexities of neonatal nursing three distinguishing factors emerged: the importance of parental choice in decision-making, the belief that technology should be used to assess response to treatment, and the belief that healthcare professionals should undertake difficult decisions. Neonatal nurses report unexpected difficulties in upholding their professionally defined role through highly complex and ever varied decision-making processes. Recognition of individual attitudes to the care of extremely preterm infants and the role of the family in the face of difficult decisions should facilitate more open communication between the nurse and the parents and improve the experience of both the nurse and the family during these emotional situations. © 2011 Blackwell Publishing Ltd.
Funk, Kylee A; Weaver, Krystalyn K
The authors share their knowledge about partnering and establishing collaborative practice agreements with nurse practitioners. State laws and regulations were reviewed that affect pharmacists' ability to fully partner with nurse practitioners. Nurse practitioners' role in primary care is growing, and, in many states, nurse practitioners practice independently. Collaborative practice agreements (CPAs) enable pharmacists to work with prescribers more efficiently. Pharmacists' and nurse practitioners' scope-of-practice laws and regulations may prevent CPAs between pharmacists and nurse practitioners. State pharmacy practice acts were reviewed to demonstrate which states allow for partnership under a CPA. Pharmacists should consider opportunities to partner more closely with nurse practitioners to provide care, sometimes under a CPA. In states where laws or regulations prevent CPAs between pharmacists and nurse practitioners, pharmacists should advocate for policy change. Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
Fox, Amanda; Gardner, Glenn; Osborne, Sonya
This research aimed to explore factors that influence sustainability of health service innovation, specifically emergency nurse practitioner service. Planning for cost effective provision of healthcare services is a concern globally. Reform initiatives are implemented often incorporating expanding scope of practice for health professionals and innovative service delivery models. Introducing new models is costly in both human and financial resources and therefore understanding factors influencing sustainability is imperative to viable service provision. This research used case study methodology (Yin, ). Data were collected during 2014 from emergency nurse practitioners, emergency department multidisciplinary team members and documents related to nurse practitioner services. Collection methods included telephone and semi-structured interviews, survey and document analysis. Pattern matching techniques were used to compare findings with study propositions. In this study, emergency nurse practitioner services did not meet factors that support health service sustainability. Multidisciplinary team members were confident that emergency nurse practitioner services were safe and helped to meet population health needs. Organizational support for integration of nurse practitioner services was marginal and led to poor understanding of service capability and underuse. This research provides evidence informing sustainability of nursing service models but more importantly raises questions about this little explored field. The findings highlight poor organizational support, excessive restrictions and underuse of the service. This is in direct contrast to contemporary expanding practice reform initiatives. Organizational support for integration is imperative to future service sustainability. © 2017 John Wiley & Sons Ltd.
Background: Nurse practitioners are increasingly conducting consultations with\\ud patients on the same basis as medical doctors. However little is known about\\ud communication within nurse practitioner consultations. Research on communication\\ud in nurse practitioner consultations has identified nurse practitioners communicate\\ud with patients in a hybrid style, combining biomedical information with the discussion\\ud of subjective information from everyday life. Research has not fully explain...
Barlow, Ian M
Adding or incorporating clinical interpretative comments on biochemistry results is widespread in UK laboratories; although this consumes considerable human resource, there is still little evidence to suggest that it is either effective or appreciated by our clinical colleagues. I therefore decided to survey our local general practitioners (GPs) and nurse practitioners to analyse whether they found biochemistry comments on reports helpful. A simple questionnaire was designed and sent to 159 GPs and 81 nurse practitioners asking them whether they found this activity useful for the limited range of test groups that we routinely comment on and also whether they would like to see commenting on more groups of tests. Overall, 49.6% of questionnaires were returned. Of these, there was overwhelming support for commenting on reports and 77% would like to see comments on a greater range of tests. Although adding clinical interpretative comments is very time-consuming for senior laboratory staff, there is overwhelming support of this activity among our GPs and nurse practitioner users; therefore, our local policy of routinely adding clinical comments will remain for the foreseeable future.
de Leon-Demare, Kathleen; MacDonald, Jane; Gregory, David M; Katz, Alan; Halas, Gayle
To further understand the interactions between nurse practitioners (NPs) and patients, King's nursing theory of goal attainment was applied as the conceptual framework to describe the interactions between NPs and patients in the primary care setting. Six dyads of NPs and their patients were video- and audio-taped over three consecutive clinic visits. For the purposes of this arm of the study, the audio-taped interactions were transcribed and then coded using King's concepts in her theory of goal attainment. King's theory was applicable to describe NP practice. King's concepts and processes of nurse-patient interactions, such as disturbances, mutual goal setting, and transactions, were observed in NP-patient interactions. Disturbances during clinical encounters were essential in the progression toward goal attainment. Elements, such as social exchange, symptom reporting, role explanation, and information around clinical processes facilitated relationship building. NPs as practitioners need to be reflective of their own practice, embrace disturbances in the clinical encounter, and attend to these as opportunities for mutual goal setting. ©2015 American Association of Nurse Practitioners.
Thaíla Corrêa Castral
• Implement the participation of Brazilian scientific societies in establishing health care policies, guidelines and protocols, creating consensus committees. Furthermore, it is important to highlight the ABEn recommendations presented during the 65th Brazilian Nursing Congress, which took place in October of 2013 in Rio de Janeiro, particularly regarding the development of strategies to meet the National Curriculum Guidelines for Nursing Undergraduate Courses, especially concerning the development, participation and application of research and other types of knowledge production that aim at improving the quality of professional practice. Therefore, this number of the Revista Eletrônica de Enfermagem has five original articles that are relevant for Pediatric and Neonatal Nursing. The studies address themes such as nursing diagnosis in children with respiratory infections, child immunization, childhood vulnerability, factors related to peripheral vascular trauma in children, and using case studies to teach diagnostic thinking. The findings are relevant for the implementation of more effective interventions, thus improving the quality of health care delivered to newborns, children and their family. REFERENCE 1. Carvalho V. Linhas de pesquisa e prioridades de enfermagem: proposta com distinção gnoseológica para o agrupamento da produção científica de pós-graduação em enfermagem. Esc. Anna Nery. 2002;6(1:145-54. 2. Lansky S, França E. Mortalidade infantil neonatal no Brasil: situação, tendências e perspectivas. In: Rede Interagencial de Informações para Saúde. Demografia e Saúde: contribuição para análise de situação e tendências [Internet]. Brasília: OPAS; 2009 [acesso em: 20 mar 2014]. p. 83-112. Disponível em: http://www.ripsa.org.br/local/docsonline/6/7/276-livro_demografia_e_saude_WEB.pdf. 3. Ministério da Saúde. Plano Nacional de Saúde–PNS:2012-2015. Brasília (Brasil: Ministério da Saúde; 2011 [acesso em: 20 mar 2014
Lovink, M.H.; Persoon, A.; Vught, A.J. van; Schoonhoven, L.; Koopmans, R.T.C.M.; Laurant, M.G.H.
INTRODUCTION: In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of
De Geest, Sabina; Moons, Philip; Callens, Betty; Gut, Chris; Lindpaintner, Lyn; Spirig, Rebecca
An increasing number of countries are exploring the option of introducing Advanced Practice Nurses (APN), such as Nurse Practitioners (NP), as part of the health care workforce. This is particular relevant in light of the increase of the elderly and chronically ill. It is crucial that this introduction is preceded by an in depth understanding of the concept of advanced practice nursing as well as an analysis of the context. Firstly, a conceptual clarification of Advanced Practice Nurses and Nurse Practitioners is provided. Secondly, a framework is introduced that assists in the analysis of the introduction and development of Advanced Practice Nurse roles in a particular health care system. Thirdly, outcomes research on Advanced Practice Nursing is presented. Argumentation developed using data based papers and policy reports on Advanced Practice Nursing. The proposed framework consists of five drivers: (1) the health care needs of the population, (2) education, (3) workforce, (4) practice patterns and (5) legal and health policy framework. These drivers act synergistically and are dynamic in time and space. Outcomes research shows that nurse practitioners show clinical outcomes similar to or better than those of physicians. Further examples demonstrate favourable outcomes in view of the six Ds of outcome research; death, disease, disability, discomfort, dissatisfaction and dollars, for models of care in which Advanced Practice Nurses play a prominent role. Advanced Practice Nurses such as Nurse Practitioners show potential to contribute favourably to guaranteeing optimal health care. Advanced Practice Nurses will wield the greatest influence on health care by focusing on the most pressing health problems in society, especially the care of the chronically ill.
Peterson, Moya; Potter, Robert Lyman
To review established codes for health care professionals and standards of practice for the nurse practitioner (NP) and to utilize these codes and standards, general ethical themes, and a new ethical triangle to propose an ethical code for NPs. Reviews of three generally accepted ethical themes (deontological, teleological, and areteological), the ethical triangle by Potter, the American Academy of Nurse Practitioners (AANP) standards of practice for NPs, and codes of ethics from the American Nurses Association (ANA) and the American Medical Association (AMA). A proposal for a code of ethics for NPs is presented. This code was determined by basic ethical themes and established codes for nursing, formulated by the ANA, and for physicians, formulated by the AMA. The proposal was also developed in consideration of the AANP standards of practice for NPs. The role of the NP is unique in its ethical demands. The authors believe that the expanded practice of NPs presents ethical concerns that are not addressed by the ANA code and yet are relevant to nursing and therefore different than the ethical concerns of physicians. This proposal attempts to broaden NPs' perspective of the role that ethics should hold in their professional lives.
Choi, Min; De Gagne, Jennie C
This integrative review of the existing literature was conducted to identify dimensions related to nurse practitioner (NP) autonomy and to recommend future areas of research related to the important topic of NP autonomy in this era of cost-conscious healthcare reform. Articles were identified from the following databases: CINAHL, MEDLINE, PubMed, Ovid, Scopus, Google Scholar, and EBSCO. Over 24 articles were found; 12 peer-reviewed articles met the inclusion criteria of research conducted with NPs, physicians, and patients. The results revealed three categories of association with regard to NP autonomy: job satisfaction, patient satisfaction, and physician-NP collaboration. This review was undertaken to advance understanding of autonomy among NPs and the dynamics involved in their delivery of care. Further research into the associations between NP autonomy and its dimensions are necessary to indicate a future direction to the NP role. ©2015 American Association of Nurse Practitioners.
Background. Appropriate resuscitation techniques are crucial to the survival of newborn infants. Objective. To assess knowledge of nurses in western Nigeria about neonatal resuscitation. Method. A cross-sectional survey of the nurses attached to secondary health facilities in western Nigeria was done using a ...
Burman, Mary E; Hart, Ann Marie; Conley, Virginia; Brown, Julie; Sherard, Pat; Clarke, Pamela N
The movement to the doctor of nursing practice (DNP) is progressing rapidly with new programs emerging and curricular documents being developed. We argue that the implementation of the DNP is a good move for nursing, provided that we use the opportunity to reconceptualize the core of advanced practice nursing, especially nurse practitioner (NP) practice. Theory and research articles from nursing focused on advanced practice nursing, NPs, and doctoral education. The foundation of NP education is currently based essentially on borrowed or shared content in assessment, pharmacology, and pathophysiology. We argue that the heart and soul of nursing is in health promotion, both in healthy persons and in those dealing with chronic illness. Current master's programs do not prepare NPs to assume high-level practice focused on health promotion and disease management using the latest theoretical developments in health behavior change, behavioral sciences, exercise physiology, nutrition, and medical anthropology. Although these are touched upon in most NP programs, they do not represent the core science of NP education and need to be a critical part of any DNP program. Ultimately, our vision is for NP care to be consistently "different," yet just as essential as physician care, leading to positive outcomes in health promotion and disease management.
Collados-Gómez, L; Camacho-Vicente, V; González-Villalba, M; Sanz-Prades, G; Bellón-Vaquerizo, B
To describe the perceptions of nurses in neonatal units on pain management, meet the educational profile and describe the use of pain assessment tools and non-pharmacological management for treatment. Cross-sectional descriptive multicentre study, developed during the months of February to September 2015, in the neonatology services of three hospitals at the Community of Madrid, Spain. Data collection was performed through an ad hoc questionnaire on paper or electronically using Survey Monkey platform. The sample consisted of 142 professionals, with a response rate of 55%: 47.9% (68) confirmed they had received specific training in pain management; 39.5% (56) stated that pain is regularly assessed in the unit; only 43.6% reported using validated scales, the most used being the Premature Infant Pain Profile (PIPP). As for the non-pharmacological management, swaddling and non-nutritive sucking it is the most used, followed by sucrose. Intravenous cannulation was identified as the most painful procedure. Pain management is in the process of improvement, because of training and because there is little pain assessment using validated scales. The improvement in the use of non-pharmacological management for the relief of pain in minor procedures is noteworthy. Copyright © 2017 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.
Lutz, Rebecca M
Human trafficking is a crime resulting in serious negative health outcomes for the victims. To provide optimal care, thus improving health outcomes, healthcare providers must be able to identify victims as they seek care for acute and chronic physical illness, communicable diseases, sexually transmitted infections, and mental health disorders (Lederer and Wetzel, 2014; Oram et al., 2012). Unfortunately, healthcare providers lack appropriate knowledge of clues that would lead to victim identification. This may result in a failure to identify victims (Beck et al., 2015; Ross et al., 2015; Konstantopoulos et al., 2013; Chisolm-Straker et al., 2012). Increasing the number of healthcare providers able to identify, treat, and refer victims of trafficking for further care is imperative. The study evaluated the knowledge level of student nurse practitioners enrolled in an adult, family, or pediatric clinical course. Knowledge domains included the definitions, laws, prevalence, identification, treatment, and community and social service resources. The study was designed as a non-probability sampling of adult, family, and pediatric nurse practitioner students (n=73). Participants included students enrolled in the Adult & Older Adult I or the Primary Care of the Child & Adolescent I course at a large public university. The study was designed as a one hour educational intervention intended for presentation in a lecture-style format. The educational intervention included a PowerPoint lecture and embedded videos. The pre-survey, designed as a paper survey, contained a demographic section followed by six survey questions covering the six domains of interest. Following the intervention, participants completed the post-survey prior to leaving the classroom. Pre-survey results pinpointed knowledge gaps across all six domains under investigation. Post-survey results revealed an increase in knowledge across all six domains of interest. The educational intervention increased knowledge
Perry, John J.
Nurse practitioners have become an increasingly important part of the US medical workforce as they have gained greater practice authority through state-level regulatory changes. This study investigates one labor market impact of this large change in nurse practitioner regulation. Using data from the National Sample Survey of Registered Nurses and a dataset of state-level nurse practitioner prescribing authority, a multivariate estimation is performed analysing the impact of greater practice a...
Gagan, M J
Vignettes have often been used to evaluate students or collect data in nursing research. The format is familiar to most nursing students as well as nurses and nurse researchers. This article presents the development and testing of the Nurse Practitioner Performance Tool (NPPT) which used vignettes as an approach to nurse practitioner performance evaluation. In this example, vignettes were used in a quasi-experimental design to collect data from Adult and Family Nurse Practitioners (A/FNP). The focus was on the diagnosis and intervention performance of the A/FNPs when addressing suspected cases of domestic violence.
Wong, Ides; Wright, Eryn; Santomauro, Damian; How, Raquel; Leary, Christopher; Harris, Meredith
To examine the quality and safety of nurse practitioner services of two newly implemented nurse practitioner models of care at a correctional facility. Nurse practitioners could help to meet the physical and mental health needs of Australia's growing prison population; however, the nurse practitioner role has not previously been evaluated in this context. A quality assurance study conducted in an Australian prison where a primary health nurse practitioner and a mental health nurse practitioner were incorporated into an existing primary healthcare service. The study was guided by Donabedian's structure, processes and outcomes framework. Routinely collected information included surveys of staff attitudes to the implementation of the nurse practitioner models (n = 21 staff), consultation records describing clinical processes and time use (n = 289 consultations), and a patient satisfaction survey (n = 29 patients). Data were analysed descriptively and compared to external benchmarks where available. Over the two-month period, the nurse practitioners provided 289 consultations to 208 prisoners. The presenting problems treated indicated that most referrals were appropriate. A significant proportion of consultations involved medication review and management. Both nurse practitioners spent more than half of their time on individual patient-related care. Overall, multidisciplinary team staff agreed that the nurse practitioner services were necessary, safe, met patient need and reduced treatment delays. Findings suggest that the implementation of nurse practitioners into Australian correctional facilities is acceptable and feasible and has the potential to improve prisoners' access to health services. Structural factors (e.g., room availability and limited access to prisoners) may have reduced the efficiency of the nurse practitioners' clinical processes and service implementation. Results suggest that nurse practitioner models can be successfully integrated into a
Carryer, Jenny; Gardner, Glenn; Dunn, Sandra; Gardner, Anne
To draw on empirical evidence to illustrate the core role of nurse practitioners in Australia and New Zealand. Enacted legislation provides for mutual recognition of qualifications, including nursing, between New Zealand and Australia. As the nurse practitioner role is relatively new in both countries, there is no consistency in role expectation and hence mutual recognition has not yet been applied to nurse practitioners. A study jointly commissioned by both countries' Regulatory Boards developed information on the core role of the nurse practitioner, to develop shared competency and educational standards. Reporting on this study's process and outcomes provides insights that are relevant both locally and internationally. This interpretive study used multiple data sources, including published and grey literature, policy documents, nurse practitioner program curricula and interviews with 15 nurse practitioners from the two countries. Data were analysed according to the appropriate standard for each data type and included both deductive and inductive methods. The data were aggregated thematically according to patterns within and across the interview and material data. The core role of the nurse practitioner was identified as having three components: dynamic practice, professional efficacy and clinical leadership. Nurse practitioner practice is dynamic and involves the application of high level clinical knowledge and skills in a wide range of contexts. The nurse practitioner demonstrates professional efficacy, enhanced by an extended range of autonomy that includes legislated privileges. The nurse practitioner is a clinical leader with a readiness and an obligation to advocate for their client base and their profession at the systems level of health care. A clearly articulated and research informed description of the core role of the nurse practitioner provides the basis for development of educational and practice competency standards. These research findings provide
Taylor, Anita; Staruchowicz, Lynda
This review asks "What is the experience and effectiveness of nurse practitioners in orthopaedic settings"?The objective of the quantitative component of this review is to synthesise the best available evidence on effectiveness of orthopaedic nurse practitioner specific care on patient outcomes and process indicators.The objective of the qualitative component of this review is to synthesise the best available evidence on the experience of becoming or being an orthopaedic nurse practitioner in relation to role development, role implementation and (ongoing) role evaluation.The objective of the text and opinion component of this review is to synthesise the best available evidence of the contemporary discourse on the effectiveness and experience of nurse practitioners in orthopaedic settings. Nurse practitioner roles have emerged in response to areas of unmet healthcare needs in a variety of settings. Nurse practitioners first evolved in the United States 40 years ago in response to a shortage of primary health care physicians. Nurse practitioners filled the void by providing access to primary health care services where otherwise there was none. Nurse practitioners comprise one branch of advanced nursing practice in the US along with Nurse Anaesthetists (NA), Clinical Nurse Specialists (CNS) and Nurse Midwives (NM). Canada soon followed America's lead by establishing the nurse practitioner role in 1967. Canada has two areas of advanced nursing practice, namely nurse practitioner and clinical nurse specialist; they are moving towards introducing nurse anaesthetists currently. The nurse practitioner role was introduced into the United Kingdom 20 years ago.There is commonality amongst the definition and characteristics of Nurse Practitioner (NP)/Advanced Practice Nurse (APN) role and practice internationally in terms of education, practice standards and regulation; operationally there is variability however. Australia's progress with nurse practitioners is very much
Kukla, Aniko; Dowling, Donna A; Dolansky, Mary A
Quality improvement has evolved rapidly in neonatal nursing. This review outlines the history and current state of quality improvement practice and education in neonatal nursing. The future of neonatal nursing includes a stronger emphasis on quality improvement in advanced practice education that promotes doctoral projects that result in clinical improvements. A collective focus will ensure that neonatal nurses not only deliver evidence-based care, but also continually improve the care they deliver.
Plath, Sharyn J; Wright, Mary; Hocking, Julia
Nurse Practitioners (NPs) receive core clinical training at master's level, with their employer providing the opportunity to upskill in clinical and procedural competencies. It is increasingly recognised that this generic education requires supplementary training for operating effectively within a specific clinical environment. In this paper we describe a pilot program designed to train Australian NP Candidates to work effectively within the Emergency Department Fast Track model of care. The training program consisted of a 12-month period: four hours in-house training per week over two semesters, running concurrently with the NP candidate's University semesters, and 3 months' clinical practice to consolidate. The training team defined milestones for Semesters one and two, and developed a case review form to assess application of the candidate's knowledge in new clinical situations, as well as check for gaps in understanding. A clinical skills guide was developed for the candidate to work toward, and a comprehensive assessment was carried out at two time points in the training program. Feedback was obtained from the mentors and the candidate at the end point of the training program, and has been used to refine the program for 2017. This in-house training program provided specialised, evidence-based training for the emergency department environment, resulting in development of the nurse practitioner candidate as a high functioning team member. Copyright © 2017 College of Emergency Nursing Australasia. All rights reserved.
Koelbel, P W; Fuller, S G; Misener, T R
Job satisfaction influences employee retention, worker productivity, and performance quality. To retain qualified nurse practitioners (NPs), health administrators must identify sources of job satisfaction and dissatisfaction. Herzberg's dual-factor theory of job satisfaction addresses extrinsic and intrinsic work-related factors. Expansion of the model to include global job satisfaction and individual differences provided a broad framework for the assessment of nurse practitioner job satisfaction. The expanded model was used to analyze the job satisfaction of 132 NPs registered with the South Carolina State Board of Nursing in 1988 (final response rate = 90%). Participants completed the Index of Job Satisfaction (IJS), the Minnesota Satisfaction Questionnaire-Short Form (MSQ-SF), and the Personal and Work Background Questionnaire (PWBQ). Although the NPs were moderately satisfied with their overall jobs, extrinsic factors were found to be major sources of dissatisfaction. The optimal combination of variables predicted by regression analysis to influence global job satisfaction were age, number of children, urban locations, achievement, company policies and practices, creativity, independence, and compensation. Implications for health administrators to improve the work environments of NPs are discussed.
LaFevers, David; Ward-Smith, Peggy; Wright, Wendy
To describe business practice knowledge from the perspectives of nurse practitioners (NPs) who are practicing clinicians, academic instructors, and clinic managers. Using the eight domains of business practice attitudes identified by the Medical Group Management Associations Body of Knowledge (MGMA), which are supported by the American Association of Colleges of Nursing (AACN), a study-specific survey was developed. Data, which describe the knowledge and attitudes with respect to business practices, were obtained from 370 participants. Regardless of their job classification, these participants described (1) quality management, (2) risk management, and (3) patient care systems as critical business practice knowledge. Consensus was also achieved when ranking the content for business practice knowledge: (1) patient care systems, (2) business operation, and (3) financial management. These data identify gaps in business practice knowledge and content that should be included in educational programs. Business practice knowledge is essential for a successful clinical practice and should be a professional practice skill for the NP. ©2015 American Association of Nurse Practitioners.
To discuss the opportunities derived, challenges faced, and lessons learned in the research process, including recruiting and retaining nurse practitioner (NP) participants, obtaining institutional approval, and solving research team issues in a National Institutes of Health/National Institute of Nursing Research (NIH/NINR)-funded study of communication between NPs and their older patients in managed care and non-managed care settings. The video-taped interactions between 30 NPs and 150 patients, research team experiences in conducting the research, and a review of relevant literature. Key factors in NP study participation included recognizing the importance of research in demonstrating the effectiveness of the NP role and for advancing the profession, having participated in previous research, enjoying the research process, employer incentives, membership in NP professional organizations, relationships with the university and the school of nursing conducting the research, and knowledge of the coinvestigator's work. NP recruitment was facilitated by word of mouth, professional organization assistance, and articles in a widely distributed, free nursing journal. Data collection was significantly delayed by attrition of NP participants, logistical problems with scheduling and travel, and varied approval procedures by Institutional Review Boards (IRBs) at study sites. The pace of nursing research could be much more efficient if IRB processes involved fewer bureaucratic entanglements. Preliminary study findings, however, show positive outcomes for older patients after NP care. To demonstrate positive patient outcomes and move the NP profession forward, NPs must be willing to commit to participation in research on their effectiveness as providers in today's healthcare environment.
Dr. A.J. ter Maten - Speksnijder; A. Pool; J.N. Streumer; M.H.F. Grypdonck
The transition from RN to nurse practitioner presents challenges. Because nurse practitioners require deeper critical decision-making abilities to provide safe and quality health care, the Master in Advanced Nursing Practice curriculum implemented reflective case studies to facilitate active and
Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid
of a busy neonatal care unit. Promoting practice uptake was initially underestimated, but nurse guided family-centred care training was improved by increasing the visibility of the study in the unit, demonstrating intervention progress to the nurses and assuring a sense of ownership among nurse leaders...... and adjustment of nurse adherence to guided family-centred care was conducted by monitoring (1) knowledge, (2) delivery, (3) practice uptake and (4) certification. RESULTS: Implementation was improved by the development of a strategic framework and by adjusting the framework according to the real-life context...
Ginger, Tracey; Ritchie, Georgina
The ever-evolving role of the Specialist Practitioner Qualified District Nurse (SPQDN) presents an increasing number of challenges for Practice Teachers and mentors in preparing SPQDN students for the elevated level clinical and transformational leadership necessary to ensure high-quality patient care. The daily challenges of clinical practice within the community nursing setting in addition to undertaking educational interventions in the clinical arena demand that a structured approach to supervision and mentorship is crucial. Employing learning plans to assess individual students learning needs, prepare plans for educational developments and interventions and evaluate a student's progress can be a helpful tool in aiding the learning journey for both the SPQDN student and Practice Teacher or mentor. This article examines how and why a structured learning plan may be used in supporting learning and competency in achieving the necessary level of practice to meet the requirements of the SPQDN.
Afzal, Zubair; Pogge, Elizabeth; Boomershine, Virginia
To evaluate the efficacy of a smoking cessation program led by a pharmacist and a nurse practitioner. During a 6-month period, patients attended 7 one-on-one face-to-face smoking cessation counseling sessions with a pharmacist and 1 to 2 one-on-one face-to-face smoking cessation counseling sessions with a nurse practitioner. The primary outcome was smoking cessation point prevalence rates at months 1, 3, and 5 post-quit date. Secondary outcomes included medication adherence rates at months 1, 3, and 5 post-quit date, nicotine dependence at baseline versus program end, and patient satisfaction. Nine (47%) of 19 total participants completed the program. Seven of the 9 patients who completed the program were smoke-free upon study completion. Point prevalence rates at months 1, 3, and 5 post-quit date were 66%, 77%, and 77%, respectively, based on patients who completed the program. Medication adherence rates were 88.6%, 54.6%, and 75% at months 1, 3, and 5 post-quit date, respectively. Based on the Fagerstrom test, nicotine dependence decreased from baseline to the end of the study, 4.89 to 0.33 ( P smoking cessation program can assist patients in becoming smoke-free.
Shea, Mary L
Job satisfaction of nurse practitioners (NPs) has been studied using quantitative methods. A grounded theory approach was used in this study to understand the contextual nature of the NPs' description of job satisfaction from a personal perspective. A grounded theory approach as described by Glaser and Strauss was used in this study. The study took place in a rural northeastern state. The researcher conducted face-to-face interviews using open-ended questions with 15 participants. Constant comparative method was utilized to analyze data culminating in a basic social process. The participants described holistic care as the foundation of their work and their relationship with patients as determining factors of job satisfaction. When NPs felt as though patient care was compromised, they became dissatisfied. NPs were highly satisfied when providing holistic care and within an environment that respected their professional values. In order to maintain accessibility to high-quality health care, it is imperative to understand the factors that contribute to job satisfaction of NPs. As the healthcare system evolves, healthcare policymakers and healthcare organizations must develop strategies to ensure job satisfaction among NPs. ©2014 American Association of Nurse Practitioners.
Herold, Beth; St Claire, Karen; Snider, Scott; Narayan, Aditee
Child maltreatment is a leading cause of childhood morbidity in the United States, often leading to lifelong adverse health consequences. Currently, there is a nationwide shortage of child abuse pediatricians (CAPs), resulting in many unfilled child abuse positions throughout the United States. In addition, the number of future CAPs currently in fellowship training will meet neither the current need for CAPs nor provide replacements for the senior CAPs who will be retiring in the next 5 to 10 years. Although it is recognized that pediatric nurse practitioners (PNPs) play an important role in the care of maltreated children, there are few available data on the impact of the PNP as an integral member of the child abuse team. Using the outcomes logic model, we present a systematic process through which the PNP can be effectively integrated into a medical child abuse team. The outcomes from this process show that the addition of PNPs to the child abuse team not only provides immediate relief to the nationwide CAP shortage but also significantly augments the diverse clinical skills and expertise available to the child abuse team. Copyright © 2018 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
The format for this curriculum guide, written for nurse practitioner faculty, consists of learning objectives, content outline, teaching methodology suggestions, references and recommended readings. Part 1 of the guide, Recognition of Early and Chronic Alcoholism, deals with features of alcoholism such as epidemiological data and theories,…
Sawyers, J E
A collaborative practice was established at the University of Southern California/Kenneth Norris Jr. Cancer Hospital utilizing combined roles of the CNS and nurse practitioner. The role was created out of a specific need of the physicians of the gastrointestinal malignancy service. Increased administrative and clinical responsibilities necessitated another clinical expert to be readily available for the management of the acute care private practice patients. As a CNS for both the departments of medicine and nursing, my primary responsibilities are focused within the ambulatory care area. This paper presents the concept for this position, the professional and personal benefits, advantages and disadvantages, and recommendations for nursing practice.
Norful, Allison A; de Jacq, Krystyna; Carlino, Richard; Poghosyan, Lusine
Various models of care delivery have been investigated to meet the increasing demands in primary care. One proposed model is comanagement of patients by more than 1 primary care clinician. Comanagement has been investigated in acute care with surgical teams and in outpatient settings with primary care physicians and specialists. Because nurse practitioners are increasingly managing patient care as independent clinicians, our study objective was to propose a model of nurse practitioner-physician comanagement. We conducted a literature search using the following key words: comanagement; primary care; nurse practitioner OR advanced practice nurse. From 156 studies, we extracted information about nurse practitioner-physician comanagement antecedents, attributes, and consequences. A systematic review of the findings helped determine effects of nurse practitioner-physician comanagement on patient care. Then, we performed 26 interviews with nurse practitioners and physicians to obtain their perspectives on nurse practitioner-physician comanagement. Results were compiled to create our conceptual nurse practitioner-physician comanagement model. Our model of nurse practitioner-physician comanagement has 3 elements: effective communication; mutual respect and trust; and clinical alignment/shared philosophy of care. Interviews indicated that successful comanagement can alleviate individual workload, prevent burnout, improve patient care quality, and lead to increased patient access to care. Legal and organizational barriers, however, inhibit the ability of nurse practitioners to practice autonomously or with equal care management resources as primary care physicians. Future research should focus on developing instruments to measure and further assess nurse practitioner-physician comanagement in the primary care practice setting. © 2018 Annals of Family Medicine, Inc.
Lin, Li-Chun; Lee, Sheuan; Ueng, Steve Wen-Neng; Tang, Woung-Ru
The objective of this study was to test the reliability and construct validity of the Nurse Practitioners' Roles and Competencies Scale. The role of nurse practitioners has attracted international attention. The advanced nursing role played by nurse practitioners varies with national conditions and medical environments. To date, no suitable measurement tool has been available for assessing the roles and competencies of nurse practitioners in Asian countries. Secondary analysis of data from three studies related to nurse practitioners' role competencies. We analysed data from 563 valid questionnaires completed in three studies to identify the factor structure of the Nurse Practitioners' Roles and Competencies Scale. To this end, we performed exploratory factor analysis using principal component analysis extraction with varimax orthogonal rotation. The internal consistency reliabilities of the overall scale and its subscales were examined using Cronbach's alpha coefficient. The scale had six factors: professionalism, direct care, clinical research, practical guidance, medical assistance, as well as leadership and reform. These factors explained 67·5% of the total variance in nurse practitioners' role competencies. Cronbach's alpha coefficient for the overall scale was 0·98, and those of its subscales ranged from 0·83-0·97. The internal consistency reliability and construct validity of the Nurse Practitioners' Roles and Competencies Scale were good. The high internal consistency reliabilities suggest item redundancy, which should be minimised by using item response theory to enhance the applicability of this questionnaire for future academic and clinical studies. The Nurse Practitioners' Roles and Competencies Scale can be used as a tool for assessing the roles and competencies of nurse practitioners in Taiwan. Our findings can also serve as a reference for other Asian countries to develop the nurse practitioner role. © 2015 John Wiley & Sons Ltd.
Doede, Megan; Trinkoff, Alison M; Gurses, Ayse P
Neonatal intensive care units (NICUs) remain one of the few areas in hospitals that still use an open bay (OPBY) design for patient stays greater than 24 hr, housing multiple infants, staff, and families in one large room. This creates high noise levels, contributes to the spread of infection, and affords families little privacy. These problems have given rise to the single-family room NICU. This represents a significant change in the care environment for nurses. This literature review answers the question: When compared to OPBY layout, how does a single family room layout impact neonatal nurses' work? Thirteen studies published between 2006 and 2015 were located. Many studies reported both positive and negative effects on nurses' work and were therefore sorted by their cited advantages and disadvantages. Advantages included improved quality of the physical environment; improved quality of patient care; improved parent interaction; and improvements in nurse job satisfaction, stress, and burnout. Disadvantages included decreased interaction among the NICU patient care team, increased nurse workload, decreased visibility on the unit, and difficult interactions with family. This review suggests that single-family room NICUs introduce a complex situation in which trade-offs occur for nurses, most prominently the trade-off between visibility and privacy. Additionally, the literature is clear on what elements of nurses' work are impacted, but how the built environment influences these elements, and how these elements interact during nurses' work, is not as well understood. The current level of research and directions for future research are also discussed.
Pron, Ann Linguiti
More primary care providers are needed to deliver health care to Americans living in poverty and those soon to be insured under the Affordable Care Act. Nurse practitioners (NPs) in nurse-managed health centers (NMHCs) are poised to meet this need. This research study examined the characteristics of NPs working in NMHCs and measured job satisfaction and perceived level of autonomy. No studies about job satisfaction or autonomy for NPs working in NMHCs had been previously reported. This descriptive, quantitative study surveyed primary care NPs working in NMHCs that are part of the National Nursing Centers Consortium (NNCC). NP e-mail addresses were obtained from NNCC center directors. Of 198 NPs invited to the electronic survey, 99 completed the Misener Nurse Practitioner Job Satisfaction Scale, demographic questionnaire, questions about perceived autonomy, and whether they would recommend working in an NMHC. Participants came from 16 states and 46 NMHCs. NPs working in NMHCs have job satisfaction, perceive their role as autonomous, and are satisfied with the autonomy they have. NMHCs can provide access to primary health care for many Americans. More NPs may choose employment in NMHCs for job satisfaction and autonomy. ©2012 The Author(s) Journal compilation ©2012 American Association of Nurse Practitioners.
Jirathananuwat, Areeya; Pongpirul, Krit
This study was aimed (1) to compare the level of physical activity (PA) between working and nonworking hours and (2) to compare the level of PA during working hours of nurse clinical practitioners (NCPs) with that of nurse managers (NMs). This cross-sectional survey was conducted at a Thai university hospital from October 2015 to March 2016. All randomly selected participants wore an activity tracker on their hip for 5 days, except during bathing and sleeping periods, to record step counts and time points. Of 884 nurses, 289 (142 NCPs and 147 NMs) were randomly selected. The average age was 35.87 years. They spent 9.76 and 6.01 hours on work and nonwork activities, respectively. Daily steps per hour were significantly lower during work than nonwork periods (P work period of NCP was significantly higher than that of NM even after adjusting for age, work experience, and body mass index (P = .034). NCP had higher overall PA than NM, which was partly contributed by work-related PA. Level of PA for a professional with variation of actual work hours should be measured on hourly basis.
.... The inevitable result is that the Family Nurse Practitioner (FNP) will take on a more active role in the deployed setting, especially in missions involving civilians with primary care needs as seen in Military Operations Other Than War (MOOTW...
Full Text Available A literature review of family-centred care in paediatric and neonatal nursing was undertaken as part of a research project. This research intended to ascertain the knowledge and attitudes of paediatric and neonatal qualified nurses and nurse educators towards family-centred care as it pertains to infants and children in hospitals in the Gauteng Province. A definition of family-centred care is difficult to formulate mainly due to the lack of consensus about its meaning. Additionally, the diverse societal contexts within which family-centred care is applied further complicate its definition. Internationally in developed countries, family-centred care is viewed as care, which is parent-led in consultation with the nurse practitioner. A family-centred care model for the South African context needs to be developed with the focus on parent participation, a precursor of family-centred care. This article traces the early developments in parental care for hospitalised children with specific reference to the USA, the UK and South Africa. Precursor concepts in family-centred care are described followed by a cursory overview of the reality of family-centred care, its cultural dimensions and matters of family strengths and choices in family-centred care.
Hu, Sophia H; Yu, Ya-Mei; Chang, Wen-Yin; Lin, Yen-Kuang
To investigate the relationship of nurse practitioners' social support as well as other factors associated with perceived self-efficacy. There is a growing demand for nurse practitioners in Taiwan, for whom self-perceived efficacy is associated with performance. Nevertheless, research on the self-efficacy and social support of nurse practitioners is limited. This is a cross-sectional survey study. Questionnaires were distributed to nurse practitioners in seven hospitals in northern Taiwan from May 2015 to March 2016. In total, data from 335 (78% return rate) certified nurse practitioners were analysed. Social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS) and the Job Content Questionnaire (JCQ), and perceived self-efficacy was measured by the General Self-Efficacy Scale (GSE). Data were analysed by ANOVAs with post hoc test and multiple linear regression. The mean score for self-efficacy was 27.60 ± 6.17. Support scores were 11.574 ± 2.37 for supervisors, 12.795 ± 1.92 for coworkers and 64.07 ± 10.16 for family, friends and significant others. nurse practitioners in the high monthly salary group had significantly higher self-efficacy than nurse practitioners in the medium and low monthly salary group (F = 8.99; p Social support from coworkers (β = 0.18, p social support were found to contribute to nurse practitioners' self-efficacy. Thus, to enhance nurse practitioners' self-efficacy and work performance, nursing leaders should address these issues. The findings inform hospital administrators to be aware of the importance of salary in relation to nurse practitioners' perceptions of social support and self-efficacy. © 2017 John Wiley & Sons Ltd.
Jennings, Natasha; Lutze, Matthew; Clifford, Stuart; Maw, Michael
The emergency nurse practitioner is now a well established and respected member of the healthcare team. Evaluation of the role has focused on patient safety, effectiveness and quality of care outcomes. Comparisons of the role continue to focus on cost, with findings based on incomplete and almost impossible to define, recognition of contribution to service delivery by paralleled practitioners. Currently there is no clear definition as to how nurse practitioners contribute to value in health service delivery. Robust and rigorous research needs to be commissioned taking into consideration the unique hybrid nature of the emergency nurse practitioner role and focusing on the value they contribute to health care delivery.
The decision to open a nurse practitioner practice is often difficult to make. Success depends on the possession of specific resources, such as adequate skills, finances, emotional support and the desire to be one's own boss. These skills will be critical as the NP develops a business plan and a budget, and makes important decisions, such as the form the business will take: sole proprietorship, partnership or corporation. Using external resources such as attorneys and accountants is also useful, especially when tackling issues of licenses, taxes and insurance. Start-up costs can be kept to a minimum with creativity and used equipment. In-house laboratories and reference laboratories must conform to strict regulations. A practice without established patients will need to market services aggressively through a successful mix of product, price, place and promotion. Patients' acceptance of the NP office will be enhanced by smooth patient flow, adequate space and cleanliness.
Brown, Deonne J
The purposes of this study were to report the results of a survey for determining the feasibility and sustainability of independently managed nurse practitioner (NP) practices, to identify the characteristics of consumers who would likely choose an independent NP practice, to assess consumer needs, and to define a target market for competitively positioning NPs. An anonymous electronic survey of 1000 employees (response rate = 21%) at a large nonprofit organization in King County, Washington. This organization employs persons in a wide range of socioeconomic and vocational situations. Descriptive statistics and chi-square analyses were applied to determine associations between demographic characteristics and having used an NP or having the intent to use an independent NP practice. Most respondents knew about NPs, and the majority had seen an NP for their care. Most were satisfied or very satisfied with NP care. A much larger percentage (90%) than previous studies knew about NPs; 58% had seen an NP for their care, making NPs the most used practitioner alternative to physicians. Evidence suggests that NP users are more likely to be female and younger. Eighty-two percent of NP users were satisfied or very satisfied with the care they had received compared to a 70% satisfaction rate for current providers. Women, relatively younger respondents, those who had seen a physician assistant or NP, and those who considered NPs to provide quality and more personalized care were significantly more likely to indicate that they would choose an independent NP practice in their community. Based on a standard marketing formula, 30% of the sample in this study would be expected to change their health care to such a practice. This is the first descriptive study to suggest widespread acceptance of NPs as independent practitioners. Compared to a 1985 study of Seattle residents, consumers are far more likely to know about NPs. Consumer studies such as this one identify the characteristics
O'Keeffe, Anne Paula; Corry, Margarita; Moser, Debra K
To describe the level of job satisfaction of advanced nurse practitioners (ANP) and advanced midwife practitioners in the Republic of Ireland (RoI). Job satisfaction is related to productivity, performance, turnover and health, and thus is a challenge for nursing and healthcare organisations. Job satisfaction data were collected from 47 ANPs using the Misener Nurse Practitioner Job Satisfaction Scale. High levels of global job satisfaction were reported. All ANPs reported satisfaction with autonomy, sense of accomplishment, challenge, social interaction and status in the organisation. Lower levels of job satisfaction were attributed to the amount of involvement in research (55%), opportunities to receive compensation for services provided outside normal working hours (55%), the amount (44%) and the quality of administrative support (51%), and the opportunity to negotiate bonuses and resources in return for productivity (36%). Advanced nurse practitioners in RoI have high levels of job satisfaction with areas relating to clinical practice but are dissatisfied with areas that lead to empowerment within organisations. Efforts to improve the negotiating and leadership skills of ANPs may improve job satisfaction. Enhancing inter-professional collegial relationships and improving managerial recognition of the role within nursing are key areas to be targeted to promote job satisfaction of ANPs. © 2013 John Wiley & Sons Ltd.
To highlight the organisation-level management's role in building leadership capacity in advanced nurse practitioners and the need for appropriate supports to increase their becoming leaders. Little is published about the role of organisation-level management in building leadership capacity and in developing the next generation of nurse leaders. In times of economic constraint, organisations need to focus their efforts on targeted leadership initiatives. Advanced nurse practitioners are ideally positioned to act as leaders both within and beyond the health care organisation. From the available research evidence, several support structures and mechanisms are identified as enablers for advanced nurse practitioners to enact their leadership role. Health care organisations need to include building leadership capacity as a priority in their strategic plan and take action to build-up the level of advanced nurse practitioner leadership. Nurse executives have a vital role in influencing the organisation's strategic plan and making a business case for prioritising leadership capacity building within advanced nurse practitioners. A challenge for nurse executives faced with competing service and leadership development demands, involves strategic decision-making regarding whether the advanced nurse practitioner's role is limited to service delivery or its potential in leading health care reforms is realised. © 2016 John Wiley & Sons Ltd.
Skorobogatova, Natalija; Žemaitienė, Nida; Šmigelskas, Kastytis; Tamelienė, Rasa
The aim of this study was to analyze nurses' professional burnout and health complaints and the relationship between the two components. The anonymous survey included 94 neonatal intensive care nurses from two centers of perinatology. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to evaluate professional burnout; it consisted of 3 components, Emotional Exhaustion, Depersonalization, and Personal Accomplishments, with 22 items in total. Health complaints were evaluated by 21 items, where nurses were asked to report the occurrence of symptoms within the last year. Scale means were presented with standard deviations (SD). Inferential analysis was conducted with multivariate logistic regression, adjusting for age, residence, and work experience. The mean score of professional burnout on the Emotional Exhaustion subscale was 14.4 (SD=7.91), Depersonalization 3.8 (SD=4.75), and Personal Accomplishment 29.1 (SD=10.12). The health assessment revealed that sleeplessness, lack of rest, nervousness, and tiredness were the most common complaints. The regression analysis revealed that tiredness was independently associated with significantly increased odds of professional burnout (OR=4.1). In our study, more than half of the nurses in neonatal intensive care had moderate or high levels of emotional exhaustion, while levels of depersonalization were significantly lower. In contrast, the level of personal accomplishment was low in more than half of the nurses. The most common health complaints were sleep disturbances, nervousness, and tiredness. Tiredness was most strongly associated with professional burnout.
Laís Machado Freire
Full Text Available OBJECTIVE Identify resources that support learning mediated by technology in the field of neonatal nursing. METHOD Systematic review with searches conducted in MEDLINE, LILACS and SciELO. Titles and abstracts were independently evaluated by two experts. RESULTS Of the 2,051 references, 203 full-text articles were analyzed, resulting in the inclusion of nine studies on semiotics and semiology, cardiopulmonary resuscitation, general aspects of neonatal care, diagnostic reasoning and assessment of pain. Only two articles addressed the development of educational strategies and seven papers described the assessment of these strategies by experts and/or users. CONCLUSION Distance education is an important resource for education, and its improvement and updating, and it particularly adds advantages for neonatal nursing by approximating teaching and real-life situations and by minimizing the exposure of newborns for teaching purposes. The lack of educational initiatives mediated by technology suggests the need for the development, evaluation and dissemination of educational resources focused on nursing care of newborns and their families.
Freire, Laís Machado; Paula, Mariane Andreza de; Duarte, Elysangela Dittz; Bueno, Mariana
Identify resources that support learning mediated by technology in the field of neonatal nursing. Systematic review with searches conducted in MEDLINE, LILACS and SciELO. Titles and abstracts were independently evaluated by two experts. Of the 2,051 references, 203 full-text articles were analyzed, resulting in the inclusion of nine studies on semiotics and semiology, cardiopulmonary resuscitation, general aspects of neonatal care, diagnostic reasoning and assessment of pain. Only two articles addressed the development of educational strategies and seven papers described the assessment of these strategies by experts and/or users. Distance education is an important resource for education, and its improvement and updating, and it particularly adds advantages for neonatal nursing by approximating teaching and real-life situations and by minimizing the exposure of newborns for teaching purposes. The lack of educational initiatives mediated by technology suggests the need for the development, evaluation and dissemination of educational resources focused on nursing care of newborns and their families.
In this 14-month ethnographic study, I examined the emotional labor and coping strategies of 114, level-4, neonatal intensive care unit (NICU) nurses. Emotional labor was an underrecognized component in the care of vulnerable infants and families. The nature of this labor was contextualized within complex personal, professional, and organizational layers of demand on the emotions of NICU nurses. Coping strategies included talking with the sisterhood of nurses, being a super nurse, using social talk and humor, taking breaks, offering flexible aid, withdrawing from emotional pain, transferring out of the NICU, attending memorial services, and reframing loss to find meaning in work. The organization had strong staffing, but emotional labor was not recognized, supported, or rewarded. The findings can contribute to the development of interventions to nurse the nurse, and to ultimately facilitate NICU nurses' nurturance of stressed families. These have implications for staff retention, job satisfaction, and delivery of care.
Tanner, Clare L; Pohl, Joanne; Ward, Sheila; Dontje, Kathy
Clinical experiences for advanced practice nurses are increasingly a challenge. Finding settings that demonstrate primary care nursing practice in its finest form can be difficult. This article reports on nurse practitioner (NP) student feedback on clinical placements in the academic nurse-managed centers (ANMCs) associated with four Michigan schools or colleges of nursing. Student feedback was solicited over three years through site and preceptor evaluation tools and focus groups. Students were overwhelmingly satisfied with their experience in ANMCs. Being mentored by an NP preceptor in an ANMC was a valuable experience for students. They valued the role modeling of the NP and the quality of their preceptors' instruction. Students stated that the nursing model of care to which they were exposed was congruent with classroom learning. They reported learning to apply an understanding of their patients' economic, social, and cultural situations to treatment decisions and patient-education efforts and learning to understand the role of community-based care. One limitation of ANMCs from the students' perspective was a relatively low volume of patients, particularly in the initial years. However, the benefit of having time to spend with clients and to reflect on clinical practice was also articulated.
Phuma-Ngaiyaye, Ellemes Everret; Adejumo, Oluyinka; Dartey, Anita Fafa
Practice-based learning is important in clinical teaching of nursing and midwifery as students develop the necessary competencies and confidence aligned by the outcomes of their learning programs. However, in Malawi, research shows that clinical teaching in neonatal nursing has not been given adequate consideration. This article reports on challenges faced by educators and students in clinical teaching and learning in neonatal nursing for nurse-midwife technicians. An explorative qualitative study was conducted. Data were collected through 23 focus group discussions with 140 students and 31 clinical teachers from eight nursing colleges. Audiorecorded data were transcribed verbatim and analyzed using Hennink's content analysis stages. Challenges faced by clinical teachers and students were short duration and variation in clinical placements, lack of emphasis in clinical teaching, and lack of skills among clinical staff. Nursing training institutions should maximize student learning opportunities in neonatal nursing practice by creating more practice-based learning opportunities that meet the students' needs. [J Nurs Educ. 2017;56(4):215-221.]. Copyright 2017, SLACK Incorporated.
Santos, Ana Paula de Souza; Silva, Maria de Lourdes Costa da; Souza, Nilba Lima de; Mota, Gabriela Miranda; França, Débora Feitosa de
OBJECTIVES: to elaborate the Nursing Diagnoses of newborns with sepsis in a neonatal intensive care unit and characterize the profile of the neonates and their mothers.METHOD: a cross-sectional and quantitative study, with a sample of 41 neonates. A physical examination and consultation of the hospital records were undertaken, using an instrument. The elaboration of the Nursing Diagnoses followed a process of diagnostic inference and was based on the North American Nursing Diagnosis Associati...
Full Text Available Background: The period of transition from registered nurse to nurse practitioner is often challenging. While adjusting to their autonomous role, nurse practitioners need to create and define a distinct role for themselves within practice contexts that may be unfamiliar, sometimes unwelcoming and inhospitable. During this time of transition, nurses need well developed negotiation skills and personal attributes including resilience, tenacity, fortitude and determination. Purpose of the research: The purpose of the research reported in this paper was to explore the transition experiences of 10 newly endorsed nurse practitioners in Australia during their first year of practice. This paper focuses on power, control and political manoeuvring that negatively impacted the ×³nurse practitioners×³ transition. A qualitative approach using a modified version of Carspecken×³s five stage critical ethnography, informed by focused ethnography, was the methodology selected for this study. Methods included observations of practice, journaling, face to face and phone interviews which were recorded, transcribed and analysed thematically. Results: âThe enemy withinâ emerged as a dominant theme highlighting issues of power, powerlessness and politics dominating the participant×³s experiences. Power struggles amongst nurses, both overt and covert, and the deliberate misuse of power were frequently encountered. Many of the participants felt powerless and ill-prepared to negotiate the challenging situations in which they found themselves. Many lacked the skills needed to address the negative behaviours they experienced. Conclusions: This paper reports on the experiences of 10 newly endorsed nurse practitioners during their transition to the nurse practitioner role. The impact of the political climate at the time of this study had an undeniable influence on many of the participants×³ transition experiences. Competition for the limited numbers of
Coombs, Lorinda A; Hunt, Lauren; Cataldo, Janine
The quality of cancer care may be compromised in the near future because of work force issues. Several factors will impact the oncology health provider work force: an aging population, an increase in the number of cancer survivors, and expansion of health care coverage for the previously uninsured. Between October 2014 and March 2015, an electronic literature search of English language articles was conducted using PubMed(®) , the Cumulative Index to Nursing and Allied Health Sciences (CINAHL(®) ), Web of Science, Journal Storage (JSTOR(®) ), Google Scholar, and SCOPUS(®) . Using the scoping review criteria, the research question was identified "How much care in oncology is provided by nurse practitioners (NPs)?" Key search terms were kept broad and included: "NP" AND "oncology" AND "workforce". The literature was searched between 2005 and 2015, using the inclusion and exclusion criteria, 29 studies were identified, further review resulted in 10 relevant studies that met all criteria. Results demonstrated that NPs are utilized in both inpatient and outpatient settings, across all malignancy types and in a variety of roles. Academic institutions were strongly represented in all relevant studies, a finding that may reflect the Accreditation Council for Graduate Medical Education (ACGME) duty work hour limitations. There was no pattern associated with state scope of practice and NP representation in this scoping review. Many of the studies reviewed relied on subjective information, or represented a very small number of NPs. There is an obvious need for an objective analysis of the amount of care provided by oncology NPs. © 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Kacel, Barbara; Millar, Mary; Norris, Diane
To describe the current level of job satisfaction of nurse practitioners (NPs) in one Midwestern state. This study utilized descriptive correlation design to examine factors that lead to job satisfaction and dissatisfaction among a randomized sample of licensed NPs from a Midwestern state. The sample of 147 NPs (63% return rate) completed self-administered questionnaires about various characteristics of their jobs. Descriptive statistics and correlations were used to analyze the data. The theoretical foundation for the study was Herzberg's Dual Factor Theory of Job Satisfaction. Overall job satisfaction of NPs was minimally satisfied to satisfied. NPs were most satisfied with intrinsic factors and least satisfied with extrinsic factors of their jobs. Factors NPs were most satisfied with were sense of accomplishment, challenge in work, level of autonomy, patient mix, and ability to deliver quality care. NPs were least satisfied with time off to serve on professional committees, reward distribution, amount of involvement in research, opportunity to receive compensation for services outside normal duties, and monetary bonuses available in addition to salary. NPs with 0-1 year practice experience were the most satisfied with their jobs, but satisfaction scores fell steadily with each additional year of experience, reaching a plateau between the 8th to 11th years of practice. Improving job satisfaction for NPs is critical to recruit and retain advanced practice nurses to enhance access to quality, cost-effective care for all patient populations. Satisfied NPs can potentially reduce healthcare costs associated with employee turnover. Employers must look at extrinsic factors such as compensation and opportunities for professional growth to enhance NP job satisfaction.
Full Text Available Although children with medically complex illness represent less than one percent of the total pediatric population, their health care expenditures and health care system utilization far exceed the numbers of other pediatric patients. Nurse practitioners, with their educational background focused on health care promotion and education, are uniquely qualified to reduce this inequity with cost effective care. Currently, nurse practitioners are used in a variety of health care settings and can provide acute and chronic care. Incorporating nurse practitioners at each step in the care of children with medical complexity can improve the quality of life for these children and their families, increase family satisfaction and decrease costs.
Byrne, Mary W
Children who exhibit the confusing symptom patterns associated with sensory processing deficits are often seen first by primary care providers, including family and pediatric nurse practitioners (NPs). The purpose of this article is to alert NPs to the state of the science for these disorders and to the roles NPs could play in filling the knowledge gaps in assessment, treatment, education, and research. Literature searches using PubMed and MedLine databases and clinical practice observations. Sensory integration disorders have only begun to be defined during the past 35 years. They are not currently included in the DSM IV standard terminology, and are not yet substantively incorporated into most health disciplines' curricula or practice, including those of the NP. NPs are in a unique position to test hypothesized terminology for Sensory Processing Disorder (SPD) by contributing precise clinical descriptions of children who match as well as deviate from the criteria for three proposed diagnostic groups: Sensory Modulation Disorder (SMD), Sensory Discrimination Disorder (SDD), and Sensory-Based Motor Disorder (SBMD). Beyond the SPD diagnostic debate, for children with sensory deficit patterns the NP role can incorporate participating in interdisciplinary treatment plans, refining differential diagnoses, providing frontline referral and support for affected children and their families, and making both secondary prevention and critical causal research possible through validation of consistently accepted diagnostic criteria.
Bart M. Demaerschalk
Full Text Available Objective. The objective was to define and evaluate a role for the Vascular Neurology-Nurse Practitioner (VN-NP in the delivery of telemedicine consultations in partnership with a vascular neurologist. Methods. Prospective stroke alert patients at participating hospitals underwent a two-way audio video telemedicine consultation with a VN-NP at a remotely located stroke center in partnership with a vascular neurologist. Demographic information, National Institutes of Health Stroke Scale (NIHSS scores, diagnoses, CT contraindications to thrombolysis, thrombolysis eligibility, and time interval data were collected. The inter-rater agreement between VN-NP and vascular neurologist assessments was calculated. Results. Ten patients were evaluated. Four were determined to have ischemic stroke, one had a transient ischemic attack, two had intracerebral hemorrhages, and three were stroke mimics. Overall, three patients received thrombolysis. The inter-rater agreement between VN-NP and vascular neurologist assessments were excellent, ranging from 0.9 to 1.0. The duration of VN-NP consultation was 53.2±9.0 minutes, which included the vascular neurologist supervisory evaluation time of 12.0±9.6 minutes. Conclusion. This study illustrated that a stroke center VN-NP, in partnership with a vascular neurologist, could deliver timely telemedicine consultations, accurate diagnoses, and correct treatments in acute stroke patients who presented to remotely located rural emergency departments within a hub and spoke network. VN-NPs may fulfill the role of a telestroke provider.
Demaerschalk, Bart M; Kiernan, Terri-Ellen J; Investigators, Starr
Objective. The objective was to define and evaluate a role for the Vascular Neurology-Nurse Practitioner (VN-NP) in the delivery of telemedicine consultations in partnership with a vascular neurologist. Methods. Prospective stroke alert patients at participating hospitals underwent a two-way audio video telemedicine consultation with a VN-NP at a remotely located stroke center in partnership with a vascular neurologist. Demographic information, National Institutes of Health Stroke Scale (NIHSS) scores, diagnoses, CT contraindications to thrombolysis, thrombolysis eligibility, and time interval data were collected. The inter-rater agreement between VN-NP and vascular neurologist assessments was calculated. Results. Ten patients were evaluated. Four were determined to have ischemic stroke, one had a transient ischemic attack, two had intracerebral hemorrhages, and three were stroke mimics. Overall, three patients received thrombolysis. The inter-rater agreement between VN-NP and vascular neurologist assessments were excellent, ranging from 0.9 to 1.0. The duration of VN-NP consultation was 53.2 +/- 9.0 minutes, which included the vascular neurologist supervisory evaluation time of 12.0 +/- 9.6 minutes. Conclusion. This study illustrated that a stroke center VN-NP, in partnership with a vascular neurologist, could deliver timely telemedicine consultations, accurate diagnoses, and correct treatments in acute stroke patients who presented to remotely located rural emergency departments within a hub and spoke network. VN-NPs may fulfill the role of a telestroke provider.
Noblett, K E; Meibalane, R
Respiratory care practitioners (RCPs) serve as the primary providers of neonatal endotracheal intubation (ETI) in our institution. ETIs are performed by registered respiratory therapists who have completed Pediatric Advanced Life Support and Neonatal Advanced Life Support training and have successfully completed 3 intubations under the direct supervision of a senior therapist. The purpose of this study was to (1) ascertain whether RCPs can successfully provide this type of service with acceptable complications rates and (2) survey the economic impact of this practice on patient charges in our hospital. An analysis of each intubation event in which an RCP participated was collected and compiled over a 5-month period (9-94 to 2-95). Calculations were made of the success rate and complications. A total of 38 ETIs were performed by the RCPs. Of these, 37 (97.4%) were performed with neonatal ETI at a Level-II nursery in a community hospital, and this practice may result in a cost reduction.
Lee, Hyejung; Kim, Anna; Meong, Anna; Seo, Minjeong
The generic competency domains of advanced nursing practice have been reported on in numerous countries, but rather few studies have examined competencies specific to pediatric nurse practitioners (PNPs). We identified the core clinical competencies of PNPs in South Korea and related these identified competencies to the five patterns of knowing in nursing. Focus group interviews were conducted with five PNP students and four PNPs using two thematic questions, one on clinical competencies required for PNPs and the other on competencies specific to Korean PNPs. A purposive sampling method was used to choose nurses with varying work experience and age from different hospital units. The inclusion criterion for PNP students was having at least two years of clinical experience and that for PNPs was having at least two years of clinical experience as a PNP in pediatric units in tertiary hospitals. The verbatim transcriptions of these interviews were analysed by two researchers using inductive content analysis. Six clinical competency domains were identified including advanced pediatric-specific knowledge and clinical skills, education and counseling, utilization and engagement in research, professional identity development, clinical and professional leadership, and holistic care. Some competencies identified were related to empirical and ethical knowledge that could be taught in nursing, whereas others were based on esthetic and personal knowledge, which can be mastered through professional experience. To provide holistic care for children and families, PNPs must acquire all necessary patterns of knowing through continuing education and individual reflection on personal practice.
Hughes, Linda; Adair, Jean; Feng, Feng; Maciejewski, Stephanie; Sharma, Harsha
In the United States, fibromyalgia affects 2%-5% of the adult population, rendering it the most common chronic, widespread pain condition. The American College of Rheumatology has published diagnostic criteria for fibromyalgia, with the latest version in 2010. The purpose of this study was to evaluate nurse practitioners' education and awareness of fibromyalgia and to evaluate nurse practitioners' practices for the management of fibromyalgia. Sixty-six nurse practitioners voluntarily completed an online survey regarding their education, diagnosis, and treatment options for patients with fibromyalgia. The majority of participants reported that they always or occasionally had difficulty diagnosing fibromyalgia and worried about labeling their patients as having fibromyalgia. The most commonly used agents were nonsteroidal anti-inflammatory drugs (70%), serotonin norepinephrine reuptake inhibitors (61%), selective serotonin reuptake inhibitors (51%), and muscle relaxants (44%). Nondrug therapies included exercise (88%), cognitive behavior therapy (58%), and nutrition (56%). Further education is needed for nurse practitioners to increase confidence in diagnosing and managing fibromyalgia.
Watanabe, Hiromi; Okuda, Reiko; Hagino, Hiroshi
Background Strong feelings about and enthusiasm for nursing care are reflected in nurses’ thoughts and behaviors in clinical practice and affect their profession. This study was conducted to identify the characteristics of core values in nursing care based on the experiences of nurses engaged in neonatal nursing through a process for recognizing the conceptualization of nursing. Methods We conceptualized nursing care in 43 nurses who were involved in neonatal nursing using a reflection sheet. We classified descriptions on a sheet based on the Three-Staged Recognition scheme and analyzed them using a text-mining approach. Results Nurses involved in neonatal nursing recognized that they must take care of the “child,” “mother,” and “family.” Important elements of nursing in nurses with less than 5 years versus 5 or more years of neonatal nursing experience were classified into seven clusters, respectively. These elements were mainly related to family members in both groups. In nurses with less than 5 years of experience, four clusters of one-way communication by nurses were observed in the analysis of the key elements in nursing. On the other hand, five clusters of mutual relationships between patients, their family members, and nurses were observed in nurses with 5 or more years of experience. Conclusion In conclusion, the core value of nurses engaged in neonatal nursing is family-oriented nursing. Nurses with 5 or more years of neonatal nursing experience understand patients and their family members well through establishing relationships and providing comfort and safety while taking care of them. PMID:29599621
Jennings, Natasha; Gardner, Glenn; O'Reilly, Gerard
To evaluate emergency nurse practitioner service effectiveness on outcomes related to quality of care and service responsiveness. Increasing service pressures in the emergency setting have resulted in the adoption of service innovation models; the most common and rapidly expanding of these is the emergency nurse practitioner. The delivery of high quality patient care in the emergency department is one of the most important service indicators to be measured in health services today. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this model in outcomes related to safety and quality of patient care. Pragmatic randomized controlled trial at one site with 260 participants. This protocol describes a definitive prospective randomized controlled trial, which will examine the impact of emergency nurse practitioner service on key patient care and service indicators. The study control will be standard emergency department care. The intervention will be emergency nurse practitioner service. The primary outcome measure is pain score reduction and time to analgesia. Secondary outcome measures are waiting time, number of patients who did not wait, length of stay in the emergency department and representations within 48 hours. Scant research enquiry evaluating emergency nurse practitioner service on patient effectiveness and service responsiveness exists currently. This study is a unique trial that will test the effectiveness of the emergency nurse practitioner service on patients who present to the emergency department with pain. The research will provide an opportunity to further evaluate emergency nurse practitioner models of care and build research capacity into the workforce. Trial registration details: Australian and New Zealand Clinical Trials Registry dated 18th August 2013, ACTRN12613000933752. © 2014 John Wiley & Sons Ltd.
Lavoie-Tremblay, Mélanie; Feeley, Nancy; Lavigne, Geneviève L; Genest, Christine; Robins, Stéphanie; Fréchette, Julie
There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork.
Sahn, David J; Kinney, James; Puntel, Robert
... & Science University in Portland will test the hypothesis that trained primary care practitioners or nurses can with telemedicine supervision perform cardiac ultrasound exams on neonates at risk...
Sahn, David J
... & Science University in Portland, will test the hypothesis that trained primary care practitioners or nurses can, with telemedicine supervision, perform cardiac ultrasound exams on neonates at risk...
Sahn, David J; Kinney, James; Puntel, Robert
... & Science University in Portland will test the hypothesis that trained primary care practitioners or nurses can with telemedicine supervision perform cardiac ultrasound exams on neonates at risk...
Nelson, Scott C; Hooker, Roderick S
One role of physician assistants (PAs) and nurse practitioners (NPs) is to meet the growing demand for access to rural health care. Critical Access Hospitals, those with less than 25 beds, are usually located in rural communities, often providing continuity of care that clinics cannot deliver. Because little is known about staffing in these small hospital emergency departments, an exploratory study was undertaken using a mixed-methods approach. In Washington State, 18 of the 39 Critical Access Hospitals staff their emergency departments with PAs and NPs. Utilization data were collected through structured interviews by phone or in person on site. Most PAs and NPs lived within the community and staffing tended to be either 24 hours in-house or short notice if they lived or worked nearby. Emergency department visits ranged from 200 to 25,000 per year. All sites were designated level V or IV trauma centers and often managed cardiac events, significant injuries and, in some larger settings, obstetrics. In most instances, PAs were the sole providers in the emergency departments, albeit with physician backup and emergency medical technician support if a surge of emergency cases arose. Two-thirds of the PAs had graduated within the last 5 years. Most preferred the autonomy of the emergency department role and all expressed job satisfaction. Geographically, the more remote a Washington State Critical Access Hospital is, the more likely it will be staffed by PAs/NPs. The diverse utilization of semiautonomous PAs and NPs and their rise in rural hospital employment is a new workforce observation that requires broader investigation.
Full Text Available Objectives: Clinical experience is an essential component of nurse practitioner (NP education that relies heavily on preceptors. Recruitment and retention of preceptors is challenging due to many variables that can affect NP education and practice. We surveyed Canadian NP programs to understand their preceptorship structures, how they support preceptorship, and to identify gaps and challenges to recruitment and retention of preceptors. Methods: An 18-item survey, developed by the NP Education Interest Group, was distributed to 24 universities across 10 Canadian provinces. Construct validity and reliability was assessed by experienced NPs and NP faculty. Data were analyzed using relative frequency statistics and thematic analysis. Participants consisted of administrative staff and/or faculty designated as responsible for recruitment and retention of NP preceptors. Results: Seventeen returned surveys were analyzed and demonstrated more similarities than differences across Canada's NP programs, particularly related to barriers affecting recruitment and retention of preceptors. The findings identified NP programs have too many students for the number of available clinical sites/preceptors, resulting in overutilization, burnout, or refusal to take students. Competition with other health disciplines for clinical placements was identified as a challenge to placements. Respondents commented they lack time to recruit, provide follow-up, offer support, or seek preceptors' feedback due to competing work demands. They identified the need for standardized funding for preceptor remuneration and recognition across the country. Conclusion: The findings suggest the need for exploring a wider intraprofessional collaboration among graduate NP programs/faculty, clinical placement sites, and NPs to facilitate the recruitment and retention of preceptors.
Since the 1980s, the emergency nurse practitioner (ENP) role has evolved as increasing socioeconomic pressures and changing government policy have led to new working practices in emergency departments. Similarly, a lack of consensus regarding educational support for ENPs and the regulation of ENP training, mean that variations remain in the scope of practice, role description and academic requirements for ENPs. To explore ENPs' perceptions of their changing role, including their educational requirements and whether their training needs are being met. This qualitative phenomenological study examined the views of six ENPs using semi-structured interviews. The study identified four themes: inadequate protected time for continuing professional development (CPD); importance of senior medical support in role expansion and CPD; inconsistent educational preparation for expanded roles; and the ENPs' perceived reasons for role expansion. Although all the participants stated that it was challenging to find time for CPD when working in busy clinical environments, this was regarded as less important than the positive effect of senior medical support for advanced roles. Over the past three decades, the ENP role has become well established, which has led to increased confidence, and the development of collaborative ways of working, among ENPs and their colleagues. However, while ENPs have embraced the challenges of their changing role, educational support has not been consistent. There are still disparities in ENPs' scope of practice, expectations of the role between services, and the educational preparation required to undertake the role. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.
Goldie, Catherine L; Prodan-Bhalla, Natasha; Mackay, Martha
High demand for acute care nurse practitioners (ACNPs) in Canadian postoperative cardiac surgery settings has outpaced methodologically rigorous research to support the role. To compare the effectiveness of ACNP-led care to hospitalist-led care in a postoperative cardiac surgery unit in a Canadian, university-affiliated, tertiary care hospital. Patients scheduled for urgent or elective coronary artery bypass and/or valvular surgery were randomly assigned to either ACNP-led (n=22) or hospitalist-led (n=81) postoperative care. Both ACNPs and hospitalists worked in collaboration with a cardiac surgeon. Outcome variables included length of hospital stay, hospital readmission rate, postoperative complications, adherence to follow-up appointments, attendance at cardiac rehabilitation and both patient and health care team satisfaction. Baseline demographic characteristics were similar between groups except more patients in the ACNP-led group had had surgery on an urgent basis (p < or = 0.01), and had undergone more complicated surgical procedures (p < or =0.01). After discharge, more patients in the hospitalist-led group had visited their family doctor within a week (p < or =0.02) and measures of satisfaction relating to teaching, answering questions, listening and pain management were higher in the ACNP-led group. Although challenges in recruitment yielded a lower than anticipated sample size, this study contributes to our knowledge of the ACNP role in postoperative cardiac surgery. Our findings provide support for the ACNP role in this setting as patients who received care from an ACNP had similar outcomes to hospitalist-led care and reported greater satisfaction in some measures of care.
Heale, Roberta; Dickieson, Patti; Carter, Lorraine; Wenghofer, Elizabeth F
To determine the perceptions of nurse practitioners (NPs) about the level of functioning of their interprofessional teams. Interprofessional teams are a global trend, and nurses play leadership roles in their management. Little is known about the impact of specific barriers to team functioning and the role of the nurse manager on team functioning. Ninety-eight NPs at a conference completed the Interprofessional Team Functioning Survey (ITFS). The survey items with the lowest mean scores were related to organisational systems. These items included workplace policies that support interprofessional teamwork, in particular, orientation to the interprofessional team. Items that generated lower mean scores were adequate time to work as a member of the interprofessional team, team dynamics, collaboration among team members and the sharing of responsibility. Organisational and team relational issues can be addressed through organisational management strategies. Nurse managers have an important role in facilitating high functioning interprofessional teams. Strategies for managers to support interprofessional team functioning emerged. These strategies include ensuring that there are appropriate policies, orientation of new members, allocation of time to support interprofessional teamwork, leadership to enhance team collaboration and clear delineation of responsibilities of each member. © 2013 John Wiley & Sons Ltd.
Turner, Melanie; Chur-Hansen, Anna; Winefield, Helen
To explore the nurses' views of their role both in the neonatal intensive care unit and in the provision of interacting with, and emotionally supporting, families. The neonatal intensive care nurse has a large and complex clinical role and also a role of emotional supporter for parents in the neonatal intensive care unit. Identifying components of their role and recognising the elements within the nursery that obstruct or encourage this role can allow for modification of nurse education and peer support. Qualitative study based on semistructured interviews. Nine neonatal nurses from a single neonatal intensive care unit were interviewed and the data analysed thematically using NVIVO version 10. Participants viewed their role as an enjoyable yet difficult one, requiring seniority, training and experience. They provided support to parents by communicating, listening, providing individualised support and by encouraging parental involvement with their baby. Constructive elements that contributed to the provision of support included a positive neonatal intensive care unit environment and providing a parent support group. More obstructive elements were a lack of physical neonatal intensive care unit space, little time available for nurse-to-parent conversation and language and cultural barriers between nurses and parents. The role of the neonatal nurse in providing emotional support is complex and requires a high level of ongoing support and education for staff, and minimisation of physical and staff-related obstructions. The modern neonatal intensive care unit offers complex medical and nursing services and with this care comes higher needs from both babies and their parents. Neonatal intensive care unit nurses should be supported in their roles by having peer support available in the neonatal intensive care unit and education and training in emotional support and counselling skills. The nursing staff also require a comfortable and practical physical working space in
Baxter, Pamela; DiCenso, Alba; Donald, Faith; Martin-Misener, Ruth; Opsteen, Joanne; Chambers, Tracey
The Council of Ontario University Programs in Nursing offers a nine-university, consortium-based primary health care nurse practitioner education program and on-line continuing education courses for primary health care nurse practitioners. Our study sought to determine the continuing education needs of primary health care nurse practitioners across Ontario, how best to meet these needs, and the barriers they face in completing continuing education. Surveys were completed by 83 (40%) of 209 learners who had participated in continuing education offered by the Council of Ontario University Programs in Nursing between 2004 and 2007. While 83% (n=50) of nurse practitioners surveyed indicated that continuing education was extremely important to them, they also identified barriers to engaging in continuing education offerings including; time intensity of the courses, difficulty taking time off work, family obligations, finances and fatigue. The most common reason for withdrawal from a continuing education offering was the difficulty of balancing work and study demands. Continuing education opportunities are important to Ontario primary health care nurse practitioners, and on-line continuing education offerings have been well received, but in order to be taken up by their target audience they must be relevant, readily accessible, flexible, affordable and offered over brief, intense periods of time using technology that is easy to use and Internet sites that are easily navigated. Copyright © 2012 Elsevier Ltd. All rights reserved.
Smoking during pregnancy and exposure to environmental tobacco smoke have harmful and sometimes devastating effects on the health of the newborn. Although interventions for smoking cessation during pregnancy demonstrate effectiveness for increasing smoking abstinence, the majority of women relapse in the postpartum period. However, modifying contributing factors for relapse may improve the success of sustained abstinence. Many parents are eager to quit smoking and willing to participate in smoking cessation interventions. Through a population-based approach to healthcare, neonatal nurses are in an ideal position to prevent relapse and to promote smoking abstinence; they can coordinate and lead efforts for establishing smoking cessation strategies that integrate obstetric, newborn, and pediatric services.
The lack of safe avenues to develop neonatal nursing competencies using human subjects leads to the notion that simulation education for neonatal nurses might be an ideal form of education. This integrative literature review compares traditional, teacher-centered education with high-fidelity simulation education for neonatal nurses. It examines the theoretical frameworks used in neonatal nursing education and outlines the advantages of this type of training, including improving communication and teamwork; providing an innovative pedagogical approach; and aiding in skill acquisition, confidence, and participant satisfaction. The importance of debriefing is also examined. High-fidelity simulation is not without disadvantages, including its significant cost, the time associated with training, the need for very complex technical equipment, and increased faculty resource requirements. Innovative uses of high-fidelity simulation in neonatal nursing education are suggested. High-fidelity simulation has great potential but requires additional research to fully prove its efficacy.
Aagaard, Hanne; Hall, Elisabeth; Ammentorp, Jette
København, EAPS Conference Okt. 2010 Background: Nurses working in neonatal intensive care units (NICUs) meet a handful of professional challenges and are nursing ever smaller and more vulnerable infants using technological devices and in addition they have to integrate parents in the care. Design......: A qualitative interview study with a hermeneutic-phenomenological approach. Aims: To investigate the lived experiences of neonatal nurses, that is, what it is like to be a neonatal nurse at the time when developmental care is introduced in the unit. Setting: An 18 bed level II-III neonatal unit at a tertiary...... university hospital in Denmark. Developmental care was recently introduced in the unit, and parents spent many hours a day with their baby and stayed overnight in guestrooms at the hospital. Method: Data were collected from seven neonatal nurses with varied experiences; they were analyzed and thematized...
A.J. ter Maten-Speksnijder (Ada)
markdownabstractThe new professional role ‘nurse practitioner’ (in Dutch: verpleegkundig specialist) challenges nurses to distuinguish themselves from nurses educated at the Bacher level by the criteria: independency, expertise, and an active attitude to role development. A crucial aspect of their
Anacilda Oliveira Vieira
Full Text Available Introduction: The PICC (peripherally inserted central catheter is a long flexible catheter which is inserted through a peripheral vein, progresses through a needle introducer until the final portion of the vena cava, acquiring characteristics of a central catheter. Objective: To point out the main theoretical and scientific ideas that demonstrate the reliability, competence and ability of nurses to perform the PICC. Methodology: Systematic review of articles, which were found by searching the database scientific journals and bibliographies area. Results: The success of integration depends on the patient assessment and choice of venous access where the catheter will be positioned, and its tip should be in the middle third of the superior vena cava, or the middle third of the inferior vena cava. In neonates, which are used more frequently, proper positioning of the catheter is through nursing care in making the dressing, and the first 24 hours it should be compressive. Ideally, the PICC remains in the vein for periods longer than seven days or until the end of treatment, thus decreasing invasive procedures. Conclusion: According to the Federal Board of Nursing (COFEN, it is lawful for the insertion of PICC nurses, provided it has undergone professional training.
Adams, Margaret; Gardner, Glenn; Yates, Patsy
To report a study protocol and the theoretical framework normalisation process theory that informs this protocol for a case study investigation of private sector nurse practitioners. Most research evaluating nurse practitioner service is focused on public, mainly acute care environments where nurse practitioner service is well established with strong structures for governance and sustainability. Conversely, there is lack of clarity in governance for emerging models in the private sector. In a climate of healthcare reform, nurse practitioner service is extending beyond the familiar public health sector. Further research is required to inform knowledge of the practice, operational framework and governance of new nurse practitioner models. The proposed research will use a multiple exploratory case study design to examine private sector nurse practitioner service. Data collection includes interviews, surveys and audits. A sequential mixed method approach to analysis of each case will be conducted. Findings from within-case analysis will lead to a meta-synthesis across all four cases to gain a holistic understanding of the cases under study, private sector nurse practitioner service. Normalisation process theory will be used to guide the research process, specifically coding and analysis of data using theory constructs and the relevant components associated with those constructs. This article provides a blueprint for the research and describes a theoretical framework, normalisation process theory in terms of its flexibility as an analytical framework. Consistent with the goals of best research practice, this study protocol will inform the research community in the field of primary health care about emerging research in this field. Publishing a study protocol ensures researcher fidelity to the analysis plan and supports research collaboration across teams. © 2016 John Wiley & Sons Ltd.
Kvarnström, Susanne; Jangland, Eva; Abrandt Dahlgren, Madeleine
The first nurse practitioners in surgical care were introduced into Swedish surgical wards in 2014. Internationally, organisations that have adopted nurse practitioners into care teams are reported to have maintained or improved the quality of care. However, close qualitative descriptions of teamwork practice may add to existing knowledge of interprofessional collaboration when introducing nurse practitioners into new clinical areas. The aim was to report on an empirical study describing how interprofessional teamwork practice was enacted by nurse practitioners when introduced into surgical ward teams. The study had a qualitative, ethnographic research design, drawing on a sociomaterial conceptual framework. The study was based on 170 hours of ward-based participant observations of interprofessional teamwork practice that included nurse practitioners. Data were gathered from 2014 to 2015 across four surgical sites in Sweden, including 60 interprofessional rounds. The data were analysed with an iterative reflexive procedure involving inductive and theory-led approaches. The study was approved by a Swedish regional ethics committee (Ref. No.: 2014/229-31). The interprofessional teamwork practice enacted by the nurse practitioners that emerged from the analysis comprised a combination of the following characteristic role components: clinical leader, bridging team colleague and ever-present tutor. These role components were enacted at all the sites and were prominent during interprofessional teamwork practice. The participant nurse practitioners utilised the interprofessional teamwork practice arrangements to enact a role that may be described in terms of a quality guarantee, thereby contributing to the overall quality and care flow offered by the entire surgical ward team. © 2017 Nordic College of Caring Science.
Full Text Available Abstract Background In many countries out-of-hours care faces serious challenges, including shortage of general practitioners, a high workload, reduced motivation to work out of hours, and increased demand for out-of-hours care. One response to these challenges is the introduction of nurse practitioner as doctor substitutes, in order to maintain the (high accessibility and safety of out of hours care. Although nurse practitioners have proven to provide equally safe and efficient care during daytime primary care, it is unclear whether substitution is effective and efficient in the more complex out of hours primary care. This study aims to assess the effects of substitution of care from general practitioners to nurse practitioners in an out of hours primary care setting. Design A quasi experimental study is undertaken at one “general practitioner cooperative” to offer out-of-hours care for 304.000 people in the South East of the Netherlands. In the experimental condition patient care is provided by a team of one nurse practitioner and four general practitioners; where the nurse practitioner replaces one general practitioner during one day of the weekend from 10 am to 5 pm. In the control condition patient care is provided by a team of five general practitioners during the other day of the weekend, also from 10 am to 5 pm. The study period last 15 months, from April 2011 till July 2012. Methods Data will be collected on number of different outcomes using a range of methods. Our primary outcome is substitution of care. This is calculated using the number and characteristics of patients that have a consultation at the GP cooperative. We compare the number of patients seen by both professionals, type of complaints, resource utilization (e.g. prescription, tests, investigations, referrals and waiting times in the experimental condition and control condition. This data is derived from patient electronic medical records. Secondary outcomes
Wijers, Nancy; Schoonhoven, Lisette; Giesen, Paul; Vrijhoef, Hubertus; van der Burgt, Regi; Mintjes, Joke; Wensing, Michel; Laurant, Miranda
In many countries out-of-hours care faces serious challenges, including shortage of general practitioners, a high workload, reduced motivation to work out of hours, and increased demand for out-of-hours care. One response to these challenges is the introduction of nurse practitioner as doctor substitutes, in order to maintain the (high) accessibility and safety of out of hours care. Although nurse practitioners have proven to provide equally safe and efficient care during daytime primary care, it is unclear whether substitution is effective and efficient in the more complex out of hours primary care. This study aims to assess the effects of substitution of care from general practitioners to nurse practitioners in an out of hours primary care setting. A quasi experimental study is undertaken at one "general practitioner cooperative" to offer out-of-hours care for 304.000 people in the South East of the Netherlands. In the experimental condition patient care is provided by a team of one nurse practitioner and four general practitioners; where the nurse practitioner replaces one general practitioner during one day of the weekend from 10 am to 5 pm. In the control condition patient care is provided by a team of five general practitioners during the other day of the weekend, also from 10 am to 5 pm. The study period last 15 months, from April 2011 till July 2012. Data will be collected on number of different outcomes using a range of methods. Our primary outcome is substitution of care. This is calculated using the number and characteristics of patients that have a consultation at the GP cooperative. We compare the number of patients seen by both professionals, type of complaints, resource utilization (e.g. prescription, tests, investigations, referrals) and waiting times in the experimental condition and control condition. This data is derived from patient electronic medical records. Secondary outcomes are: patient satisfaction; general practitioners workload; quality
Kilpatrick, Kelley; Lavoie-Tremblay, Mélanie; Lamothe, Lise; Ritchie, Judith A; Doran, Diane
This article describes a new conceptual framework for acute care nurse practitioner role enactment, boundary work and perceptions of team effectiveness. Acute care nurse practitioners contribute positively to patient care by enacting an expanded scope of practise. Researchers have found both positive and negative reactions to the introduction of acute care nurse practitioners in healthcare teams. The process of role enactment, shifting role boundaries, and perceptions of team effectiveness has been studied disparately. A framework linking team structures and processes to desirable outcomes is needed. Literature was obtained by searching CINAHL, PsycInfo, MedLine, PubMed, British Nursing Index, Cochrane Library, JSTOR Archive, Web of Science, and Google Scholar from 1985-2010. A descriptive multiple-case study was completed from March 2009-May 2009. A new conceptual framework describing how role enactment and boundary work affect perceptions of team effectiveness was developed by combining theoretical and empirical sources. The framework proposes proximal indicators used by team members to assess their team's performance. The framework identifies the inter-related dimensions and concepts that different stakeholders need to consider when introducing nurse practitioners in healthcare teams. Further study is needed to identify team-level outcomes that reflect the contributions of all providers to quality patient care, and explore the patients' and families' perceptions of team effectiveness following the introduction of acute care nurse practitioners. The new framework can guide decision-making and research related to the structures, processes, and outcomes of nurse practitioner roles in healthcare teams. © 2012 Blackwell Publishing Ltd.
Temane, Annie M; Poggenpoel, Marie; Myburgh, Chris P H
Supervision forms an integral part of psychiatric nursing. The value of clinicalsupervision has been demonstrated widely in research. Despite efforts made toward advancedpsychiatric nursing, supervision seems to be non-existent in this field. The aim of this study was to explore and describe advanced psychiatric nursepractitioners' ideas and needs with regard to supervision in private practice in order tocontribute to the new efforts made in advanced psychiatric nursing in South Africa. A qualitative, descriptive, exploratory, and contextual design using a phenomenological approach as research method was utilised in this study. A purposive sampling was used. Eight advanced psychiatric nurse practitioners in private practice described their ideas and needs for supervision during phenomenological interviews. Tesch's method of open coding was utilised to analyse data. After data analysis the findings were recontextualised within literature. The data analysis generated the following themes - that the supervisor should have or possess: (a) professional competencies, (b) personal competencies and (c) specificfacilitative communication skills. The findings indicated that there was a need for supervision of advanced psychiatric nurse practitioners in private practice in South Africa. This study indicates that there is need for supervision and competent supervisors in private practice. Supervision can be beneficial with regard to developing a culture of support for advanced psychiatric practitioners in private practice and also psychiatric nurse practitioners.
Saltmarsh, Tina; Wilson, Denise
To explore the processes neonatal intensive care nurses used in their child protection role with preterm infants. Neonatal nurses' screening for family violence is important in identifying at-risk preterm infants requiring protection upon discharge from neonatal intensive care settings. We know little about neonatal nurses and their role in child protection. A qualitative research design using Glaserian grounded theory. Ten in-depth semi-structured interviews were conducted with New Zealand neonatal intensive care nurses. Data were simultaneously analysed using constant comparative analysis and theoretical sampling to develop a substantive grounded theory. Dancing around families is the substantive grounded theory explaining how neonatal intensive care nurses respond to and manage an infant needing child protection. Knowing at-risk families is the process these nurses used, which draws on their personal and professional knowledge to identify an infant's child welfare requirements. A tension exists for neonatal nurses in shaping and framing the baby's safety and protection needs between their role of nurturing and protecting an at-risk infant and it belonging to the family. Child protection is a source of conflict for neonatal intensive care nurses. A lack of education, dodgy families and lack of confidence in child welfare services all compromise effective child protection. Their reality is tension between wanting the best possible outcomes for the baby, but having little or no control over what happens following its discharge. Neonatal intensive care nurses are ideally positioned to identify and respond to those preterm infants at risk of child maltreatment. They need education in child maltreatment, and protection focused on preterm infants, collegial support and clinical supervision. © 2016 John Wiley & Sons Ltd.
Full Text Available Introduction: Clinical competence of nurses working in the neonatal intensive care units together with advancements in medical science and technology increased the survival rate of newborns that need specialized care. To ensure the quality of care and provide the safety of patients, evaluating the clinical competence of nurses seems necessary. This study aimed to evaluate the clinical competence of nurses in the neonatal intensive care units. Methods: In this cross-sectional study, 117 nurses working in the neonatal intensive care units of the hospitals affiliated to Tehran University of Medical Sciences were selected by census method. The research tool was Development of Competency Inventory for Registered Nurses questionnaire which completed by self-assessment. The mean clinical competence scores of participants categorized into 3 levels: weak: 273. Data were analyzed by SPSS version 13 using the Pearson correlation coefficient, t-test and Chi-square test. Results: The highest levels of competence were related to critical thinking and research attitude and interpersonal relationships, and the lowest level was related to training and mentoring. There was a direct statistically significant relationship between marital status, employment status, level of interest in working in the neonatal intensive-care units and the clinical competence of nurses. Conclusion: Since the clinical competence of nurses in the Neonatal Intensive Care Units is vital, some variables such as interest in the nursing profession, employment status, the neonatal intensive theoretical and practical training courses and the amount of overtime working hours should be taken into consideration.
Lovink, Marleen Hermien; Persoon, Anke; van Vught, Anneke J A H; Schoonhoven, Lisette; Koopmans, Raymond T C M; Laurant, Miranda G H
In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare. This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context-mechanism-outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory. The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government. © Article author(s) (or their employer(s) unless otherwise stated
Bae, Sung-Heui; Champion, Jane Dimmitt
To explore the nature and prevalence of nurse practitioner (NP) overtime, work hours, and their relationship to practice within NP work conditions. A secondary analysis of data extracted from the 2012 National Sample Survey of Nurse Practitioners. The focus in this study was on data from NPs in active practice in clinical settings. The final analytic sample consisted of 9010 NPs. NPs working in hospitals and long-term care settings tended to work more than 40 h/week (p work more hours per week than those who did not. Regarding the type of relationships with physicians, NPs who worked more than 40 h/week either had hierarchical relationships with them (p work hours/overtime and work conditions related to longer work hours. Further study is indicated to assess the potential impact of work hours/overtime on NP roles and patient outcomes. ©2015 American Association of Nurse Practitioners.
Gorton, Karen L; Hayes, Janice
The purpose of this study was to determine whether there was a relationship between critical thinking skills and clinical judgment in nurse practitioner students. The study used a convenience, nonprobability sampling technique, engaging participants from across the United States. Correlational analysis demonstrated no statistically significant relationship between critical thinking skills and examination-style questions, critical thinking skills and scores on the evaluation and reevaluation of consequences subscale of the Clinical Decision Making in Nursing Scale, and critical thinking skills and the preceptor evaluation tool. The study found no statistically significant relationships between critical thinking skills and clinical judgment. Educators and practitioners could consider further research in these areas to gain insight into how critical thinking is and could be measured, to gain insight into the clinical decision making skills of nurse practitioner students, and to gain insight into the development and measurement of critical thinking skills in advanced practice educational programs. Copyright 2014, SLACK Incorporated.
Schadewaldt, Verena; McInnes, Elizabeth; Hiller, Janet E; Gardner, Anne
In 2010 policy changes were introduced to the Australian healthcare system that granted nurse practitioners access to the public health insurance scheme (Medicare) subject to a collaborative arrangement with a medical practitioner. These changes facilitated nurse practitioner practice in primary healthcare settings. This study investigated the experiences and perceptions of nurse practitioners and medical practitioners who worked together under the new policies and aimed to identify enablers of collaborative practice models. A multiple case study of five primary healthcare sites was undertaken, applying mixed methods research. Six nurse practitioners, 13 medical practitioners and three practice managers participated in the study. Data were collected through direct observations, documents and semi-structured interviews as well as questionnaires including validated scales to measure the level of collaboration, satisfaction with collaboration and beliefs in the benefits of collaboration. Thematic analysis was undertaken for qualitative data from interviews, observations and documents, followed by deductive analysis whereby thematic categories were compared to two theoretical models of collaboration. Questionnaire responses were summarised using descriptive statistics. Using the scale measurements, nurse practitioners and medical practitioners reported high levels of collaboration, were highly satisfied with their collaborative relationship and strongly believed that collaboration benefited the patient. The three themes developed from qualitative data showed a more complex and nuanced picture: 1) Structures such as government policy requirements and local infrastructure disadvantaged nurse practitioners financially and professionally in collaborative practice models; 2) Participants experienced the influence and consequences of individual role enactment through the co-existence of overlapping, complementary, traditional and emerging roles, which blurred perceptions of
Aagaard, Hanne; Hall, Elisabeth; Ammentorp, Jette
. London, St. George Hospital Juni 2011 Objective: To investigate the lived experiences of neonatal nurses, that is, what it is like to be a neonatal nurse after developmental care is introduced in the unit. Methods: The study was designed as a qualitative interview study with a hermeneuticphenom....... London, St. George Hospital Juni 2011 Objective: To investigate the lived experiences of neonatal nurses, that is, what it is like to be a neonatal nurse after developmental care is introduced in the unit. Methods: The study was designed as a qualitative interview study...... with a hermeneuticphenomenological approach. Participants were seven neonatal nurses working in an 18-bed level 2 and 3 neonatal unit at a tertiary university hospital in Denmark. Developmental care was recently introduced in the unit, parents spend many hours a day with their baby and stay overnight in guestrooms at the hospital....... Results: The essential theme of the phenomenon being a neonatal nurse is found to be ‘walking the line between the possible and the ideal’. Five themes illuminate this essence. They are: ‘being attentive to the infant and the mother—infant dyad’, ‘the body tells’, ‘time is everything’, ‘working in a quiet...
Biezen, M.G. van der; Adang, E.M.; Burgt, R. Van Der; Wensing, M.; Laurant, M.G.
BACKGROUND: The pressure in out-of-hours primary care is high due to an increasing demand for care and rising health-care costs. During the daytime, substituting general practitioners (GPs) with nurse practitioners (NPs) shows positive results to contribute to these challenges. However, there is a
questions or they seem to get over their heads they hand it off to the docs. Depending of their training, nurse practitioners in the right situation...conference and explain themselves, it’s just experience, so we just have had a head start there. Years and years of nursing experience isn’t the same...years of medical school is spent in Chemistry and Embryology . I have spent the last 12 years completely dedicated to my career and a physician
Full Text Available Carolyn M Rutledge,1 Karen Kott,2 Patty A Schweickert,3 Rebecca Poston,1 Christianne Fowler,1 Tina S Haney1 1College of Health Sciences, School of Nursing, 2College of Health Sciences, School of Physical Therapy, Old Dominion University, Norfolk, 3Department of Neuroradiology, University of Virginia, Charlottesville, VA, USA Abstract: Telehealth is becoming a vital process for providing access to cost-effective quality care to patients at a distance. As such, it is important for nurse practitioners, often the primary providers for rural and disadvantaged populations, to develop the knowledge, skills, and attitudes needed to utilize telehealth technologies in practice. In reviewing the literature, very little information was found on programs that addressed nurse practitioner training in telehealth. This article provides an overview of both the topics and the techniques that have been utilized for training nurse practitioners and nurse practitioner students in the delivery of care utilizing telehealth. Specifically, this article focuses on topics including 1 defining telehealth, 2 telehealth etiquette, 3 interprofessional collaboration, 4 regulations, 5 reimbursement, 6 security/Health Insurance Portability and Accountability Act (HIPAA, 7 ethical practice in telehealth, and 8 satisfaction of patients and providers. A multimodal approach based on a review of the literature is presented for providing the training: 1 didactics, 2 simulations including standardized patient encounters, 3 practice immersions, and 4 telehealth projects. Studies found that training using the multimodal approach allowed the students to develop comfort, knowledge, and skills needed to embrace the utilization of telehealth in health care. Keywords: telehealth, nurse practitioner education, telemedicine, simulation, health care
Dr. A.L. van Staa; O.K. Helder; J.C.M. Verweij
To explore parents' and nurses' experiences with the transition of infants from the neonatal intensive care unit to a special care nursery. Qualitative explorative study in two phases. Level IIID neonatal intensive care unit in a university hospital and special care nurseries (level II) in five
Andrus, Len Hughes; Fenley, Mary D.
Describes a Family Nurse Practitioner Program that has effectively improved the distribution of primary health care manpower in rural areas. Program characteristics include selection of personnel from areas of need, decentralization of clinical and didactic training sites, competency-based portable curriculum, and circuit-riding institutionally…
, support. Abstract. Background: The purpose of this study was to evaluate the role of the clinical nurse practitioner (CNP) in a doctor- driven primary health .... CNPs have a need for financial reward and .... filling the same function as a CNP. In.
van der Linden, Christien; Reijnen, Resi; de Vos, Rien
Our objectives were to determine the incidence of missed injuries and inappropriately managed cases in patients with minor injuries and illnesses and to evaluate diagnostic accuracy of the emergency nurse practitioners (ENPs) compared with junior doctors/senior house officers (SHOs). In a
Wijers, N.; Schoonhoven, L.; Giesen, P.H.J.; Vrijhoef, H.; van der Burgt, R.; Mintjes, J.; Wensing, M.J.P.; Laurant, M.G.H.
ABSTRACT: BACKGROUND: In many countries out-of-hours care faces serious challenges, including shortage of general practitioners, a high workload, reduced motivation to work out of hours, and increased demand for out-of-hours care. One response to these challenges is the introduction of nurse
McFarland, Marilyn M; Eipperle, Marilyn K
Leininger's Theory of Culture Care Diversity and Universality is presented as a foundational basis for the educational preparation, primary care contextual practice, and outcomes-focused research endeavours of advanced practice nursing. Discussion emphasises the value of care and caring as the essence of advanced practice nursing through the use of three modes of care, use of the Sunrise and other enablers, and the ethnonursing method. Education, research, practice, and key concepts of the theory are connected as essential components toward the provision of culturally congruent care to meet the healthcare needs of diverse individuals, families, groups, and communities by family nurse practitioners.
Grant, Julian; Lines, Lauren; Darbyshire, Philip; Parry, Yvonne
This scoping review explores the work of nurse practitioners in primary health care settings in developed countries and critiques their contribution to improved health outcomes. A scoping review design was employed and included development of a research question, identification of potentially relevant studies, selection of relevant studies, charting data, collating, summarising and reporting findings. An additional step was added to evaluate the methodological rigor of each study. Data sources included literature identified by a search of electronic databases conducted in September 2015 (CINAHL, Informit, Web of Science, Scopus and Medline) and repeated in July 2016. Additional studies were located through hand searching and authors' knowledge of other relevant studies. 74 articles from eight countries were identified, with the majority emanating from the United States of America. Nurse practitioners working in communities provided care mostly in primary care centres (n=42), but also in community centres (n=6), outpatient departments (n=6), homes (n=5), schools (n=3), child abuse clinics (n=1), via communication technologies (n=6), and through combined face-to-face and communication technologies (n=5). The scope of nurse practitioner work varied on a continuum from being targeted towards a specific disease process or managing individual health and wellbeing needs in a holistic manner. Enhanced skills included co-ordination, collaboration, education, counselling, connecting clients with services and advocacy. Measures used to evaluate outcomes varied widely from physiological data (n=25), hospital admissions (n=10), use of health services (n=15), self-reported health (n=13), behavioural change (n=14), patient satisfaction (n=17), cost savings (n=3) and mortality/morbidity (n=5). The majority of nurse practitioners working in community settings did so within a selective model of primary health care with some examples of nurse practitioners contributing to
Brown, Kristen M; Mudd, Shawna S; Hunt, Elizabeth A; Perretta, Julianne S; Shilkofski, Nicole A; Diddle, J Wesley; Yurasek, Gregory; Bembea, Melania; Duval-Arnould, Jordan; Nelson McMillan, Kristen
Assess the effect of a simulation "boot camp" on the ability of pediatric nurse practitioners to identify and treat a low cardiac output state in postoperative patients with congenital heart disease. Additionally, assess the pediatric nurse practitioners' confidence and satisfaction with simulation training. Prospective pre/post interventional pilot study. University simulation center. Thirty acute care pediatric nurse practitioners from 13 academic medical centers in North America. We conducted an expert opinion survey to guide curriculum development. The curriculum included didactic sessions, case studies, and high-fidelity simulation-based on high-complexity cases, congenital heart disease benchmark procedures, and a mix of lesion-specific postoperative complications. To cover multiple, high-complexity cases, we implemented Rapid Cycle Deliberate Practice method of teaching for selected simulation scenarios using an expert driven checklist. Knowledge was assessed with a pre-/posttest format (maximum score, 100%). A paired-sample t test showed a statistically significant increase in the posttest scores (mean [SD], pre test, 36.8% [14.3%] vs post test, 56.0% [15.8%]; p simulation. Median time improved overall "time to task" across these scenarios. There was a significant increase in the proportion of clinically time-sensitive tasks completed within 5 minutes (pre, 60% [30/50] vs post, 86% [43/50]; p = 0.003] Confidence and satisfaction were evaluated with a validated tool ("Student Satisfaction and Self-Confidence in Learning"). Using a five-point Likert scale, the participants reported a high level of satisfaction (4.7 ± 0.30) and performance confidence (4.8 ± 0.31) with the simulation experience. Although simulation boot camps have been used effectively for training physicians and educating critical care providers, this was a novel approach to educating pediatric nurse practitioners from multiple academic centers. The course improved overall knowledge, and the
Kaasalainen, Sharon; Wickson-Griffiths, Abigail; Akhtar-Danesh, Noori; Brazil, Kevin; Donald, Faith; Martin-Misener, Ruth; DiCenso, Alba; Hadjistavropoulos, Thomas; Dolovich, Lisa
Considering the high rates of pain as well as its under-management in long-term care (LTC) settings, research is needed to explore innovations in pain management that take into account limited resource realities. It has been suggested that nurse practitioners, working within an inter-professional model, could potentially address the under-management of pain in LTC. This study evaluated the effectiveness of implementing a nurse practitioner-led, inter-professional pain management team in LTC in improving (a) pain-related resident outcomes; (b) clinical practice behaviours (e.g., documentation of pain assessments, use of non-pharmacological and pharmacological interventions); and, (c) quality of pain medication prescribing practices. A mixed method design was used to evaluate a nurse practitioner-led pain management team, including both a quantitative and qualitative component. Using a controlled before-after study, six LTC homes were allocated to one of three groups: 1) a nurse practitioner-led pain team (full intervention); 2) nurse practitioner but no pain management team (partial intervention); or, 3) no nurse practitioner, no pain management team (control group). In total, 345 LTC residents were recruited to participate in the study; 139 residents for the full intervention group, 108 for the partial intervention group, and 98 residents for the control group. Data was collected in Canada from 2010 to 2012. Implementing a nurse practitioner-led pain team in LTC significantly reduced residents' pain and improved functional status compared to usual care without access to a nurse practitioner. Positive changes in clinical practice behaviours (e.g., assessing pain, developing care plans related to pain management, documenting effectiveness of pain interventions) occurred over the intervention period for both the nurse practitioner-led pain team and nurse practitioner-only groups; these changes did not occur to the same extent, if at all, in the control group
Brødsgaard, Anne; Larsen, Palle; Weis, Janne
REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify how parents of premature infants in neonatal intensive care units (NICUs) and nurses perceive their partnership.The review questions are: how do parents of premature infants and nurses perceive their partnership during...
Rochefort, Christian M; Clarke, Sean P
This paper is a report of a study of the relationship between work environment characteristics and neonatal intensive care unit nurses' perceptions of care rationing, job outcomes, and quality of care. International evidence suggests that attention to work environments might improve nurse recruitment and retention, and the quality of care. However, comparatively little attention has been given to neonatal care, a specialty where patient and nurse outcomes are potentially quite sensitive to problems with staffing and work environments. Over a 6-month period in 2007-2008, a questionnaire containing measures of work environment characteristics, nursing care rationing, job satisfaction, burnout and quality of care was distributed to 553 nurses in all neonatal intensive care units in the province of Quebec (Canada). A total of 339 nurses (61.3%) completed questionnaires. Overall, 18.6% were dissatisfied with their job, 35.7% showed high emotional exhaustion, and 19.2% rated the quality of care on their unit as fair or poor. Care activities most frequently rationed because of insufficient time were discharge planning, parental support and teaching, and comfort care. In multivariate analyses, higher work environment ratings were related to lower likelihood of reporting rationing and burnout, and better ratings of quality of care and job satisfaction. Additional research on the determinants of nurse outcomes, the quality of patient care, and the impact of rationing of nursing care on patient outcomes in neonatal intensive care units is required. The Neonatal Extent of Work Rationing Instrument appears to be a useful tool for monitoring the extent of rationing of nursing care in neonatal units. © 2010 Blackwell Publishing Ltd.
Full Text Available Justin M Cousins, Luke RE Bereznicki, Nick B Cooling, Gregory M Peterson School of Medicine, Faculty of Health, University of Tasmania, Hobart, TAS, Australia Objective: The aim of this study was to identify factors influencing the prescribing of psychotropic medication by general practitioners (GPs to nursing home residents with dementia.Subjects and methods: GPs with experience in nursing homes were recruited through professional body newsletter advertising, while 1,000 randomly selected GPs from south-eastern Australia were invited to participate, along with a targeted group of GPs in Tasmania. An anonymous survey was used to collect GPs’ opinions.Results: A lack of nursing staff and resources was cited as the major barrier to GPs recommending non-pharmacological techniques for behavioral and psychological symptoms of dementia (BPSD; cited by 55%; 78/141, and increasing staff levels at the nursing home ranked as the most important factor to reduce the usage of psychotropic agents (cited by 60%; 76/126.Conclusion: According to GPs, strategies to reduce the reliance on psychotropic medication by nursing home residents should be directed toward improved staffing and resources at the facilities. Keywords: dementia, nursing homes, general practitioners, antipsychotic agents, benzodiazepines
Ammentorp, Jette; Kofoed, Poul-Erik
OBJECTIVE: In this pilot study we have investigated the impact of coach training offered to neonatal nurses on their assessment of their ability to meet the needs of the mothers and fathers. METHODS: The effect of a 3-day coaching training offered to neonatal nurses was investigated...... significant. CONCLUSION: Coaching can improve nurses' self-efficacy in relation to meet the needs of the mothers and fathers. PRACTICE IMPLICATIONS: Coaching could be a method that can maximize the personal and professional potential of the staff, and prepare them for the mindful being-in-relation approach...
Kilcullen, Meegan; Ireland, Susan
Neonatology has made significant advances in the last 30 years. Despite the advances in treatments, not all neonates survive and a palliative care model is required within the neonatal context. Previous research has focused on the barriers of palliative care provision. A holistic approach to enhancing palliative care provision should include identifying both facilitators and barriers. A strengths-based approach would allow barriers to be addressed while also enhancing facilitators. The current study qualitatively explored perceptions of neonatal nurses about facilitators and barriers to delivery of palliative care and also the impact of the regional location of the unit. The study was conducted at the Townsville Hospital, which is the only regional tertiary neonatal unit in Australia. Semi-structured interviews were conducted with a purposive sample of eight neonatal nurses. Thematic analysis of the data was conducted within a phenomenological framework. Six themes emerged regarding family support and staff factors that were perceived to support the provision of palliative care of a high quality. Staff factors included leadership, clinical knowledge, and morals, values, and beliefs. Family support factors included emotional support, communication, and practices within the unit. Five themes emerged from the data that were perceived to be barriers to providing quality palliative care. Staff perceived education, lack of privacy, isolation, staff characteristics and systemic (policy, and procedure) factors to impact upon palliative care provision. The regional location of the unit also presented unique facilitators and barriers to care. This study identified and explored facilitators and barriers in the delivery of quality palliative care for neonates in a regional tertiary setting. Themes identified suggested that a strengths-approach, which engages and amplifies facilitating factors while identified barriers are addressed or minimized, would be successful in
Martin, A E; D'Agostino, J A; Passarella, M; Lorch, S A
Nurses provide parental support and education in the neonatal intensive care unit (NICU), but it is unknown if satisfaction and expectations about nursing care differ between racial groups. A prospective cohort was constructed of families with a premature infant presenting to primary care between 1 January 2010 and 1 January 2013 (N=249, 52% white, 42% black). Responses to questions about satisfaction with the NICU were analyzed in ATLAS.ti using the standard qualitative methodology. One hundred and twenty (48%) parents commented on nursing. Fifty-seven percent of the comments were positive, with black parents more negative (58%) compared with white parents (33%). Black parents were most dissatisfied with how nurses supported them, wanting compassionate and respectful communication. White parents were most dissatisfied with inconsistent nursing care and lack of education about their child. Racial differences were found in satisfaction and expectations with neonatal nursing care. Accounting for these differences will improve parental engagement during the NICU stay.
Chavez, Krista S; Dwyer, Andrew A; Ramelet, Anne-Sylvie
To identify and summarize the common clinical settings, interventions, and outcomes of nurse practitioner care specific to older people. Scoping review of the international published and grey literature. A structured literature search was conducted of CINAHL, EMBASE, MEDLINE, Google Scholar, and Cochrane Collaboration and Joanna Briggs Institute databases. Following the Arksey and O'Malley framework, randomized controlled and quasi-experimental studies of Masters-prepared nurse practitioners providing care for patients over 65 years were included. Studies were reviewed independently by two investigators. Data were extracted, collated by setting, summarized in tables and synthesized for analysis. In total, 56 primary research studies from four countries and 23 systematic reviews were identified. Primary studies were conducted in primary care (n=13), home care (n=14), long-term care (n=10), acute/hospital care (n=9), and transitional care (n=10). Nurse practitioner interventions included substitutive as well as a supplementation NP role elements to meet specific unmet patient care needs. Studies examined six main outcome measures: service utilization (n=41), cost (n=24), length of stay (n=14), health indices (n=44), satisfaction (n=14) and quality of life (n=7). Cumulatively, nurse practitioners demonstrated enhanced results in 83/144 (58%) of outcomes compared to physician-only or usual care. The most commonly measured financial-related outcome was service utilization (n=41) and benefits were frequently reported in home care (8/9, 89%) and long-term care (7/10, 70%) settings. Among patient and care-related outcomes health indices were most frequently measured (n=44). Primary care most frequently reported improved health indices (11/13, 85%). Transitional care reported improved outcomes across all measures, except for service utilization. This review demonstrates improved or non-inferiority results of nurse practitioner care in older people across settings. More well
Coleman, Liz; Piper, Keith
Aim: To assess how accurately and confidently casualty officers, nurse practitioners and radiographers, practicing within the emergency department (ED), recognize and describe radiographic trauma within an image test bank of 20 appendicular radiographs. Method: The participants consisted of 7 casualty officers, 13 nurse practitioners and 18 radiographers. All 20 radiographic examinations selected for the image test bank had been acquired following trauma and included some subtle, yet clinically significant abnormalities. The test bank score (maximum 40 marks), sensitivity and specificity percentages were calculated against an agreed radiological diagnosis (reference standard). Alternative Free-response Receiver Operating Characteristic (AFROC) analysis was used to assess the overall performance of the diagnostic accuracy of these professional groups. The variation in performance between each group was measured using the analysis of variance (ANOVA) test, to identify any statistical significant differences in the performance in interpretation between these groups. The relationship between the participants' perceived image interpretation accuracy during clinical practice and the actual accuracy of their image test bank score was examined using Pearson's Correlation Coefficient (r). Results: The results revealed that the radiographers gained the highest mean test bank score (28.5/40; 71%). This score was statistically higher than the mean test bank scores attained by the participating nurse practitioners (21/40; 53%) and casualty officers (21.5/40; 54%), with p < 0.01 and p = 0.02, respectively. When compared with each other, the scores from these latter groups showed no significant difference (p = 0.91). The mean 'area under the curve' (AUC) value achieved by the radiographers was also significantly higher (p < 0.01) in comparison to the AUC values demonstrated by the nurse practitioners and casualty officers, whose results, when compared, showed no significant
District nursing as a profession has been under significant threat over the last few years due to a lack of foresight and funding, resulting in an undervalued and underinvested workforce. The once-heralded specialist practitioner programme was slowly decommissioned in all but a handful of universities, leaving no alternative but for community trusts to employ staff nurses in team leader roles without the development the added qualification gave them. In light of the renewed focus on the fundamental advancement of district nurses and recent Government publications clearly reinforcing the district nurse's role, this article argues for the need for educational commissioners and workforce planners to commit to continued investment in this vital profession.
Raleigh, Mary; Allan, Helen
To explore multiple perspectives on the use of physical assessment skills by advanced nurse practitioners in the UK. Physical assessment skills practices are embedded in advanced nursing practice roles in the UK. There is little evidence on how these skills are used by advanced nurse practitioners in the community. Case study. A qualitative interpretative single-embedded case study of 22 participants from South of England. A framework method analysed interview data collected by the researcher between March-August 2013. Participants included nurses, doctors, nurse educators and managers. Physical assessment skills education at universities is part of a policy shift to develop a flexible workforce in the UK. Shared physical assessment practices are less to do with role substitution and more about preparing practitioners with skills that are fit for purpose. Competence, capability and performance with physical assessment skills are an expectation of advanced nursing practice. These skills are used successfully by community advanced nurse practitioners to deliver a wide range of services in response to changing patient need. The introduction of physical assessment skills education to undergraduate professional preparation would create a firm foundation to develop these skills in postgraduate education. Physical assessment education prepares nurses with the clinical competencies to carry out healthcare reforms in the UK. Shared sets of clinical assessment competencies between disciplines have better outcomes for patients. Levels of assessment competence can depend on the professional attributes of individual practitioners. Unsupportive learning cultures can hinder professional development of advanced nursing practice. © 2016 John Wiley & Sons Ltd.
Kerr, Jill; Price, Marva; Kotch, Jonathan; Willis, Stephanie; Fisher, Michael; Silva, Susan
Chronic early school absence (preschool through third grade) is associated with school failure. The presence of school nurses may lead to fewer absences, and nurse practitioners in school-based health centers (SBHCs) can facilitate a healthier population resulting in improved attendance. Efforts to get students back to school are unexplored in nursing literature. This article describes a nursing intervention to decrease early school absence in two elementary schools K-3 (N = 449) and a Head Start program (N = 130). The Head Start Family Nurse Practitioner (FNP) contacted families of chronically and excessively absent students by telephone, clinic visit at school, or home visit. The aggregate percentage attendance was evaluated by grades (preschool to third grade), schools (Head Start, Elementary Schools 1 and 2), and grades and schools and compared with publicly available school district aggregate data. There were statistically significant increases in attendance from Year 1 to Year 2 at p < .05 at the elementary level but not at the Head Start level. Student demographics, types of contacts, absence reasons (including sick child), and medical diagnoses are described.
Full Text Available Recently, new staffing rules for neonatal nurses in intensive care units (ICU were issued in Germany, using categories of care of the British Association of Perinatal Medicine as blueprint. Neonates on intensive care require a nurse-to-patient ratio of 1:1, on intensive surveillance (high dependency care of 1:2. No requirements exist for special care, transitional care, and pediatric ICU patients. Using these rules, nursing staff requirement was calculated over a period of 31 consecutive days once a day in a combined pediatric and neonatal ICU of a metropolitan academic medical center in south-west Germany. Each day, 18.9±0.98 patients (mean±standard deviation were assessed (14.26±1.21 neonatal, 4.65±0.98 pediatric. Among neonates, 9.94±2.56 received intensive therapy, 3.77±1.85 intensive surveillance, and 0.65±0.71 special care. Average nursing staff requirement was 12.10±1.81 full time equivalents (FTE per shift. Considering additional pediatric patients in the ICU and actual nursing staff availability (8.97±0.87 FTE per shift, this ICU seems understaffed.
Hunter, James; Freer, Yvonne; Gatt, Albert; Reiter, Ehud; Sripada, Somayajulu; Sykes, Cindy
Our objective was to determine whether and how a computer system could automatically generate helpful natural language nursing shift summaries solely from an electronic patient record system, in a neonatal intensive care unit (NICU). A system was developed which automatically generates partial NICU shift summaries (for the respiratory and cardiovascular systems), using data-to-text technology. It was evaluated for 2 months in the NICU at the Royal Infirmary of Edinburgh, under supervision. In an on-ward evaluation, a substantial majority of the summaries was found by outgoing and incoming nurses to be understandable (90%), and a majority was found to be accurate (70%), and helpful (59%). The evaluation also served to identify some outstanding issues, especially with regard to extra content the nurses wanted to see in the computer-generated summaries. It is technically possible automatically to generate limited natural language NICU shift summaries from an electronic patient record. However, it proved difficult to handle electronic data that was intended primarily for display to the medical staff, and considerable engineering effort would be required to create a deployable system from our proof-of-concept software. Copyright © 2012 Elsevier B.V. All rights reserved.
Kant, Rebecca E; Vejar, Maria; Parnes, Bennett; Mulder, Joy; Daddato, Andrea; Matlock, Daniel D; Lum, Hillary D
This study explores the use of a nurse practitioner-led paramedicine program for acute, home-based care of geriatric patients. This case series describes patients, outcomes, and geriatric primary care provider perspectives related to use of this independent paramedicine program. There were 40 patient visits from August 2016-May 2017. We reviewed patient demographics, medical conditions, healthcare utilization, and communication processes and used semi-structured interviews and content analysis to explore staff perspectives. The most commonly treated diagnoses were respiratory conditions, urinary tract infections, and gastrointestinal concerns. Two patients required an immediate transfer to a higher level of care. Six patients had emergency department visits and five patients were hospitalized within two weeks. Geriatric providers identified three themes including: potential benefits to geriatric patients, importance of enhanced care coordination and communication, and considerations for the specific role of nurse practitioner-led community paramedicine programs for geriatric patient care. Published by Elsevier Inc.
Kathy Puskar; Giuliana Mazza
Background: Statistics have shown that veteran men and women are at greater risk for suicide than the general population. In order to decrease the incidence of suicide in veterans, nurse practitioners (NPs) and other health care professionals must not only become more aware of the risk factors for veteran suicides but also develop strong psychiatric interviewing skills. Purpose: To discuss the risk factors associated with veteran suicide, the assessment tools to ensure a comprehensive...
Slyne, Tai C; Gautam, Ramraj; King, Valerie
Colorectal cancer screening aims to detect colorectal cancer at an early stage, when treatment is more likely to be curative. Lack of participation in such screening is a major issue in primary care practices, where nurse practitioners (NPs) often provide care. This study aimed to determine whether an educational intervention for NPs would increase their awareness of, and increase patients' participation in, colorectal cancer screening. .
Gallagher, Katie; Partridge, Colin; Tran, Hoang T; Lubran, Suzanna; Macrae, Duncan
Neonatal mortality accounts for nearly three quarters of all infant deaths in Vietnam. The nursing team are the largest professional group working with newborns, however do not routinely receive neonatal training and there is a lack of research into the impact of educational provision. This study explored changes in nursing perceptions towards their role following a neonatal educational intervention. Parents perceptions of nursing care were explored to determine any changes as nurses gained more experience. Semi-Structured qualitative interviews were conducted every 6 months over an 18 month period with 16 nurses. At each time point, parents whose infant was resident on the neonatal unit were invited to participate in an interview to explore their experiences of nursing care. A total of 67 parents participated over 18 months. Interviews were conducted and transcribed in Vietnamese before translation into English for manifest content analysis facilitated by NVivo V14. Analysis of nursing transcripts identified 14 basic categories which could be grouped (23) into 3 themes: (1) perceptions of the role of the neonatal nurse, (2) perception of the parental role and (3) professional recollections. Analysis of parent transcripts identified 14 basic categories which could be grouped into 3 themes: (1) information sharing, (2) participation in care, and (3) personal experience. Qualitative interviews highlighted the short term effect that the introduction of an educational intervention can have on both nursing attitudes towards and parental experience of care in one neonatal unit in central Vietnam. Nurses shared a growing awareness of their role along with its ethical issues and challenges, whilst parents discussed their overall desire for more participation in their infants care. Further research is required to determine the long term impact of the intervention, the ability of nurses to translate knowledge into clinical practice through assessment of nursing knowledge
Athey, Erin K; Leslie, Mayri Sagady; Briggs, Linda A; Park, Jeongyoung; Falk, Nancy L; Pericak, Arlene; El-Banna, Majeda M; Greene, Jessica
Nurse practitioners (NPs) have reported aspects of their jobs that they are more and less satisfied with. However, few studies have examined the factors that predict overall job satisfaction. This study uses a large national sample to examine the extent to which autonomy and work setting predict job satisfaction. The 2012 National Sample Survey of Nurse Practitioners (n = 8311) was used to examine bivariate and multivariate relationships between work setting and three autonomy variables (independent billing practices, having one's NP skills fully utilized, and relationship with physician), and job satisfaction. NPs working in primary care reported the highest levels of autonomy across all three autonomy measures, while those working in hospital surgical settings reported the lowest levels. Autonomy, specifically feeling one's NP skills were fully utilized, was the factor most predictive of satisfaction. In multivariate analyses, those who strongly agreed their skills were being fully utilized had satisfaction scores almost one point higher than those who strongly disagreed. Work setting was only marginally related to job satisfaction. In order to attract and retain NPs in the future, healthcare organizations should ensure that NPs' skills are being fully utilized. ©2015 American Association of Nurse Practitioners.
Brom, Heather M; Melnyk, Bernadette M; Szalacha, Laura A; Graham, Margaret
There is a growing demand for nurse practitioners (NPs) within academic medical centers (AMCs) because of physician shortages and increased need for access to care. In order to retain these NPs, it is important to assess their role perception and satisfaction. The purpose of this study was to evaluate these concepts and their relationships to stress and intent to stay. A 90-item descriptive survey, including a new role perception scale and the Misener Nurse Practitioner Job Satisfaction Scale, was administered to all NPs at a Midwestern AMC. The response rate was 62.4% (n = 181). Overall, the NPs had moderate role perception (M = 4.30, SD = 1.23) and were somewhat satisfied (M = 4.23, SD = 0.74). Over a third (39.4%) reported they were unsure about staying or did not intend to stay in their position. Intent to stay and stress were moderately correlated with overall satisfaction and weakly correlated with role perception. There were significant differences in the intrapractice and professional aspects of job satisfaction based on their supervisor. With increased NP needs, it is crucial for AMCs and NP supervisors to assess role perception, satisfaction, and stress among NPs in order to ensure a stable, satisfied, and productive workforce. ©2015 American Association of Nurse Practitioners.
Kverno, Karan; Kozeniewski, Kate
Workforce shortages in mental health care are especially relevant to rural communities. People often turn to their primary care providers for mental healthcare services, yet primary care providers indicate that more education is needed to fill this role. Rural primary care nurse practitioners (NPs) are ideal candidates for educational enhancement. Online programs allow NPs to continue living and working in their communities while developing the competencies to provide comprehensive and integrated mental healthcare services. This article presents a review of current online postgraduate psychiatric mental health NP (PMHNP) options. Website descriptions of online PMHNP programs were located using keywords: PMHNP or psychiatric nurse practitioner, postgraduate or post-master's, and distance or online. Across the United States, 15 online postgraduate certificate programs were located that are designed for primary care NPs seeking additional PMHNP specialization. For rural primary care NPs who are ready, willing, and able, a postgraduate PMHNP specialty certificate can be obtained online in as few as three to four semesters. The expected outcome is a cadre of dually credentialed NPs capable of functioning in an integrated role and of increasing rural access to comprehensive mental healthcare services. ©2016 American Association of Nurse Practitioners.
Hicks, C; Hennessy, D
The current confusion surrounding the definition and role function of the nurse practitioner (NP) has created a situation in which advanced clinical practice is delivered in a variety of ways and at many levels. Not surprisingly, this has led to difficulties in regulating educational provision for NPs. This study reports a survey of the perceptions of the role definitions and training needs of all nurses working at advanced clinical levels within an acute sector Trust. Although this concept is not a novel one in advanced nursing practice, the procedure adopted differed from previous studies in two fundamental ways: firstly, a unique training needs assessment instrument was used, which because of its validity and opacity, was capable of yielding a highly reliable data-base, comprising a prioritized profile of real training needs as opposed to the standard wish-list typically elicited. Secondly, it did not rely simply on the self-reported needs of the nurse sample, but also included the perceptions of the sample's immediate medical and managerial colleagues. In this way, a triangulation paradigm was adopted. The results indicated that overall, there was high agreement between the nurses and their managers, regarding both the definition of the NP role and the essential training requirements, with somewhat different opinions being offered by the medical staff. When the raw scores were standardized to correct for response bias, the data provided an operational definition of the role of the NP and a prioritized profile of training needs for nurses who wished to train to this level.
Nimbalkar, Archana S; Dongara, Ashish R; Phatak, Ajay G; Nimbalkar, Somashekhar M
Neonates receiving care in intensive care units are highly likely to experience pain due to investigations and/or treatments carried out by the health care providers. Neonates are a vulnerable population because they are unable to vocalize their pain. Unaddressed and mismanaged pain can not only affect the child's comfort, but also may alter the development and cognitive abilities of the child in a later part of his/her life. Therefore it is entirely the caregiver's responsibility to accurately assess and manage neonatal pain. We assessed and compared the knowledge and attitudes regarding neonatal pain among the nurses posted in the various units of a pediatric department [pediatric ward, pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU)]. An appropriately modified Knowledge and Attitudes Survey Regarding Pain questionnaire was consensually validated, pretested, and then administered to the nursing staff of the pediatric department at a department at a hospital in Gujarat. Data were entered in Epi-Info and analyzed with the use of SPSS 14.0. The questionnaire was administered to 41 nurses working in the Department of Pediatrics, and the response rate was 97.5%. Mean age of the nurses in the study sample was 25.75 years (SD 5.513). The mean total score of the participants was 8.75 out of 17 (SD 2.549), which was unsatisfactory. The mean correct answer rate was 49.67% among the staff of NICU and 48.67% among the pediatric ward and PICU staff. The attitudes among the nurses were assessed. It was concluded that the nurses lack knowledge and that their attitudes also were hindering pain management. One of the barriers identified by the nurses was that physicians do not prescribe analgesics for managing neonatal pain. So not only the nursing staff, but all of the caregivers involved in neonatal care may be lacking in knowledge and hold perceptions and attitudes that hamper neonatal pain management. Copyright © 2014 American Society for Pain
Johansen, May-Lill; Ervik, Bente
Generalists such as general practitioners and district nurses have been the main actors in community palliative care in Norway. Specialised oncology nurses with postgraduate palliative training are increasingly becoming involved. There is little research on their contribution. This study explores how general practitioners (GPs) and oncology nurses (ONs) experience their collaboration in primary palliative care. A qualitative focus group and interview study in rural Northern Norway, involving 52 health professionals. Five uni-professional focus group discussions were followed by five interprofessional discussions and six individual interviews. Transcripts were analysed thematically. The ideal cooperation between GPs and ONs was as a "meeting of experts" with complementary competencies. GPs drew on their generalist backgrounds, including their often long-term relationship with and knowledge of the patient. The ONs contributed longitudinal clinical observations and used their specialised knowledge to make treatment suggestions. While ONs were often experienced and many had developed a form of pattern recognition, they needed GPs' competencies for complex clinical judgements. However, ONs sometimes lacked timely advice from GPs, and could feel left alone with sick patients. To avoid this, some ONs bypassed GPs and contacted palliative specialists directly. While traditional professional hierarchies were not a barrier, we found that organization, funding and remuneration were significant barriers to cooperation. GPs often did not have time to meet with ONs to discuss shared patients. We also found that ONs and GPs had different strategies for learning. While ONs belonged to a networking nursing collective aiming for continuous quality improvement, GPs learned mostly from their individual experience of caring for patients. The complementary competences and autonomous roles of a specialised nurse and a general practitioner represented a good match for primary palliative
Wielenga, Joke M; Tume, Lyvonne N; Latour, Jos M; van den Hoogen, Agnes
This study aimed to identify and prioritise neonatal intensive care nursing research topics across Europe using an e-Delphi technique. An e-Delphi technique with three questionnaire rounds was performed. Qualitative responses of round one were analysed by content analysis and research statements were generated to be ranged on importance on a scale of 1-6 (not important to most important). Neonatal intensive care units (NICUs) in 17 European countries. NICU clinical nurses, managers, educators and researchers (n=75). None. A list of 43 research statements in eight domains. The six highest ranking statements (≥5.0 mean score) were related to prevention and reduction of pain (mean 5.49; SD 1.07), medication errors (mean 5.20; SD 1.13), end-of-life care (mean 5.05; SD 1.18), needs of parents and family (mean 5.04; SD 1.23), implementing evidence into nursing practice (mean 5.02; SD 1.03), and pain assessment (mean 5.02; SD 1.11). The research domains were prioritised and ranked: (1) pain and stress; (2) family centred care; (3) clinical nursing care practices; (4) quality and safety; (5) ethics; (6) respiratory and ventilation; (7) infection and inflammation; and (8) professional issues in neonatal intensive care nursing. The results of this study might support developing a nursing research strategy for the nursing section of the European Society of Paediatric and Neonatal Intensive Care. In addition, this may promote more European researcher collaboratives for neonatal nursing research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Dudding, Katherine M; Gephart, Sheila M; Carrington, Jane M
In this article, we examine the unintended consequences of nurses' use of electronic health records. We define these as unforeseen events, change in workflow, or an unanticipated result of implementation and use of electronic health records. Unintended consequences experienced by nurses while using electronic health records have been well researched. However, few studies have focused on neonatal nurses, and it is unclear to what extent unintended consequences threaten patient safety. A new instrument called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire has been validated, and secondary analysis using the tool explored the phenomena among neonatal nurses (N = 40). The purposes of this study were to describe unintended consequences of use of electronic health records for neonatal nurses and to explore relationships between the phenomena and characteristics of the nurse and the electronic health record. The most frequent unintended consequences of electronic health record use were due to interruptions, followed by a heavier workload due to the electronic health record, changes to the workflow, and altered communication patterns. Neonatal nurses used workarounds most often with motivation to better assist patients. Teamwork was moderately related to higher unintended consequences including patient safety risks (r = 0.427, P = .007), system design (r = 0.419, P = .009), and technology barriers (r = 0.431, P = .007). Communication about patients was reduced when patient safety risks were high (r = -0.437, P = .003). By determining the frequency with which neonatal nurses experience unintended consequences of electronic health record use, future research can be targeted to improve electronic health record design through customization, integration, and refinement to support patient safety and better outcomes.
blood diseases and conditions; parasitic infections; rheumatic and inflammatory diseases; and rare and neglected diseases. CMRP’s collaborative approach to clinical research and the expertise and dedication of staff to the continuation and success of the program’s mission has contributed to improving the overall standards of public health on a global scale. The Clinical Monitoring Research Program (CMRP) provides support to the Genitourinary Malignancies Branch (GMB), NCI, for activities conducted in out-patient and in-patient clinics at the National Institutes of Health (NIH). KEY ROLES/RESPONSIBILITIES Recruits candidates, performs initial assessments and coordinates studies for clinical trials in collaboration with a Principal Investigator (PI) and other members of the team Performs assessments by obtaining comprehensive medical histories and performing physical examinations Manages patients with complex and difficult multi-system aspects of illness and disease Orders, performs and interprets basic laboratory diagnostic/treatment tests and procedures Assesses needs and/or problem areas and plans appropriate therapeutic measures Distinguishes between normal and abnormal findings and determines which findings need further evaluation and/or collaboration assessment Provides continuity-of-care, counsels, supports and educates patients, family members, and staff on matters relating to health and research studies/protocols Participates in clinical rounds and meetings/conferences related to study protocols and research Prepares progress notes and admission/discharge dictation summary documentation Maintains clinical competence in an area of specialty practice, integrating the art and science of both nursing and medicine into practice Ensures compliance with applicable licensure/certification requirements, applicable healthcare standards, governmental laws and regulations, as well as policies, procedures and philosophy in nature Records, enters, and retrieves clinical
Petty, Julia; Treves, Richard
A digital storytelling resource focusing on the experience of nursing in neonatal care was developed using the narratives of six undergraduate children's nursing students who had undergone a practice placement on a neonatal unit. An evaluation of the resource in relation to its contribution to learning for students in a new, specialised area of practice revealed that storytelling based on peers' experiences is a valuable and insightful approach to learning. This is particularly important in a specialty such as neonatal care where the unfamiliarity of the environment and patient group can cause anxiety and uncertainty among students. Overall, the resource was seen to be useful to children's nursing students who are preparing for a practice placement in an unfamiliar clinical area.
repeatedly deployed, potentially leading to burnout or difficulties with post-traumatic stress .36 Some of this burden could be relieved with the use of an...1 AIR COMMAND AND STAFF COLLEGE AIR UNIVERSITY UTILIZATION OF ACUTE CARE NURSE PRACTITIONERS TO COMBAT PHYSICIAN SHORTAGES IN THE...providers such as nurse practitioners to aid in achieving patient care goals, there is little published to support their use in the military
Roots, Alison; MacDonald, Marjorie
The formalized nurse practitioner (NP) role in British Columbia is relatively new with most roles implemented in primary care. The majority of primary care is delivered by physicians using the fee-for-service model. There is a shortage of general practitioners associated with the difficulties of recruitment and retention, particularly in rural and remote locations. The uptake of the primary care NP role has been slow due to challenges in understanding the extent of its contributions. This study aims to identify the outcomes associated with the NP role in collaborative primary care practice. Three case studies where NPs were embedded into rural fee-for-service practices were undertaken to determine the outcomes at the practitioner, practice, community, and health services levels. Interviews, documents, and before and after data, were analyzed to identify changes in practise, access, and acute care service utilization. The results showed that NPs affected how care was delivered, particularly through the additional time afforded each patient visit, development of a team approach with interprofessional collaboration, and a change in style of practise from solo to group practise, which resulted in improved physician job satisfaction. Patient access to the practice improved with increased availability of appointments and practice staff experienced improved workplace relationships and satisfaction. At the community level, access to primary care improved for harder-to-serve populations and new linkages developed between the practice and their community. Acute care services experienced a statistically significant decrease in emergency use and admissions to hospital (P = 0.000). The presence of the NP improved their physician colleagues' desire to remain in their current work environment. This study identified the diversity of needs that can be addressed by the NP role. Namely, the importance of time to enhance patient care and its associated benefits, especially in the fee
Pediatric nurse practitioners (PNPs) need an integrated, comprehensive classification that includes nursing, disease, and developmental diagnoses to effectively describe their practice. No such classification exists. Further, methodologic studies to help evaluate the content validity of any nursing taxonomy are unavailable. A conceptual framework was derived. Then 178 diagnoses from the North American Nursing Diagnosis Association (NANDA) 1986 list, selected diagnoses from the International Classification of Diseases, the Diagnostic and Statistical Manual, Third Revision, and others were selected. This framework identified and listed, with definitions, three domains of diagnoses: Developmental Problems, Diseases, and Daily Living Problems. The diagnoses were ranked using a 4-point scale (4 = highly related to 1 = not related) and were placed into the three domains. The rating scale was assigned by a panel of eight expert pediatric nurses. Diagnoses that were assigned to the Daily Living Problems domain were then sorted into the 11 Functional Health patterns described by Gordon (1987). Reliability was measured using proportions of agreement and Kappas. Content validity of the groups created was measured using indices of content validity and average congruency percentages. The experts used a new method to sort the diagnoses in a new way that decreased overlaps among the domains. The Developmental and Disease domains were judged reliable and valid. The Daily Living domain of nursing diagnoses showed marginally acceptable validity with acceptable reliability. Six Functional Health Patterns were judged reliable and valid, mixed results were determined for four categories, and the Coping/Stress Tolerance category was judged reliable but not valid using either test. There were considerable differences between the panel's, Gordon's (1987), and NANDA's clustering of NANDA diagnoses. This study defines the diagnostic practice of nurses from a holistic, patient
Williamson, Susan; Twelvetree, Timothy; Thompson, Jacqueline; Beaver, Kinta
This article is a report of a study that aimed to examine the role of ward-based Advanced Nurse Practitioners and their impact on patient care and nursing practice. Revised doctor/nurse skill mix combined with a focus on improving quality of care while reducing costs has had an impact on healthcare delivery in the western world. Diverse advanced nursing practice roles have developed and their function has varied globally over the last decade. However, roles and expectations for ward-based Advanced Nurse Practitioners lack clarity, which may hinder effective contribution to practice. An ethnographic approach was used to explore the advanced nurse practitioner role. Participant observation and interviews of five ward-based Advanced Nurse Practitioners working in a large teaching hospital in the North West of England during 2009 were complemented by formal and informal interviews with staff and patients. Data were descriptive and broken down into themes, patterns and processes to enable interpretation and explanation. The overarching concept that ran through data analysis was that of Advanced Nurse Practitioners as a lynchpin, using their considerable expertise, networks and insider knowledge of health care not only to facilitate patient care but to develop a pivotal role facilitating nursing and medical practice. Sub-themes included enhancing communication and practice, acting as a role model, facilitating the patients' journey and pioneering the role. Ward-based Advanced Nurse Practitioners are pivotal and necessary for providing quality holistic patient care and their role can be defined as more than junior doctor substitutes. © 2012 Blackwell Publishing Ltd.
Aydon, Laurene; Hauck, Yvonne; Zimmer, Margo; Murdoch, Jamee
The aim of this study was to identify factors that influence nurse's decisions to question concerning aspects of medication administration within the context of a neonatal clinical care unit. Medication error in the neonatal setting can be high with this particularly vulnerable population. As the care giver responsible for medication administration, nurses are deemed accountable for most errors. However, they are recognised as the forefront of prevention. Minimal evidence is available around reasoning, decision making and questioning around medication administration. Therefore, this study focuses upon addressing the gap in knowledge around what nurses believe influences their decision to question. A critical incident design was employed where nurses were asked to describe clinical incidents around their decision to question a medication issue. Nurses were recruited from a neonatal clinical care unit and participated in an individual digitally recorded interview. One hundred and three nurses participated between December 2013-August 2014. Use of the constant comparative method revealed commonalities within transcripts. Thirty-six categories were grouped into three major themes: 'Working environment', 'Doing the right thing' and 'Knowledge about medications'. Findings highlight factors that influence nurses' decision to question issues around medication administration. Nurses feel it is their responsibility to do the right thing and speak up for their vulnerable patients to enhance patient safety. Negative dimensions within the themes will inform planning of educational strategies to improve patient safety, whereas positive dimensions must be reinforced within the multidisciplinary team. The working environment must support nurses to question and ultimately provide safe patient care. Clear and up to date policies, formal and informal education, role modelling by senior nurses, effective use of communication skills and a team approach can facilitate nurses to
Darlow Brian A
Full Text Available Abstract Background Increased survival of preterm infants in developing countries has often been accompanied by increased morbidity. A previous study found rates of severe retinopathy of prematurity varied widely between different neonatal units in Rio de Janeiro. Nurses have a key role in the care of high-risk infants but often do not have access to ongoing education programmes. We set out to design a quality improvement project that would provide nurses with the training and tools to decrease neonatal mortality and morbidity. The purpose of this report is to describe the methods and make the teaching package (POINTS of care--six modules addressing Pain control; optimal Oxygenation; Infection control; Nutrition interventions; Temperature control; Supportive care available to others. Methods/Design Six neonatal units, caring for 40% of preterm infants in Rio de Janeiro were invited to participate. In Phase 1 of the study multidisciplinary workshops were held in each neonatal unit to identify the neonatal morbidities of interest and to plan for data collection. In Phase 2 the teaching package was developed and tested. Phase 3 consisted of 12 months data collection utilizing a simple tick-sheet for recording. In Phase 4 (the Intervention all nurses were asked to complete all six modules of the POINTS of care package, which was supplemented by practical demonstrations. Phase 5 consisted of a further 12 months data collection. In Phase 1 it was agreed to include inborn infants with birthweight ≤ 1500 g or gestational age of ≤ 34 weeks. The primary outcome was death before discharge and secondary outcomes included retinopathy of prematurity and bronchopulmonary dysplasia. Assuming 400-450 infants in both pre- and post-intervention periods the study had 80% power at p = Discussion The results of the POINTS of Care intervention will be presented in a separate publication. Trial registration Current Controlled Trials: ISRCTN83110114
Daly, Barbara; Kenealy, Timothy; Arroll, Bruce; Sheridan, Nicolette; Scragg, Robert
To describe primary health care (practice and specialist) nurses involvement in the government-funded annual diabetes review 'Get Checked' programme and the division of care between nurses and general practitioners in Auckland, New Zealand. Of the total 911 practice and specialist nurses identified and working in the greater Auckland region, 276 (30%) were randomly selected and invited to undertake a self-administered questionnaire and telephone interview in 2006-8. An 86% response rate was achieved. Over 60% of practice nurses and over half of specialist nurses participate in 'Get Checked' reviews. Of those nurses, 40% of practice and 70% specialist nurses, reported completing over half of the total number of 'Get Checked' reviews at their practice. Of the nurses sampled who work in general practice (n=198), 38% reported that 'nurses mostly complete' the reviews, 45% stated that 'nurses and doctors equally complete' them and 17% reported that only 'doctors' did so. For the nurses who reported that 'nurses and doctors equally complete' the reviews (n=89), most nurses undertake blood pressure measurements (90%), weigh patients (88%), give lifestyle advice (87%), examine patient's feet (73%), and 44% carried out the complete review of the patients they consult. These findings show the 'Get Checked' programme was successful in engaging practice and community-based specialist nurses in the community management of diabetes and has revealed positive relationships between nurses and doctors, extended roles for nurses and the importance of engaging nurses in the design of health care programmes.
Barrett, Elizabeth; Salem, Lesley; Wilson, Sue; O'Neill, Claire; Davis, Kathleen; Bagnulo, Sharif
Chronic kidney disease (CKD) is a significant health problem impacting Australia's Aboriginal and Torres Strait Islander population. After age adjustment, the prevalence of kidney disease is 3.7 times higher in Aboriginal people and 7.3 times higher for end-stage kidney disease compared with the wider population. Yet at an Aboriginal Community Controlled Health Service (ACCHS) with a significant patient population, fewer than expected numbers of Aboriginal patients were identified with CKD. The ACCHS engaged a nurse practitioner to lead a systematic approach to the identification and treatment of CKD. This nurse practitioner-led approach to CKD was developed and implemented at a rural NSW ACCHS, with the support of a partnership formed between the nurse practitioner, the ACCHS, a nephrologist from a referral hospital and a statewide NGO. The primary measure for improvement has been to identify and stage patients with CKD and establish management plans as appropriate. This nurse-led project was established to: (i) identify patients with CKD; (ii) provide access for CKD patients to appropriate services; (iii) commence pharmacological and non-pharmacological strategies that enable remission or regression of CKD; and (iv) educate practice GPs and other staff members on CKD clinical guidelines and best practice. The CKD project has improved access to essential health care for vulnerable and at-risk populations, with 187 patients to date having been identified with kidney disease and staged for its severity. The need for strong multi-disciplinary teamwork has been demonstrated with good communication strategies implemented. © 2015 National Rural Health Alliance Inc.
Kelvin, Joanne Frankel; Moore-Higgs, Giselle J.; Maher, Karen E.; Dubey, Ajay K.; Austin-Seymour, Mary M.; Daly, Nancy Riese; Mendenhall, Nancy Price; Kuehn, Eric F.
Purpose: With changes in reimbursement and a decrease in the number of residents, there is a need to explore new ways of achieving high quality patient care in radiation oncology. One mechanism is the implementation of non-physician practitioner roles, such as the advanced practice nurse (APN) and physician assistant (PA). This paper provides information for radiation oncologists and nurses making decisions about: (1) whether or not APNs or PAs are appropriate for their practice, (2) which type of provider would be most effective, and (3) how best to implement this role. Methods: Review of the literature and personal perspective. Conclusions: Specific issues addressed regarding APN and PA roles in radiation oncology include: definition of roles, regulation, prescriptive authority, reimbursement, considerations in implementation of the role, educational needs, and impact on resident training. A point of emphasis is that the non-physician practitioner is not a replacement or substitute for either a resident or a radiation oncologist. Instead, this role is a complementary one. The non-physician practitioner can assist in the diagnostic work-up of patients, manage symptoms, provide education to patients and families, and assist them in coping. This support facilitates the physician's ability to focus on the technical aspects of prescribing radiotherapy
Toole, Cheryl A; DeGrazia, Michele; Connor, Jean Anne; Gauvreau, Kimberlee; Kuzdeba, Hillary Bishop; Hickey, Patricia A
Neonatal intensive care units (NICUs) located in freestanding children's hospitals may exhibit significant variation in nursing and organizational characteristics, which can serve as opportunities for collaboration to understand optimal staffing models and linkages to patient outcomes. Adopting methods used by Hickey et al in pediatric cardiovascular critical care, the purpose of this study was to provide a foundational description of the nursing and organizational characteristics for NICUs located in freestanding children's hospitals in the United States. Clinical nurse leaders in NICUs located in freestanding children's hospitals were invited to participate in an electronic cross-sectional survey. Descriptive analyses were used to summarize nursing and organizational characteristics. The response rate was 30% (13/43), with 69.2% of NICUs classified as level III/IV and 30.8% classified as level II/III. Licensed bed capacity varied significantly (range, 24-167), as did the proportion of full-time equivalent nurses (range, 71.78-252.3). Approximately three-quarters of staff nurses held baccalaureate degrees or higher. A quarter of nurses had 16 or more years (26.3%) of experience, and 36.9% of nurses had 11 or more years of nursing experience. Nearly one-third (29.2%) had 5 or less years of total nursing experience. Few nurses (10.6%) held neonatal specialty certification. All units had nurse educators, national and unit-based quality metrics, and procedural checklists. This study identified (1) variation in staffing models signaling an opportunity for collaboration, (2) the need to establish ongoing processes for sites to participate in future collaborative efforts, and (3) survey modifications necessary to ensure a more comprehensive understanding of nursing and organizational characteristics in freestanding children's hospital NICUs.
Green, Janet; Darbyshire, Philip; Adams, Anne; Jackson, Debra
The ability to save the life of an extremely premature baby has increased substantially over the last decade. This survival, however, can be associated with unfavourable outcomes for both baby and family. Questions are now being asked about quality of life for survivors of extreme prematurity. Quality of life is rightly deemed to be an important consideration in high technology neonatal care; yet, it is notoriously difficult to determine or predict. How does one define and operationalise what is considered to be in the best interest of a surviving extremely premature baby, especially when the full extent of the outcomes might not be known for several years? The research investigates the caregiving dilemmas often faced by neonatal nurses when caring for extremely premature babies. This article explores the issues arising for neonatal nurses when they considered the philosophical and ethical questions about quality of life in babies ≤24 weeks gestation. Data were collected via a questionnaire to Australian neonatal nurses and semi-structured interviews with 24 neonatal nurses in New South Wales, Australia. Ethical considerations: Ethical processes and procedures have been adhered to by the researchers. A qualitative approach was used to analyse the data. The theme 'difficult choices' was generated which comprised three sub-themes: 'damaged through survival', 'the importance of the brain' and 'families are important'. The results show that neonatal nurses believed that quality of life was an important consideration; yet they experienced significant inner conflict and uncertainty when asked to define or suggest specific elements of quality of life, or to suggest how it might be determined. It was even more difficult for the nurses to say when an extremely premature baby's life possessed quality. Their previous clinical and personal experiences led the nurses to believe that the quality of the family's life was important, and possibly more so than the quality of life
Marrocco, Anna; Krouse, Helene J
Individuals with disabilities have been identified as a population with a significantly lower usage of preventive services. Nurse practitioners (NPs) provide a key access point in the healthcare delivery system for preventive services for vulnerable populations such as those with disabilities. It is essential to understand existing barriers that prohibit access to effective preventive care for this vulnerable population. Systematic search and review of Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, PubMed, Google Scholar, and government reports and World Health Organizations reports. Twenty-six articles were included in the review. This literature review confirmed previous notions that people with disabilities are receiving much fewer preventive services than the general population. The studies reviewed identified four major barriers that contributed to the lack of preventive care. These barriers included physical environment and system, transportation, provider knowledge and attitude, and financial. Recognition of the obstacles that this subpopulation faces in accessing preventive care services is the first step to effectively remedying this problem. Preventive services have been identified as one of the cornerstones to improving health and quality of life. By understanding the circumstances that restrict those with disabilities from accessing preventive services, NPs can provide meaningful and effective solutions. ©2017 American Association of Nurse Practitioners.
J.M. Wielenga (Joke); L.N. Tume (Lyvonne); J.M. Latour (Jos); A. van den Hoogen (Agnes)
textabstractObjective This study aimed to identify and prioritise neonatal intensive care nursing research topics across Europe using an e-Delphi technique.Design An e-Delphi technique with three questionnaire rounds was performed. Qualitative responses of round one were analysed by content analysis
Wielenga, Joke M; Tume, Lyvonne N; Latour, Jos M; van den Hoogen, Agnes
OBJECTIVE: This study aimed to identify and prioritise neonatal intensive care nursing research topics across Europe using an e-Delphi technique. DESIGN: An e-Delphi technique with three questionnaire rounds was performed. Qualitative responses of round one were analysed by content analysis and
Wielenga, Joke M.; Tume, Lyvonne N.; Latour, Jos M.; van den Hoogen, Agnes
This study aimed to identify and prioritise neonatal intensive care nursing research topics across Europe using an e-Delphi technique. An e-Delphi technique with three questionnaire rounds was performed. Qualitative responses of round one were analysed by content analysis and research statements
Aagaard, Hanne; Hall, Elisabeth; Ammentorp, Jette
with a hermeneuticphenomenological approach. Participants were seven neonatal nurses working in an 18-bed level 2 and 3 neonatal unit at a tertiary university hospital in Denmark. Developmental care was recently introduced in the unit, parents spend many hours a day with their baby and stay overnight in guestrooms at the hospital....... Results: The essential theme of the phenomenon being a neonatal nurse is found to be ‘walking the line between the possible and the ideal’. Five themes illuminate this essence. They are: ‘being attentive to the infant and the mother—infant dyad’, ‘the body tells’, ‘time is everything’, ‘working in a quiet...
Jennings, Natasha; O'Reilly, Gerard; Lee, Geraldine; Cameron, Peter; Free, Belinda; Bailey, Michael
The aim of this study was to evaluate the impact of the introduction of Emergency Nurse Practitioner Candidates (ENPC) on waiting times and length of stay of patients presenting to a major urban Emergency Department (ED) in Melbourne, Australia. As part of a Victorian state funded initiative to improve patient outcomes, the role of the Emergency Nurse Practitioner has been developed. The integration and implementation of this role, is not only new to the Alfred Emergency and Trauma Centre but to EDs in Melbourne, Australia, with aims of providing holistic and comprehensive care for patients. A retrospective case series of all patients with common ED diagnostic subgroups were included. The ENPC group (n = 572) included all patients managed by the ENPC and the Traditional Model (TM) group (n = 2584) included all patients managed by the traditional medical ED model of care. Outcome measures included waiting times and length of stay. Statistically significant differences were evident between the two groups in waiting times and length of stay in the ED. The overall median waiting time for emergency patients to be seen by the ENPC was less than for the TM group [median (IQR): ENPC 12 (5.5-28) minutes; TM 31 (11.5-76) minutes (Wilcoxon p times for ENPC shifts vs. non-ENPC shifts revealed significant differences [median (IQR): ENPC rostered 24 (9-52) minutes; ENPC not rostered 33 (13-80.5) minutes (Wilcoxon p Melbourne, Australia were associated with significantly reduced waiting times and length of stay for emergency patients. Emergency Nurse Practitioners should be considered as a potential long term strategy to manage increased service demands on EDs. Relevance to clinical practice. This study is the first in Australia with a significant sample size to vigorously compare ENPC waiting times and length of stay outcomes with the TM model of care in the ED. The study suggests that ENPCs can have a favourable impact on patient outcomes with regard to waiting times and length
Poghosyan, Lusine; Nannini, Angela; Finkelstein, Stacey R; Mason, Emanuel; Shaffer, Jonathan A
Policy makers and healthcare organizations are calling for expansion of the nurse practitioner (NP) workforce in primary care settings to assure timely access and high-quality care for the American public. However, many barriers, including those at the organizational level, exist that may undermine NP workforce expansion and their optimal utilization in primary care. This study developed a new NP-specific survey instrument, Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), to measure organizational climate in primary care settings and conducted its psychometric testing. Using instrument development design, the organizational climate domain pertinent for primary care NPs was identified. Items were generated from the evidence and qualitative data. Face and content validity were established through two expert meetings. Content validity index was computed. The 86-item pool was reduced to 55 items, which was pilot tested with 81 NPs using mailed surveys and then field-tested with 278 NPs in New York State. SPSS 18 and Mplus software were used for item analysis, reliability testing, and maximum likelihood exploratory factor analysis. Nurse Practitioner Primary Care Organizational Climate Questionnaire had face and content validity. The content validity index was .90. Twenty-nine items loaded on four subscale factors: professional visibility, NP-administration relations, NP-physician relations, and independent practice and support. The subscales had high internal consistency reliability. Cronbach's alphas ranged from.87 to .95. Having a strong instrument is important to promote future research. Also, administrators can use it to assess organizational climate in their clinics and propose interventions to improve it, thus promoting NP practice and the expansion of NP workforce.
Grossman, Sheila; Conelius, Jaclyn
Family nurse practitioner (FNP) students must achieve basic competency in managing patients' primary care needs across the lifespan. Students in the FNP program have simulations integrated throughout their clinical theory courses to increase practice time with various patient cases. Students who received individualized faculty feedback immediately after self-evaluation of simulation performance showed statistically significantly increased knowledge (as evidenced by higher grades in course examinations and preceptor evaluations) than a control group of students who received feedback in a group class via a rubric grading guide 2-4 weeks after all students completed their individual simulations.
Valek, Rebecca M; Greenwald, Beverly J; Lewis, Carolyn C
The authors discuss the psychological factors associated with weight loss maintenance and the use of Pender's health promotion model as a guide for the construction of clinical interventions to address these factors. The psychological factors include internal drive for weight maintenance, ongoing self-monitoring, long-term flexibility, positive mood and emotions, appropriate goals, and management of external stimuli. Nurse practitioners can help combat obesity trends through caring for patients in a holistic manner. Periodic psychological needs-assessments for patients who desire to maintain weight loss may further promote long-term success in weight management. © The Author(s) 2015.
Abell, Cathy Hoots; Jepson, Terry; Gabbard, Jay
The purpose of this descriptive, correlational research study was to examine the relationship between the level of use of PDAs by nurse practitioners and their perception of managers following established change strategies. A convenience sample of 159 NPs was obtained for the study. Findings included a low, positive correlation between the level of PDA use and total Change Process Survey score (r = 0.23) that was significant (P = .006) at the .01 level. The use of PDAs by NPs is important to patient safety; therefore, administrators must be aware of change strategies that may enhance the use of PDAs. Recommendations for future research include replicating the study using a larger, randomized sample.
Wilson, Rosemary; Godfrey, Christina M; Sears, Kim; Medves, Jennifer; Ross-White, Amanda; Lambert, Natalie
The objective of this review is to examine conceptual and/or theoretical frameworks that are relevant to nurse practitioner education.The specific review question is: What conceptual and/or theoretical frameworks are available that are relevant to the structuring of nurse practitioner education? The use of conceptual and theoretical frameworks to organize the educational curriculum of nursing programs is essential to protect and preserve the focus and clarity of nursing's distinct contribution to health care. Conceptual frameworks of nursing provide a means to look at nursing in relationship to external factors, thereby assigning meaning to the practice. Graduate level nursing education in the preparation of Nurse Practitioners (NPs) specifically and Advanced Practice Nurses (APNs) in general, is significantly compromised by the tendency to conceptualize the learning in these complex programs as being primarily related to skills-based tasks and competencies alone. According to Baumann, advanced nursing education must focus on the uniqueness of the NP position, in contrast to other health care professions. To do this, Baumann suggests using a conceptual nursing model and nursing theory as opposed to a strictly biomedical model. This allows NPs to interpret information in a way that differs from the strict biomedical model, providing opportunities for the NPs to be truly present in the lives of their patients.Canadian Nurse Practitioner (NP) practice competency documents are based primarily on the Canadian Nurses Association (CNA) Nurse Practitioner (NP) Core Competency Framework. This document defines the core set of entry-level competencies required for all NPs to practice in all Canadian jurisdictions, settings and client populations. The Core Competencies in the CNA NP Framework are organized within four main categories: professional role, responsibility and accountability; health assessment and diagnosis; therapeutic management; and health promotion and
Ndiwane, Abraham N; Baker, Nancy C; Makosky, Antonia; Reidy, Patricia; Guarino, Anthony J
Increasing cultural humility among nursing students requires the application of knowledge and skills. The integration of an Objective Structured Clinical Examination (OSCE) offered nurse practitioner students practice in simulation. This learning activity included pre- and postassessments of knowledge regarding cultural issues and level of student satisfaction. Course content included an exemplar video and a simulation interview with an African American standardized patient. Of the 65 students enrolled, 97% completed OSCE interviews and 81% completed pre- and postsurveys. A 2-domain 3 × 2-time within-subjects ANOVA indicated a statistically significant interaction effect, reinforced by descriptive statistics. Follow-up paired t tests detected a significantly large knowledge increase. Standardized patient scenarios scored highest for satisfaction, followed by critical thinking, and with self-confidence scoring lowest. The favorable knowledge outcomes from this teaching intervention support future applications of OSCE methodology for teaching sensitive cross-cultural content. [J Nurs Educ. 2017;56(9):567-571.]. Copyright 2017, SLACK Incorporated.
The purpose of this qualitative study was to uncover patterns across nurse practitioner (NP) experiences that contribute to understanding their perceptions of managed care, how it affects daily practice, and how NPs respond to a changing managed care workplace. In-depth interviews were conducted with 14 NPs representing primary care, specialty, and independent practices. Over an 18-month period, data collection and analysis occurred simultaneously using standard methods of purposive sampling, constant comparison, memoing, and member checks. This study illuminates the tension NPs experience between a business and a professional ethic and the strategies they use to reconcile this difference with core nursing values. Type of setting, workplace dynamics, and length of time in practice contributed to variation in NP perspectives.
The Emergency Nurse Practitioner (ENP) role has become established over the last two decades within emergency care. This role has developed to meet the rising demands of healthcare, combat the continuing medical workforce shortfall and address targets around healthcare delivery within emergency care. The ENP role has been widely evaluated in terms of patient satisfaction, safety and outcome. To date there is no published literature exploring what drives senior nurses to undertake this role which involves additional clinical responsibility and educational preparation for no increase in pay. This research seeks to explore how Emergency Nurse Practitioners view their role within the Emergency Department and Emergency Care Team. A qualitative approach was utilised in order to gain greater in-depth understanding of ENPs' perspectives. A purposive sample of eight ENPs was chosen and semi-structured interviews were digitally recorded. The transcribed interviews were subjected to thematic analysis to look for any recurrent themes. Following analysis of the data, four main themes emerged with a total of eight sub themes. The findings suggested that whilst the role had been accepted amongst doctors within the ED, there was still a lack of understanding of the role outside the ED and conflict still existed amongst junior nurses. ENPs were motivated to undertake the role in order to gain greater job satisfaction. The findings also highlighted the concerns regarding financial remuneration for the role, lack of standardisation of the role and educational preparation. The study concludes that education has a key role in the development and acceptance of the role and that ENPs are disappointed with the lack of financial remuneration for the role. Copyright © 2015 Elsevier Ltd. All rights reserved.
Currie, J; Chiarella, M; Buckley, T
To investigate and synthesize the international literature surrounding nurse practitioner (NP) private practice models in order to provide an exposition of commonalities and differences. NP models of service delivery have been established internationally and most are based in the public healthcare system. In recent years, opportunities for the establishment of NP private practice models have evolved, facilitated by changes in legislation and driven by identification of potential patient need. To date, NP private practice models have received less attention in the literature and, to the authors' knowledge, this is the first international investigation of NP private practice models. Integrative literature review. A literature search was undertaken in October 2012. Database sources utilized included Medical Literature Analyses and Retrieval (MEDLINE), the Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest, Scopus and the Cochrane Database of Systematic Reviews (CDSR). The grey literature was also searched. The following Medical Subject Headings (MeSH) and search terms used both individually and in combination included nurse practitioners; private practice; joint practice; collaboration; and insurance, health and reimbursement. Once literature had been identified, a thematic analysis was undertaken to extract themes. Thirty manuscripts and five publications from the grey literature were included in the final review. Private practice NP roles were identified in five countries, with the majority of the literature emanating from the USA. The thematic analysis resulted in the identification of five themes: reimbursement, collaborative arrangements, legislation, models of care and acceptability. Proportionally, there are very few NPs engaged in private practice internationally. The most common NP private practice models were community based, with NPs working in clinic settings, either alone or with other health professionals. Challenges in the
Castro, Fernanda Salim Ferreira de; Dias, Danielle Monteiro Vilela; Higarashi, Ieda Harumi; Scochi, Carmen Gracinda Silvan; Fonseca, Luciana Mara Monti
To assess the digital educational technology interface Caring for the sensory environment in the neonatal unit: noise, lighting and handling based on ergonomic criteria. Descriptive study, in which we used the guidelines and ergonomic criteria established by ISO 9241-11 and an online Likert scale instrument to identify problems and interface qualities. The instrument was built based on Ergolist, which follows the criteria of ISO 9141-11. There were 58 undergraduate study participants from the School of Nursing of Ribeirao Preto, University of Sao Paulo, who attended the classes about neonatal nursing content. All items were positively evaluated by more than 70% of the sample. Educational technology is appropriate according to the ergonomic criteria and can be made available for teaching nursing students.
Eliene de Souza Porto
Full Text Available The study aimed to analyze the implementation of the Nursing Care System (NCS in the ICU - Neonatal Hospital Regional de Cáceres Dr. Anthony Fontes - HRCAF. This is an exploratory qualitative approach with descriptive profile of the case study. Data were collected through interviews with five nurses from ICU - Neonatal, using as research instrument, a questionnaire containing open and closed questions and analyzing a chart. The results showed that nurses know and realize the importance of NCS as a methodological tool that guides the practice of care and as professional recognition, although not held by all. The analysis of the records showed that there Systematization of Nursing Care at this clinic. Of the 707 days analyzed records there were only 30 (4.25% Nursing Research, none (0.0% record Diagnosis and Planning, 57 (8.26% days with record Deployment, Assessment and 23 record (3.24% in which its registered nursing care, assistance totaling 15.55% recorded in medical records. With the completion of this study, it was noted that the SAE often becomes impossible in practice of nursing because of various difficulties such as lack of time, lack of human resources, work overload, and the generic form organizational structure.
McCrory, Geraldine; Patton, Declan; Moore, Zena; O'Connor, Tom; Nugent, Linda
Management of individuals with chronic kidney disease (CKD) requires a collaborative approach. Nurses have diversified their skills to take on roles which have been traditionally physician-led. The impact of such roles, mainly that of the advanced nurse practitioner (ANP), has not been previously assessed using a systematic approach. The aim of this systematic review (SR) was to determine the impact of the addition of an ANP on patient outcomes in adults with CKD. A SR, following the guidance of PRISMA was undertaken. Population: adults with CKD. ANP. Databases searched included The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase and Medline. Outcome measures were blood pressure (BP), lipids, haemoglobin A1c (HbA1c), phosphate and parathormone (PTH) measures and recommended medication use. Four studies met the inclusion criteria. All possessed external validity and demonstrated low risk for random sequence generation and allocation concealment but were at high risk of performance bias and detection bias. The addition of an ANP resulted in the superior management of BP in all studies. Three studies reported improved control of low-density lipoprotein (LDL) and PTH. One study reported greater achievement of phosphate control. Glycaemic control was equal in both groups. All studies reported higher rates of recommended medication use. The addition of an ANP is superior or equal to the usual care models for the management of BP, LDL, PTH and glycaemic control in adults with CKD. © 2018 European Dialysis and Transplant Nurses Association/European Renal Care Association.
Lovink, Marleen H; van Vught, Anneke J A H; Persoon, Anke; Schoonhoven, Lisette; Koopmans, Raymond T C M; Laurant, Miranda G H
More and more older adults desire to and are enabled to grow old in their own home, regardless of their physical and mental capabilities. This change, together with the growing number of older adults, increases the demand for general practitioners (GPs). However, care for older people lacks prestige among medical students and few medical students are interested in a career in care for older people. Innovative solutions are needed to reduce the demand for GPs, to guarantee quality of healthcare and to contain costs. A solution might be found in skill mix change by introducing nurse practitioners (NPs), physician assistants (PAs) or registered nurses (RNs). The aim of this study was to describe how skill mix change is organised in daily practice, what influences it and what the effects are of introducing NPs, PAs or RNs into primary healthcare for older people. In total, 34 care providers working in primary healthcare in the Netherlands were interviewed: GPs (n = 9), NPs (n = 10), PAs (n = 5) and RNs (n = 10). Five focus groups and 14 individual interviews were conducted. Analysis consisted of open coding, creating categories and abstraction. In most cases, healthcare for older people was only a small part of the tasks of NPs, PAs and RNs; they did not solely focus on older people. The tasks they performed and their responsibilities in healthcare for older people differed between, as well as within, professions. Although the interviewees debated the usefulness of proactive structural screening on frailty in the older population, when implemented, it was also unclear who should perform the geriatric assessment. Interviewees considered NPs, PAs and RNs an added value, and it was stated that the role of the GP changed with the introduction of NPs, PAs or RNs. The roles and responsibilities of NPs, PAs and RNs for the care of older people living at home are still not established. Nonetheless, these examples show the potential of these professionals. The
Roman, Cortnee; Menning, Kara
This review discusses the role of the nurse practitioner (NP) in evaluating the clinical effects, potential side effects, and monitoring requirements for treatment options in multiple sclerosis (MS) and provides guidance on how to help patients understand these issues. A literature search was conducted on PubMed to identify publications on monitoring and disease management of MS patients. Additional resources included drug information web sites and package inserts. NPs play an active role in the management of MS patients via effective monitoring and communication throughout the patient's treatment regimen and disease course. In the shared decision-making model of MS treatment, NPs ensure that patients understand the implications of their disease-modifying therapies (DMTs). As patients move through treatments during the course of their disease, the importance of this role increases, and it is critical that NPs follow the guidelines in each medication's product label and take into account any potential lingering effects of prior medications. It is critical for NPs to promote patient adherence, to ensure that patients understand treatment side effects and monitoring requirements, and to take sequencing and reversibility implications of DMTs into account when making clinical decisions. ©2017 American Association of Nurse Practitioners.
Jarczyk, Kimberly S; Pieper, Pam; Brodie, Lori; Ezzell, Kelly; D'Alessandro, Tina
Evidence suggests that urinary and fecal incontinence and abnormal voiding and defecation dynamics are different manifestations of the same syndrome. This article reports the success of an innovative program for care of children with incontinence and dysfunctional elimination. This program is innovative because it is the first to combine subspecialty services (urology, gastroenterology, and psychiatry) in a single point of care for this population and the first reported independent nurse practitioner-run specialty referral practice in a free-standing pediatric ambulatory subspecialty setting. Currently, services for affected children are siloed in the aforementioned subspecialties, fragmenting care. Retrospective data on financial, patient satisfaction, and patient referral base were compiled to assess this program. Analysis indicates that this model is fiscally sound, has similar or higher patient satisfaction scores when measured against physician-run subspecialty clinics, and has an extensive geographic referral base in the absence of marketing. This model has potential transformative significance: (a) the impact of children achieving continence cannot be underestimated, (b) configuration of services that cross traditional subspecialty boundaries may have broader application to other populations, and (c) demonstration of effectiveness of non-physician provider reconfiguration of health care delivery in subspecialty practice may extend to the care of other populations. Copyright © 2017 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
Poghosyan, Lusine; Nannini, Angela; Clarke, Sean
The purpose of this review is to investigate literature related to organizational climate, define organizational climate, and identify its domains for nurse practitioner (NP) practice in primary care settings. A search was conducted using MEDLINE, PubMed, HealthSTAR/Ovid, ISI Web of Science, and several other health policy and nursingy databases. In primary care settings, organizational climate for NPs is a set of organizational attributes, which are perceived by NPs about their practice setting, emerge from the way the organization interacts with NPs, and affect NP behaviors and outcomes. Autonomy, NP-physician relations, and professional visibility were identified as organizational climate domains. NPs should be encouraged to assess organizational climate in their workplace and choose organizations that promote autonomy, collegiality between NPs and physicians, and encourage professional visibility. Organizational and NP awareness of qualities that foster NP practice will be a first step for developing strategies to creating an optimal organizational climate for NPs to deliver high-quality care. More research is needed to develop a comprehensive conceptual framework for organizational climate and develop new instruments to accurately measure organizational climate and link it to NP and patient outcomes. ©2012 The Author(s) Journal compilation ©2012 American Association of Nurse Practitioners.
Ahmed, Arif; Fincham, Jack E
To estimate consumer utilities associated with major attributes of retail clinics (RCs). A discrete choice experiment (DCE) with 383 adult residents of the metropolitan statistical areas in Georgia conducted via Random Digit Dial survey of households. The DCE had two levels each of four attributes: price ($59; $75), appointment wait time (same day; 1 day or more), care setting-provider combination (nurse practitioner [NP]-RC; physician-private office), and acute illness (urinary tract infection; influenza), resulting in 16 choice scenarios. The respondents indicated whether they would seek care under each scenario. Cost savings and convenience offered by RCs are attractive to urban patients, and given sufficient cost savings they are likely to seek care there. All else equal, one would require cost savings of at least $30.21 to seek care from an NP at RC rather than a physician at private office, and $83.20 to wait one day or more. Appointment wait time is a major determinant of care-seeking decisions for minor illnesses. The size of the consumer utility associated with the convenience feature of RCs indicates that there is likely to be further growth and employment opportunities for NPs in these clinics. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.
Hornor, Gail; Bretl, Deborah; Chapman, Evelyn; Herendeen, Pamela; Mitchel, Nancy; Mulvaney, Barbara; Quinones, Saribel Garcia; VanGraafeiland, Brigit
Given the number of children affected by child maltreatment and the dire consequences that can develop, prompt identification of child maltreatment is crucial. The purpose of this study was to describe pediatric nurse practitioner (PNP) practice behaviors related to screening and providing anticipatory guidance for child maltreatment and its psychosocial risk factors. The Risk Assessment Survey was developed for this study by 12 PNPs, all of whom were members of NAPNAP's Child Maltreatment Special Interest Group to ensure face validity; all 12 PNPs were content experts in child maltreatment. The content of the survey was derived from key characteristics from the evidence on child maltreatment. The survey was emailed to the more than 8500 NAPNAP members. Two hundred forty-three PNPs responded to the survey, which represents a response rate of 3%. Approximately half of the participants (n = 121; 51%) stated that they never/rarely ask parents questions about domestic violence, more than one-fourth (n = 71; 30%) reported that they never/rarely ask parents questions about discipline, and half of the responding PNPs (n = 120; 50%) reported that they perform an ano-genital exam at well visits. This study demonstrates that a significant number of PNPs do not routinely screen for child maltreatment and psychosocial risk factors. This is especially true in regards to sexual abuse screening and anticipatory guidance. Copyright © 2017 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
Horner, Diane Kostrey
The purpose of study was to determine whether mentoring based on Watson's Caring Model positively influences nurse practitioner (NP) job satisfaction. This nonexperimental mixed-methods study utilized an online survey, administered through Qualtrics containing demographic and mentoring variables. Job satisfaction results were obtained from the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS). Also, open-ended questions regarding mentoring were reported. There was a 54% response rate in which 37 of the 69 participants responded (n = 37), with statistical significance set at p job satisfaction. Scores from the MNPJSS ranged from 141 to 246, with a mean of 195.26 (SD = 28.29) corresponding to "minimally satisfied" or a mean of 4.44 on the 6-point scale. These results are similar to the MNPJSS score with a mean of 4.39. A mentoring experience can provide a positive environment, which can lead to increased job satisfaction. In turn, a higher level of satisfaction in the work environment can be associated with reduced turnover and improved retention and patient outcomes. Ultimately, a safer health care system will evolve and improve patient care and outcomes. Through Watson's Caring Model, a reciprocal relationship between the mentor and the mentee can provide a new NP hire a sense of community and direct availability. By experiencing a mentor relationship, job satisfaction can improve, which is a key factor in retaining NPs. As E-mentoring is a newer topic in nursing literature, further research is needed. Further studies could also review and develop one-on-one mentoring programs.
Taysa Costa da Silva
Full Text Available Objective: To verify the main measures of care for the newborn in the neonatal intensive care unit. Method: This is an integrative review, in which, it is possible to identify, analyze and synthesize research results with the inclusion of experimental and non-experimental studies. A total of 133 articles were collected. After reading titles, exclusion criteria and reading resumes, 10 were left, in which the sample was composed. Results: The selected publications were placed in 3 thematic categories: The importance of knowledge in nursing care, to the internal NB in NICU; Nursing evaluation and care used for pain relief in NB; Main factors and adverse events that may lead to the hospitalization of the newborn and the increase of morbidity and mortality in an NICU. Conclusion: The analysis of the aforementioned study exposes the importance and main nursing care that can be administered in newborns in a NICU, so that the reduction of neonatal mortality can be provided. Descriptors: Neonatal Intensive Care Unit; Nursing care; Newborn.
Hamdan, Mohamed H; Walsh, Kathleen E; Brignole, Michele; Key, Jamie
Introduction The purpose of this study was to assess the clinical and financial outcomes of a novel outreach syncope clinic. Methods We compared the clinical outcome of the Faint and Fall Clinic at the American Center (January-June 2016) with that of the University of Wisconsin Health and Clinics Faint and Fall Clinic (January 2013-December 2014). The American Center-Faint and Fall Clinic is run solely by a nurse practitioner, assisted by online faint-decision software and consultancy of a faint specialist through video-conferencing. Results Five hundred and twenty-eight consecutive patients were seen at the University of Wisconsin Hospital and Clinics-Faint and Fall Clinic and 68 patients at the American Center-Faint and Fall Clinic. The patients' clinical characteristics were similar except for a lower age in the American Center patients (45 ± 18 vs 51 ± 22, p = 0.03). Overall, a diagnosis was made within 45 days in 70% (95% confidence interval 66-74%) of the University of Wisconsin Hospital and Clinics patients and 69% (95% confidence interval 58-80%) of the American Center patients, ( p = 0.9). A mean of 3.0 ± 1.6 tests per patient was used in the University of Wisconsin Hospital and Clinics group compared to 1.5 ± 0.8 tests per patient in the American Center group, p = 0.001. Over the six-month study period, the total revenue at the American Center was US$152,597 (contribution margin of US$122,393 plus professional revenue of US$30,204). The total cost of the nurse practitioner including benefits was US$66,662 ((US$98,466 salary/year + 35.4% benefits)/2). Total revenue minus expenses resulted in a net profit of US$85,935. Discussion A nurse practitioner-run outreach syncope-clinic equipped with online faint-decision software and consultancy of a faint specialist through vedio-conferencing is feasible and financially self-sustainable. It allows the dissemination of standardized high-quality syncope care to patients who have
Green, Janet; Darbyshire, Philip; Adams, Anne; Jackson, Debra
Improved life-sustaining technology in the neonatal intensive care has resulted in an increased probability of survival for extremely premature babies. In the neonatal intensive care, the condition of a baby can deteriorate rapidly. Nurses and parents are together for long periods at the bedside and so form close and trusting relationships. Neonatal nurses as the constant caregivers may be presented with contradictory demands in attempting to meet the baby's needs and being a patient and family advocate. This article aims to explore the issues arising for neonatal nurses when holding information about changes to a condition of a baby that they are unable to share with parents. Data were collected via interviews with 24 neonatal nurses in New South Wales, Australia. A qualitative approach was used to analyse the data. The theme 'keeping secrets' was identified and comprised of three sub-themes 'coping with potentially catastrophic news', 'fear of inadvertent disclosure' and 'a burden that could damage trust'. Keeping secrets and withholding information creates internal conflict in the nurses as they balance the principle of confidentiality with the parent's right to know information. The neonatal nurses experienced guilt and shame when they were felt forced by circumstances to keep secrets or withhold information from the parents of extremely premature babies. © The Author(s) 2014.
Serra, J; Ferreira, G; Mirabito, L; Lévy, F; Nowak, R
Nursing-suckling interactions facilitate olfactory learning in newborns as long as suckling and the olfactory stimulus temporally overlap. We tested the hypothesis that olfactory preferences would develop even with a long delay between odor presentation and nursing. Thyme was presented to 2-day-old rabbit pups by placing an odorized plate 2 cm above their nest box. Duration and time of nursing were controlled and occurred before, during, or after odor presentation. Controls were not nursed. When exposed to the odor for 15 min, control pups preferred thyme to a novel odor in a 2-choice test immediately after exposure but not 3 and 22 h later. When pups were nursed immediately before thyme exposure or during exposure, they preferred the familiar odorant until 22 h later. Identically, when nursing occurred 30 min before odor exposure, a preference for thyme was maintained up to 22 h. This was not observed when nursing occurred 60 min before odor presentation. We concluded that enhancement of olfactory memory occurs in neonates during nursing but also after post-oral stimulation by postprandial internal state.
Kadivar, Maliheh; Mosayebi, Ziba; Asghari, Fariba; Zarrini, Pari
The challenging nature of neonatal medicine today is intensified by modern advances in intensive care and treatment of sicker neonates. These developments have caused numerous ethical issues and conflicts in ethical decision-making. The present study surveyed the challenges and dilemmas from the viewpoint of the neonatal intensive care personnel in the teaching hospitals of Tehran University of Medical Sciences (TUMS) in the capital of Iran. In this comparative cross-sectional study conducted between March 2013 and February 2014, the physicians' and nurses' perceptions of the ethical issues in neonatal intensive care units were compared. The physicians and nurses of the study hospitals were requested to complete a 36-item questionnaire after initial accommodations. The study samples consisted of 284 physicians (36%) and nurses (64%). Content validity and internal consistency calculations were used to examine the psychometric properties of the questionnaire. Data were analyzed by Pearson's correlation, t-test, ANOVA, and linear regression using SPSS v. 22. Respecting patients' rights and interactions with parents were perceived as the most challenging aspects of neonatal care. There were significant differences between sexes in the domains of the perceived challenges. According to the linear regression model, the perceived score would be reduced 0.33 per each year on the job. The results of our study showed that the most challenging issues were related to patients' rights, interactions with parents, communication and cooperation, and end of life considerations respectively. It can be concluded, therefore, that more attention should be paid to these issues in educational programs and ethics committees of hospitals.
Koettker, Joyce Green; Brüggemann, Odaléa Maria; Dufloth, Rozany Mucha
The objective of this explorative and descriptive study was to describe the rates and reasons for intrapartum transfers from home to hospital among women assisted by nurse midwives, and the outcomes of those deliveries. The sample consisted of eleven women giving birth and their newborns, from January 2005 to December 2009. Data was collected from the maternal and neonatal records and was analyzed using descriptive statistics. The transfer rate was 11%, most of the women were nulliparous (63.6%), and all of them were transferred during the first stage of labor. The most common reasons for transfer were arrested cervical dilation, arrested progress of the fetal head and cephalopelvic disproportion. Apgar scores were >7 for 81.8% of the newborns; and there were no admissions to the neonatal intensive care unit. The results show that planned home births assisted by nurse midwives following a clinical protocol, had good outcomes even when a transfer to the hospital was needed.
Cleveland, Lisa Marie
The admission of an infant to the neonatal intensive care unit (NICU) has the potential to cause significant stress for the mothers of these infants. Researchers have found that nurse-mother communication has the potential to either aid or hinder the mother's adaptation to the NICU environment. These communication patterns are relatively complex in nature and therefore warrant further investigation. Symbolic interactionism (SI) is a theoretical framework that offers the potential to direct such an investigation. The purpose of this article is to examine nurse-mother communication patterns in the NICU through the theoretical lens of SI.
Boyle, Eileen; Saunders, Rosemary; Drury, Vicki
To explore patient experiences of type 2 diabetes mellitus care delivered by general practice nurses in collaboration with the general practitioner. Australian general practice nurses are expanding their role in multidisciplinary type 2 diabetes care with limited research on patient perceptions of care provision within this collaborative model. Qualitative interpretive. Purposeful sampling was used to invite the patients (n = 10). Data were collected from semi-structured face-to-face interviews. Braun and Clarke's () inductive coding thematic analysis process was used to interpret the data. All participants experienced their General Practice Nurse consultation as a clinical assessment for their General Practitioner. While they appreciated the extra time with the General Practice Nurse, they were unsure of the purpose of the consultation beyond clinical assessment. They described the ongoing challenge of living with T2DM and identified a need for additional information and advice. The results suggest that the model of general practice nurse type 2 diabetes care has an important role to play in the delivery of effective ongoing care of patients. However, this role requires further development to ensure that it is understood by the patients as a role that not only conducts clinical assessments but also provides relevant education and self-management support as part of a collaborative approach to care delivery with General Practitioners. The findings are relevant to primary health care clinicians providing diabetes care to inform more relevant supportive care by general practice nurses. © 2016 John Wiley & Sons Ltd.
Lu, Chueh-Fen; Tung, Ching-Chuan; Ely, Linda
Sponsored by the pilot overseas internships project of the Ministry of Education, Taiwan, the authors and ten undergraduate students from Taiwan visited several mental health facilities in Virginia for one month. These facilities included the Catawba State Hospital, Salem Veteran Affairs Medical Center, Carilion Saint Albans Behavioral Health (New River Valley Medical Center), Warm Hearth Village, Adult & Child Family Counseling private outpatient clinic, the Free Clinic of the New River Valley, New Life Clubhouse, and Self-Government Program for Assertive Community Treatment. In-depth dialogue and participation in nursing care under the supervision of registered nurses facilitated the authors' reflection on mental health care and the roles and functions of Taiwanese nurse practitioners. The present article adopts a macro view in order to compare the related issues between Taiwan and Virginia, including: geographic features, history, culture of health-seeking behavior, healthcare insurance, and the relationships among various professionals. How these issues relate to social-cultural background and how the overall healthcare environment impacts upon the roles of nurse practitioners in Taiwan are rarely discussed in literature. We expect that this cross-cultural contrast and reflection will elicit a better understanding of how these factors have shaped and affected the roles of Taiwanese nurse practitioners. Further, suggestions about how to improve the nursing profession in Taiwan are presented.
Kelley, Frances J; Klopf, Maria Ignacia
To describe the Clinical Communication Program developed to integrate second language learning (L2), multimedia, Web-based technologies, and the Internet in an advanced practice nursing education program. Electronic recording devices as well as audio, video editing, Web design, and programming software were used as tools for developing L2 scenarios for practice in clinical settings. The Clinical Communication Program offers opportunities to support both students and faculty members to develop their linguistic and cultural competence skills to serve better their patients, in general, and their students who speak a language other than English, in particular. The program provided 24 h on-demand access for using audio, video, and text exercises via the Internet. L2 education for healthcare providers includes linguistic (listening, speaking, reading, and writing) experiences as well as cultural competence and practices inside and outside the classroom environment as well as online and offline the Internet realm.
Stallinga, Hillegonda A.; Jansen, Gerard J.; Kastermans, Marijke C.; Pranger, Albert; Dijkstra, Pieter U.; Roodbol, Petrie F.
Aim. To explore the focus of nurse practitioners on health care in terms of cure and care, Background. Nurse practitioners are expected to act on the intersection of cure and care. However, in clinical practice and education, a clear model covering this area is lacking; therefore, it is unknown to
Wooten, Katherine T; Lee, Jessica; Jared, Heather; Boggess, Kim; Wilder, Rebecca S
The purpose of this study was to assess the knowledge, opinions and practice behaviors of nurse practitioners (NP) and certified nurse midwives (CNM) regarding periodontal disease and adverse pregnancy outcomes. A 45 item survey was developed, approved, pretested, revised and mailed to 404 North Carolina NPs and CNMs who provide prenatal care. Data was entered into an excel database and transferred to SPSS for Windows for complete analysis. Linear regression modeling was used to determine statistical significance. A total of 219 NPs and CNMs responded to the mailed survey, achieving a response rate of 54%. NPs and CNMs reported having limited knowledge regarding oral health. The majority felt they should collaborate with oral health care professionals to screen patients for periodontal disease. Most agreed they needed more information about periodontal disease and adverse pregnancy outcomes. NPs and CNMs who frequently examine women could serve an important role in screening for oral health problems and making appropriate dental health referrals. Increased basic and continuing education could prepare these professionals for collaborative care with oral health care professionals. This study suggests that collaboration between NPs and CNMs with dental professionals could lead to improved oral health care for pregnant patients.
Nov 4, 2008 ... nurses' knowledge about NR at a secondary health care level in western Nigeria. Methods ... section II tested appropriate decisions and actions such as appropriate ... lying-in ward (17; 9.5%) and in other wards and clinics not.
Li, Julie; Westbrook, Johanna; Callen, Joanne; Georgiou, Andrew
The disruptive potential of the Nurse Practitioner (NP) is evident in their ability to offer services traditionally provided by primary care practitioners and their provision of a health promotion model of care in response to changing health trends. No study has qualitatively investigated the role of the Emergency NP in Australia, nor the impact of Information and Communication Technology (ICT) on this disruptive workforce innovation. This study aimed to investigate ways in which Nurse Practitioners (NP) have incorporated the use of ICT as a mechanism to support their new clinical role within Emergency Departments. A cross-sectional qualitative study was undertaken in the Emergency Departments (EDs) of two large Australian metropolitan public teaching hospitals. Semi-structured, in-depth interviews were conducted with five nurse practitioners, four senior physicians and five senior nurses. Transcribed interviews were analysed using a grounded theory approach to develop themes in relation to the conceptualisation of the ED nurse practitioner role and the influences of ICT upon the role. Member checking of results was achieved by revisiting the sites to clarify findings with participants and further explore emergent themes. The role of the ENP was distinguished from those of Emergency nurses and physicians by two elements: advanced practice and holistic care, respectively. ICT supported the advanced practice dimension of the NP role in two ways: availability and completeness of electronic patient information enhanced timeliness and quality of diagnostic and therapeutic decision-making, expediting patient access to appropriate care. The ubiquity of patient data sourced from a central database supported and improved quality of communication between health professionals within and across sites, with wider diffusion of the Electronic Medical Record holding the potential to further facilitate team-based, holistic care. ICT is a facilitator through which the disruptive
Coughlan, Linda Martina; Patton, Declan
The scarcity of appropriately qualified nurses and midwives is a major obstacle in achieving an effective health system. Neonatal nurses and midwives require a high level of skill and education to fulfil their role. It is also an area that sees high staff turnover rates. For this study a descriptive qualitative approach was used to ascertain early career neonatal nurses' and midwives' experiences of further education, their future career plans, and their perceived facilitators and barriers to further education and career progression. After receiving ethical approval, twelve nurses and midwives were recruited across three tertiary level neonatal units in Ireland. Semi structured interviews were carried out and interview transcripts were subsequently analysed using Attride-Stirling's (2001) Thematic Networks to deduce themes from the data. Support and involvement, mentoring, and career progression and retention were the three main themes identified upon analysis of the data. The majority of participants identified definitive career plans but some felt their goals were unachievable in their current workplace. Consequently a large number of participants have plans to leave their employment in neonates and pursue a career in other areas of nursing. Staff appraisals and succession planning programmes may assist early career nurses and midwives in focusing on their individual career goals, leading to a greater uptake of further specialised education and improved retention of neonatal nurses and midwives. Copyright © 2017 Elsevier Ltd. All rights reserved.
Viale, Pamela Hallquist
To describe the marketing strategies of direct-to-consumer (DTC) advertising and the risks, benefits, and potential influence on the prescribing practices of nurse practitioners (NPs). Journal articles, media sources, and clinical experience. The effect of DTC advertising of prescription medications on NPs has not been well studied. Although there are studies that examine the effects of DTC advertising on physician prescribing as well as the effects of this practice on the consumer, opinions on the benefits of DTC advertising are varied. NPs need to recognize the potential influence of DTC advertising and to be prepared to guide patients toward appropriate medication choices by participating in a partnership with patients. Health care providers, including NPs, need to work with the pharmaceutical industry to encourage accountability of DTC advertising, thus improving dissemination of correct information and promoting positive outcomes for health consumers and patients.
Farrell, Todd Charles; Keeping-Burke, Lisa
Cardiovascular disease (CVD) places great financial strain on the health care system and dramatically affects individual quality of life. As primary health care providers, nurse practitioners (NPs) are ideally positioned to advise clients on risk factor and lifestyle modifications that ameliorate the impact of CVD. While the lifestyle targets for CVD prevention are established, the most effective means of achieving these goals remain uncertain. Behaviour modification strategies, including motivational interviewing (MI) and the transtheoretical model (TTM), have been suggested, but neither approach is established as being more efficacious than the other. In this paper, evidence on the effectiveness of the two approaches for modifying smoking, diet, and exercise behaviour are presented, and a recommendation for NP practice is made.
Olsen, Douglas P; Dixon, Jane Karpe; Grey, Margaret; Deshefy-Longhi, Terry; Demarest, Jo Cecille
This study explores and compares the privacy concerns of primary care nurse practitioners (NPs) and their patients. Privacy concerns were identified in separate focus groups of NPs and patients, and then parallel survey instruments were designed and administered to 27 NPs and 185 of their patients. All subjects were recruited through APRNet, a regional practice-based research network of NPs in southern New England encompassing 58 practices. Both groups demonstrated high levels of concern regarding privacy. While NPs and patients had similar levels of concern about most issues, there were some notable differences regarding breeches because of carelessness, disclosures for research, and which disorders require the most care in maintaining privacy. These results allow NPs to anticipate patient privacy concerns and to enhance trust in the clinical relationship. These results also indicate the need to educate patients regarding privacy rights and expectations.
Miquel Capó Rn, I
The objectives of this study are to analyse nursing interventions regarding noise and lighting that influence neurodevelopment of the preterm infant in the Neonatal Intensive Care Unit. A review of the literature was performed using the databases: Cuiden Plus, PubMed, IBECS and Cochrane Library Plus. The inclusion and exclusion criteria were established in accordance with the objectives and limits used in each database. Of the 35 articles used, most were descriptive quantitative studies based on the measurement of sound pressure levels and lighting in the Neonatal Intensive Care Units. The countries included in this study are Brazil and the United States, and the variables analysed were the recording the times of light and noise. Based on the high levels of light and noise recorded in the Neonatal Intensive Care Units, nursing interventions that should be carried out to reduce them are described. The evidence indicates that after the implementation of these interventions, the high levels of both environmental stimuli are reduced significantly. Despite the extensive literature published on this problem, the levels of light and noise continue to exceed the recommended limits. Therefore, nurses need to increase and enhance their efforts in this environment, in order to positively influence neurodevelopment of premature newborn. Copyright © 2016 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
Maurício Caxias de Souza
Full Text Available It is an article about the historical evolution of nursing, emphasizing conceptual and reflexive aspects about the impact of technology on the care process in Obstetrical/Neonatal ICU. Although the technology has contributed to the survival pregnant / premature infants extremes and very low weight in recent years, reveals at times a mechanical and impersonal service, a counterpoint to ethical and human issues. A critical-reflexive discussion is proposed under the use of technology in obstetric and neonatal intensive care, highlighting their implications and adaptations to maternal and child needs. It was concluded that what determines whether a technology is good or bad, if it dehumanises, depersonalises or objectifies care is the way in which it is used, making it necessary to improve and update health professionals. In this reflexive exercise, new ways of caring will be rethought, using art, sensitivity and creativity in the appropriation and humanization of technologies. Descriptors: Nursing Informatics. Information Technology. Nursing Care. Maternal Health. Intensive Care Units, Neonatal.
Hallowell, Sunny G; Rogowski, Jeannette A; Lake, Eileen T
Parental presence in the neonatal intensive care unit (NICU) is essential for families to participate in infant care and prepare them to transition from hospital to home. Nurses are the principal caregivers in the NICU. The nurse work environment may influence whether parents spend time with their hospitalized infants. To examine the relationship between the NICU work environment and parental presence in the NICU using a national data set. We conducted a cross-sectional, observational study of a national sample of 104 NICUs, where 6060 nurses reported on 15,233 infants cared for. Secondary analysis was used to examine associations between the Practice Environment Scale of the Nursing Work Index (PES-NWI) (subscale items and with a composite measure) and the proportion of parents who were present during the nurses' shift. Parents of 60% (SD = 9.7%) of infants were present during the nurses' shift. The PES-NWI composite score and 2 domains-Nurse Participation in Hospital Affairs and Manager Leadership and Support-were significant predictors of parental presence. A 1 SD higher score in the composite or either subscale was associated with 2.5% more parents being present. Parental presence in the NICU is significantly associated with better nurse work environments. NICU practices may be enhanced through enhanced leadership and professional opportunities for nurse managers and staff. Future work may benefit from qualitative work with parents to illuminate their experiences with nursing leaders and nurse-led interventions in the NICU and design and testing of interventions to improve the NICU work environment.
Full Text Available Abstract Background Primary health care specialists have a key role in the management of obesity. Through understanding how they conceive the encounter with patients with obesity, treatment may be improved. The aim of this study was thus to explore general practitioners' and district nurses' conceptions of encountering patients with obesity in primary health care. Method Data were collected through semi-structured interviews, and analysed using a phenomenographic approach. The participants were 10 general practitioners (6 women, 4 men and 10 district nurses (7 women, 3 men from 19 primary health care centres within a well-defined area of Sweden. Results Five descriptive categories were identified: Adequate primary health care, Promoting lifestyle change, Need for competency, Adherence to new habits and Understanding patient attitudes. All participants, independent of gender and profession, were represented in the descriptive categories. Some profession and gender differences were, however, found in the underlying conceptions. The general staff view was that obesity had to be prioritised. However, there was also the contradictory view that obesity is not a disease and therefore not the responsibility of primary health care. Despite this, staff conceived it as important that patients were met with respect and that individual solutions were provided which could be adhered to step-by-step by the patient. Patient attitudes, such as motivation to change, evasive behaviour, too much trust in care and lack of self-confidence, were, however, conceived as major barriers to a fruitful encounter. Conclusions Findings from this study indicate that there is a need for development and organisation of weight management in primary health care. Raising awareness of staff's negative views of patient attitudes is important since it is likely that it affects the patient-staff relationship and staff's treatment efforts. More research is also needed on gender and
Schoen, E J; Erickson, R J; Barr, G; Allen, H
A single-mailing questionnaire surveyed attitudes of members of District IX, American Academy of Pediatrics (California) toward the role of the pediatric nurse practitioner (pnp). Responses from 568 members (53%) represented a broad range of age, practice type (58% group, 25% solo, 17% "other"), geographic location, and opinion. The most favorable attitudes toward pnp use were expressed by young pediatricians in large-group and "other" categories; least favorable were solo practitioners older than 60 years. Practice type was more important than age. Most respondents expressed the opinion that a pediatrician-pnp team approach would enrich both professions, and that parental acceptance of the pnp was likely; but that pnp use would not reduce costs. Majorities favored the concept of the pnp as part of the practice team but under constant pediatrician surveillance: seeing the patient for part of the visit and participating under supervision in care for minor illness, but not replacing the pediatrician even in well-child care. Some pnps hope for a more independent role on the pediatrician-pnp team. Modification of both pediatrician and pnp ideas appears requisite to a team approach that will satisfy both professional groups and the public.
Lacny, Sarah; Zarrabi, Mahmood; Martin-Misener, Ruth; Donald, Faith; Sketris, Ingrid; Murphy, Andrea L; DiCenso, Alba; Marshall, Deborah A
To examine the cost-effectiveness of a nurse practitioner-family physician model of care compared with family physician-only care in a Canadian nursing home. As demand for long-term care increases, alternative care models including nurse practitioners are being explored. Cost-effectiveness analysis using a controlled before-after design. The study included an 18-month 'before' period (2005-2006) and a 21-month 'after' time period (2007-2009). Data were abstracted from charts from 2008-2010. We calculated incremental cost-effectiveness ratios comparing the intervention (nurse practitioner-family physician model; n = 45) to internal (n = 65), external (n = 70) and combined internal/external family physician-only control groups, measured as the change in healthcare costs divided by the change in emergency department transfers/person-month. We assessed joint uncertainty around costs and effects using non-parametric bootstrapping and cost-effectiveness acceptability curves. Point estimates of the incremental cost-effectiveness ratio demonstrated the nurse practitioner-family physician model dominated the internal and combined control groups (i.e. was associated with smaller increases in costs and emergency department transfers/person-month). Compared with the external control, the intervention resulted in a smaller increase in costs and larger increase in emergency department transfers. Using a willingness-to-pay threshold of $1000 CAD/emergency department transfer, the probability the intervention was cost-effective compared with the internal, external and combined control groups was 26%, 21% and 25%. Due to uncertainty around the distribution of costs and effects, we were unable to make a definitive conclusion regarding the cost-effectiveness of the nurse practitioner-family physician model; however, these results suggest benefits that could be confirmed in a larger study. © 2016 John Wiley & Sons Ltd.
Kyle Richard G
Full Text Available Abstract Background Children’s emergency admissions in England are increasing. Community Children’s Nursing Teams (CCNTs have developed services to manage acutely ill children at home to reduce demand for unscheduled care. Referral between General Practitioners (GPs and CCNTs may reduce avoidable admissions and minimise the psychosocial and financial impact of hospitalisation on children, families and the NHS. However, facilitators of GP referral to CCNTs are not known. The aim of this study was to identify facilitators of GP referral to CCNTs. Methods Semi-structured interviews with 39 health professionals were conducted between June 2009 and February 2010 in three Primary Care Trusts served by CCNTs in North West England. Interviewees included GPs, Community Children’s Nurses (CCNs, consultant paediatricians, commissioners, and service managers. Qualitative data were analysed thematically using the Framework approach in NVivo 8. Results Five facilitators were identified: 1 CCN/CCNT visibility; 2 clear clinical governance procedures; 3 financial and organisational investment in the role of CCNTs in acute care pathways; 4 access and out of hours availability; 5 facilitative financial frameworks. Conclusion GPs required confidence in CCNs’ competence to safely manage acutely ill children at home and secure rapid referral if a child’s condition deteriorated. Incremental approaches to developing GP referral to CCNTs underpinned by clear clinical governance protocols are likely to be most effective in building GP confidence and avoiding inappropriate admission.
Many healthcare stakeholders view nurse practitioners (NPs) as an important workforce resource to help fill the anticipated shortage of 20,400 ambulatory care physicians that is expected by 2020. Multiple quantitative studies revealed the attributes of NPs' practice autonomy and roles. However, there is no qualitative meta-synthesis that describes the experiences of NPs' practice autonomy and roles. To describe and understand the experiences of NPs regarding their practice autonomy and roles in various ambulatory settings through the exploration of existing qualitative studies: meta-synthesis. A qualitative meta-synthesis was conducted to gain insight into ambulatory NPs' practice autonomy and roles through content analysis and reciprocal translation. Articles published between 2000 and 2017 were retrieved by searching 7 databases using the following key words: U.S. qualitative studies, advance practice nurses, NP role in ambulatory care, NP autonomy, and outpatient care. Autonomy, NPs' roles and responsibilities, practice relationships, and organizational work environment pressures are the four main themes that emerged from the content analysis of the nine selected qualitative studies. Within and between states, NPs' experiences with autonomy and NPs' roles are multifaceted depending on state regulations, practice relationships, and organizational work environments. © 2017 Wiley Periodicals, Inc.
Finlayson, Mary P; Raymont, Antony
Teamwork in primary health care has been encouraged in New Zealand and in the international literature. It may improve work satisfaction for staff, and satisfaction and outcomes for patients. Teamwork may be classified as being multi-, inter- or transdisciplinary and is likely to be influenced by the nature of the work and the organisational context. To describe and analyse teamwork between general practitioners and practice nurses in New Zealand. Data were drawn from a survey of general practices and from interviews with primary health care staff and management. Doctors and nurses in general practice in New Zealand see themselves as a team. Evidence suggests that the nature of the work and the business context most often leads to a multidisciplinary style of teamwork. Some providers have adopted a more intense teamwork approach, often when serving more disadvantaged populations or in caring for those with chronic illnesses. Concepts of teamwork differ. This article provides a classification of teams and suggests that most general practice teams are multidisciplinary. It is hoped that this will help personnel to communicate their expectations of a team and encourage progressive team development where it would be of value.
Jones, Masha G.; Ornstein, Katherine A.; Skovran, David M.; Soriano, Theresa A.; DeCherrie, Linda V.
By providing more frequent provider visits, prompt responses to acute issues, and care coordination, nurse practitioner (NP) co-management has been beneficial for the care of chronically ill older adults. This paper describes the homebound patients with high symptom burden and healthcare utilization who were referred to an NP co-management intervention and outlines key features of the intervention. We compared demographic, clinical, and healthcare utilization data of patients referred for NP co-management within a large home-based primary care (HBPC) program (n=87) to patients in the HBPC program not referred for co-management (n=1027). A physician survey found recurrent hospitalizations to be the top reason for co-management referral and a focus group with nurses and social workers noted that co-management patients are typically those with active medical issues more so than psychosocial needs. Co-management patients are younger than non-co-management patients (72.31 vs. 80.30 years old, P<0.001), with a higher mean Charlson comorbidity score (3.53 vs. 2.47, P=0.0001). They have higher baseline annual hospitalization rates (2.27 vs. 0.61, P=0.0005) and total annual home visit rates (13.1 vs. 6.60, P=0.0001). NP co-management can be utilized in HBPC to provide intensive medical management to high-risk homebound patients. PMID:27876403
Advanced Practice Registered Nurse (APRN)-owned clinics in Texas are becoming more common and because of the success of these early clinics, more APRNs are considering opening their own practice; but Texas remains one of the most restrictive states for APRN practice and many questions remain. What are the regulations about physician delegation? Will you get reimbursed from insurance companies and at what rates? Can you be a primary care provider (PCP)? Changes enacted after the adoption of Senate Bill 406 improved the opportunities for APRNs in Texas yet several requirements must be met and early consultation with a lawyer and accountant can facilitate the initial business setup. The Prescriptive Authority Agreement simplified the delegation requirements and allows the APRN increased flexibility in obtaining and consulting with a delegating physician. Becoming credentialed as a PCP with private insurance companies is often complicated; however, utilizing the Council for Affordable Quality Healthcare's Universal Provider Data source for initial credentialing can facilitate this. Although this article does not discuss the financial implications of opening a practice, it does cover many aspects including legislative and regulatory requirements for practice, credentialing process and challenges, business structure, and tax implications. ©2015 American Association of Nurse Practitioners.
McInnes, Susan; Peters, Kath; Bonney, Andrew; Halcomb, Elizabeth
To identify facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general (family) practice. Internationally, a shortage of doctors entering and remaining in general practice and an increasing burden of chronic disease has diversified the nurse's role in this setting. Despite a well-established general practice nursing workforce, little attention has been paid to the ways doctors and nurses collaborate in this setting. Integrative literature review. CINAHL, Scopus, Web of Life, Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews and Trove (dissertation and theses) were searched for papers published between 2000 and May 2014. This review was informed by the approach of Whittemore and Knafl (2005). All included papers were assessed for methodological quality. Findings were extracted, critically examined and grouped into themes. Eleven papers met the inclusion criteria. Thematic analysis revealed three themes common to the facilitators of and barriers to collaboration and teamwork between GPs in general practice: (1) roles and responsibilities; (2) respect, trust and communication; and (3) hierarchy, education and liability. This integrative review has provided insight into issues around role definition, communication and organizational constraints which influence the way nurses and general practitioners collaborate in a team environment. Future research should investigate in more detail the ways doctors and nurses work together in general practice and the impact of collaboration on nursing leadership and staff retention. © 2015 John Wiley & Sons Ltd.
Thompson, Stephen; Moorley, Calvin; Barratt, Julian
To investigate the decision-making skills of secondary care nurse practitioners compared with those of medical doctors. A literature review was conducted, searching for articles published from 1990 - 2012. The review found that nurse practitioners are key to the modernization of the National Health Service. Studies have shown that compared with doctors, nurse practitioners can be efficient and cost-effective in consultations. Qualitative research design. The information processing theory and think aloud approach were used to understand the cognitive processes of 10 participants (5 doctors and 5 nurse practitioners). One nurse practitioner was paired with one doctor from the same speciality and they were compared using a structured scenario-based interview. To ensure that all critical and relevant cues were covered by the individual participating in the scenario, a reference model was used to measure the degree of successful diagnosis, management and treatment. This study was conducted from May 2012 - January 2013. The data were processed for 5 months, from July to November 2012. The two groups of practitioners differed in the number of cue acquisitions obtained in the scenarios. In our study, nurse practitioners took 3 minutes longer to complete the scenarios. This study suggests that nurse practitioner consultations are comparable to those of medical doctors in a secondary care environment in terms of correct diagnoses and therapeutic treatments. The information processing theory highlighted that both groups of professionals had similar models for decision-making processes. © 2016 John Wiley & Sons Ltd.
Koo, Laura W; Horowitz, Alice M; Radice, Sarah D; Wang, Min Q; Kleinman, Dushanka V
We examined nurse practitioners' use and opinions of recommended communication techniques for the promotion of oral health as part of a Maryland state-wide oral health literacy assessment. Use of recommended health-literate and patient-centered communication techniques have demonstrated improved health outcomes. A 27-item self-report survey, containing 17 communication technique items, across 5 domains, was mailed to 1,410 licensed nurse practitioners (NPs) in Maryland in 2010. Use of communication techniques and opinions about their effectiveness were analyzed using descriptive statistics. General linear models explored provider and practice characteristics to predict differences in the total number and the mean number of communication techniques routinely used in a week. More than 80% of NPs (N = 194) routinely used 3 of the 7 basic communication techniques: simple language, limiting teaching to 2-3 concepts, and speaking slowly. More than 75% of respondents believed that 6 of the 7 basic communication techniques are effective. Sociodemographic provider characteristics and practice characteristics were not significant predictors of the mean number or the total number of communication techniques routinely used by NPs in a week. Potential predictors for using more of the 7 basic communication techniques, demonstrating significance in one general linear model each, were: assessing the office for user-friendliness and ever taking a communication course in addition to nursing school. NPs in Maryland self-reported routinely using some recommended health-literate communication techniques, with belief in their effectiveness. Our findings suggest that NPs who had assessed the office for patient-friendliness or who had taken a communication course beyond their initial education may be predictors for using more of the 7 basic communication techniques. These self-reported findings should be validated with observational studies. Graduate and continuing education for NPs
Broers, C. J. M.; Sinclair, N.; van der Ploeg, T. J.; Jaarsma, T.; van Veldhuisen, D. J.; Umans, V. A. W. M.
Objectives. To confirm the feasibility of nurse practitioner intervention in non-high-risk patients with recent myocardial infarction (MI). Design. Observational study. Setting. Acute coronary care unit in a teaching hospital. Methods. We performed an open-label feasibility study to identify
van der Plas, Annicka G M; Onwuteaka-Philipsen, Bregje D; Vissers, Kris C; Deliens, Luc; Jansen, Wim J J; Francke, Anneke L
To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case management are associated with this view. For sustainable palliative care in an ageing society, basic palliative care is provided by generalists and specialist palliative care is reserved for complex situations. Acceptance of and cooperation with specialist palliative care providers by the general practitioner and community nurse is pivotal. Cross-sectional questionnaire study. Questionnaire data from 168 general practitioners and 125 community nurses were analysed using chi-square tests, univariate and multivariate logistic regression. Data were gathered between March 2011-December 2013. Of general practitioners, 46% rated the case manager as helpful in realizing care that is appropriate for the patient; for community nurses this was 49%. The case manager did not hinder the process of care and had added value for patients, according to the general practitioners and community nurses. The tasks of the case manager were associated with whether or not the case manager was helpful in realizing appropriate care, whereas patient characteristics and the number of contacts with the case manager were not. General practitioners and community nurses are moderately positive about the support from the case manager. To improve cooperation further, case managers should invest in contact with general practitioners and community nurses. © 2015 John Wiley & Sons Ltd.
Tomazoni, Andréia; Rocha, Patrícia Kuerten; de Souza, Sabrina; Anders, Jane Cristina; de Malfussi, Hamilton Filipe Correia
OBJECTIVE: to verify the assessment of the patient safety culture according to the function and length of experience of the nursing and medical teams at Neonatal Intensive Care Units. METHOD: quantitative survey undertaken at four Neonatal Intensive Care Units in Florianópolis, Brazil. The sample totaled 141 subjects. The data were collected between February and April 2013 through the application of the Hospital Survey on Patient Safety Culture. For analysis, the Kruskal-Wallis and Chi-Square tests and Cronbach's Alpha coefficient were used. Approval for the research project was obtained from the Ethics Committee, CAAE: 05274612.7.0000.0121. RESULTS: differences in the number of positive answers to the Hospital Survey on Patient Safety Culture, the safety grade and the number of reported events were found according to the professional characteristics. A significant association was found between a shorter Length of work at the hospital and Length of work at the unit and a larger number of positive answers; longer length of experience in the profession represented higher grades and less reported events. The physicians and nursing technicians assessed the patient safety culture more positively. Cronbach's alpha demonstrated the reliability of the instrument. CONCLUSION: the differences found reveal a possible relation between the assessment of the safety culture and the subjects' professional characteristics at the Neonatal Intensive Care Units. PMID:25493670
Ryckeghem, Hannah; Delesie, Liesbeth; Tobback, Els; Lievens, Stefaan; Vogelaers, Dirk; Mariman, An
To explore the experiences and expectations of patients with chronic fatigue syndrome and general practitioners to develop the potential role of an advanced nurse practitioner at the diagnostic care path of abnormal fatigue developed for regional transmural implementation in the Belgian provinces of East and West Flanders. Patients with chronic fatigue syndrome experience an incapacitating chronic fatigue that is present for at least 6 months. Since many uncertainties exist about the causes and progression of the disease, patients have to cope with disbelief and scepticism. Access to health care may be hampered, which could lead to inappropriate treatments and guidance. Qualitative design. Individual semi-structured interviews were conducted with patients with chronic fatigue syndrome and general practitioners in Belgium. Data were collected over 9 months in 2014-2015. All interviews were audio recorded and transcribed for qualitative analysis using open explorative thematic coding. Fifteen patients and 15 general practitioners were interviewed. Three themes were identified: mixed feelings with the diagnosis, lack of one central intermediator and insufficient coordination. Participants stressed the need for education, knowledge and an intermediator to provide relevant information at the right time and to build up a trust relationship. This qualitative exploration underscores some clear deficiencies in the guidance of patients suffering from chronic fatigue syndrome and abnormal fatigue. An advanced nurse practitioner as a central intermediator in the transmural care of these patients could promote interdisciplinary/multidisciplinary collaboration and effective communication, provide education and ensure a structured and coordinated approach. © 2016 John Wiley & Sons Ltd.
Ammi, Mehdi; Ambrose, Sarah; Hogg, Bill; Wong, Sabrina
Nurses, whether registered nurses (RNs) or nurse practitioners (NPs), are becoming key providers of primary care services. While evidence for the influence of NPs on patient experience in primary care is mounting, this is less so for RNs. We use the Canadian component of the international Quality and Costs of Primary Care 2013/14 survey to investigate the mechanisms by which nurses can affect patients' experience in primary care, focusing on accessibility and appropriateness of care. The data allow us to distinguish between family practice RNs, specialised RNs and NPs, and covers all types of patients visiting a primary care clinic in a variety of contexts in all Canadian provinces. In addition to the types of nurses and full-time equivalent (FTE) numbers, we explore the role of nurse autonomy and collaboration. Our regression results show that one of the most important predictors of patient experience is the collaboration between health professionals, whereas nurse staffing in terms of FTE numbers has little influence by itself. Different types of nurses influence different dimensions of accessibility, and the association between patient experience and nurse staffing depends on the number of physicians in the clinic. Our results can inform decision-makers on how to strengthen primary care provision, and particularly in Canadian context, the adaptation of the recently implemented interprofessional primary care teams. Copyright © 2017 Elsevier B.V. All rights reserved.
Full Text Available The purpose of this study is to identify risk factors of physical violence in Chinese township hospitals.A cross-sectional survey was used in a sample of 442 general practitioners and 398 general nurses from 90 township hospitals located in Heilongjiang province, China (response rate = 84.8%.A total of 106 of the 840 (12.6% respondents reported being physically attacked in their workplace in the previous 12 months. Most perpetrators were the patients' relatives (62.3%, followed by the patient (22.6%; 73.6% of perpetrators were aged between 20 and 40 years. Of the physical violence incidents, about 56.6% (n = 60 resulted in a physical injury, and 45.4% of respondents took two or three days of sick leave. Reporting workplace violence in hospitals to superiors or authorities was low (9.4%. Most respondents (62.8% did not receive training on how to avoid workplace violence. Logistic regression analyses indicated that general nurses, aged 35 years or younger, and with a higher-level professional title were more likely to experience physical violence. Healthcare workers with direct physical contact (washing, turning, lifting with patients had a higher risk of physical violence compared to other health care workers. Procedures for reporting workplace violence were a protective factor for physical violence; when in place, reporting after psychological violence (verbal abuse, bullying/mobbing, harassment, and threats was more protective than waiting until an instance of physical violence (beating, kicking, slapping, stabbing, etc..Physical violence in Chinese township hospitals is an occupational hazard of rural public health concern. Policies, procedures, and intervention strategies should be undertaken to manage this issue.
Collins, Andrea; Broeseker, Amy; Cunningham, Jill; Cortes, Cyndi; Beall, Jennifer; Bigham, Amy; Chang, Jongwha
Interprofessional education (IPE) continues to gain traction worldwide. Challenges integrating IPE into health profession programmes include finding convenient times, meeting spaces, and level-appropriate assignments for each profession. This article describes the implementation of a 21-month prospective cohort study pilot programme for the Master of Science in nursing family nurse practitioner (FNP) and doctor of pharmacy (PharmD) students at a private university in the United States. This IPE experience utilised a blended approach for the learning activities; these students had initial and final sessions where they met face-to-face, with asynchronous online activities between these two sessions. The online assignments, discussions, and quizzes during the pilot programme involved topics such as antimicrobial stewardship, hormone replacement therapy, human papilloma virus vaccination, prenatal counselling, emergency contraception, and effects of the Affordable Care Act on practice. The results suggested that the FNP students held more favourable attitudes about online IPE and that the PharmD students reported having a clearer understanding of their own roles and those of the other participating healthcare students. However, the students also reported wanting more face-to-face interaction during their online IPE experience. Implications from this study suggest that effective online IPE can be supported by ensuring educational parity between students regarding the various topics discussed and a consistent approach of the required involvement for all student groups is needed. In addition, given the students desire for more face-to-face interaction, it may be beneficial to offer online IPE activities for a shorter time period. It is anticipated that this study may inform other programmes that are exploring innovative approaches to provide IPE to promote effective collaboration in patient care.
Mutch, S J; Wentworth, S D P
Modern neonatal incubators incorporate an X-ray tray device into the mattress support structure to facilitate patient examination with minimal disturbance and distress. However, the usual method of examination is to place the image plate directly underneath the baby. Users often cite radiological reasons for not using X-ray trays but modern quantitative evidence is lacking. This work looks at the technical and clinical aspects of imaging neonates in incubators and the impact that these may have in determining the imaging protocol. A number of hospitals were surveyed to determine their current method of examination and the reasons for their preference. Experimental measurements of the radiological impact of using (or not using) the X-ray tray were performed for a range of neonatal incubators. The average dose to the image plate was 5.9 microGy (range 5.4-6.4 microGy) for the "plate on mattress" method and 3.0 microGy (2.0-3.8 microGy) when using the tray--a 49% reduction owing to the mattress support materials. However, when using a computed radiography (CR) imaging system, the image quality differences were marginal. Survey results indicated that nurses preferred to use the tray but that radiographers were reluctant. We conclude that incubator manufacturers could do much to improve the radiological performance of their equipment and we offer recommendations. We also conclude that, with appropriate nurse and radiographer training and the advent of CR imaging systems, use of X-ray tray facilities may optimize imaging of the neonate in the incubator.
Morris, Douglas; Henegar, J; Khanin, S; Oberle, G; Thacker, S
Instrumental touch is identified as having purposeful physical contact in order to complete a task. Expressive touch is identified as warm, friendly physical contact and is not solely for performing a task. Expressive touch has been associated with improved client status, increased rapport and greater gains made during therapy. The purpose of the study was to observe the frequency of expressive and instrumental touch utilized by an occupational therapist during an occupational therapy session. Thirty-three occupational therapy professionals, including occupational therapists and occupational therapy assistants, employed at skilled nursing facilities in southwest Florida were observed. Data were collected on the Occupational Therapy Interaction Assessment. The results of the data analysis showed a positive relationship between the gender of the therapist and the frequency of expressive touch. The data also showed that a large majority of touches were instrumental touch and pertained to functional mobility. The results of the study can contribute to a better understanding of the holistic aspects of occupational therapy. By the use of more expressive touch, occupational therapy practitioners may have a positive, beneficial effect on both the client and the therapy process as a whole. Further research is needed to determine the effect an occupational therapy setting has on the frequency of instrumental and expressive touch. A larger sample size and a distinction between evaluation and treatment sessions would benefit future studies. Copyright © 2014 John Wiley & Sons, Ltd.
Andrusyszyn, M A; Cragg, C E; Humbert, J
The relationships among multiple distance delivery methods, preferred learning style, content, and achievement was sought for primary care nurse practitioner students. A researcher-designed questionnaire was completed by 86 (71%) participants, while 6 engaged in follow-up interviews. The results of the study included: participants preferred learning by "considering the big picture"; "setting own learning plans"; and "focusing on concrete examples." Several positive associations were found: learning on own with learning by reading, and setting own learning plans; small group with learning through discussion; large group with learning new things through hearing and with having learning plans set by others. The most preferred method was print-based material and the least preferred method was audio tape. The most suited method for content included video teleconferencing for counseling, political action, and transcultural issues; and video tape for physical assessment. Convenience, self-direction, and timing of learning were more important than delivery method or learning style. Preferred order of learning was reading, discussing, observing, doing, and reflecting. Recommended considerations when designing distance courses include a mix of delivery methods, specific content, outcomes, learner characteristics, and state of technology.
Leidel, Stacy; Hauck, Yvonne; McGough, Shirley
To explore the views of employers about the value nurse practitioners (NPs) add to health services, enablers and barriers to employing NPs, and intentions to employ NPs or expand NP services in the future. Research on Australian NPs has focused on NPs' experiences or patient-related factors like waiting times. Few studies have explored NP roles from the perspective of employers. Australian NPs employed by the private sector are eligible for reimbursement by the national health insurance scheme (Medicare Australia), potentially generating revenue for employers and broadening their career opportunities. We aimed to explore private sector employers' views on the barriers and facilitators to employing NPs and to identify factors affecting NP employability. A qualitative descriptive exploratory study. Employers of NPs from 23 private and nonprofit health services in Western Australia were interviewed. Inductive content analysis was used to explore the data. Enablers to employing an NP included enhanced customer service and improved health outcomes. Barriers to employing an NP included lack of financial benefit and inadequate experience or qualifications. Employers also identified future directions for NP employability, such as filling a gap that added value to the health service. Employers wanted NPs to work towards a shared vision of patient care that aligned with organisational needs. Findings can inform NP education and workforce planning to optimally meet employer and patient health needs. © 2018 John Wiley & Sons Ltd.
Varghese, Jane R; Silvestri, Antonette; Lopez, Patricia
With nationwide resident shortages and decreasing resident shifts, and legislation decreasing resident work hours, the nurse practitioners (NPs) have been called upon to expand their scope of practice to encompass patients with immediate and critical conditions and to perform quick procedures. Most pediatric NP (PNP) programs do not have formal training for NP students to work in a pediatric emergency department (ED). Senior ED NPs in collaboration with an NP educator developed a comprehensive clinical program to prepare a general PNP student to practice in an ED. The fellowship committee, met with 3 local university PNP program directors. The fellowship program targeted highly motivated individuals with an interest in working in a pediatric ED at the completion of their program as recruits for the position. Based on positive feedback, there has been overwhelming support and acceptance from the ED attending physicians, the NPs in the specialty clinics, as well as the ED staff regarding the new NP fellowship role. The NP fellow experienced less stress transitioning from student to NP. The development of the fellowship program is a step forward in the future training of NPs. The structured fellowship will hopefully facilitate a seamless transition from student to NP.
Hayes, Eileen F
To explore the attitudes of nurse practitioners (NPs) toward managed care and to identify the sources of negative attitudes and the factors that may ameliorate them. NPs, members of the Massachusetts Coalition of NPs, participated in in-depth interviews about the impact of managed care on their practice. The sources of NP negativity about managed care for many study participants lay in their not appreciating the importance of the business aspects of practice and the provider's role in controlling healthcare costs, reluctance to work with what they perceived as a rigid "system," and lack of support for them to navigate it. They felt pressured by productivity issues, time constraints, practice restrictions, and documentation demands associated with reimbursement. Those who sustained a more positive attitude were realistic about healthcare economics, were willing and able to negotiate the system, were creative and flexible, and felt empowered by knowledge of the business of practice. Some NPs, however, chose to work in practices where they did not feel as pressured as their counterparts in large, busy primary care practices. IMPLICATIONS FOR NP PRACTICE AND EDUCATION: Understanding experiences that have influenced NP attitudes regarding managed care may assist NP faculty to better prepare NP students for their future roles. NPs must be able to challenge, yet be part of, an evolving system that promotes cost-effective health care for everyone, which was what managed care originally was intended to do.
Poghosyan, Lusine; Nannini, Angela; Stone, Patricia W; Smaldone, Arlene
The expansion of the nurse practitioner (NP) workforce in primary care is key to meeting the increased demand for care. Organizational climates in primary care settings affect NP professional practice and the quality of care. This study investigated organizational climate and its domains affecting NP professional practice in primary care settings. A qualitative descriptive design, with purposive sampling, was used to recruit 16 NPs practicing in primary care settings in Massachusetts. An interview guide was developed and pretested with two NPs and in 1 group interview with 7 NPs. Data collection took place in spring of 2011. Individual interviews lasted from 30-70 minutes, were audio recorded, and transcribed. Data were analyzed using Atlas.ti 6.0 software by 3 researchers. Content analysis was applied. Three previously identified themes, NP-physician relations, independent practice and autonomy, and professional visibility, as well as two new themes, organizational support and resources and NP-administration relations emerged from the analyses. NPs reported collegial relations with physicians, challenges in establishing independent practice, suboptimal relationships with administration, and lack of support. NP contributions to patient care were invisible. Favorable organizational climates should be promoted to support the expanding of NP workforce in primary care and to optimize recruitment and retention efforts. © 2013.
Fowler, Christopher; Kirschner, Michelle; Van Kuiken, Debra; Baas, Linda
To present a theory of illness representation useful in clinical practice along with two case studies as examples of theory implementation. Literature review of relevant theory and associated literature, case studies from clinical practice. An individual asks several questions when experiencing a physical sensation: "Am I sick, stressed, or is this a sign of aging? If I'm sick, is the symptom connected with a disease label?" After asking these questions, the individual develops a cognitive and emotional illness representation that includes the dimensions of identity, cause, consequences, control, and timeline. This representation is guided by personal, cultural, and environmental contexts and determines coping strategies. By assessing the individual's cognitive and emotional representations of the illness, the nurse practitioner (NP) can use the common sense model of illness representation (CSM) to establish interventions and action plans helpful in decreasing distress in the management of symptoms. NPs frequently care for patients who present with very severe symptoms related to their health problem. This becomes a major challenge in effective disease management. Leventhal's CSM can be used as a framework to identify the cognitive and emotional illness representations individuals develop when acute and chronic symptoms are presented. By assessing the individual's cognitive and emotional representations of the illness, the NP will be able to use the CSM to establish interventions and action plans that will be helpful in decreasing the patient's distress in the management of symptoms.
Krishnan, Preetha; Hawranik, Pamela
To discuss the assessment, diagnosis, and management of geriatric insomnia, a challenging clinical condition of older adults frequently seen by primary care providers. Extensive literature review of the published research articles and textbooks. Complaints of insomnia among older adults are frequently ignored, considered a part of the normal aging process or viewed as a difficult to treat condition. Geriatric insomnia remains a challenge for primary care providers because of the lack of evidence-based clinical guidelines and limited treatment options available. Effective management of this condition is necessary for improved quality of life, which is a primary issue for the elderly and their families. Therefore, geriatric insomnia warrants thorough attention from the nurse practitioners (NPs) who provide care for older adults. Undiagnosed or under treated insomnia can cause increased risk for falls, motor vehicle accidents, depression, and shorter survival. Insomniacs double their risk for cardiovascular disease, stroke, cancer, and suicide compared to their counterparts. Insomnia is also associated with increased healthcare utilization and institutionalization. NPs could play a central role in reducing the negative consequences of insomnia through a systematic approach for diagnosis, evaluation, and management.
Rugen, Kathryn Wirtz; Watts, Sharon A; Janson, Susan L; Angelo, Laura A; Nash, Melanie; Zapatka, Susan A; Brienza, Rebecca; Gilman, Stuart C; Bowen, Judith L; Saxe, JoAnne M
To integrate health care professional learners into patient-centered primary care delivery models, the Department of Veterans Affairs has funded five Centers of Excellence in Primary Care Education (CoEPCEs). The main goal of the CoEPCEs is to develop and test innovative structural and curricular models that foster transformation of health care training from profession-specific "silos" to interprofessional, team-based educational and care delivery models in patient-centered primary care settings. CoEPCE implementation emphasizes four core curricular domains: shared decision making, sustained relationships, interprofessional collaboration, and performance improvement. The structural models allow interprofessional learners to have longitudinal learning experiences and sustained and continuous relationships with patients, faculty mentors, and peer learners. This article presents an overview of the innovative curricular models developed at each site, focusing on nurse practitioner (NP) education. Insights on transforming NP education in the practice setting and its impact on traditional NP educational models are offered. Preliminary outcomes and sustainment examples are also provided. Published by Mosby, Inc.
Hansen, Kevin T; McDonald, Cheryl; O'Hara, Sue; Post, Leslie; Silcox, Susan; Gutmanis, Iris A
The number of older adults with multiple complex comorbidities and frailty is expected to increase dramatically in the coming decades, which will necessitate a concomitant increase in the need for skilled clinicians who are able to manage complex geriatric needs. Many physicians, however, lack the required formal training, often leading to long wait-lists for specialist clinics. Yet, clinics led by non-physician professionals specialising in geriatric care could decrease these delays. This article describes the development and evaluation of a nurse practitioner-led interprofessional geriatric outpatient clinic (Inter-D Clinic). A combination of semi-structured clinician interviews, post-clinic follow-up phone calls, satisfaction surveys, and information from the hospital workload management system served as data sources for this formative programme evaluation. Between January 2013 and December 2014, 293 patients were seen in the clinic with the majority being referred for either memory issues (49%) or functional decline (35%). The clinic assessment frequently uncovered other issues, which led to guidance around falls prevention, improved nutrition, medication management, and referrals to available community supports. Both patients and referring physicians were very satisfied with this model of care, which is likely transferable to other locations provided the needed clinical expertise and community support services are available.
Sangster-Gormley, Esther; Griffith, Janessa; Schreiber, Rita; Borycki, Elizabeth
To discuss and provide examples of how mixed-methods research was used to evaluate the integration of nurse practitioners (NPs) into a Canadian province. Legislation enabling NPs to practise in British Columbia (BC) was enacted in 2005. This research evaluated the integration of NPs and their effect on the BC healthcare system. Data were collected using surveys, focus groups, participant interviews and case studies over three years. Data sources and methods were triangulated to determine how the findings addressed the research questions. The challenges and benefits of using the multiphase design are highlighted in the paper. The multiphase mixed-methods research design was selected because of its applicability to evaluation research. The design proved to be robust and flexible in answering research questions. As sub-studies within the multiphase design are often published separately, it can be difficult for researchers to find examples. This paper highlights ways that a multiphase mixed-methods design can be conducted for researchers unfamiliar with the process.
Ahmed, Azza H
The preterm birth rate has been increasing steadily during the past two decades. Up to two thirds of this increase has been attributed to the increasing rate of late preterm births (34 to stamina; difficulty with latch, suck, and swallow; temperature instability; increased vulnerability to infection; hyperbilirubinemia, and more respiratory problems than the full-term infant. Late preterm infants usually are treated as full term and discharged within 48 hours of birth, so pediatric nurse practitioners in primary care settings play a critical role in promoting breastfeeding through early assessment and detection of breastfeeding difficulties and by providing anticipatory guidance related to breastfeeding and follow-up. The purpose of this article is to describe the developmental and physiologic immaturity of late preterm infants and to highlight the role of pediatric nurse practitioners in primary care settings in supporting and promoting breastfeeding for late preterm infants.
The study aim was to determine the direct and indirect relations of the five-factor model of personality traits and work stress with professional quality of life in neonatal nurses. Neonatal intensive care nursing has positive and negative effects on neonatal nurses' psychological well-being. Although individual and situational factors interact to influence professional quality of life, there have been few studies of these relationships in neonatal nurses. A cross-sectional study conducted in 2016. Self-report questionnaires were used to measure professional quality of life (burnout, secondary traumatic stress and compassion satisfaction), five-factor model of personality traits (neuroticism, agreeableness, extraversion, conscientiousness and openness) and work stress (role ambiguity, role conflict and role overload). One hundred and forty (34%) of 405 eligible neonatal nurses provided the data. After controlling for work stress, neuroticism and agreeableness were related to burnout, neuroticism was related to secondary traumatic stress, and extraversion was related to compassion satisfaction. Work stress controlled for personality traits was related to burnout and secondary traumatic stress, but not to compassion satisfaction. Neuroticism moderated the effect of work stress on secondary traumatic stress and agreeableness and openness moderated the effect of work stress on compassion satisfaction. Work stress mediated the effect of neuroticism and extraversion on burnout and the effects of extraversion and conscientiousness on compassion satisfaction. Strategies to reduce work stress may not lessen burnout and secondary traumatic stress or increase compassion satisfaction in neonatal nurses who are prone to high neuroticism, low agreeableness and low extraversion. © 2018 John Wiley & Sons Ltd.
Full Text Available Abstract Background The disruptive potential of the Nurse Practitioner (NP is evident in their ability to offer services traditionally provided by primary care practitioners and their provision of a health promotion model of care in response to changing health trends. No study has qualitatively investigated the role of the Emergency NP in Australia, nor the impact of Information and Communication Technology (ICT on this disruptive workforce innovation. This study aimed to investigate ways in which Nurse Practitioners (NP have incorporated the use of ICT as a mechanism to support their new clinical role within Emergency Departments. Methods A cross-sectional qualitative study was undertaken in the Emergency Departments (EDs of two large Australian metropolitan public teaching hospitals. Semi-structured, in-depth interviews were conducted with five nurse practitioners, four senior physicians and five senior nurses. Transcribed interviews were analysed using a grounded theory approach to develop themes in relation to the conceptualisation of the ED nurse practitioner role and the influences of ICT upon the role. Member checking of results was achieved by revisiting the sites to clarify findings with participants and further explore emergent themes. Results The role of the ENP was distinguished from those of Emergency nurses and physicians by two elements: advanced practice and holistic care, respectively. ICT supported the advanced practice dimension of the NP role in two ways: availability and completeness of electronic patient information enhanced timeliness and quality of diagnostic and therapeutic decision-making, expediting patient access to appropriate care. The ubiquity of patient data sourced from a central database supported and improved quality of communication between health professionals within and across sites, with wider diffusion of the Electronic Medical Record holding the potential to further facilitate team-based, holistic care
Albers-Heitner, Pytha; Winkens, Ron; Berghmans, Bary; Joore, Manuela; Nieman, Fred; Severens, Johan; Lagro-Janssen, Toine
Urinary incontinence (UI) is a very common problem, but existing guidelines on UI are not followed. To bring care in line with guidelines, we planned an intervention to involve nurse specialists on UI in primary care and assessed this in a randomised controlled trial. Alongside this intervention, we assessed consumer satisfaction among patients and general practitioners (GPs). Patients' satisfaction with the care provided by either nurse specialists (intervention group) or GPs (control group), respectively, was measured with a self-completed questionnaire. GPs' views on the involvement of nurse specialists were measured in a structured telephone interview. The patient satisfaction score on the care offered by nurse specialists was 8.4 (scale 1-10), vs. 6.7 for care-as-usual by GPs. Over 85% of patients would recommend nurse specialist care to their best friends and 77% of the GPs considered the role of the nurse specialist to be beneficial, giving it a mean score of 7.2. Although the sample was relatively small and the stability of the results only provisionally established, substituting UI care from GP to nurse specialist appears to be welcomed by both patients and GPs. Small changes like giving additional UI-specific information and devoting more attention to UI (which had been given little attention before) would provide a simple instrument to stimulate patients to change their behaviour in the right direction. © 2012 Nordic College of Caring Science.
Fleischmann, Nina; Tetzlaff, Britta; Werle, Jochen; Geister, Christina; Scherer, Martin; Weyerer, Siegfried; Hummers-Pradier, Eva; Mueller, Christiane A
Interprofessionalism, considered as collaboration between medical professionals, has gained prominence over recent decades and evidence for its impact has grown. The steadily increasing number of residents in nursing homes will challenge medical care and the interaction across professions, especially nurses and general practitioners (GPs). The nursing home visit, a key element of medical care, has been underrepresented in research. This study explores GP perspectives on interprofessional collaboration with a focus on their visits to nursing homes in order to understand their experiences and expectations. This research represents an aspect of the interprof study, which explores medical care needs as well as the perceived collaboration and communication by nursing home residents, their families, GPs and nurses. This paper focusses on GPs' views, investigating in particular their visits to nursing homes in order to understand their experiences. Open guideline-interviews covering interprofessional collaboration and the visit process were conducted with 30 GPs in three study centers and analyzed with grounded theory methodology. GPs were recruited via postal request and existing networks of the research partners. Four different types of nursing home visits were found: visits on demand, periodical visits, nursing home rounds and ad-hoc-decision based visits. We identified the core category "productive performance" of home visits in nursing homes which stands for the balance of GPs´ individual efforts and rewards. GPs used different strategies to perform a productive home visit: preparing strategies, on-site strategies and investing strategies. We compiled a theory of GPs home visits in nursing homes in Germany. The findings will be useful for research, and scientific and management purposes to generate a deeper understanding of GP perspectives and thereby improve interprofessional collaboration to ensure a high quality of care.
Full Text Available Background: South Africa has a 32-year history of training ophthalmic nurse practitioners (ONPs. The role and required skills and competencies of ONPs are not well documented in the international literature and are also absent from South African publications, including South African Nursing Council publications. Aim: This study aims to inform curriculum development and human resource planning by reporting on the clinical skills expected of ONPs by members of multidisciplinary ophthalmology teams. Method: A limited survey was undertaken in the ophthalmology wards and outpatient departments of three tertiary level hospitals in the Western Cape Province. A researcher-designed structured self-completion questionnaire was distributed to 30 ophthalmology practitioners: doctors, nurses and technicians. Respondents were asked to indicate the expected clinical skills of ONPs. Findings: All questionnaires were completed. All respondents favoured ONPs taking histories and performing emergency eye irrigations. There was less support for more complex procedures, such as B-scans. One-third of respondents did not expect ONPs to have skills in eight key areas, including examination of the anterior chamber angle for glaucoma. No statistically significant differences were found between responses of doctors and nurses, with one exception: more nurses (15/18 than doctors (4/10 had confidence in the ONP undertaking basic eye examinations for ocular motility (Fisher‘s exact test, P = 0 .035. Conclusion: In the study settings, ONPs are not using their specialist skills to the full. Not all practitioners were receptive to ONPs using the skills that they had acquired during their postgraduate diploma, threatening the educational effectiveness of this initiative.
Vanessa da Silva Neves Moreira Arakaki
Full Text Available AbstractIntroduction The high-risk newborns may require long periods of hospitalization until they reach clinical stability for hospital discharge. Avoiding babies to be in only one body position may be an effective way to cause respiratory and neuro-psycho-motor benefits, comfort and preventing pressure ulcers.Objectives This study investigated the impact of physiotherapy/nursing integration in update on body positioning of the newborn in the Neonatal Intensive Care Unit.Methods A questionnaire was administered to nurses and nursing technicians of the neonatal unit of Maternity School of UFRJ and nurses of the Advanced Course in Neonatal Nursing from the same institution. Two classes were taught by the physical therapist of the sector and the questions answered before and after these lessons. It was also a brief characterization of professional participants of the study. We used the Student's t test to compare the correct answers before (PRE and after (POST the classes, considering p < 0.05.Results There was a significant increase in the degree of knowledge of nurses and nursing technicians when compared the responses before (nurses: 68.8%; technicians: 70.1% and after classes (nurses: 78.4 %; technicians: 88.9%. The nurses were less than five years of graduated (45% and little time of professional experience in neonatology (60%. Forty-seven percent of technicians had less than five years of training and 82% had less than 10 years of experience.Conclusion The use of training by the nursing staff was significant, showing the importance of multidisciplinary approach and the integration of knowledge in the search for a humanized and effective care.
Wilson, Laurie N; Wainwright, Gail A; Stehly, Christy D; Stoltzfus, Jill; Hoff, William S
Because of multiple changes in the health care environment, the use of services of physician assistants (PAs) and nurse practitioners (NPs) in trauma and critical care has expanded. Appropriate training and ongoing professional development for these providers are essential to optimize clinical outcomes. This study offers a baseline assessment of the academic and professional needs of the contemporary trauma PAs/NPs in the United States. A 14-question electronic survey, using SurveyMonkey, was distributed to PAs/NPs at trauma centers identified through the American College of Surgeons Web site and other online resources. Demographic questions included trauma center level, provider type, level of education, and professional affiliations. Likert scale questions were incorporated to assess level of mentorship, comfort level with training, and individual perceived needs for academic and professional development. There were 120 survey respondents: 60 NPs and 60 PAs. Sixty-two respondents (52%) worked at level I trauma centers and 95 (79%) were hospital-employed. Nearly half (49%) reported working in trauma centers for 3 years or less. One hundred nineteen respondents (99%) acknowledged the importance of trauma-specific education; 98 (82%) were required by their institution to obtain such training. Thirty-five respondents (32%) reported receiving $1000 per year or less as a continuing medical education benefit. Insufficient mentorship, professional development, and academic development were identified by 22 (18%), 16 (13%), and 30 (25%) respondents, respectively. Opportunities to network with trauma PAs/NPs outside their home institution were identified as insufficient by 79 (66%). While PAs/NPs in trauma centers recognize the importance of continued contemporary trauma care and evidence-based practices, attending trauma-related education is not universally required by their employers. Financial restrictions may pose an additional impediment to academic development
Laiho, Anne; Ruoholinna, Tarita
Nursing in Western countries has become increasingly more theoretical, and nurse education has been integrated more often with the higher education system. Historically, nursing has been viewed as a non-academic domain. Establishing Nursing Science (NS) in Finland in the 1970s has meant that the new discipline is defined as the core of nurse…
Amin, Amee A; Vankar, Jagdish R; Nimbalkar, Somashekhar M; Phatak, Ajay G
To study the levels of perceived stress in Neonatal Intensive Care Unit (NICU) nurses and its association with professional quality of life domains viz. compassion satisfaction, burnout and secondary trauma. In this multicenter, cross sectional study, data was collected by surveying 129 nurses from nine NICUs across six cities of Gujarat, India using demographic questionnaire, Perceived Stress Scale (PSS14) and Professional Quality of Life Scale (ProQOL5) during July to September 2013. Descriptive statistics, correlation coefficient and multiple regression were used for analysis. The mean (SD) age of participants was 28.37 (8.20) y. Most were single, satisfied with salary benefits and reported 'good' to 'excellent' relationships at work. The mean (SD) duration of duty hours was 8.12 (0.76) h and 43.6% were attending to more than 4 patients/shift. The mean (SD) perceived stress level was 22.19 (7.17) [Range: 3 to 39]. High compassion satisfaction, high burnout, and high secondary traumatic stress were reported by 25 (19.4%), 30 (23.3%) and 30 (23.3%) nurses respectively. PSS14 was negatively correlated with compassion satisfaction (r = -0.28) and positively correlated with burnout (r = 0.43) and secondary traumatic stress (r = 0.24). Most of the nurses (91, 70.5%) were identified as perceiving moderate to high stress. Professional quality of life domains correlated with perceived stress. There is further need to study domains influencing NICU nurses' professional QOL. Identifying stress and QOL issues in NICU nurses can help formulate relevant policies.
Storytelling is an increasingly well recognised and valued platform to learn about the human experience within healthcare. Little is known however about how stories can enhance understanding in neonatal care, a specialised field offering rich opportunities for learning. This study focuses on the creation of stories based on the experiences of student nurses to inform teaching and learning strategies in the neonatal field. The study aimed to create stories from the narratives of student nurses working within the neonatal field and identify what key themes for learning emerged in order to develop a storytelling resource to share experiences with their peers. An interpretive, constructivist approach was used to collect, analyse and create stories from student nurse's experiences, in line with narrative inquiry. Six pre-registration children's nursing students were selected by purposive sampling. Interviews were undertaken within six weeks following placement completion in an agreed location. Narratives were obtained by semi-structured interviews. Narrative analysis and core story creation was undertaken to construct stories and key learning themes emerged which provided the pedagogical basis for subsequent digital resource development. Key themes emerged relating to the insight and observances of student nurses and the neonatal journey they had experienced, including the nature of neonatal care, experiences of the neonate and parents, the environment and their own learning transition. Preliminary peer evaluation of the storytelling resource revealed storytelling as an interesting and novel approach to teaching & learning, learning from ones' peers, preparation for practice and a valuable insight into a new specialist area. The study has value to teaching and learning by enabling an appreciation of how narrative can be used to portray the experiences of learners. Findings also support an approach to analysing narrative to create stories for learning and inform
Aquilino, M L; Damiano, P C; Willard, J C; Momany, E T; Levy, B T
To evaluate factors associated with primary care physician attitudes toward nurse practitioners (NPs) providing primary care. A mailed survey of primary care physicians in Iowa. Half (N = 616) of the non-institutional-based, full-time, primary care physicians in Iowa in spring 1994. Although 360 (58.4%) responded, only physicians with complete data on all items in the model were used in these analyses (n = 259 [42.0%]). There were 2 principal dependent measures: physician attitudes toward NPs providing primary care (an 11-item instrument) and physician experience with NPs in this role. Bivariate relationships between physician demographic and practice characteristics were evaluated by chi 2 tests, as were both dependent variables. Ordinary least-squares regression was used to determine factors related to physician attitudes toward NPs. In bivariate analyses, physicians were significantly more likely to have had experience with an NP providing primary care if they were in pediatrics or obstetrics-gynecology (78.3% and 70.0%, respectively; P < .001), had been in practice for fewer than 20 years (P = .045), or were in practices with 5 or more physicians. The ordinary least-squares regression indicated that physicians with previous experience working with NPs providing primary care (P = .01), physicians practicing in urban areas with populations greater than 20,000 but far from a metropolitan area (P = .03), and general practice physicians (P = .04) had significantly more favorable attitudes toward NPs than did other primary care physicians. The association between previous experience with a primary care NP and a more positive attitude toward NPs has important implications for the training of primary care physicians, particularly in community-based, multidisciplinary settings.
Background A team approach in primary care has proven benefits in achieving better outcomes, reducing health care costs, satisfying patient needs, ensuring continuity of care, increasing job satisfaction among health providers and using human health care resources more efficiently. However, some research indicates constraints in collaboration within primary health care (PHC) teams in Lithuania. The aim of this study was to gain a better understanding of the phenomenon of teamwork in Lithuania by exploring the experiences of teamwork by general practitioners (GPs) and community nurses (CNs) involved in PHC. Methods Six focus groups were formed with 29 GPs and 27 CNs from the Kaunas Region of Lithuania. Discussions were recorded and transcribed verbatim. A thematic analysis of these data was then performed. Results The analysis of focus group data identified six thematic categories related to teamwork in PHC: the structure of a PHC team, synergy among PHC team members, descriptions of roles and responsibilities of team members, competencies of PHC team members, communications between PHC team members and the organisational background for teamwork. These findings provide the basis for a discussion of a thematic model of teamwork that embraces formal, individual and organisational factors. Conclusions The need for effective teamwork in PHC is an issue receiving broad consensus; however, the process of teambuilding is often taken for granted in the PHC sector in Lithuania. This study suggests that both formal and individual behavioural factors should be targeted when aiming to strengthen PHC teams. Furthermore, this study underscores the need to provide explicit formal descriptions of the roles and responsibilities of PHC team members in Lithuania, which would include establishing clear professional boundaries. The training of team members is an essential component of the teambuilding process, but not sufficient by itself. PMID:23945286
Spychalla, Megan T; Heathman, Joanne H; Pearson, Katherine A; Herber, Andrew J; Newman, James S
Hospital medicine is a growing field with an increasing demand for additional healthcare providers, especially in the face of an aging population. Reductions in resident duty hours, coupled with a continued deficit of medical school graduates to appropriately meet the demand, require an additional workforce to counter the shortage. A major dilemma of incorporating nonphysician providers such as nurse practitioners and physician assistants (NPPAs) into a hospital medicine practice is their varying academic backgrounds and inpatient care experiences. Medical institutions seeking to add NPPAs to their hospital medicine practice need a structured orientation program and ongoing NPPA educational support. This article outlines an NPPA orientation and training program within the Division of Hospital Internal Medicine (HIM) at the Mayo Clinic in Rochester, MN. In addition to a practical orientation program that other institutions can model and implement, the division of HIM also developed supplemental learning modalities to maintain ongoing NPPA competencies and fill learning gaps, including a formal NPPA hospital medicine continuing medical education (CME) course, an NPPA simulation-based boot camp, and the first hospital-based NPPA grand rounds offering CME credit. Since the NPPA orientation and training program was implemented, NPPAs within the division of HIM have gained a reputation for possessing a strong clinical skill set coupled with a depth of knowledge in hospital medicine. The NPPA-physician model serves as an alternative care practice, and we believe that with the institution of modalities, including a structured orientation program, didactic support, hands-on learning, and professional growth opportunities, NPPAs are capable of fulfilling the gap created by provider shortages and resident duty hour restrictions. Additionally, the use of NPPAs in hospital medicine allows for patient care continuity that is otherwise missing with resident practice models.
Dasanayake, Ananda P; Gennaro, Susan; Hendricks-Muñoz, Karen D; Chhun, Nok
The purpose of this article is to review the current literature on the association between maternal periodontal disease and poor pregnancy and neonatal outcomes and outline the role nurses can play in improving the oral health of pregnant women. Maternal periodontal disease is linked to preterm birth, low birthweight, and preterm low birthweight, but treatment of periodontal disease during pregnancy has been shown to be safe and effective. Nurses, nurse practitioners, and nurse-midwives are in a position to educate pregnant women on the benefits of good oral health and identify and refer women who are in need of dental care for treatment.
Thijs, HFH; Massawe, AW; Okken, A; Coenraads, PJ; Muskiet, FAJ; Huisman, M; Boersma, ER
In healthy cot-nursed Tanzanian neonates (n = 92, gestation 26-42 weeks) measurements of transepidermal water loss (TEWL) and weight change were performed during the first 24 h after birth at an average ambient humidity of 70% and an environmental temperature of 32 degrees C. Urine production on day
Plas, A.G.M. van der; Onwuteaka-Philipsen, B.D.; Vissers, K.C.; Deliens, L.; Jansen, W.J.J.; Francke, A.L.
Aims: To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case
Kuethe, Maarten; Vaessen-Verberne, Anja; Mulder, Paul; Bindels, Patrick; van Aalderen, Wim
For children with stable asthma, to test non-inferiority of care provided by a hospital-based specialised asthma nurse versus a general practitioner (GP) or paediatrician. Randomised controlled trial evaluating standard care by a GP, paediatrician or an asthma nurse, with two-year follow-up. 107
M.C. Kuethe (Maarten ); A.A.P.H. Vaessen-Verberne (Anja); P.G.H. Mulder (Paul); P.J.E. Bindels (Patrick); W.M.C. van Aalderen (Willem)
textabstractAims: For children with stable asthma, to test non-inferiority of care provided by a hospital-based specialised asthma nurse versus a general practitioner (GP) or paediatrician. Methods: Randomised controlled trial evaluating standard care by a GP, paediatrician or an asthma nurse, with
Bossema, Ercolie R; Meijs, Tineke H J M; Peters, Jeroen W B
Study delay and attrition are major concerns in higher education. They cost time and effort, and threaten the availability of higher qualified professionals. Knowing early what factors contribute to delay and attrition may help prevent this. The aim of this study was to examine whether student characteristics, including a literature study report grade as a proxy of cognitive abilities, predicted study success in a dual advanced nurse practitioner education program. Retrospective cohort study, including all 214 students who between September 2009 and September 2015 started the two-year program at the HAN University of Applied Sciences in Nijmegen, the Netherlands. Study success was defined as having completed the program within the envisaged period. Variables examined included: age, gender, previous education (bachelor's degree or in-service training in nursing), work setting (general health, mental health, public health, or nursing home care), and literature study report grade (from 1 to 10). A hierarchical logistic regression analysis was performed. Most students were female (80%), had a bachelor's degree in nursing (67%), and were employed in a general healthcare setting (58%). Mean age was 40.5years (SD 9.4). One hundred thirty-seven students (64%) had study success. Being employed in a general healthcare setting (p≤0.004) and a higher literature study report grade (p=0.001) were associated with a higher study success rate. In advanced nurse practitioner education, study success rate seems associated with the student's cognitive abilities and work field. It might be worthwhile to identify students 'at risk of failure' before the start of the program and offer them extra support. Copyright © 2017 Elsevier Ltd. All rights reserved.
Kinder, Frances DiAnna
The purposes of this study were to explore parents' perceptions of satisfaction with care from primary care pediatric nurse practitioners (PNPs) and to explore the relationships of the four components of parental satisfaction with parents' intent to adhere to recommended health care regimen. The study used a descriptive correlational research design. A convenience sample of 91 participants was recruited from practices in southeastern Pennsylvania. The 28-item, Parents' Perceptions of Satisfaction with Care from Pediatric Nurse Practitioners (PPSC-PNP) tool was developed to measure four components of satisfaction and overall satisfaction of parents with PNP care after the health visit. A 100 mm visual analog (VAS) scale measured parental intent to adhere to the care regimen recommended by the PNP. Parents' perceptions of overall satisfaction with care from PNPs and satisfaction with each of the four components (communication, clinical competence, caring behavior, and decisional control) were high as measured by the PPSC-PNP. Multiple regression analysis revealed that clinical competence had the strongest positive relationship with parental intent to adhere to PNP recommended health regimen and was the only variable to enter the regression equation. The findings of this study have implications for nursing practice. The PPSC-PNP instrument may be used with a variety of pediatric populations and settings as a benchmark for quality care. Clinical competence is important for the role of the PNP. Other variables of parental intent to adhere to the health regimen should be explored in future studies.
Jones, Jacqueline; Kotthoff-Burrell, Ernestine; Kass-Wolff, Jane; Brownrigg, Vicki
With a shortage of primary care providers prepared to care for an aging U.S. population, nurse practitioner (NP) programs are integrating gerontological content. This qualitative descriptive study explored NP graduate perceptions on the adequacy of their education to prepare them to care for seniors. Twenty-three graduates of NP program options at two universities in the western U.S. participated in focus group discussions or interviews. Participants shared their perceptions of their NP educational preparation and suggestions for enhancing gerontologic curriculum. Four main domains emerged from analysis of qualitative data: (a) "Getting your boots on and getting into the role"; (b) "Older people are more complex than we were prepared to care for"; (c) "It is very different as a provider, but I am so glad I was a nurse with experience first"; (d) "NPs have a scope of practice, physician assistants (PAs) have a job description-but I wish we had their [procedural] preparation." Graduates identified a need for more educational content and clinical experiences specific to the care of older adults. Some suggested a postgraduate residency or mentoring option to assist NP role transition and progression and limit role confusion. ©2015 American Association of Nurse Practitioners.
Viale, Pamela Hallquist; Sanchez Yamamoto, Deanna
To obtain information about the knowledge and attitudes of oncology nurse practitioners (ONPs) concerning the effect of direct-to-consumer (DTC) advertising of prescription medications on prescribing patterns. Exploratory survey. Oncology Nursing Society Nurse Practitioner Special Interest Group members in the United States. 221 of 376 ONPs completed the survey (58%). Researcher-developed 12-question postal survey. Knowledge and attitudes of ONPs on DTC advertising effects on prescribing patterns. The findings were similar to those of previous studies of physicians regarding the number of visits when patients requested DTC-advertised medications. Major differences were the positive attitudes of ONPs toward potentially longer patient visits to explain and educate patients regarding medication requests based on DTC advertising and smaller percentages of ONPs who felt "pressured" to prescribe requested medications. ONPs have mixed opinions regarding the practice of DTC advertising but do not believe that they are influenced heavily by advertising with regard to prescriptive practices. ONPs consider patient encounters for education purposes as appropriate and include information about requested DTC-advertised medications in their approach to patient care. This is an exploratory survey of a specialty group of ONPs. More research is needed to further explore the practice of DTC advertising and potential influences on the prescribing patterns of ONPs. DTC advertising of prescription medications is increasing; ONPs need to increase their knowledge base about the potential for influences of prescriptive practices.
Vogel, Tina Kovacs; Kleib, Manal; Davidson, Sandra J; Scott, Shannon D
Parents often turn to the Internet to seek health information about their child's diagnosis and condition. Information, support, and resources regarding pediatric neurosurgery are scarce, hard to find, and difficult to comprehend. To address this gap, a pediatric nurse practitioner designed a website called the Neurosurgery Kids Fund (NKF). Analyzing the legitimacy of the NKF website for parents seeking health information and fulfilling their social and resource needs is critical to the website's future development and success. To explore parental usage of the NKF website, track visitor behavior, evaluate usability and design, establish ways to improve user experience, and identify ways to redesign the website. The aim of this study was to assess and evaluate whether a custom-designed health website could meet parents' health information, support, and resource needs. A multimethod approach was used. Google Analytic usage reports were collected and analyzed for the period of April 23, 2013, to November 30, 2013. Fifty-two online questionnaires that targeted the website's usability were collected between June 18, 2014, and July 30, 2014. Finally, a focus group was conducted on August 20, 2014, to explore parents' perceptions and user experiences. Findings were analyzed using an inductive content analysis approach. There were a total of 2998 sessions and 8818 page views, with 2.94 pages viewed per session, a 56.20% bounce rate, an average session duration of 2 minutes 24 seconds, and a 56.24% new sessions rate. Results from 52 eligible surveys included that the majority of NKF users were Caucasian (90%), females (92%), aged 36-45 years (48%), with a university or college degree or diploma (69%). Half plan to use the health information. Over half reported turning to the Internet for health information and spending 2 to 4 hours a day online. The most common reasons for using the NKF website were to (1) gather information about the 2 summer camps, (2) explore the Media
Lohr, Robert H; West, Colin P; Beliveau, Margaret; Daniels, Paul R; Nyman, Mark A; Mundell, William C; Schwenk, Nina M; Mandrekar, Jayawant N; Naessens, James M; Beckman, Thomas J
To compare the quality of referrals of patients with complex medical problems from nurse practitioners (NPs), physician assistants (PAs), and physicians to general internists. We conducted a retrospective comparison study involving regional referrals to an academic medical center from January 1, 2009, through December 31, 2010. All 160 patients referred by NPs and PAs combined and a random sample of 160 patients referred by physicians were studied. Five experienced physicians blinded to the source of referral used a 7-item instrument to assess the quality of referrals. Internal consistency, interrater reliability, and dimensionality of item scores were determined. Differences between item scores for patients referred by physicians and those for patients referred by NPs and PAs combined were analyzed by using multivariate ordinal logistical regression adjusted for patient age, sex, distance of the referral source from Mayo Clinic, and Charlson Index. Factor analysis revealed a 1-dimensional measure of the quality of patient referrals. Interrater reliability (intraclass correlation coefficient for individual items: range, 0.77-0.93; overall, 0.92) and internal consistency for items combined (Cronbach α=0.75) were excellent. Referrals from physicians were scored higher (percentage of agree/strongly agree responses) than were referrals from NPs and PAs for each of the following items: referral question clearly articulated (86.3% vs 76.0%; P=.0007), clinical information provided (72.6% vs 54.1%; P=.003), documented understanding of the patient's pathophysiology (51.0% vs 30.3%; P<.0001), appropriate evaluation performed locally (60.3% vs 39.0%; P<.0001), appropriate management performed locally (53.5% vs 24.1%; P<.0001), and confidence returning patient to referring health care professional (67.8% vs 41.4%; P<.0001). Referrals from physicians were also less likely to be evaluated as having been unnecessary (30.1% vs 56.2%; P<.0001). The quality of referrals to an
Carpenter, David L; Gregg, Sara R; Owens, Daniel S; Buchman, Timothy G; Coopersmith, Craig M
Use of nurse practitioners and physician assistants ("affiliates") is increasing significantly in the intensive care unit (ICU). Despite this, few data exist on how affiliates allocate their time in the ICU. The purpose of this study was to understand the allocation of affiliate time into patient-care and non-patient-care activity, further dividing the time devoted to patient care into billable service and equally important but nonbillable care. We conducted a quasi experimental study in seven ICUs in an academic hospital and a hybrid academic/community hospital. After a period of self-reporting, a one-time monetary incentive of $2,500 was offered to 39 affiliates in each ICU in which every affiliate documented greater than 75% of their time devoted to patient care over a 6-month period in an effort to understand how affiliates allocated their time throughout a shift. Documentation included billable time (critical care, evaluation and management, procedures) and a new category ("zero charge time"), which facilitated record keeping of other patient-care activities. At baseline, no ICUs had documentation of 75% patient-care time by all of its affiliates. In the 6 months in which reporting was tied to a group incentive, six of seven ICUs had every affiliate document greater than 75% of their time. Individual time documentation increased from 53% to 84%. Zero-charge time accounted for an average of 21% of each shift. The most common reason was rounding, which accounted for nearly half of all zero-charge time. Sign out, chart review, and teaching were the next most common zero-charge activities. Documentation of time spent on billable activities also increased from 53% of an affiliate's shift to 63%. Time documentation was similar regardless of during which shift an affiliate worked. Approximately two thirds of an affiliate's shift is spent providing billable services to patients. Greater than 20% of each shift is spent providing equally important but not reimbursable
St-Martin, Lyne; Harripaul, Anastasia; Antonacci, Rosetta; Laframboise, Devon; Purden, Margaret
New graduate nurses (NGNs) are a precious resource, but their development from advanced beginners to competent nurses is challenging. This qualitative descriptive study explored NGNs' perceptions of strategies that influenced their development in the first 2 years of employment. Semistructured interviews were conducted with a sample of 13 nurses. The study revealed that NGNs learn to master aspects of the nursing role as they construct a professional identity. They identified organizational, educational, and personal strategies as being important to their development, including tailored orientation, opportunities for skill acquisition, and personal support. Few strategies supported the development of professional identity. Mastering the nursing role and constructing a professional identity is central to NGNs' development. Further attention from nursing leaders is needed to promote concurrent development in both dimensions. Nurses with a strong professional identity are more likely to remain in the profession. Copyright 2015, SLACK Incorporated.
Full Text Available Background: Weakness of curriculum development in nursing education results in lack of professional skills in graduates. This study was done on master's students in nursing to evaluate challenges of neonatal intensive care nursing curriculum based on context, input, process, and product (CIPP evaluation model. Materials and Methods: This study was conducted with qualitative approach, which was completed according to the CIPP evaluation model. The study was conducted from May 2014 to April 2015. The research community included neonatal intensive care nursing master's students, the graduates, faculty members, neonatologists, nurses working in neonatal intensive care unit (NICU, and mothers of infants who were hospitalized in such wards. Purposeful sampling was applied. Results: The data analysis showed that there were two main categories: “inappropriate infrastructure” and “unknown duties,” which influenced the context formation of NICU master's curriculum. The input was formed by five categories, including “biomedical approach,” “incomprehensive curriculum,” “lack of professional NICU nursing mentors,” “inappropriate admission process of NICU students,” and “lack of NICU skill labs.” Three categories were extracted in the process, including “more emphasize on theoretical education,” “the overlap of credits with each other and the inconsistency among the mentors,” and “ineffective assessment.” Finally, five categories were extracted in the product, including “preferring routine work instead of professional job,” “tendency to leave the job,” “clinical incompetency of graduates,” “the conflict between graduates and nursing staff expectations,” and “dissatisfaction of graduates.” Conclusions: Some changes are needed in NICU master's curriculum by considering the nursing experts' comments and evaluating the consequences of such program by them.
Osteogenesis imperfecta (OI), also called "brittle bone disease," is a rare heterozygous connective tissue disorder that is caused by mutations of genes that affect collagen. Osteogenesis imperfecta is characterized by decreased bone mass, bone fragility, and skin hyperlaxity. The phenotype present is determined according to the mutation on the affected gene as well as the type and location of the mutation. Osteogenesis imperfecta is neither preventable nor treatable. Osteogenesis imperfecta is classified into 11 types to date, on the basis of their clinical symptoms and genetic components. This article discusses the definition of the disease, the classifications on the basis of its clinical features, incidence, etiology, and pathogenesis. In addition, phenotype, natural history, diagnosis and management of this disease, recurrence risk, and, most importantly, the implications for the neonatal nurse and management for the family are discussed.
van der Biezen, Mieke; Wensing, Michel; Poghosyan, Lusine; van der Burgt, Regi; Laurant, Miranda
Increasingly, nurse practitioners (NPs) are deployed in teams along with general practitioners (GPs) to help meet the demand for out-of-hours care. The purpose of this study was to explore factors influencing collaboration between GPs and NPs in teams working out-of-hours. A descriptive qualitative study was done using a total of 27 semi-structured interviews and two focus group discussions. Data was collected between June, 2014 and October, 2015 at an out-of-hours primary care organisation in the Netherlands. Overall, 38 health professionals (GPs, NPs, and support staff) participated in the study. The interviews were audio-taped and transcribed verbatim. Two researchers conducted an inductive content analysis, involving the identification of relevant items in a first phase and clustering into themes in a second phase. The following four themes emerged from the data: clarity of NP role and regulation, shared caseload and use of skills, communication concerning professional roles, trust and support in NP practice. Main factors influencing collaboration between GPs and NPs included a lack of knowledge regarding the NPs' scope of practice and regulations governing NP role; differences in teams in sharing caseload and using each other's skills effectively; varying support of GPs for the NP role; and limited communication between GPs and NPs regarding professional roles during the shift. Lack of collaboration was perceived to result in an increased risk of delay for patients who needed treatment from a GP, especially in teams with more NPs. Collaboration was not perceived to improve over time as teams varied across shifts. In out-of-hours primary care teams constantly change and team members are often unfamiliar with each other or other's competences. In this environment, knowledge and communication about team members' roles is continuously at stake. Especially in teams with more NPs, team members need to use each other's skills to deliver care to all patients on time.
PURPOSE: Traditionally, medical personnel have undertaken bone marrow (BM) examination. However, specially trained nurses in advanced practice roles are increasingly undertaking this role. This paper presents the findings from an audit of BM examinations undertaken by an advanced nurse practitioner (ANP) at a regional haematology specialist centre. METHODS: The audit evaluated the quality of BM examinations performed by the ANP over the past two years (September 2007-September 2009). Over the two year period, 324 BM examinations were performed at the centre of which 156 (48.1%) were performed by the ANP. A random sample of 30 BM examinations undertaken by the ANP were analysed by the consultant haematologist. RESULTS: All 30 BM examinations undertaken by the ANP were sufficient for diagnosis. CONCLUSIONS: The ANP is capable and competent to obtain BM samples which are of a sufficient quality to permit diagnosis.
Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid
To evaluate and adjust systematic implementation of guided family-centred care in a neonatal intensive care unit. Family-centred care is valued in neonatal intensive care units internationally, but innovative strategies are needed to realise the principles. Guided family-centred care was developed to facilitate person-centred communication by bridging the gap between theory and practice in family-centred care. Main mechanisms of guided family-centred care are structured dialogue, reflection and person-centred communication. Qualitative and quantitative data were used to monitor participatory implementation of a systematic approach to training and certification of nurses delivering guided family-centred care. Systematic implementation of guided family-centred care included workshops, supervised delivery and certification. Evaluation and adjustment of nurse adherence to guided family-centred care was conducted by monitoring (1) knowledge, (2) delivery, (3) practice uptake and (4) certification. Implementation was improved by the development of a strategic framework and by adjusting the framework according to the real-life context of a busy neonatal care unit. Promoting practice uptake was initially underestimated, but nurse guided family-centred care training was improved by increasing the visibility of the study in the unit, demonstrating intervention progress to the nurses and assuring a sense of ownership among nurse leaders and nonguided-family-centred-care-trained nurses. An adjusted framework for guided family-centred care implementation was successful in overcoming barriers and promoting facilitators. Insights gained from our pioneering work might help nurses in a similar context to reach their goals of improving family-centred care. © 2014 John Wiley & Sons Ltd.
Malmström, B; Nohlert, E; Ewald, U; Widarsson, M
The use of simulation-based team training in neonatal resuscitation has increased in Sweden during the last decade, but no formal evaluation of this training method has been performed. This study evaluated the effect of simulation-based team training on the self-assessed ability of personnel to perform neonatal resuscitation. We evaluated a full-day simulation-based team training course in neonatal resuscitation, by administering a questionnaire to 110 physicians, nurses and midwives before and after the training period. The questionnaire focused on four important domains: communication, leadership, confidence and technical skills. The study was carried out in Sweden from 2005 to 2007. The response rate was 84%. Improvements in the participants' self-assessed ability to perform neonatal resuscitation were seen in all four domains after training (p technical skills domain compared to experienced personnel (p = 0.001). No differences were seen between professions or time since training in any of the four domains. Personnel with less previous experience with neonatal resuscitation showed improved confidence (p = 0.007) and technical skills (p = 0.003). A full-day course on simulation-based team training with video-supported debriefing improved the participants' self-assessed ability to perform neonatal resuscitation. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
Buckley, Thomas; Stasa, Helen; Cashin, Andrew; Stuart, Meg; Dunn, Sandra V
The purpose of this study was to investigate the sources, both print and electronic formats, which Australian nurse practitioners (NPs) currently use to obtain information regarding quality use of medicines (QUM). An additional aim was to document NPs' preferences for continuing education in relation to QUM. A national electronic survey of Australian NPs was conducted in 2007 and again in 2010. Eighty percent of respondents accessed information on QUM from professional literature, which may include scholarly journal articles, reports, and independent publications. There was a decrease in the percentage of respondents who obtained information from drug industry representatives. NPs prefer to receive medicines information in an electronic form, rather than a paper-based version, and over the time period more NPs are utilizing electronic sources rather than paper. These findings provide important insights into medical information products for the developers who may be able to use these results to ensure that their products meet the needs of NP clinicians. Additionally, the finding that NPs prefer to receive their continuing information related to medicines in electronic format, but also highly value conference proceedings, may help to inform future planning of NP education needs in relation to QUM. ©2014 American Association of Nurse Practitioners.
Kelly, Michelle M; Blunt, Elizabeth; Nestor, Kelly
Few nurse practitioner (NP) programs include an after-hours/on-call component in their clinical preparation of NP students. This role is expected in many primary and specialty care practices, and is one that students feel unprepared to competently navigate. Utilizing simulated callers as patients or parents, NP students participated in a simulated after-hours/on-call experience that included receiving the call, managing the patient, and submitting documentation of the encounter. Students completed pre- and postparticipation evaluations, and were evaluated by the simulated patient callers and faculty using standardized evaluation tools. NP students rated the experience as an educationally valuable experience despite feeling anxious and nervous about the experience. Several essential skills were identified including critical thinking, clear communication, self-confidence, and access to resources. After participation NP students were more receptive to an NP position with an on-call component. Inclusion of a simulated on-call experience is a feasible component of NP education and should be added to the NP curriculum. ©2017 American Association of Nurse Practitioners.
Salk, Allison; Ehrenpreis, Eli D
The Food and Drug Administration Adverse Event Reporting System (FAERS) is used for postmarketing pharmacovigilance. Our study sought to assess attitudes and usage of the FAERS among gastroenterology nurse practitioners (NPs) and physician assistants (PAs). A survey was administered at the August 2012 Principles of Gastroenterology for the Nurse Practitioner and Physician Assistant course, held in Chicago, IL. Of the 128 respondents, 123 (96%) reported a specialty in gastroenterology or hepatology and were included in analysis. Eighty-nine participants were NPs and 32 PAs, whereas 2 did not report their profession. Although 119 (98%) agreed or strongly agreed with the statement that accurately reporting adverse drug reactions is an important process to optimize patient safety, the majority of participants (54% NPs and 81% PAs) were unfamiliar with the FAERS. In addition, only 20% of NPs and 9% of PAs reported learning about the FAERS in NP or PA schooling. Our study shows enthusiasm among gastroenterology NPs and PAs for the reporting of adverse drug reactions, coupled with a lack of familiarity with the FAERS. This presents an opportunity for enhanced education about reporting of adverse drug reactions for gastroenterology NPs and PAs.
Hobson, Alexandra; Curtis, Alexa
Improving healthcare delivery for U.S. veterans is a national priority. The Veterans Health Administration (VHA) employs a variety of team-based, population health strategies to address critical issues in veterans' health including the effective management of chronic disease. Nurse practitioners (NPs) are integral members of the VHA patient care team with a substantial role to play in the organization and delivery of healthcare services for veterans. This report explores the contributions of NPs in team-based, population health strategies within the VHA. This review of the literature examines peer-reviewed articles published between 2006 and 2017 to explore the contributions of NPs in team-based, population health strategies within the VHA. Search words include veterans, VHA, NPs, population health, panel management, and chronic disease. NPs are vital members of the VHA primary care team; however, there is a dearth of available evidence reflecting the unique contribution of NPs within VHA team-based, population health management strategies. The VHA adoption of full practice authority for NP practice provides NPs with an expanded capacity to lead improvements in veterans' health. Future research is needed to fully understand the unique role of the NP in the delivery of population health management strategies for veterans. ©2017 American Association of Nurse Practitioners.
Agazio, Janice; Hillier, Shannon L; Throop, Meryia; Goodman, Petra; Padden, Diane; Greiner, Shawna; Turner, Annette
Many military women are being called to separate from their children to go to war. Most previous research has focused upon paternal, rather than, maternal, separation. The purpose of this article is to describe the experience of military mothers and their children during wartime deployments with clinical implications for nurse practitioners (NPs) in military or community settings. Using grounded theory methods, 37 active duty and reserve component military women participated in a one-time interview. Included were women who deployed for at least 4 months to Iraq or Afghanistan and had at least one child under the age of 12 during the separation. Military families present unique challenges for NPs. Mother deployments offer opportunities for intervention and anticipatory guidance across the trajectory of the separation. Military women's emotional and physical health must be supported before, during, and following deployment. NPs are ideally positioned to support military families. During deployment, the NP's focus may shift to care of the children and their caregiver. Before and at reintegration, NPs are in a key position to intervene early for posttraumatic stress and support family readjustment. ©2012 The Author(s) Journal compilation ©2012 American Association of Nurse Practitioners.
Vecchiarelli, Kelly; Amar, Arun Paul; Emanuele, Donna
Pulsatile tinnitus is a whooshing sound heard synchronous with the heartbeat. It is an uncommon symptom affecting fewer than 10% of patients with tinnitus. It often goes unrecognized in the primary care setting. Failure to recognize this symptom can result in a missed or delayed diagnosis of a potentially life-threatening condition known as a dural arteriovenous fistula. The purpose of this case study is to provide a structured approach to the identification of pulsatile tinnitus and provide management recommendations. A case study and review of pertinent literature. Pulsatile tinnitus usually has a vascular treatable cause. A comprehensive history and physical examination will alert the nurse practitioner (NP) when pulsatile tinnitus is present. Auscultation in specific areas of the head can detect audible or objective pulsatile tinnitus. Pulsatile tinnitus that is audible to the examiner is an urgent medical condition requiring immediate consultation and referral. Knowledge of pulsatile tinnitus and awareness of this often treatable condition directs the NP to perform a detailed assessment when patients present with tinnitus, directs appropriate referral for care and treatment, and can reduce the risk of delayed or missed diagnosis. ©2017 American Association of Nurse Practitioners.
Dauenhauer, Jason A; Podgorski, Carol A; Karuza, Jurgis
To inform the development of educational programming designed to teach providers appropriate methods of exercise prescription for older adults, the authors conducted a survey of 177 physicians, physician assistants, and nurse practitioners (39% response rate). The survey was designed to better understand the prevalence of exercise prescriptions, attitudes, barriers, and educational needs of primary care practitioners toward older adults. Forty-seven percent of primary care providers report not prescribing exercise for older adults; 85% of the sample report having no formal training in exercise prescription. Practitioner attitudes were positive toward exercise, but were not predictive of their exercise prescribing behavior, which indicates that education efforts aimed at changing attitudes as a way of increasing exercise-prescribing behaviors would not be sufficient. In order to facilitate and reinforce practice changes to increase exercise-prescribing behaviors of primary care providers, results suggest the need for specific skill training on how to write an exercise prescription and motivate older adults to follow these prescriptions.
Balboni, Michael J.; Babar, Amenah; Dillinger, Jennifer; Phelps, Andrea C.; George, Emily; Block, Susan D.; Kachnic, Lisa; Hunt, Jessica; Peteet, John; Prigerson, Holly G.; VanderWeele, Tyler J.; Balboni, Tracy A.
Context Although prayer potentially serves as an important practice in offering religious/spiritual support, its role in the clinical setting remains disputed. Few data exist to guide the role of patient-practitioner prayer in the setting of advanced illness. Objectives To inform the role of prayer in the setting of life-threatening illness, this study used mixed quantitative-qualitative methods to describe the viewpoints expressed by patients with advanced cancer, oncology nurses, and oncology physicians concerning the appropriateness of clinician prayer. Methods This is a cross-sectional, multisite, mixed-methods study of advanced cancer patients (n = 70), oncology physicians (n = 206), and oncology nurses (n = 115). Semistructured interviews were used to assess respondents’ attitudes toward the appropriate role of prayer in the context of advanced cancer. Theme extraction was performed based on interdisciplinary input using grounded theory. Results Most advanced cancer patients (71%), nurses (83%), and physicians (65%) reported that patient-initiated patient-practitioner prayer was at least occasionally appropriate. Furthermore, clinician prayer was viewed as at least occasionally appropriate by the majority of patients (64%), nurses (76%), and physicians (59%). Of those patients who could envision themselves asking their physician or nurse for prayer (61%), 86% would find this form of prayer spiritually supportive. Most patients (80%) viewed practitioner-initiated prayer as spiritually supportive. Open-ended responses regarding the appropriateness of patient-practitioner prayer in the advanced cancer setting revealed six themes shaping respondents’ viewpoints: necessary conditions for prayer, potential benefits of prayer, critical attitudes toward prayer, positive attitudes toward prayer, potential negative consequences of prayer, and prayer alternatives. Conclusion Most patients and practitioners view patient-practitioner prayer as at least occasionally
Tubbs-Cooley, Heather L; Mara, Constance A; Carle, Adam C; Gurses, Ayse P
The NASA Task Load Index (NASA-TLX) is a subjective workload assessment scale developed for use in aviation and increasingly applied to healthcare. The scale purports to measure overall workload as a single variable calculated by summing responses to six items. Since no data address the validity of this scoring approach in health care, we evaluated the single factor structure of the NASA-TLX as a measure of overall workload among intenisive care nurses. Confirmatory factor analysis of data from two studies of nurse workload in neonatal, paediatric, and adult intensive care units. Study 1 data were obtained from 136 nurses in one neonatal intensive care unit. Study 2 data were collected from 300 nurses in 17 adult, paediatric and neonatal units. Nurses rated their workload using the NASA-TLX's paper version. A single factor model testing whether all six items measured a single overall workload variable fit least well (RMSEA = 0.14; CFI = 0.91; TLI = 0.85). A second model that specified two items as outcomes of overall workload had acceptable fit (RMSEA = 0.08; CFI = 0.97; TLI = 0.95) while a third model of four items fit best (RMSEA = 0.06; CFI > 0.99; TLI = 0.99). A summed score from four of six NASA-TLX items appears to most reliably measure a single overall workload variable among intensive care nurses. Copyright © 2018 Elsevier Ltd. All rights reserved.
Dwyer, Trudy; Craswell, Alison; Rossi, Dolene; Holzberger, Darren
Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia. Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings. Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction. This study provides valuable insights into the contribution of the NP model of care within an aged care
Traynor, Michael; Nissen, Nina; Lincoln, Carol; Buus, Niels
In healthcare, occupational groups have adopted tactics to maintain autonomy and control over their areas of work. Witz described a credentialist approach to occupational closure adopted by nursing in the United Kingdom during the 19th and early 20th centuries. However, the recent advancement of assistant, 'non-qualified' workers by governments and managers forms part of a reconfiguration of traditional professional work. This research used focus groups with three cohorts of healthcare support workers undertaking assistant practitioner training at a London university from 2011 to 13 (6 groups, n = 59). The aim was to examine how these workers positioned themselves as professionals and accounted for professional boundaries. A thematic analysis revealed a complex situation in which participants were divided between articulating an acceptance of a subordinate role within traditional occupational boundaries and a usurpatory stance towards these boundaries. Participants had usually been handpicked by managers and some were ambitious and confident in their abilities. Many aspired to train to be nurses claiming that they will gain recognition that they do not currently get but which they deserve. Their scope of practice is based upon their managers' or supervisors' perception of their individual aptitude rather than on a credentialist claim. They 'usurp' nurses claim to be the healthcare worker with privileged access to patients, saying they have taken over what nursing has considered its core work, while nurses abandon it for largely administrative roles. We conclude that the participants are the not unwilling agents of a managerially led project to reshape the workforce that cuts across existing occupational boundaries. Copyright © 2015 Elsevier Ltd. All rights reserved.
van der Biezen, Mieke; Derckx, Emmy; Wensing, Michel; Laurant, Miranda
Due to the increasing demand on primary care, it is not only debated whether there are enough general practitioners (GPs) to comply with these demands but also whether specific tasks can be performed by other care providers. Although changing the workforce skill mix care by employing Physician Assistants (PAs) and Nurse Practitioners (NPs) has proven to be both effective and safe, the implementation of those professionals differs widely between and within countries. To support policy making regarding PAs/NPs in primary care, the aim of this study is to provide insight into factors influencing the decision of GPs and managers to train and employ a PA/NP within their organisation. A qualitative study was conducted in 2014 in which 7 managers of out-of-hours primary care services and 32 GPs who owned a general practice were interviewed. Three main topic areas were covered in the interviews: the decision-making process in the organisation, considerations and arguments to train and employ a PA/NP, and the tasks and responsibilities of a PA/NP. Employment of PAs/NPs in out-of-hours services was intended to substitute care for minor ailments in order to decrease GPs' caseload or to increase service capacity. Mangers formulated long-term planning and role definitions when changing workforce skill mix. Lastly, out-of-hours services experienced difficulties with creating team support among their members regarding the employment of PAs/NPs. In general practices during office hours, GPs indented both substitution and supplementation for minor ailments and/or target populations through changing the skill mix. Supplementation was aimed at improving quality of care and extending the range of services to patients. The decision-making in general practices was accompanied with little planning and role definition. The willingness to employ PAs/NPs was highly influenced by an employees' motivation to start the master's programme and GPs' prior experience with PAs/NPs. Knowledge about
Dräger, Dagmar; Budnick, Andrea; Kuhnert, Ronny; Kalinowski, Sonja; Könner, Franziska; Kreutz, Reinhold
Although chronic pain is common in older adults, its treatment is frequently inappropriate. This problem is particularly prevalent in nursing home residents. We therefore developed an intervention to optimize pain management and evaluated its effects on pain intensity and pain interference with function in nursing home residents in Germany. In a cluster-randomized controlled intervention, 195 residents of 12 Berlin nursing homes who were affected by pain were surveyed at three points of measurement. A modified German version of the Brief Pain Inventory was used to assess pain sites, pain intensity and pain interference with function in various domains of life. The intervention consisted of separate training measures for nursing staff and treating physicians. The primary objective of reducing the mean pain intensity by 2 points was not achieved, partly because the mean pain intensity at baseline was relatively low. However, marginal reductions in pain were observed in the longitudinal assessment at 6-month follow up. The intervention and control groups differed significantly in the intensity sum score and in the domain of walking. Furthermore, the proportion of respondents with pain scores >0 on three pain intensity items decreased significantly. Given the multifocal nature of the pain experienced by nursing home residents, improving the pain situation of this vulnerable group is a major challenge. To achieve meaningful effects not only in pain intensity, but especially in pain interference with function, training measures for nursing staff and physicians need to be intensified, and long-term implementation appears necessary. Geriatr Gerontol Int 2017; 17: 1534-1543. © 2016 Japan Geriatrics Society.
Jennings, Natasha; Clifford, Stuart; Fox, Amanda R; O'Connell, Jane; Gardner, Glenn
To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. The delivery of quality care in the emergency department is emerging as one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. A comprehensive search of four electronic databases from 2006 to 2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. A three step approach was used. Following a comprehensive search, two reviewers assessed all identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data were extracted using standardised tools. Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding outcomes of a cost benefit analysis. Synthesis of the available research attempts to provide an
Chen, Chin-Huang; Wang, Jane; Yang, Cheng-San; Fan, Jun-Yu
We explored the impact of job content and stress on anxiety, depressive symptoms and self-perceived health status among nurse practitioners (NPs). Taiwan's NP roles vary between hospitals as a result of the diverse demands and complex tasks that cause job-related stress, potentially affecting the health of the NP. This study utilised a cross-sectional descriptive design with 161 NPs from regional hospitals participating. Data collection involved demographics, the Taiwan Nurse Stress Checklist, the Job Content Questionnaire, the Beck Anxiety Inventory, the Beck Depression Inventory, a General Health Status Checklist and salivary cortisol tests. NPs reported moderate job stress, similar job control to nurses, mild anxiety and depression, and below-average self-perceived health. Being a licensed NP, personal response, competence, and incompleteness of the personal arrangements subscales of job stress, and anxiety predicted self-perceived health after adjusting for other covariates. Job stress and anxiety affect NP health. NPs are a valuable resource, and the healthcare system demand is growing. Reasonable NP staffing, working hours, proper promotion systems, the causes of job stress, job content clarification and practical work shift scheduling need to be considered. The occupational safety and physical and psychological health of NPs are strongly associated with the quality of patient care. © 2016 John Wiley & Sons Ltd.
Lancaster, Jason W; Wong, Adrian; Roberts, Susan J
Generation Y students have a strong preference for technology that has caused educators to re-evaluate their instructional techniques. Limited published literature exists evaluating the benefits of electronic lecture delivery to students enrolled within nursing degree programs, with no publications to date comparing traditional to blended learning modalities. To retrospectively compare student outcomes, including overall course grade and individual examination scores, between two cohorts of students utilizing two distinctly different methods of lecture delivery, traditional and blended. IRB approval was granted to retrospectively compare student outcomes from fifty-two students enrolled within Northeastern University's Master of Science Nurse Practitioner degree program. A total of 23 students were enrolled in the traditional section taught in 2010 and 29 students were enrolled in the blended section taught in 2011. Student'st-test was used to compare studied outcomes between each section. A p-value of ≤0.05 was considered to be statistically significant. The students enrolled within blended course scored statistically significantly higher than their counterparts within the traditional course for three of the four studied outcomes, including overall course score. This study demonstrates that nursing students enrolled within a more technologically advanced course may have improved performance over students enrolled in courses with traditional lecture styles given their generational preferences for learning. Copyright © 2011 Elsevier Ltd. All rights reserved.
While various reports have been published concerning ethical dilemmas in nursing and midwifery, and while many nurses and midwives struggle with the conflict between personal feelings raised by abortion and the duties of their position, few studies investigate the extent and conditions of abortion-care education for registered nurses (RNs) and certified nurse-midwives (CNMs) in Japan. To describe Japanese abortion-care education programs and to investigate program directors' or other relevant persons' perceptions of abortion-care education. Descriptive study was used to determine the extent of abortion-care education programs and the respondents' perceptions of abortion-care education. All 228 Japanese nursing and/or midwifery schools were invited to participate in the study. The response rate was 33.8% (n=77). Response rate varied by program type: 18.4% (n=45) for nursing programs and 29.0% (n=32) for midwifery programs. A confidential survey requesting information about curricular coverage of ten reproductive health topics related to abortion was mailed to program directors. The results show that the majority of CNM and RN programs surveyed offer didactic exposure to instruction in family planning and contraception, emergency contraception, legal considerations, and possible medical complications. However, few programs offer clinical exposure to all 10 topics. Of the respondents, 36% reported that lack of time and the low priority given to abortion-care education were issues of curriculum priority. As for educational materials, few textbooks or guidebooks exist on abortion care in Japan, and most educators use general nursing textbooks to cover this topic. Regardless of interest in or intention to provide abortion services as part of their practice, all providers of abortion-care education need to be knowledgeable about the full range of reproductive health options, including family planning and abortion, and to be able to convey this information to clients
Rutherford-Hemming, Tonya; Nye, Carla; Coram, Cathy
The National Organization for Nurse Practitioner Faculty (NONPF) does not allow simulation to be used in lieu of traditional clinical hours. The NONPF cites a lack of empirical evidence related to learning outcomes with simulation as rationale for its stance. The purpose of this systematic review was to search, extract, appraise, and synthesize research related to the use of simulation in Nurse Practitioner (NP) education in order to answer the two following questions: 1) What research related to simulation in NP education has emerged in the literature between 2010 and April 2015?, and 2) Of the research studies that have emerged, what level of Kirkpatrick's Training Evaluation Model (1994) is evaluated? This review was reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A literature search was completed in PubMed and CINAHL using a combination of medical subject headings, or Mesh terms, as well as keywords to retrieve non-indexed citations. The inclusion criteria for this review were broad in order to disseminate information on future research needed. The review considered studies related to NP education that included any form of simulation intervention, e.g. role-playing and standardized patients. The review considered studies that described original research, but no other design restrictions were imposed. The review was limited to studies published in the English language. The database search strategy yielded 198 citations. These results were narrowed down to 15 studies based on identified inclusion criteria. There is a lack of empirical evidence in the literature to support using simulation in lieu of direct patient care clinical hours in NP education. The evidence in this systematic review affirms NONPF's statement. Five years after the inception of NONPF's position statement, research to support learning outcomes with simulation in nurse practitioner education remains lacking. There is a need to produce rigorous
Kuethe, Maarten; Vaessen-Verberne, Anja; Mulder, Paul; Bindels, Patrick; Aalderen, Willem
textabstractAims: For children with stable asthma, to test non-inferiority of care provided by a hospital-based specialised asthma nurse versus a general practitioner (GP) or paediatrician. Methods: Randomised controlled trial evaluating standard care by a GP, paediatrician or an asthma nurse, with two-year follow-up. Results: 107 children were recruited, 45 from general practice and 62 from hospital. After two years, no significant differences between groups were found for airway responsiven...
Halcomb, Elizabeth J; Furler, John S; Hermiz, Oshana S; Blackberry, Irene D; Smith, Julie P; Richmond, Robyn L; Zwar, Nicholas A
Support in primary care can assist smokers to quit successfully, but there are barriers to general practitioners (GPs) providing this support routinely. Practice nurses (PNs) may be able to effectively take on this role. The aim of this study was to perform a process evaluation of a PN-led smoking cessation intervention being tested in a randomized controlled trial in Australian general practice. Process evaluation was conducted by means of semi-structured telephone interviews with GPs and PNs allocated in the intervention arm (Quit with PN) of the Quit in General Practice trial. Interviews focussed on nurse training, content and implementation of the intervention. Twenty-two PNs and 15 GPs participated in the interviews. The Quit with PN intervention was viewed positively. Most PNs were satisfied with the training and the materials provided. Some challenges in managing patient data and follow-up were identified. The Quit with PN intervention was acceptable to participating PNs and GPs. Issues to be addressed in the planning and wider implementation of future trials of nurse-led intervention in general practice include providing ongoing mentoring support, integration into practice management systems and strategies to promote greater collaboration in GPs and PN teams in general practice. The ongoing feasibility of the intervention was impacted by the funding model supporting PN employment and the competing demands on the PNs time. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: email@example.com.
Graarup, Jytte; Pedersen, Preben Ulrich; Bjerrum, Merete
Background: Nutrition plays an important role to the success of fast track programs, but under nutrition are still reported. Nutritional care seems to be a low priority among nurses even though it is well-known that insufficient nutrition has severe consequences for the patients. The aim is to re......Background: Nutrition plays an important role to the success of fast track programs, but under nutrition are still reported. Nutritional care seems to be a low priority among nurses even though it is well-known that insufficient nutrition has severe consequences for the patients. The aim...... is to report to what extent a training program has made Nutritional Nurse Practitioners aware of the nutritional care for short-term hospitalized patients, and how they deal with patients’ nutritional needs and ability to provide self-care in the context of a fast track program. Methods: Deductive content...... analysis was used to analyse data from four focus group interviews. Sixteen Nutritional Nurse Practitioners from either medical or surgery wards participated. The Nutritional Nurse Practitioners were interviewed twice. The interviews were recorded and verbally transcribed. Results: In the Nutritional Nurse...
Conclusion: The students’ skills in neonatal resuscitation were lower than expected. As competence in this area is of high significance for the improvement of neonatal outcomes, holding training workshops through applying novel training methods is recommended.
Stallinga, Hillegonda A; Jansen, Gerard J; Kastermans, Marijke C; Pranger, Albert; Dijkstra, Pieter U; Roodbol, Petrie F
To explore the focus of nurse practitioners on health care in terms of cure and care. Nurse practitioners are expected to act on the intersection of cure and care. However, in clinical practice and education, a clear model covering this area is lacking; therefore, it is unknown to what extent nurse practitioners are focused on this specific area. Graduate theses may reflect the focus of nurse practitioners. Sequential exploratory mixed method. In total, 413 published abstracts of graduate theses of a Dutch Master of Advanced Nursing Practice (2000-2015) were analysed using the International Classification of Functioning, Disability and Health. Data source included aim, question and outcome of each thesis and graduates' characteristics. A qualitative deductive approach was used for the analyses. Theses were classified as focused on cure, care, or on the intersection of cure and care. A small majority of 53% (N = 219) of the graduate theses addressed patient's health status and could be classified in the International Classification of Functioning, Disability and Health. Of the classified theses, 48% were focused on cure, 39% on the intersection of cure and care and 13% on care. While the percentage of theses addressing health status increased significantly over the 15-year period, the percentage of theses focused on cure, care and on the intersection of cure and care remained the same. The graduate theses reflected that nurse practitioners are increasingly oriented towards patients' health status. However, their focus is predominantly on cure rather than on the intersection of cure and care. © 2016 John Wiley & Sons Ltd.
Joshi, Rohan; Mortel, Heidi van de; Feijs, Loe; Andriessen, Peter; Pul, Carola van
Alarm fatigue is a well-recognized patient safety concern in intensive care settings. Decreased nurse responsiveness and slow response times to alarms are the potentially dangerous consequences of alarm fatigue. The aim of this study was to determine the factors that modulate nurse responsiveness to critical patient monitor and ventilator alarms in the context of a private room neonatal intensive care setting. The study design comprised of both a questionnaire and video monitoring of nurse-responsiveness to critical alarms. The Likert scale questionnaire, comprising of 50 questions across thematic clusters (critical alarms, yellow alarms, perception, design, nursing action, and context) was administered to 56 nurses (90% response rate). Nearly 6000 critical alarms were recorded from 10 infants in approximately 2400 hours of video monitoring. Logistic regression was used to identify patient and alarm-level factors that modulate nurse-responsiveness to critical alarms, with a response being defined as a nurse entering the patient's room within the 90s of the alarm being generated. Based on the questionnaire, the majority of nurses found critical alarms to be clinically relevant even though the alarms did not always mandate clinical action. Based on video observations, for a median of 34% (IQR, 20-52) of critical alarms, the nurse was already present in the room. For the remaining alarms, the response rate within 90s was 26%. The median response time was 55s (IQR, 37-70s). Desaturation alarms were the most prevalent and accounted for more than 50% of all alarms. The odds of responding to bradycardia alarms, compared to desaturation alarms, were 1.47 (95% CI = 1.21-1.78; heuristics in determining whether or not to respond to the alarm. Amongst other factors, the category and duration of critical alarms along with the clinical status of the patient determine nurse-responsiveness to alarms.
Lamarche, Kimberley; Park, Caroline; Fraser, Shawn; Rich, Mariann; MacKenzie, Susan
The use of mobile devices by nurse practitioners (NPs) to meet an evolving technological landscape is expanding rapidly. A longitudinal study of the ways NP students "normalize" the use of mobile devices in clinical education was completed. This study used researcher-designed survey tools, including sociodemographic questions, and the numerical picture was augmented and interpreted in light of the textual data in the form of selected interviews. Data indicate that mobile technology is normalized in the social realm but still developing in the clinical realm. Progress is hindered by non-modelling by faculty, inconsistent healthcare policy and lack of understanding of the affordances available through this technology. Overall, mobile technology is utilized and normalized in practice; this in turn has influenced their ability to prepare students for practice. Data presented can assist educators and clinicians alike in developing a more fulsome understanding on how to appropriately incorporate mobile technology into education and practice.
Porras-Povedano, Miguel; Santacruz-Hamer, Virginia; Oliva-Reina, Inmaculada
The aim of this study aim is to describe the perception of occupational risks by nursing professionals in health care center. A descriptive cross-sectional study was conducted on a total population of 122 registered nurses (RNs) and 89 certified nurse aides (CNAs). A convenience sample of nursing professionals was recruited with 72 RNs (27 males and 45 females), and 45 CNAs (1 male and 44 females). They were asked about their perception of occupational risks during their everyday work practice. Sex and age variables were considered, as well as work-related accidents and occupational risk prevention training that had been registered in the last five years. The sample mean age was 47.29 ± 7.98 years (RNs, 45.11; and CNAs, 50.77). Main sources of risks as perceived by RNs were those accidents due to biological materials exposure (52.78%), carrying and moving weight (19.44%), and to occupational stress (19.44%); amongst CNAs, those accidents due to carrying and moving weight (44.44%), biological materials exposure (26.67%) and other infections (15.56%) were also mentioned. As regards the overall risks identified by these professionals, 23.08% of them had perceived no risk at all during their work; 35.04% only identified one risk, and 29.06% perceived two risks in their day to day activity, whereas 12.82% identified three or more occupational risks. As a general rule, the nursing professionals tend to underestimate the occupational risks they are exposed to, with biological, musculoskeletal, and occupational-related stress are perceived as the main sources of risks. Copyright © 2013 Elsevier España, S.L. All rights reserved.
Valerie ten Dam; Mattijs Numans; Nienke Bleijenberg; Bas Steunenberg; Niek de Wit; Prof. Dr. Marieke J. Schuurmans; Irene Drubbel
Aim. To report the expectations and experiences of general practitioners and practice nurses regarding the U-CARE programme, to gain a better understanding of the barriers and facilitators in providing proactive, structured care to frail older people and to determine whether implementation is
Roche, Tina E; Gardner, Glenn; Jack, Leanne
Health reforms in service improvement have included the use of nurse practitioners. In rural emergency departments, nurse practitioners work to the full scope of their expanded role across all patient acuities including those presenting with undifferentiated chest pain. Currently, there is a paucity of evidence regarding the effectiveness of emergency nurse practitioner service in rural emergency departments. Inquiry into the safety and quality of the service, particularly regarding the management of complex conditions is a priority to ensure that this service improvement model meets health care needs of rural communities. This study used a prospective, longitudinal nested cohort study of rural emergency departments in Queensland, Australia. Sixty-one consecutive adult patients with chest pain who presented between November 2014 and February 2016 were recruited into the study cohort. A nested cohort of 41 participants with suspected or confirmed acute coronary syndrome were identified. The primary outcome was adherence to guidelines and diagnostic accuracy of electrocardiograph interpretation for the nested cohort. Secondary outcomes included service indicators of waiting times, diagnostic accuracy as measured by unplanned representation rates, satisfaction with care, quality-of-life, and functional status. Data were examined and compared for differences for participants managed by emergency nurse practitioners and those managed in the standard model of care. The median waiting time was 8.0 min (IQR 20) and length-of-stay was 100.0 min (IQR 64). Participants were 2.4 times more likely to have an unplanned representation if managed by the standard service model. The majority of participants (91.5%) were highly satisfied with the care that they received, which was maintained at 30-day follow-up measurement. In the evaluation of quality of life and functional status, summary scores for the SF-12 were comparable with previous studies. No differences were
The purposes of this review are to examine the types of clinical decision support systems in use and to identify patterns of how critical care advanced practice nurses (APNs) have integrated these systems into their nursing care patient management practices. The decision-making process itself is analyzed with a focus on how automated systems attempt to capture and reflect human decisional processes in critical care nursing, including how systems actually organize and process information to create outcome estimations based on patient clinical indicators and prognosis logarithms. Characteristics of APN clinicians and implications of these characteristics on decision system use, based on the body of decision system user research, are introduced. A review of the Medline, Ovid, CINAHL, and PubMed literature databases was conducted using "clinical decision support systems,"computerized clinical decision making," and "APNs"; an examination of components of several major clinical decision systems was also undertaken. Use patterns among APNs and other clinicians appear to vary; there is a need for original research to examine how APNs actually use these systems in their practices in critical care settings. Because APNs are increasingly responsible for admission to, and transfer from, critical care settings, more understanding is needed on how they interact with this technology and how they see automated decision systems impacting their practices. APNs who practice in critical care settings vary significantly in how they use the clinical decision systems that are in operation in their practice settings. These APNs must have an understanding of their use patterns with these systems and should critically assess whether their patient care decision making is affected by the technology.
Solberg, Marianne Trygg; Tandberg, Bente Silnes; Lerdal, Anners
To implement a didactic model for students specialising in intensive care nursing (n=12) and nurses working in neonatal intensive care units (NICU) (n=17). To evaluate nurse self-assessments following observation of children with congenital heart disease (CHD), before and after participation in the programme, as well as the usefulness of the programme. A pilot study with a pre- and post-test design, using self-administered questionnaires. The didactic model increased the number of clinical observations and assessments of physiological factors made by both students and NICU nurses during evaluation of children with suspected CHD. The majority of nurses reported that both participation in the programme and the didactic model were useful and they demonstrated high-level knowledge, according to Bloom's taxonomy for cognitive learning. In particular, subjects found that the literature provided and structured bedside guidance in the clinical setting assisted learning. Intensive care students and NICU nurses performed clinical observations and physical factor assessments more frequently after completing the programme, compared with baseline. We speculate that this didactic model may also be useful in other clinical settings. Copyright © 2011 Elsevier Ltd. All rights reserved.
Zhao, Siqi; Qu, Lijun; Liu, He; Gao, Lijun; Jiao, Mingli; Liu, Jinghua; Liang, Libo; Zhao, Yanming; Wu, Qunhong
The study's objectives were to: 1) use social support theory to examine factors influencing healthcare workers' opinions about workplace violence (WPV) prevention strategies, and 2) to determine the types of support that general practitioners (GPs) and general nurses sought and expected to use after WPV exposure. A cross-sectional survey was used to assess a sample of 448 GPs and 412 general nurses from 90 township hospitals located in Heilongjiang province, China. Results revealed that workers exposed to physical, psychological or both WPV types had a strong opinion about the necessity of improving diagnosis/treatment competence, developing violence prevention guidelines and plans, using protective equipment, and reinforcing staff by providing back-up support. The last two strategies were also selected by tertiary hospital workers in our previous study. In addition, workers with high anxiety selected the following prevention strategies as most effective: improving doctor-patient communication skills; installing cameras on wards; keeping work areas bright; improvements in violence reporting, statistics, and interventions; security patrols in the key departments; reinforcing staff; and correcting inaccurate media perspectives and reports. The last four strategies were also selected by tertiary hospital workers. All respondents expected to receive organisational and social support. In conclusion, these prevention strategies should be tailored to the different requirements of specific populations. Furthermore, it is necessary for organisations, the public, and policymakers to provide powerful support in WPV prevention.
Rosenzweig, Margaret; Giblin, Joan; Mickle, Marsha; Morse, Allison; Sheehy, Patricia; Sommer, Valerie; Bridging The Gap Working Group
To identify the knowledge and skill needs of oncology nurse practitioners (ONPs) as they enter cancer care practice, and to identify necessary educational resources. Cross-sectional, descriptive. A national e-mail survey. 610 self-described ONPs from the Oncology Nursing Society's database. The project team developed a 28-item electronic survey. The survey was randomly distributed via e-mail. ONPs' feelings of preparedness in the first year of ONP practice. In the first year of practice, 90% of ONPs rated themselves as prepared or very prepared in obtaining patient history, performing physical examination, and documenting findings. ONPs rated themselves as not at all or somewhat prepared in clinical issues of chemotherapy/biotherapy competency (n = 81, 78%), recognizing and managing oncologic emergencies, (n = 77, 70%), and recognizing and managing drug toxicities (n = 63, 61%). The primary source of oncology education for ONPs new to practice was almost exclusively the collaborating or supervising physician (n = 84, 81%). Specific knowledge and skills, such as information about chemotherapy, oncologic emergencies, and side effects of therapy, are needed before an ONP enters a cancer care practice. Cancer-specific education should be made available to new ONPs as they begin independent practice.
Liu, He; Gao, Lijun; Jiao, Mingli; Liu, Jinghua; Liang, Libo; Zhao, Yanming; Wu, Qunhong
The study’s objectives were to: 1) use social support theory to examine factors influencing healthcare workers’ opinions about workplace violence (WPV) prevention strategies, and 2) to determine the types of support that general practitioners (GPs) and general nurses sought and expected to use after WPV exposure. A cross-sectional survey was used to assess a sample of 448 GPs and 412 general nurses from 90 township hospitals located in Heilongjiang province, China. Results revealed that workers exposed to physical, psychological or both WPV types had a strong opinion about the necessity of improving diagnosis/treatment competence, developing violence prevention guidelines and plans, using protective equipment, and reinforcing staff by providing back-up support. The last two strategies were also selected by tertiary hospital workers in our previous study. In addition, workers with high anxiety selected the following prevention strategies as most effective: improving doctor-patient communication skills; installing cameras on wards; keeping work areas bright; improvements in violence reporting, statistics, and interventions; security patrols in the key departments; reinforcing staff; and correcting inaccurate media perspectives and reports. The last four strategies were also selected by tertiary hospital workers. All respondents expected to receive organisational and social support. In conclusion, these prevention strategies should be tailored to the different requirements of specific populations. Furthermore, it is necessary for organisations, the public, and policymakers to provide powerful support in WPV prevention. PMID:27326460
Full Text Available The study's objectives were to: 1 use social support theory to examine factors influencing healthcare workers' opinions about workplace violence (WPV prevention strategies, and 2 to determine the types of support that general practitioners (GPs and general nurses sought and expected to use after WPV exposure. A cross-sectional survey was used to assess a sample of 448 GPs and 412 general nurses from 90 township hospitals located in Heilongjiang province, China. Results revealed that workers exposed to physical, psychological or both WPV types had a strong opinion about the necessity of improving diagnosis/treatment competence, developing violence prevention guidelines and plans, using protective equipment, and reinforcing staff by providing back-up support. The last two strategies were also selected by tertiary hospital workers in our previous study. In addition, workers with high anxiety selected the following prevention strategies as most effective: improving doctor-patient communication skills; installing cameras on wards; keeping work areas bright; improvements in violence reporting, statistics, and interventions; security patrols in the key departments; reinforcing staff; and correcting inaccurate media perspectives and reports. The last four strategies were also selected by tertiary hospital workers. All respondents expected to receive organisational and social support. In conclusion, these prevention strategies should be tailored to the different requirements of specific populations. Furthermore, it is necessary for organisations, the public, and policymakers to provide powerful support in WPV prevention.
Pölkki, Tarja; Laukkala, Helena; Korhonen, Anne
Despite growing knowledge of parents' important role in their infants' pain management, the extent to which nurses in neonatal intensive care units (NICUs) provide guidance to parents on nonpharmacological methods is unclear. This study aimed to describe and compare the perceptions of parental guidance in using nonpharmacological pain-relieving methods among neonates in NICUs from the viewpoints of nurses and parents, and to examine the participants' demographics related to the guidance. A cross-sectional, descriptive, correlational study using questionnaire surveys was conducted. Eight NICUs of 5 university hospitals in Finland. A total of 427 participants, including 294 nurses and 178 parents. The participants indicated that the methods of touching and holding were the most commonly introduced strategies in infants' pain alleviation, as they were given as an alternative "nearly always/always" (nurses 91%, 87% and parents 61%, 58%, respectively). In contrast, music and breast-feeding were the less commonly introduced nonpharmacological methods (nurses 11%, 6% and parents 1%, 6%, respectively). A significant difference (p methods compared with parents. In addition, many demographic factors of the nurses, the parents, and their infants were related to the parental guidance. Our findings indicate that parental guidance should not be based on nurses' evaluations of their activities without taking into account parents' perspectives. When counseling parents to use nonpharmacological methods, neonatal nurses should actively interact with families and discuss parents' individual needs. Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Full Text Available Abstract Background The definition of primary care varies between countries. Swedish primary care has developed from a philosophic viewpoint based on quality, accessibility, continuity, co-operation and a holistic view. The meaning of holism in international literature differs between medicine and nursing. The question is, if the difference is due to different educational traditions. Due to the uncertainties in defining holism and a holistic view we wished to study, in depth, how holism is perceived by doctors and nurses in their clinical work. Thus, the aim was to explore the perceived meaning of a holistic view among general practitioners (GPs and district nurses (DNs. Methods Seven focus group interviews with a purposive sample of 22 GPs and 20 nurses working in primary care in two Swedish county councils were conducted. The interviews were transcribed verbatim and analysed using qualitative content analysis. Results The analysis resulted in three categories, attitude, knowledge, and circumstances, with two, two and four subcategories respectively. A professional attitude involves recognising the whole person; not only fragments of a person with a disease. Factual knowledge is acquired through special training and long professional experience. Tacit knowledge is about feelings and social competence. Circumstances can either be barriers or facilitators. A holistic view is a strong motivator and as such it is a facilitator. The way primary care is organised can be either a barrier or a facilitator and could influence the use of a holistic approach. Defined geographical districts and care teams facilitate a holistic view with house calls being essential, particularly for nurses. In preventive work and palliative care, a holistic view was stated to be specifically important. Consultations and communication with the patient were seen as important tools. Conclusion 'Holistic view' is multidimensional, well implemented and very much alive among both
Davis, Teresa K
School-based health centers in high schools provide a unique setting in which to deliver risk-reduction and resilience-building services to adolescents. The traditional health care system operating in the United States focuses on the treatment of illness and disease rather than on preventing problems originating from health risk behaviors. Nurse practitioners can promote healthy behavior in adolescents through linkages to parents, schools, and community organizations; by conducting individual risk assessments; and by providing health education and access to creative health programs that build resilience and promote protective factors. With a focus on wellness, nurse practitioners as advanced practice nurses and specialists in disease prevention and health promotion can establish students' health priorities in the context of the primary health care they deliver on a daily basis.
Trajkovski, Suza; Schmied, Virginia; Vickers, Margaret; Jackson, Debra
Family-centred care (FCC) has been well recognised, accepted and reported in the literature as an optimised way of caring for hospitalised children. While neonatal units strive to adopt this philosophy, published research suggests there are difficulties implementing FCC principles in daily practice. Appreciative inquiry (AI) is a philosophy and methodology that offers a unique, strength-based approach to promoting organisational learning and positive organisational change. As a participatory approach, AI facilitates change from the ground up and lends itself to building effective partnerships or collaborations. This article reports the findings of a one-day workshop using an AI methodology to bring neonatal nurses and parents together to enhance the FCC within a neonatal intensive care unit in Sydney, Australia. Participants (n = 15) developed collaborative insights of optimal FCC that can be built upon to support neonates and their families in the future. Shared visions were formed, strategies identified and a development plan made for ongoing collaborations and partnerships. AI provides a flexible framework that enables the mandatory collaboration needed to develop action plans that can form the catalyst for organizational change in health-care research and practice. © The Author(s) 2013.
MacKenzie, Emma; Smith, Amanda; Angus, Neil; Menzies, Sue; Brulisauer, Franz; Leslie, Stephen J
The treatment of patients with chronic heart failure (CHF) remains sub-optimal. Specialist CHF nurses are proven to improve care and reduce admission but developing such services, especially in remote areas, can be difficult. This study aimed: first, to assess the perceived acceptability and effectiveness of a new community based nurse-led heart failure service by general practitioners (GPs) in an area with a dispersed population; second, to assess the knowledge and learning needs of GPs; and third, to assess perceptions of the use of national guidelines and telehealth on heart failure management. The study was conducted in the Scottish Highlands, a large geographical area in the north of the UK which includes both rural and urban populations. The area has a total population of 240 000, approximately 60% of whom are within 1 hour travel time of the largest urban centre. A postal survey of all GPs (n = 260) and structured email survey of all CHF specialist nurses (n = 3) was performed. All responses were entered into a Microsoft Excel spreadsheet, summarised and subjected to thematic analysis. Differences between GPs in 'rural', 'urban' or both 'urban & rural' was investigated using an F-test for continuous variables and a three-sample test for equality of proportions for nominal data. Questionnaires were returned from 83 GPs (32%) and all three CHF specialist nurses. In this sample there were only a few differences between GPs from 'rural', 'urban' and 'urban & rural'. There also appeared to be little difference in responses between those who had the experience of the CHF nurse service and those who had not. Overall, 32 GPs (39%) wished better, local access to echocardiography, while 63 (76%) wished access to testing for brain natriuretic peptide (BNP). Only 27 GPs (33%) referred all patients with CHF to hospital. A number of GPs stated that this was dependant on individual circumstances and the patient's ability to travel. The GPs were confident to initiate
Full Text Available Background. Improved quality of care and control of healthcare costs are important factors influencing decisions to implement nurse practitioner (NP and clinical nurse specialist (CNS roles. Objective. To assess the quality of randomized controlled trials (RCTs evaluating NP and CNS cost-effectiveness (defined broadly to also include studies measuring health resource utilization. Design. Systematic review of RCTs of NP and CNS cost-effectiveness reported between 1980 and July 2012. Results. 4,397 unique records were reviewed. We included 43 RCTs in six groupings, NP-outpatient (n=11, NP-transition (n=5, NP-inpatient (n=2, CNS-outpatient (n=11, CNS-transition (n=13, and CNS-inpatient (n=1. Internal validity was assessed using the Cochrane risk of bias tool; 18 (42% studies were at low, 17 (39% were at moderate, and eight (19% at high risk of bias. Few studies included detailed descriptions of the education, experience, or role of the NPs or CNSs, affecting external validity. Conclusions. We identified 43 RCTs evaluating the cost-effectiveness of NPs and CNSs using criteria that meet current definitions of the roles. Almost half the RCTs were at low risk of bias. Incomplete reporting of study methods and lack of details about NP or CNS education, experience, and role create challenges in consolidating the evidence of the cost-effectiveness of these roles.
Czarnecki, Michelle L; Hainsworth, Keri; Simpson, Pippa M; Arca, Marjorie J; Uhing, Michael R; Varadarajan, Jaya; Weisman, Steven J
Continuous opioid infusion (COI) remains the mainstay of analgesic therapy in the neonatal intensive care unit (NICU). Parent/nurse-controlled analgesia (PNCA) has been accepted as safe and effective for pediatric patients, but few reports include use in neonates. This study sought to compare outcomes of PNCA and COI in postsurgical neonates and young infants. Twenty infants treated with morphine PNCA were retrospectively compared with 13 infants treated with fentanyl COI in a Midwestern pediatric hospital in the United States. Outcome measures included opioid consumption, pain scores, frequency of adverse events, and subsequent methadone use. The PNCA group (median 6.4 μg · kg(-1) · h(-1) morphine equivalents, range 0.0-31.4) received significantly less opioid (P < 0.001) than the COI group (median 40.0 μg · kg(-1) · h(-1) morphine equivalents; range 20.0-153.3), across postoperative days 0-3. Average daily pain scores (based on 0-10 scale) were low for both groups, but median scores differed nonetheless (0.8 PNCA vs 0.3 COI, P < 0.05). There was no significant difference in the frequency of adverse events or methadone use. Results suggest PNCA may be a feasible and effective alternative to COI for pain management in postsurgical infants in the NICU. Results also suggest PNCA may provide more individualized care for this vulnerable population and in doing so, may potentially reduce opioid consumption; however, more studies are needed. © 2014 John Wiley & Sons Ltd.
Thompson, Hilaire J; Belza, Basia; Baker, Margaret; Christianson, Phyllis; Doorenbos, Ardith; Nguyen, Huong
Enhancing existing curricula to meet newly published adult-gerontology advanced practice registered nurse (APRN) competencies in an efficient manner presents a challenge to nurse educators. Incorporating shared, published electronic learning resources (ELRs) in existing or new courses may be appropriate in order to assist students in achieving competencies. The purposes of this project were to (a) identify relevant available ELR for use in enhancing geriatric APRN education and (b) to evaluate the educational utility of identified ELRs based on established criteria. A multilevel search strategy was used. Two independent team members reviewed identified ELR against established criteria to ensure utility. Only resources meeting all criteria were retained. Resources were found for each of the competency areas and included formats such as podcasts, Web casts, case studies, and teaching videos. In many cases, resources were identified using supplemental strategies and not through traditional search or search of existing geriatric repositories. Resources identified have been useful to advanced practice educators in improving lecture and seminar content in a particular topic area and providing students and preceptors with additional self-learning resources. Addressing sustainability within geriatric APRN education is critical for sharing of best practices among educators and for sustainability of teaching and related resources. © 2014.
Fitzgerald, Les; Wong, Pauline; Hannon, John; Solberg Tokerud, Marte; Lyons, Judith
Innovative curriculum designs are vital for effective learning in contemporary nursing education where traditional modes of delivery are not adequate to meet the learning needs of postgraduate students. This instance of postgraduate teaching in a distributed learning environment offered the opportunity to design a flexible learning model for teaching advanced clinical skills. To present a sustainable model for flexible learning that enables specialist nurses to gain postgraduate qualifications without on-campus class attendance by teaching and assessing clinical health care skills in an authentic workplace setting. An action research methodology was used to gather evidence and report on the process of curriculum development of a core unit, Comprehensive Health Assessment (CHA), within 13 different postgraduate speciality courses. Qualitative data was collected from 27 teaching academics, 21 clinical specialist staff, and 7 hospital managers via interviews, focus groups and journal reflections. Evaluations from the initial iteration of CHA from 36 students were obtained. Data was analyzed to develop and evaluate the curriculum design of CHA. The key factors indicated by participants in the curriculum design process were coordination and structuring of teaching and assessment; integration of content development; working with technologies, balancing specialities and core knowledge; and managing induction and expectations. A set of recommendations emerged as a result of the action research process. These included: a constructive alignment approach to curriculum design; the production of a facilitator's guide that specifies expectations and unit information for academic and clinical education staff; an agreed template for content authors; and the inclusion of synchronous communication for real-time online tutoring. The highlight of the project was that it built curriculum design capabilities of clinicians and students which can sustain this alternative model of online
Hallowell, Sunny G; Rogowski, Jeannette A; Spatz, Diane L; Hanlon, Alexandra L; Kenny, Michael; Lake, Eileen T
Nurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting. To examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge. Cross sectional analysis combining nurse survey data with infant discharge data. A national sample of neonatal intensive care units (N=97), nurses (N=5614) and very low birth weight infants (N=6997). Sequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on "any human milk") and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support). The majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (pmilk (pmilk at discharge (p=.056). A 1 SD increase (7%) in the fraction of infants who received breastfeeding support was associated with an eight percentage point increase in the fraction of infants discharged on human milk (pmilk. Investments by nurse administrators to improve work environments and support educational preparation of nursing staff may ensure that the most vulnerable infants have the best
Latour, Jos M.; Hazelzet, Jan A.; Duivenvoorden, Hugo J.; van Goudoever, Johannes B.
To identify satisfaction with neonatal intensive care as viewed by parents and healthcare professionals and to explore similarities and differences between parents and healthcare professionals. A 3-round Delphi method to identify neonatal care issues (round 1) and to determine the importance of
Warren, Jessie N; Luctkar-Flude, Marian; Godfrey, Christina; Lukewich, Julia
High-fidelity simulation (HFS) is becoming an integral component in healthcare education programs. There is considerable evidence demonstrating the effectiveness of HFS on satisfaction and learning outcomes within undergraduate nursing programs; however, there are few studies that have investigated its use and effectiveness within nurse practitioner (NP) programs. To synthesize the best available evidence about the effectiveness of HFS within NP education programs worldwide. The specific review question was: what is the effect of HFS on learner satisfaction, knowledge, attitudes, and skill performance in NP education? Joanna Briggs Institute systematic review methodology was utilized. The following databases were searched: MEDLINE, CINAHL, EMBASE, Epistemonikos, PROSPERO, HealthSTAR, AMED, Cochrane, Global Health and PsycINFO. Studies were included if they were quantitative in nature and reported on any aspect HFS within a NP program. Ten studies were included in the review. All studies were conducted in the United States and published between 2007 and 2014. Outcomes explored included: knowledge, attitudes, skills and satisfaction. The majority of studies compared HFS to online learning or traditional classroom lecture. Most study scenarios featured high acuity, low frequency events within acute care settings; only two studies utilized scenarios simulated within primary care. There is limited evidence supporting the use of HFS within NP programs. In general, HFS increases students' knowledge and confidence, and students are more satisfied with simulation-based teaching in comparison to other methods. Future studies should explore the effectiveness of simulation training within NP programs in reducing the theory to practice gap, and evaluate knowledge retention, transferability to real patient situations, and impact of simulation on patient outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.
In 2013, the Advisory Committee of the Food and Drug Administration determined hydrocodone combination medications (HCMs) needed tighter regulation due to high abuse potential; they recommended upscheduling HCMs from Schedule III to II. The purpose of this study was to examine the effect of upscheduling of HCMs on pain management practices of advanced practiced registered nurses (APRNs) in Oklahoma. In this qualitative study, 25 participants described their primary care experiences after the upscheduling. A thematic analysis was used to understand the effects on APRN pain management practices. The upscheduling of HCMs has greatly affected the pain management practices of APRNs in a state where Schedule II narcotic prescribing is forbidden. Findings will assist APRNs with improving patient access to care, implementing practice regulations, and exploring options for alternative pain therapies in primary care. Upscheduling of HCMs has had a severe impact on APRNs, affecting their prescribing practices and leading to increased referrals. They noted limited treatment options, increased health care costs, and decreased access to care. The APRNs understand the problem of prescription opioid abuse, diversion, and misuse. A consensus model could standardize the regulatory process for APRNs, increase interstate mobility for practice, and increase access to APRN care nationwide.
Kellams, Joni R; Maye, John P
Nurse practitioners (NPs) now have prescriptive authority for controlled substances in all 50 states in the United States. Florida, the last state to grant NPs DEA licensure, has been wrought with prescription diversion practices for a number of years as pill mills, doctor shopping, and overprescribing proliferated. Prescription Drug Monitoring Programs (PDMPs) help curb drug diversion activity and play a key role in reducing the abuse of controlled substances. The primary objective of this education improvement initiative was to increase knowledge of actively licensed NPs in the state of Florida regarding the state's PDMP. The main themes included the drug abuse problem, description and progression of the PDMP, and how to use the Florida PDMP. Upon approval from the institutional review board, this education improvement initiative gauged NP knowledge of the PDMP and main themes before and after an educational PowerPoint intervention. A pretest/posttest questionnaire was administered for assessment of all knowledge questions. One hundred forty-five NPs with active advanced registered NP licenses in Florida completed both the pretest and posttest questionnaires. Descriptive statistics and paired t tests were used for statistical significance testing. Knowledge of the PDMP and the main themes of the education improvement initiative significantly increased (p < .001) from pretest to posttest results. This education improvement initiative had positive effects for NPs on the knowledge of the Florida PDMP and the main themes. This indicated that Florida NPs are able to acquire greater comprehension of the PDMP by an education intervention.
Full Text Available Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined roles can become a source of conflict in clinical teams and reduce the effectiveness of care and services delivered to the population. Our objective in this paper is to outline processes for clarifying professional roles when a new role is introduced into clinical teams, that of the primary healthcare nurse practitioner (PHCNP. To support our empirical analysis we used the Canadian National Interprofessional Competency Framework, which defines the essential components for role clarification among professionals. A qualitative multiple-case study was conducted on six cases in which the PHCNP role was introduced into primary care teams. Data collection included 34 semistructured interviews with key informants involved in the implementation of the PHCNP role. Our results revealed that the best performing primary care teams were those that used a variety of organizational and individual strategies to carry out role clarification processes. From this study, we conclude that role clarification is both an organizational process to be developed and a competency that each member of the primary care team must mobilize to ensure effective interprofessional collaboration.
Brault, Isabelle; Kilpatrick, Kelley; D'Amour, Danielle; Contandriopoulos, Damien; Chouinard, Véronique; Dubois, Carl-Ardy; Perroux, Mélanie; Beaulieu, Marie-Dominique
Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined roles can become a source of conflict in clinical teams and reduce the effectiveness of care and services delivered to the population. Our objective in this paper is to outline processes for clarifying professional roles when a new role is introduced into clinical teams, that of the primary healthcare nurse practitioner (PHCNP). To support our empirical analysis we used the Canadian National Interprofessional Competency Framework, which defines the essential components for role clarification among professionals. A qualitative multiple-case study was conducted on six cases in which the PHCNP role was introduced into primary care teams. Data collection included 34 semistructured interviews with key informants involved in the implementation of the PHCNP role. Our results revealed that the best performing primary care teams were those that used a variety of organizational and individual strategies to carry out role clarification processes. From this study, we conclude that role clarification is both an organizational process to be developed and a competency that each member of the primary care team must mobilize to ensure effective interprofessional collaboration.
Rowan, Courtney M; Cristea, A Ioana; Hamilton, Jennifer C; Taylor, Nicole M; Nitu, Mara E; Ackerman, Veda L
AIM: To hypothesize a dedicated critical care nurse practitioner (NP) is associated with a decreased length of stay (LOS) from a pediatric chronic ventilator dependent unit (PCVDU). METHODS: We retrospectively reviewed patients requiring care in the PCVDU from May 2001 through May 2011 comparing the 5 years prior to the 5 years post implementation of the critical care NP in 2005. LOS and room charges were obtained. RESULTS: The average LOS decreased from a median of 55 d [interquartile range (IQR): 9.8-108.3] to a median of 12 (IQR: 4.0-41.0) with the implementation of a dedicated critical care NP (P < 1.0001). Post implementation of a dedicated NP, a savings of 25738049 in room charges was noted over 5 years. CONCLUSION: Our data demonstrates a critical care NP coverage model in a PCVDU is associated with a significantly reduced LOS demonstrating that the NP is an efficient and likely cost-effective addition to a medically comprehensive service. PMID:27170929
Scheffler, R M; Waitzman, N J; Hillman, J M
Managed care is spreading rapidly in the United States and creating incentives for physician practices to find the most efficient combination of health professionals to deliver care to an enrolled population. Given these trends, it is appropriate to reexamine the roles of physician assistants (PAs) and nurse practitioners (NPs) in the health care workforce. This paper briefly reviews the literature on PA and NP productivity, managed care plans' use of PAs and NPs, and the potential impact of PAs and NPs on the size and composition of the future physician workforce. In general, the literature supports the idea that PAs and NPs could have a major impact on the future health care workforce. Studies show significant opportunities for increased physician substitution and even conservative assumptions about physician task delegation imply a large increase in the number of PAs and NPs that can be effectively deployed. However, the current literature has certain limitations that make it difficult to quantify the future impact of PAs and NPs. Among these limitations is the fact that virtually all formal productivity studies were conducted in fee-for-service settings during the 1970s, rather than managed care settings. In addition, the vast majority of PA and NP productivity studies have viewed PAs and NPs as physician substitutes rather than as members of interdisciplinary health care teams, which may become the dominant health care delivery model over the next 10-20 years.
Sølvik, Una Ørvim; Bjelkarøy, Wenche Iren; Berg, Kari van den; Saga, Anne Lise; Hager, Helle Borgstrøm; Sandberg, Sverre
Errors in the preanalytical phase in clinical laboratories affect patient safety. The aim of this study was to evaluate the effect of intensive educational efforts together with external quality assessment (EQA) of the preanalytical phase from 2013 to 2015 to improve patient identification in primary health care in Norway. In addition, routines for venous and capillary blood sampling were investigated. A preanalytical EQA was circulated in 2013 by the Norwegian Quality Improvement of Laboratory Examinations (Noklus) to general practitioner offices and nursing homes (n=2000) to obtain information about important issues to focus on before launching an intensive educational program with courses, posters and visits in 2013-2015. Preanalytical EQA surveys were further circulated in 2014 and 2015. The response rate varied between 42% and 55%. The percentages of participants asking for the patients' name and the Norwegian identification number increased from about 8% in 2013 to about 35% in 2015. The increase was similar for those participating in only one EQA survey and for those who participated in EQA surveys both in 2013 and 2015. Guidelines for venous and capillary blood sampling were not always followed. Educational efforts more than the preanalytical EQA influenced the actions and resulted in an increase in the percentages of participants that followed the guidelines for patient identification. Some aspects of blood sampling routines need improvement.
Prosser, Brenton; Clark, Shannon; Davey, Rachel; Parker, Rhian
A frustration often expressed by researchers and policy-makers in public health is an apparent mismatch between respective priorities and expectations for research. Academics bemoan an oversimplification of their work, a reticence for independent critique and the constant pressure to pursue evaluation funding. Meanwhile, policy-makers look for research reports written in plain language with clear application, which are attuned to current policy settings and produced quickly. In a context where there are calls in western nations for evidence based policy with stronger links to academic research, such a mismatch can present significant challenges to policy program evaluation. The purpose of this paper is to present one attempt to overcome these challenges. Specifically, the paper describes the development of a conceptual framework for a large-scale, multifaceted evaluation of an Australian Government health initiative to expand Nurse Practitioner models of practice in aged care service delivery. In doing so, the paper provides a brief review of key points for the facilitation of a strong research-policy nexus in public health evaluations, as well as describes how this particular evaluation embodies these key points. As such, the paper presents an evaluation approach which may be adopted and adapted by others undertaking public health policy program evaluations. Copyright © 2013 Elsevier Ltd. All rights reserved.
Noffsinger, Dana L
The role of acute care nurse practitioners (ACNPs) in trauma care has evolved over time. A survey was performed with the aim of describing the role across the United States. There were 68 respondents who depicted the typical trauma ACNP as being a 42-year-old woman who works full-time at a level I American College of Surgeons verified trauma center. Trauma ACNPs typically practice with 80% of their time for clinical care and are based on a trauma and acute care surgery service. They are acute care certified and hold several advanced certifications to supplement their nursing license.
White, Katherine M; Wise, Susi E; Young, Ross McD; Hyde, Melissa K
A qualitative study explored beliefs about active voluntary euthanasia (AVE) in a sample (N = 18) of medical practitioners and nurses from Australia, where AVE is not currently legal. Four behaviors relating to AVE emerged during the interviews: requesting euthanasia for oneself, legalizing AVE, administering AVE to patients if it were legalized, and discussing AVE with patients if they request it. Using thematic analysis, interviews were analyzed for beliefs related to advantages and disadvantages of performing these AVE behaviors. Medical practitioners and nurses identified a number of similar benefits for performing the AVE-related behaviors, both for themselves personally and as health professionals. Benefits also included a consideration of the positive impact for patients, their families, and the health care system. Disadvantages across behaviors focused on the potential conflict between those parties involved in the decision making process, as well as conflict between one's own personal and professional values.
Buchholz, Susan W; Klein, Tracy; Cooke, Cindy; Cook, Michelle L; Knestrick, Joyce; Dickins, Kirsten
In 2015, an invitational think tank was convened by the Fellows of the American Association of Nurse Practitioners to update the 2010 Nurse Practitioner (NP) Research Agenda Roundtable. This effort was undertaken to provide guidance for future health care research. The purpose of this article is to introduce the process used for conducting four reviews that address critical topics related to specific research priorities emanating from the 2015 NP Research Agenda Roundtable. The four reviews are published in this issue of Journal of the American Association of Nurse Practitioners (JAANP) to address the state of current research relevant to NP policy, workforce, education, and practice. This introductory article provides an overview of the systematic process used to evaluate the four topical area. The type of review selected, the search strategy, critical appraisal, data extraction, and data synthesis will be further described in the four review articles. Four reviews that examine literature regarding specific aims important to NPs will address strengths as well as gaps in the literature. The knowledge offered by the four reviews has the potential to inform future research, which will benefit NPs and other health care stakeholders.
Yoder, Linda; Walden, Marlene; Verklan, M Terese
This article presents the struggle between social justice and market justice within the current health care system, specifically issues affecting neonatal care. Community benefit is described and discussed as an aspect of social justice demonstrated by hospitals. The federal and state Children's Health Insurance Program also is discussed in relation to social justice and health care costs. Implications for managers and executives overseeing neonatal care are presented in relation to the economic and social issues.
Fonseca, Luciana Mara Monti; Aredes, Natália Del' Angelo; Fernandes, Ananda Maria; Batalha, Luís Manuel da Cunha; Apóstolo, Jorge Manuel Amado; Martins, José Carlos Amado; Rodrigues, Manuel Alves
to evaluate the cognitive learning of nursing students in neonatal clinical evaluation from a blended course with the use of computer and laboratory simulation; to compare the cognitive learning of students in a control and experimental group testing the laboratory simulation; and to assess the extracurricular blended course offered on the clinical assessment of preterm infants, according to the students. a quasi-experimental study with 14 Portuguese students, containing pretest, midterm test and post-test. The technologies offered in the course were serious game e-Baby, instructional software of semiology and semiotechnique, and laboratory simulation. Data collection tools developed for this study were used for the course evaluation and characterization of the students. Nonparametric statistics were used: Mann-Whitney and Wilcoxon. the use of validated digital technologies and laboratory simulation demonstrated a statistically significant difference (p = 0.001) in the learning of the participants. The course was evaluated as very satisfactory for them. The laboratory simulation alone did not represent a significant difference in the learning. the cognitive learning of participants increased significantly. The use of technology can be partly responsible for the course success, showing it to be an important teaching tool for innovation and motivation of learning in healthcare. avaliar a aprendizagem cognitiva de estudantes de enfermagem na avaliação clínica neonatal a partir de um curso semipresencial com uso de simulação por computador e em laboratório; comparar a aprendizagem cognitiva dos estudantes em grupo controle e experimental ao testar a simulação em laboratório; e avaliar o curso semipresencial extracurricular oferecido sobre avaliação clínica do bebê pré-termo, segundo os estudantes. estudo quase-experimental com 14 estudantes portugueses contendo pré-teste, teste intermediário e pós-teste. As tecnologias oferecidas no curso foram serious
Hallowell, Sunny G.; Rogowski, Jeannette A.; Spatz, Diane L.; Hanlon, Alexandra L.; Kenny, Michael; Lake, Eileen T.
Context Nurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting. Objectives To examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge. Design and setting Cross sectional analysis combining nurse survey data with infant discharge data. Participants A national sample of neonatal intensive care units (N = 97), nurses (N = 5614) and very low birth weight infants (N = 6997). Methods Sequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on “any human milk”) and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support). Results The majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (p nurses with a bachelor’s degree in nursing was associated with a three percentage point increase in the fraction infants discharged on human milk (p nurses, and more infants who receive breastfeeding support by nurses have higher rates of very low birth weight infants discharged home on human milk. Investments by nurse
Rodger, Daragh; Hussey, Pamela
Most of the health issues encountered in persons of older age are the result of one or more chronic diseases. The evidence base reports that chronic diseases can be prevented or delayed by engaging in healthy behaviors. Education provides a cost effective intervention on both economic grounds in addition to delivery of optimal patient outcomes. Information and Communication Technology (ICT) increasingly is viewed as a critical utility in eHealth delivery, providing scope for expanding online education facilities for older persons. Developing nursing competencies in the delivery of eHealth solutions to deliver user education programs therefore makes sense. This chapter discusses nursing competencies on the development of targeted eHealth programs for healthy ageing. The role of Advanced Nurse Practitioner in Ireland and its associated competency set identifies how a strong action learning model can be designed to deliver eHealth educational programs for effective delivery of healthy ageing in place.
Nieuwboer, Minke S; Perry, Marieke; van der Sande, Rob; Maassen, Irma T H M; Olde Rikkert, Marcel G M; van der Marck, Marjolein A
As the number of patients with complex healthcare needs grows, inter-professional collaboration between primary care professionals must be constantly optimized. General practitioners (GPs) and community nurses (CNs) are key professions in primary care; however, poor GP-CN communication is common, and research into the factors influencing its quality is limited. To explore patient-related GP-CN communication and facilitating and hindering factors, and to identify strategies to enhance this communication. A qualitative focus group design was used to identify the facilitating and hindering factors and strategies for improvement. In a Dutch primary care setting, 6 mono-professional focus group interviews (3 meetings of 13 GPs; 3 meetings of 18 CNs) were organized between June 2015 and April 2016, recorded and transcribed verbatim. Two independent researchers performed the coding of these interviews, identifying their categories and themes. Results show that, despite the regular contact between GPs and CNs, communication was generally perceived as poor in effectiveness and efficiency by both professions. Mutual trust was considered the most important facilitating factor for effective communication. Profession-specific factors (e.g. differences in responsibility and profession-specific language) and organizational factors (e.g. lack of shared care plans, no in-person communication, lack of time) may be of influence on communication. Participants' suggestions for improvement included organizing well-structured and reimbursed team meetings and facilitating face-to-face contact. GP-CN patient-related communication benefits most from trusting inter-personal relationships. Inter-professional training programmes should address both professional and organizational factors and should be evaluated for their effect on quality of care.
Yang, Bo Kyum; Trinkoff, Alison M; Zito, Julie Magno; Burcu, Mehmet; Safer, Daniel J; Storr, Carla L; Johantgen, Mary E; Idzik, Shannon
Little is known about how nurse practitioner independent practice authority (NP-IPA) influences patient care. This study examined the effect of NP-IPA on patterns of mental health-related visits provided by NPs in U.S. community health centers (CHCs). State NP regulatory information was linked to National Ambulatory Medical Care Survey data on NP- and physician-provided visits (N=61,457) in CHCs from 2006 through 2011. The proportion of NP-provided versus physician-provided mental health-related visits in states with NP-IPA was compared with the proportion in states without NP-IPA. The adjusted odds of mental health-related visits in CHCs provided by NPs in states with and without NP-IPA were compared by using multiple logistic regression models while accounting for the complex survey design. Between 2006 and 2011, the odds of NP- versus physician-provided mental health-related visits in CHCs were more than two times greater in states with NP-IPA than in states with no NP-IPA (adjusted odds ratio [OR]= 2.43, 95% confidence interval [CI]=1.12-4.60). In contrast, no significant difference between states with and without NP-IPA was noted in non-mental health-related CHC visits provided by NPs. Among all mental health-related visits, the odds of visits in which psychotropic medications were prescribed by an NP were more than three times higher in states with NP-IPA than in those without NP-IPA (adjusted OR=3.14, CI=1.50-6.54). Compared with physicians, NPs provided proportionally more CHC mental health-related visits in states with NP-IPA than in states without NP-IPA.
Liu, Nan; D'Aunno, Thomas
To develop simple stylized models for evaluating the productivity and cost-efficiencies of different practice models to involve nurse practitioners (NPs) in primary care, and in particular to generate insights on what affects the performance of these models and how. The productivity of a practice model is defined as the maximum number of patients that can be accounted for by the model under a given timeliness-to-care requirement; cost-efficiency is measured by the corresponding annual cost per patient in that model. Appropriate queueing analysis is conducted to generate formulas and values for these two performance measures. Model parameters for the analysis are extracted from the previous literature and survey reports. Sensitivity analysis is conducted to investigate the model performance under different scenarios and to verify the robustness of findings. Employing an NP, whose salary is usually lower than a primary care physician, may not be cost-efficient, in particular when the NP's capacity is underutilized. Besides provider service rates, workload allocation among providers is one of the most important determinants for the cost-efficiency of a practice model involving NPs. Capacity pooling among providers could be a helpful strategy to improve efficiency in care delivery. The productivity and cost-efficiency of a practice model depend heavily on how providers organize their work and a variety of other factors related to the practice environment. Queueing theory provides useful tools to take into account these factors in making strategic decisions on staffing and panel size selection for a practice model. © Health Research and Educational Trust.
Bern-Klug, Mercedes; Connolly, Robert; Downes, Deirdre; Galambos, Colleen; Kusmaul, Nancy; Kane, Rosalie; Hector, Paige; Beaulieu, Elise
In July of 2015, the Federal Register published for public comment proposed rule changes for nursing homes certified to receive Medicare and/or Medicaid. If the final rules are similar to the proposed rules, they will represent the largest change in federal rules governing nursing homes since the Nursing Home Reform Act which was part of OBRA 1987. The proposed changes have the potential to enhance the quality of care and quality of life of nursing home residents. Many of the proposed changes would directly affect the practice of social work and would likely expand the role for nursing home social workers. This article discusses the role that members of the National Nursing Home Social Work Network (NNHSW Network) played in developing and submitting a response to CMS. The article provides the context for the publication of the proposed rules, describes the process used by the NNHSW Network to develop and build support for comments on these rules, and also includes the actual comments submitted to CMS. Social work education programs and continuing education programs throughout the country will continue to have an important role to play in helping to prepare social work students and practitioners for a career in long-term care.
Full Text Available Abstract Background Urinary incontinence affects approximately 5% (800.000 of the Dutch population. Guidelines recommend pelvic floor muscle/bladder training for most patients. Unfortunately, general practitioners use this training only incidentally, but prescribe incontinence pads. Over 50% of patients get such pads, costing €160 million each year. Due to ageing of the population a further increase of expenses is expected. Several national reports recommend to involve nurse specialists to support general practitioners and improve patient care. The main objective of our study is to investigate the effectiveness and cost-effectiveness of involving nurse specialists in primary care for urinary incontinence. This paper describes the study protocol. Methods/Design In a pragmatic prospective multi centre two-armed randomized controlled trial in the Netherlands the availability and involvement for the general practitioners of a nurse specialist will be compared with usual care. All consecutive patients consulting their general practitioner within 1 year for urinary incontinence and patients already diagnosed with urinary incontinence are eligible. Included patients will be followed for 12 months. Primary outcome is severity of urinary incontinence (measured with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF. Based on ICIQ-UI SF outcome data the number of patients needed to include is 350. For the economic evaluation quality of life and costs will be measured alongside the clinical trial. For the longer term extrapolation of the economic evaluation a Markov modelling approach will be used. Discussion/Conclusion This is, to our knowledge, the first trial on care for patients with urinary incontinence in primary care that includes a full economic evaluation and cost-effectiveness modelling exercise from the societal perspective. If this intervention proves to be effective and cost-effective, implementation of this
Mjörnheim, Berit; Rosendahl, Anders; Eriksson, Lennart C; Takman, Christina
The rate of autopsies has dropped to low levels in Western countries. The aim of this study was to describe the experiences and attitudes of registered nurses (RNs) and physicians (MD) toward clinical autopsies in neonatal and adult hospital care in Sweden. RNs and MDs in neonatal and adult care specialized clinics at a university-affiliated hospital in Sweden were surveyed. Survey responses were tallied, and free-text comments were assessed with qualitative content analysis. Three hundred thirty-six surveys were distributed; the response rate was 35%. Most RNs and 14% of the MDs had limited or no experience participating in an autopsy. Notably, few RNs and approximately one third of the MDs were familiar with the autopsy processes and the treatment of the deceased person's body after an autopsy. More than one third of RNs had experience with talking to relatives regarding autopsy. Most agreed that an autopsy could be supportive for relatives during the grieving process and beneficial for the quality of healthcare. Most MDs (70%) thought that autopsies should be performed more frequently. Qualitative results emphasized that RNs and MDs thought that autopsy information supported the grieving process of relatives-especially parents who had lost a child. The survey data confirm belief in the value of clinical autopsies in neonatal and adult hospital care. RNs and MDs should receive training about the autopsy process and procedures for obtaining consent for an autopsy. RNs are in a position to support the decision making of relatives about providing consent for autopsy and have an opportunity to take a more active role in the autopsy process.
Riley, Lydia; Litsch, Tyler; Cook, Michelle L
The purpose of this study was twofold: to describe the average cost of nurse practitioner (NP) tuition based on degree program, program type, and geography; and to compare the cost of NP tuition to medical school tuition. A listing of all NP degree granting universities was obtained from the American Association of Colleges of Nursing during the fall of 2014, and tuition data were obtained from university websites. Medical school tuition data were obtained online during the fall of 2014 from the American Association of Medical Colleges. Average 1-year tuition rates were calculated for NP programs and medical schools and compared across private and public institutions. Average 1-year resident tuition for public university NP programs ranges between $8671 and $11,077 based on type of program. The cost of 1-year NP program tuition at the master's and the doctoral level is much lower than the cost of 1-year medical school tuition at both private and public universities. NPs can perform many of the same services as physicians in the primary care setting with comparable outcomes, yet the cost of educating NPs is much lower. NPs are a cost-effective solution to the healthcare workforce shortage. ©2015 American Association of Nurse Practitioners.
Full Text Available Abstract Background Patients with chronic kidney disease (CKD are at a greatly increased risk of developing cardiovascular disease. Recently developed guidelines address multiple risk factors and life-style interventions. However, in current practice few patients reach their targets. A multifactorial approach with the aid of nurse practitioners was effective in achieving treatment goals and reducing vascular events in patients with diabetes mellitus and in patients with heart failure. We propose that this also holds for the CKD population. Design MASTERPLAN is a multicenter randomized controlled clinical trial designed to evaluate whether a multifactorial approach with the aid of nurse-practicioners reduces cardiovascular risk in patients with CKD. Approximately 800 patients with a creatinine clearance (estimated by Cockcroft-Gault between 20 to 70 ml/min, will be included. To all patients the same set of guidelines will be applied and specific cardioprotective medication will be prescribed. In the intervention group the nurse practitioner will provide lifestyle advice and actively address treatment goals. Follow-up will be five years. Primary endpoint is the composite of myocardial infarction, stroke and cardiovascular mortality. Secondary endpoints are cardiovascular morbidity, overall mortality, decline of renal function, change in markers of vascular damage and change in quality of life. Enrollment has started in April 2004 and the study is on track with 700 patients included on October 15th, 2005. This article describes the design of the MASTERPLAN study.
Lyngstad, Merete; Hofoss, Dag; Grimsmo, Anders; Hellesø, Ragnhild
Nurses providing home health care services are dependent on access to patient information and communicating with general practitioners (GPs) to deliver safe and effective health care to patients. Information and communication technology (ICT) systems are viewed as powerful tools for this purpose. In Norway, a standardized electronic messaging (e-messaging) system is currently being established in health care. The aim of this study was to explore home health care nurses' assessments of the utility of the e-messaging system for communicating with GPs and identify elements that influence the assessment of e-messaging as a useful communication tool. The data were collected using a self-developed questionnaire based on variables identified by focus group interviews with home health care nurses (n=425) who used e-messaging and existing research. Data were analyzed using logistic regression analyses. Over two-thirds (425/632, 67.2%) of the home health care nurses returned the questionnaire. A high proportion (388/399, 97.2%) of the home health care nurses who returned the questionnaire found the e-messaging system to be a useful tool for communication with GPs. The odds of reporting that e-messaging was a useful tool were over five times higher (OR 5.1, CI 2.489-10.631, Pcommunicate with GPs. By identifying these elements, it is easier to determine which interventions are the most important for the development and implementation of ICT systems in home health care services.
Ulrich, Connie M; Zhou, Qiuping Pearl; Hanlon, Alexandra; Danis, Marion; Grady, Christine
Nurse practitioners (NPs) and physician assistants (PAs) provide primary care services for many American patients. Ethical knowledge is foundational to resolving challenging practice issues, yet little is known about the importance of ethics and work-related factors in the delivery of quality care. The aim of this study was to quantitatively assess whether the quality of the care that practitioners deliver is influenced by ethics and work-related factors. This paper is a secondary data analysis of a cross-sectional self-administered mailed survey of 1,371 primary care NPs and PAs randomly selected from primary care and primary care subspecialties in the United States. Ethics preparedness and confidence were significantly associated with perceived quality of care (pfactors. Investing in ethics education and addressing restrictive practice environments may improve collaborative practice, teamwork, and quality of care. Copyright © 2014 Elsevier Inc. All rights reserved.
Fabiane de Amorim Almeida
Full Text Available Objective To understand the experiences of nurses when caring for dying newborns and their families in the NICU; and redeem their perceptions about acting before the death and grieving process. Method A descriptive exploratory study with a qualitative approach, developed with nine nurses at the ICU of a hospital in São Paulo (SP, Brazil. Data was collected through semi-structured interviews and analyzed using the Collective Subject Discourse (CSD. Results Caring for newborns who are dying and their families is very difficult for nurses, due to the intense involvement. They seek strategies to deal with the situation and, before the newborn’s death, despite the suffering, express the feeling of accomplishment. Conclusions Facing death and grief triggers mechanisms that emerge life references, coming across painful issues. Learning to deal with these questions is a daily challenge for nurses of the NICU.
Tadeu Sartini Ferreira
Full Text Available Abstract OBJECTIVE To assess the effect of a 12-hour shift on mood states and sleepiness at the beginning and end of the shift. METHOD Quantitative, cross-sectional and descriptive study.It was conducted with 70 neonatal intensive care unit nurses. The Brunel Mood Scale (BRUMS, Karolinska Sleepiness Scale (KSS, and a socio-demographic profile questionnaire were administered. RESULTS When the KSS and BRUMS scores were compared at the beginning of the shift associations were found with previous sleep quality (p ≤ 0.01, and quality of life (p ≤ 0.05. Statistical significant effects on BRUMS scores were also associated with previous sleep quality, quality of life, liquid ingestion, healthy diet, marital status, and shift work stress. When the beginning and end of the shift were compared, different KSS scores were seen in the group of all nurses and in the night shift one. Significant vigor and fatigue scores were observed within shift groups. CONCLUSION A good night’s sleep has positive effects on the individual`s mood states both at the beginning and the end of the shift. The self-perception of a good quality of life also positively influenced KSS and BRUMS scores at the beginning and end of the shift. Proper liquid ingestion led to better KSS and BRUMS scores.
Bárbara Bertolossi Marta de Araújo
Full Text Available Objetivo: refletir sobre a infecção hospitalar nas utins a partir da análise da produção científica da enfermagem nacional e internacional acerca desta temática. Método: abordagem qualitativa a partir da revisão bibliográfica em base de dados. Resultados: Os dados analisados foram publicações dos últimos dez anos, em revistas indexadas nas bases de dados: Medline, Lilacs, Bdenf e Scielo. Após a busca com os descritores: “infecção hospitalar”; “neonatal”. em inglês: “infection”, “hospitalar” e “neonatologic foram encontradas 134 publicações das quais 28 se enquadravam no objetivo da pesquisa. Para análise das produções foi adotada a análise de conteúdo na modalidade temática, originando 3 categorias: a Fatores de risco para disseminação da infecção hospitalar; b Infecções comuns no cenário neonatal; c Assistência de enfermagem na prevenção da infecção hospitalar neonatal. Conclusão: Trata-se de uma temática fundamental na Assistência de enfermagem ao neonato nas Unidades de Terapia Intensiva Neonatal, contudo pouco explorada por enfermeiros. Descritores: Infecção hospitalar; Neonatal; Cuidado de enfermagem.
Maehara, Tadaaki; Nishida, Hiroshi; Watanabe, Takashi; Tominaga, Ryuji; Tabayashi, Koichi
The healthcare system surrounding surgeons is collapsing due to Japan's policy of limiting health expenditure, market fundamentalism, shortage of healthcare providers, unfavorable working environment for surgeons, increasing risk of malpractice suits, and decreasing number of those who desire to pursue the surgery specialty. In the USA, nonphysician and mid-level clinicians such as nurse practitioners (NPs) and physician assistants (PAs) have been working since the 1960s, and the team approach to medicine which benefits patients is functioning well. One strategy to avoid the collapse of the Japanese surgical healthcare system is introducing the NP/PA system. The division of labor in medicine can provide high-quality, safe healthcare and increase the confidence of the public by contributing to: reduced postoperative complications; increased patient satisfaction; decreased length of postoperative hospital stay: and economic benefits. We have requested that the Ministry of Health, Labor and Welfare establish a Japanese NP/PA system to care for patients more efficiently perioperatively. The ministry has decided to launch a trial profession called "tokutei (specifically qualified) nurse" in February 2010. These nurses will be trained and educated at the Master's degree level and allowed to practice several predetermined skill sets under physician supervision. We hope that all healthcare providers will assist in transforming the tokutei nurse system into a Japanese NP/PA system.
Zhang, Y; Zhang, J L; Li, Y
Hypoxic ischemic encephalopathy (HIE), one of the common causes of newborn invalidism, is likely to induce nervous system-associated sequelae and even intracranial hemorrhage in severe cases. The incidence rate of HIE has been rising in recent years. In order to study the clinical nursing effect for HIE combined with intracranial hemorrhage, 76 newborns diagnosed with HIE combined with intracranial hemorrhage by spiral computed tomography (CT) from the of Binzhou Peoples Hospital, Shandong, China were selected. They were divided into a control group and an intervention group. The control group received routine nursing, while the intervention group received comprehensive nursing intervention. The experimental results suggested that the mental developmental index (MDI) value and the psychomotor developmental index (PDI) value of patients in the intervention group were much higher than those of the control group and the difference was significant (phemorrhage recover more effectively, therefore is worth applying.
Tero T Kivelä
Full Text Available From 7% to 10% of all retinoblastomas and from 44% to 71% of familial retinoblastomas in developed countries are diagnosed in the neonatal period, usually through pre- or post-natal screening prompted by a positive family history and sometimes serendipitously during screening for retinopathy of prematurity or other reasons. In developing countries, neonatal diagnosis of retinoblastoma has been less common. Neonatal retinoblastoma generally develops from a germline mutation of RB1, the retinoblastoma gene, even when the family history is negative and is thus usually hereditary. At least one-half of infants with neonatal retinoblastoma have unilateral tumors when the diagnosis is made, typically the International Intraocular Retinoblastoma Classification (Murphree Group B or higher, but most germline mutation carriers will progress to bilateral involvement, typically Group A in the fellow eye. Neonatal leukokoria usually leads to the diagnosis in children without a family history of retinoblastoma, and a Group C tumor or higher is typical in the more advanced involved eye. Almost all infants with neonatal retinoblastoma have at least one eye with a tumor in proximity to the foveola, but the macula of the fellow eye is frequently spared. Consequently, loss of reading vision from both eyes is exceptional. A primary ectopic intracranial neuroblastic tumor known as trilateral retinoblastoma is no more common after neonatal than other retinoblastoma. For many reasons, neonatal retinoblastoma may be a challenge to eradicate, and the early age at diagnosis and relatively small tumors do not guarantee the preservation of both eyes of every involved child. Oncology nurses can be instrumental in contributing to better outcomes by ensuring that hereditary retinoblastoma survivors receive genetic counseling, by referring families of survivors to early screening programs when they are planning for a baby, and by providing psychological and practical support
Universe H. Mulenga
Conclusions: Findings are consistent with findings from the limited number of other published studies suggesting that nurses can provide high-quality care for patients with HIV and AIDS. Further research is recommended to assess the impact of such programs on morbidity and mortality indicators, and on staff retention and job satisfaction of nurses and also of the HNPs.
Taylor-Fishwick, Judith C; Okafor, Maureen; Fletcher, Monica
The Asthma Principle and Practice (APP) course, an evidence-based blended distance-learning educational encounter, was designed to aid in the dissemination of the 2007 asthma clinical guidelines (EPR-3) and priority messages, increase knowledge of content of the guidelines as well as create an environment to enable participants to apply knowledge and skills into clinical practice. Students received a self-study binder 6-week period prior to attendance at an interactive study day. The APP is grounded in adult education principle and practices. A questionnaire was completed before reading the study binder and post study day to measure demographic variables as well as awareness of and changes in knowledge and confidence in key attributes of the clinical guidelines including patient education. The results showed that by taking the APP course confidence levels related to knowledge of asthma and its management increased with specific reference to the asthma clinical guidelines. Confidence in the use of patient education/communication strategies improved as well as the use of pulmonary function tests and the interpretation of test results. Nurse practitioners are an important audience to target in the dissemination of clinical guidelines and benefit from educational materials based on adult education strategies. ©2014 American Association of Nurse Practitioners.
Pendergrass, Kathy M; Nemeth, Lynne; Newman, Susan D; Jenkins, Carolyn M; Jones, Elaine G
Nurse practitioners (NPs), as well as all healthcare clinicians, have a legal and ethical responsibility to provide health care for deaf American Sign Language (ASL) users equal to that of other patients, including effective communication, autonomy, and confidentiality. However, very little is known about the feasibility to provide equitable health care. The purpose of this study was to examine NP perceptions of barriers and facilitators in providing health care for deaf ASL users. Semistructured interviews in a qualitative design using a socio-ecological model (SEM). Barriers were identified at all levels of the SEM. NPs preferred interpreters to facilitate the visit, but were unaware of their role in assuring effective communication is achieved. A professional sign language interpreter was considered a last resort when all other means of communication failed. Gesturing, note-writing, lip-reading, and use of a familial interpreter were all considered facilitators. Interventions are needed at all levels of the SEM. Resources are needed to provide awareness of deaf communication issues and legal requirements for caring for deaf signers for practicing and student NPs. Protocols need to be developed and present in all healthcare facilities for hiring interpreters as well as quick access to contact information for these interpreters. ©2017 American Association of Nurse Practitioners.
Elliott, Lydia; DeCristofaro, Claire; Carpenter, Alesia
This article describes the development and implementation of integrated use of personal handheld devices (personal digital assistants, PDAs) and high-fidelity simulation in an advanced health assessment course in a graduate family nurse practitioner (NP) program. A teaching tool was developed that can be utilized as a template for clinical case scenarios blending these separate technologies. Review of the evidence-based literature, including peer-reviewed articles and reviews. Blending the technologies of high-fidelity simulation and handheld devices (PDAs) provided a positive learning experience for graduate NP students in a teaching laboratory setting. Combining both technologies in clinical case scenarios offered a more real-world learning experience, with a focus on point-of-care service and integration of interview and physical assessment skills with existing standards of care and external clinical resources. Faculty modeling and advance training with PDA technology was crucial to success. Faculty developed a general template tool and systems-based clinical scenarios integrating PDA and high-fidelity simulation. Faculty observations, the general template tool, and one scenario example are included in this article. ©2012 The Author(s) Journal compilation ©2012 American Academy of Nurse Practitioners.
Full Text Available The necessity is emphasized to distinguish between the traditional model of data acquisition reported by a patient in doctor’s office and the more valuable and desired model to become acquainted with the core of the problem by going to a patient’s domicile. In the desired model it is possible to come across various determinants of health during home visits. Family members can be approached and there is a possibility to evaluate the relationships between the patient and his loved ones. One can visually assess one’s living conditions and predictable environmental hazard. For several years, the desired model has been put into practice by general practitioners and home health care nurses. Recently this model is also promoted by “health care therapists” who are members of “teams of home health care”. The authors, being convinced of the merits of “home and environmental model” of practical medicine, have developed a method of recording and illustrating data collected during visits in patient’s home. The elaborated tool helps to communicate and exchange information among general practitioners, home health care nurses, social workers of primary health care centers and specialists. The method improves the formulation of the plan of further therapeutic steps and remedial interventions in psycho-social relations and living conditions of patients.
Hemingway, Steve; Rogers, Melanie; Elsom, Stephen
To evaluate the influence of a mental health training module on the therapeutic optimism of advanced nurse practitioner (ANP) students in primary care (family practice). Three cohorts of ANPs who undertook a Mental Health Problems in Primary Care Module as part of their MSc ANP (primary care) run by the University of Huddersfield completed the Elsom Therapeutic Optimism Scale (ETOS), in a pre- and postformat. The ETOS is a 10-item, self-administered scale, which has been used to evaluate therapeutic optimism previously in mental health professionals. All three cohorts who completed the scale showed an improvement in their therapeutic optimism scores. With stigma having such a detrimental effect for people diagnosed with a mental health problem, ANPs who are more mental health literate facilitated by education and training in turn facilitates them to have the skills and confidence to engage and inspire hope for the person diagnosed with mental health problems. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.
Loresto, Figaro L; Jupiter, Daniel; Kuo, Yong-Fang
Few studies have examined differences in functional, cognitive, and psychological factors between patients utilizing only nurse practitioners (NPs) and those utilizing only primary care medical doctors (PCMDs) for primary care. Patients utilizing NP-only or PCMD-only models for primary care will be characterized and compared in terms of functional, cognitive, and psychological factors. Cohorts were obtained from the Medicare Current Beneficiary Survey linked to Medicare claims data. Weighted analysis was conducted to compare the patients within the two care models in terms of functional, cognitive, and psychological factors. From 2007 to 2013, there was a 170% increase in patients utilizing only NPs for primary care. In terms of health status, patients utilizing only NPs in their primary care were not statistically different from patients utilizing only PCMDs. There is a perception that NPs, as compared with PCMDs, tend to provide care to healthier patients. Our results are contrary to this perception. In terms of health status, NP-only patients are similar to PCMD-only patients. Results of this study may inform research comparing NP-only care and PCMD-only care using Medicare and the utilization of NPs in primary care. ©2017 American Association of Nurse Practitioners.
Wright, Wendy L; Morrell, Elise; Lee, Jennie; Cuellar, Norma Graciela; White, Patricia
Adults ages ≥65 years are at increased risk for infectious diseases. Ensuring these individuals are fully vaccinated is imperative. The purpose of this study was to assess the immunization rates of adults ages ≥65 years managed by nurse practitioners (NPs) and compare the results with national immunization rates and Healthy People 2020 goals. A convenience sample of adults ages ≥65 years was obtained from two NP-managed clinics. The vaccine records of each subject were reviewed for documentation of having received five vaccines (tetanus, diphtheria, and pertussis; influenza; pneumococcal polysaccharide vaccine 23; pneumococcal conjugate vaccine 13; and herpes zoster vaccine). One hundred and fifty females (70.8%) and 62 males (29.2%) met inclusion criteria. NP-managed patients had higher immunization rates than the national averages across all five major vaccines. The herpes zoster vaccination rates exceeded the recommendations from Healthy People 2020 whereas pneumococcal and influenza rates were below. The stocking of vaccines within the NP-managed clinics, direct billing to Medicare for Part D vaccines, and previsit care planning likely contributed to the high vaccination rates. These high immunization rates in patients managed by NPs provide support for the important role that NPs play in the care of older adults. ©2017 American Association of Nurse Practitioners.
Schwartz, Richard H; O'Laughlen, Mary C; Kim, Joshua
There is an ongoing shortage of child mental health professionals. Nurse practitioners (NPs) who completed behavioral and mental health training have proven that they can diagnose and manage many pediatric problems. To ask the training directors of both child/adolescent psychiatry (CAP) and developmental/behavioral pediatric (DBP) programs about their receptivity and willingness to give additional training for NPs who provide care to children with behavioral and mental health issues and examine the main obstacles to the development of such programs. A survey was sent to 151 CAP and DBP training directors in the United States. The return rate was 67% (N = 101). Only 12% expressed objection to the concept of additional NP training in CAP or DBP, but only 53% of training directors currently reported having sufficient faculty to do so. Some training directors reported already having advanced behavioral and mental health training programs for NPs (31%) and most (82%) would consider expanding, if funded. There is support for advanced training for NPs, but funding is needed to make this a reality. Expansion of such programs might rapidly improve accessibility and reduce waiting time of mental health providers for children and adolescents. ©2017 American Association of Nurse Practitioners.
Teare, Jean; Horne, Maria; Clements, Gill; Mohammed, Mohammed A
To compare and contrast job descriptions for nursing roles in out-of-hours services to obtain a general understanding of what is required for a nurse working in this job. Out-of-hours services provide nursing services to patients either through telephone or face-to-face contact in care centres. Many of these services are newly created giving job opportunities to nurses working in this area. It is vital that nurses know what their role entails but also that patients and other professionals know how out-of-hours nurses function in terms of competence and clinical role. Content analysis of out-of-hours job descriptions. Content analysis of a convenience sample of 16 job descriptions of out-of-hours nurses from five out-of-hours care providers across England was undertaken. The findings were narratively synthesised, supported by tabulation. Key role descriptors were examined in terms of job titles, managerial skills, clinical skills, professional qualifications and previous experience. Content analysis of each out-of-hours job description revealed a lack of consensus in clinical competence and skills required related to job title although there were many similarities in skills across all the roles. This study highlights key differences and some similarities between roles and job titles in out-of-hours nursing but requires a larger study to inform workforce planning. Out-of-hours nursing is a developing area of practice which requires clarity to ensure patient safety and quality care. © 2016 John Wiley & Sons Ltd.
Hofoss, Dag; Grimsmo, Anders; Hellesø, Ragnhild
Background Nurses providing home health care services are dependent on access to patient information and communicating with general practitioners (GPs) to deliver safe and effective health care to patients. Information and communication technology (ICT) systems are viewed as powerful tools for this purpose. In Norway, a standardized electronic messaging (e-messaging) system is currently being established in health care. Objective The aim of this study was to explore home health care nurses’ assessments of the utility of the e-messaging system for communicating with GPs and identify elements that influence the assessment of e-messaging as a useful communication tool. Methods The data were collected using a self-developed questionnaire based on variables identified by focus group interviews with home health care nurses (n=425) who used e-messaging and existing research. Data were analyzed using logistic regression analyses. Results Over two-thirds (425/632, 67.2%) of the home health care nurses returned the questionnaire. A high proportion (388/399, 97.2%) of the home health care nurses who returned the questionnaire found the e-messaging system to be a useful tool for communication with GPs. The odds of reporting that e-messaging was a useful tool were over five times higher (OR 5.1, CI 2.489-10.631, Pmessaging was easy to use. The odds of finding e-messaging easy to use were nearly seven times higher (OR 6.9, CI 1.713-27.899, P=.007) if the nurses did not consider the system functionality poor. If the nurses had received training in the use of e-messaging, the odds were over six times higher (OR 6.6, CI 2.515-17.437, Pmessaging easy to use. The odds that a home health care nurse would experience e-messaging as easy to use increased as the full-time equivalent percentage of the nurses increased (OR 1.032, CI 1.001-1.064, P=.045). Conclusions This study has shown that technical (ease of use and system functionality), organizational (training), and individual (full
Goldberg, Sarah Elizabeth; Cooper, Jo; Blundell, Adrian; Gordon, Adam Lee; Masud, Tahir; Moorchilot, Ravisankar
advanced nurse practitioners (ANPs) are experienced nurses who undertake some activities traditionally performed by medical staff. There are four pillars of advanced practice: advanced clinical skills, leadership, education and research. ANPs are starting to specialise in the management of older adults with frailty in the acute hospital. However, the role and competencies required for this have not been well defined. This study aimed to establish an expert consensus on the role description and essential competencies for ANPs working with older people with frailty to develop a curriculum. a literature review and workshops including multi-professional and lay representatives generated a role description and a list of 69 competencies. A modified Delphi process was then conducted with three rounds involving a panel of 31 experts including representatives from the RCN, BGS Education and Training Committee, BGS Senior Nurses and Practitioners Group, Chartered Society of Physiotherapy Older People Network, College of Occupational Therapists Older People Specialist Section and lay representatives. Consensus on the statements was established by 70% panel agreement. the role description reached 100% agreement within three rounds. Twenty-five essential competencies were agreed after Round 1, increasing to 43 after Round 2 and 49 after Round 3. this Delphi study has allowed, for the first time, a national panel of clinical experts and lay representatives to refine and agree a set of competencies for ANPs working with older people with frailty. It is the first step towards ensuring consistency in the training of ANPs in geriatric medicine. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Mortensen Anne Mette M
Full Text Available Abstract Background Surprisingly little is known about the most efficient organization of admissions to an emergency hospital. It is important to know, who should be in front when the GP requests an acute admission. The aim of the study was to analyse how experienced ED nurses perform when assessing requests for admissions, compared with hospital physicians. Methods Before- and after ED nurse assessment study, in which two cohorts of patients were followed from the time of request for admission until one month later. The first cohort of patients was included by the physicians on duty in October 2008. The admitting physicians were employed in the one of the specialized departments and only received request for admission within their speciality. The second cohort of patients was included by the ED in May 2009. They received all request from the GPs for admission, independent of the speciality in question. Results A total of 944 requests for admission were recorded. There was a non-significant trend towards the nurses admitting a smaller fraction of patients than the physicians (68 versus 74%. While the nurses almost never rejected an admission, the physicians did this in 7% of the requests. The nurses redirected 8% of the patients to another hospital, significantly more than the physicians with only 1%. (p Conclusions We found no differences in the frequency of admitted patients or unnecessary admissions, but the nurses redirected significantly more patients to the right hospital according to the catchment area, and used only half the time for the assessment. We find, that nurses, trained for the assignment, are able to handle referrals for emergency admissions, but also advise the subject to be explored in further studies including other assessment models and GP satisfaction.
van Rossem, Carolien; Spigt, Mark; Viechtbauer, Wolfgang; Lucas, Annelies E M; van Schayck, Onno C P; Kotz, Daniel
To study the effectiveness of intensive counselling by a practice nurse (PN) versus brief advice by a general practitioner (GP), each combined with pharmacotherapy, for 6 months' tobacco abstinence (primary outcome). Secondary outcomes included 12-month abstinence, medication adherence and incremental costs per life-year gained. A multi-site (n = 10), two-group, parallel, pragmatic randomized controlled trial. A network of primary health-care centres in the Netherlands. A total of 295 adult daily smokers (mean age = 48 years; mean cigarettes/day = 19). Patients were randomized to receive individual counselling by a practice nurse (PN) (n = 149) or brief advice by a general practitioner (GP) (146). All patients received 12 weeks of open-label varenicline. The primary outcome was prolonged biochemically validated abstinence from weeks 9 to 26 after treatment initiation. Secondary outcomes included abstinence from weeks 9 to 52, good dosing adherence (> 80% days taken) and incremental costs per life-year gained. Abstinence rates in the PN versus GP groups were 32.2% (n = 48) versus 39.0% [n = 57; odds ratio (OR) = 0.71; 95% confidence interval (CI) = 0.44-1.16] from weeks 9 to 26 and 25.5% (n = 38) versus 28.8% (n = 42; OR = 0.84, 95% CI = 0.50-1.43) from weeks 9 to 52, respectively. Values of the Bayes factor indicated that the PN and GP were equally effective. Good dosing adherence was significantly lower in the PN (45.5%, n = 56/123) than in the GP group (62.0%, n = 75/121; OR = 0.45, 95% CI = 0.26-0.77), and the incremental costs per life-year gained were -€416.10. Among people seeking help to stop smoking from their general practice, one-off brief advice from a general practitioner appears to be as effective as several sessions of behavioural support from a practice nurse when smoking cessation medication is provided. © 2017 Society for the Study of Addiction.
Almeida, Fabiane de Amorim; Moraes, Mariana Salim de; Cunha, Mariana Lucas da Rocha
To understand the experiences of nurses when caring for dying newborns and their families in the NICU; and redeem their perceptions about acting before the death and grieving process. A descriptive exploratory study with a qualitative approach, developed with nine nurses at the ICU of a hospital in São Paulo (SP), Brazil. Data was collected through semi-structured interviews and analyzed using the Collective Subject Discourse (CSD). Caring for newborns who are dying and their families is very difficult for nurses, due to the intense involvement. They seek strategies to deal with the situation and, before the newborn's death, despite the suffering, express the feeling of accomplishment. Facing death and grief triggers mechanisms that emerge life references, coming across painful issues. Learning to deal with these questions is a daily challenge for nurses of the NICU. Compreender as experiências vivenciadas por enfermeiros ao cuidar de neonatos que estão morrendo e seus familiares na UTIN; e resgatar as suas percepções sobre a atuação diante do processo de morte e luto. Estudo descritivo exploratório, de abordagem qualitativa, desenvolvido com nove enfermeiras da UTIN de um hospital de São Paulo (SP), Brasil. Os dados foram coletados por meio de entrevista semi-estruturada e analisados pela técnica do Discurso de Sujeito Coletivo (DSC). Cuidar de neonatos que estão morrendo e suas famílias é muito difícil para as enfermeiras, devido ao intenso envolvimento. Buscam estratégias para lidar com a situação e, diante do óbito do neonato, apesar do sofrimento, manifestam o sentimento de dever cumprido. Enfrentar a morte e o luto aciona mecanismos que afloram referências de vida, deparando-se com questões dolorosas. Aprender a lidar com essas questões é um desafio diário para os enfermeiros de UTIN.
Approximately 6% of births worldwide, 7.9 million children, are born with a serious genetic congenital abnormality each year. A factor thought to increase the prevalence of birth defects is parental consanguinity, which is a social custom practiced in at least 20% of the world's population. The purpose of this article is to explore the relationship between consanguinity and congenital defects. This article also aims to enhance neonatal healthcare practitioners' comprehension of its implications for practice and research. A review of literature was compiled from a search of the online databases Cumulative Index of Nursing and Allied Health (CINAHL), PubMed, EBSCO MegaFILE, and Google Scholar. Literature pertinent to this topic primarily consists of research studies that examine the inbreeding depression phenomenon through comparison of the prevalence of birth defects among the offspring of consanguineous and nonconsanguineous couples. Current studies indicate that the progeny of consanguineous couples are at an increased risk of congenital defects compared with those of nonconsanguineous couples. Consanguinity is one risk factor among many that can lead to a major birth defect. Relationships between consanguineous populations and neonatal healthcare practitioners such as registered nurses, advanced practice nurses, and physicians could significantly alter neonatal health outcomes. Specific recommendations such as genetic counseling and therapeutic communication are discussed. Further studies need to investigate the connection between consanguinity and birth defects while controlling for nongenetic variables. Moreover, a focus on consanguineous communities in the United States would prove beneficial.
Social Media for Nurses - Educating Practitioners and Patients in a Networked World Nelson Ramona Social Media for Nurses - Educating Practitioners and Patients in a Networked World 284pp Springer Publishing Company 9780826195883 0826195881 [Formula: see text].
This book's three American authors describe how social media is changing the way nurses and patients interact. They argue that not only do healthcare professionals need to establish their telepresence, they also have a responsibility to educate patients to use Health 2.0 tools in managing their health and health care.
Jecilea Pereira Barbosa
Full Text Available Resumo: Este estudo aborda a manutenção do Cateter Venoso Central de Inserção Periférica, sendo ela um dos episódios mais comuns utilizadas nas Unidades de Terapia Intensiva Neonatal, objetivando identificar as dificuldades encontradas pelo enfermeiro na manutenção desse cateter, de modo a contribuir para melhoria da assistência prestada ao recém-nascido. Para tanto, foi realizada uma pesquisa exploratória, descritiva, bibliográfica com abordagem qualitativa realizada na Biblioteca Virtual de Saúde (LILACS E BDENF.Após a coleta de dados foi realizada uma leitura exploratória, seletiva,critica e analise temática,emergindo as seguintes categorias:Principais dificuldades encontradas na manutenção do PICC e A importância do papel do enfermeiro na manutenção do PICC.Concluímos então que se faz necessário o conhecimento teórico prático do enfermeiro na implantação, manutenção e remoção do PICC reduzindo a dificuldade de utilização desse cateter para um tratamento de qualidade.
Bellini, Lisa M; Shea, Judy A
Nurse practitioners (NPs) are assuming larger roles in many residency programs as a result of work hour reform, which is creating the potential for collaboration with interns and residents. To assess housestaff perceptions of NPs. We used a 17-item survey before and after the implementation of a collaborative care model in a university-based medicine residency. The majority of residents held favorable attitudes about NPs before the introduction of the collaborative care model. After 1 year, more interns and residents appreciated NPs' clinical judgment (effect size [ES] = .26, p =.02), thought they should be able to order laboratory tests (ES = .23, p = .05) and perform basic procedures (ES = .67, p collaborative care can be an unintended consequence of work hour reform. Educators are encouraged to think about how changes in the curriculum structure can provide opportunities for positive collaborative care experiences.
Holm, Kristina Garne
Neonatal homecare (NH) implies that parents manage tube feeding and care of their preterm infant at home supported by home visits from neonatal nurses, to monitor infant growth and the well-being of the family. Home visits are costly and time consuming in rural areas. The overall aim of this study...
Knowledge Translation to Advance the Nurse Practitioner Role in British Columbia: Researchers and decision-makers conduct policy-relevant research to guide legislative and regulatory development and the design of a nurse practitioner education program.
MacDonald, Marjorie; Regan, Sandra; Davidson, Heather; Schreiber, Rita; Crickmore, Jane; Moss, Lesley; Pinelli, Janet; Pauly, Bernadette
This project brought together a team of researchers and decision-makers to conduct policy-relevant research to support the introduction of advanced nursing practice roles in British Columbia. All team members, including decision-makers, were actively involved in the conceptualization, design, data collection, analysis and interpretation of the study. This level of engagement, coupled with ongoing knowledge translation (KT) activities, led to the implementation by stakeholders of a majority of...
Schuttelaar, M L A; Vermeulen, K M; Coenraads, P J
BACKGROUND: In a randomized, controlled trial (RCT) on childhood eczema we reported that substituting nurse practitioners (NPs) for dermatologists resulted in similar outcomes of eczema severity and in the quality of life, and higher patient satisfaction. OBJECTIVES: To determine costs and
Never have there been such a vast number of career opportunities for all levels of staff within the perioperative environment including healthcare support workers, operating department practitioners and nurses.
Neonates, especially those in neonatal intensive care units (NICU), are at high risk for infection. And nosocomial infections are responsible for almost 50% of the deaths that occur beyond 2 weeks of age. Advances in neonatal intensive care have resulted in survival of more low birth weight and sick infants. On the other hand, infection control measures in NICU are hard to say that we established. Therefore it is often that infection control measure in NICU of our country is taken in original...
Strandberg, Eva Lena; Ovhed, Ingvar; Borgquist, Lars; Wilhelmsson, Susan
Background The definition of primary care varies between countries. Swedish primary care has developed from a philosophic viewpoint based on quality, accessibility, continuity, co-operation and a holistic view. The meaning of holism in international literature differs between medicine and nursing. The question is, if the difference is due to different educational traditions. Due to the uncertainties in defining holism and a holistic view we wished to study, in depth, how holism is perceived by doctors and nurses in their clinical work. Thus, the aim was to explore the perceived meaning of a holistic view among general practitioners (GPs) and district nurses (DNs). Methods Seven focus group interviews with a purposive sample of 22 GPs and 20 nurses working in primary care in two Swedish county councils were conducted. The interviews were transcribed verbatim and analysed using qualitative content analysis. Results The analysis resulted in three categories, attitude, knowledge, and circumstances, with two, two and four subcategories respectively. A professional attitude involves recognising the whole person; not only fragments of a person with a disease. Factual knowledge is acquired through special training and long professional experience. Tacit knowledge is about feelings and social competence. Circumstances can either be barriers or facilitators. A holistic view is a strong motivator and as such it is a facilitator. The way primary care is organised can be either a barrier or a facilitator and could influence the use of a holistic approach. Defined geographical districts and care teams facilitate a holistic view with house calls being essential, particularly for nurses. In preventive work and palliative care, a holistic view was stated to be specifically important. Consultations and communication with the patient were seen as important tools. Conclusion 'Holistic view' is multidimensional, well implemented and very much alive among both GPs and DNs. The word
Mahl, Sukhy; Lee, Shoo K; Baker, G Ross; Cronin, Catherine M G; Stevens, Bonnie; Ye, Xiang Y
Studies of adult patient populations suggest that organizational culture is associated with quality improvement (QI) implementation, as well as patient outcomes. However, very little research on organizational culture has been performed in neonatal patient populations. This combined cross-sectional survey and retrospective cohort study assessed employee perceptions of organizational culture and QI implementation within 18 Canadian neonatal intensive care units. The associations between these data and neonatal outcomes in extremely preterm infants (born at culture and QI implementation varied according to occupation and age. Higher hierarchical culture was associated with increased survival without major morbidities (odds ratio, 1.04; 95% confidence interval, 1.01-1.06), as were higher QI implementation scores (odds ratio range, 1.20-1.36 by culture type). Our data suggest that organizational culture, particularly hierarchical culture, and level of QI implementation may play a role in neonatal outcomes. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
森田, 敏子; モリタ, トシコ; Morita, Toshiko
Higher nursing ethics can raise nursing quality. The author attempts to define theproblem from the seedling of sensibility in practical nursing and focuses on the clinical environment surrounding nursing ethics from its pedagogical and historicalaspects. On the basis of these standpoints, the author discusses issues on the practical nursing as a practitioner of nursing ethics.
Bunker Jeremy M
Full Text Available Abstract Background Chronic Obstructive Pulmonary Disease (COPD is a leading cause of disability, hospitalization, and premature mortality. General practice is well placed to diagnose and manage COPD, but there is a significant gap between evidence and current practice, with a low level of awareness and implementation of clinical practice guidelines. Under-diagnosis of COPD is a world-wide problem, limiting the benefit that could potentially be achieved through early intervention strategies such as smoking cessation, dietary advice, and exercise. General practice is moving towards more structured chronic disease management, and the increasing involvement of practice nurses in delivering chronic care. Design A pragmatic cluster randomised trial will test the hypothesis that intervention by a practice nurse-general practitioner (GP team leads to improved health-related quality of life and greater adherence with clinical practice guidelines for patients with newly-diagnosed COPD, compared with usual care. Forty general practices in greater metropolitan Sydney Australia will be recruited to identify patients at risk of COPD and invite them to attend a case finding appointment. Practices will be randomised to deliver either practice nurse-GP partnership care, or usual care, to patients newly-diagnosed with COPD. The active intervention will involve the practice nurse and GP working in partnership with the patient in developing and implementing a care plan involving (as appropriate, smoking cessation, immunisation, pulmonary rehabilitation, medication review, assessment and correction of inhaler technique, nutritional advice, management of psycho-social issues, patient education, and management of co-morbidities. The primary outcome measure is health-related quality of life, assessed with the St George’s Respiratory Questionnaire 12 months after diagnosis. Secondary outcome measures include validated disease-specific and general health related
Hubbert, Ann O
The paper presents a historically unique partnership between an American Southwestern, Catholic faith-based, urban hospital and a program it sponsored on the spirituality of American Indian Traditional Indian Medicine (TIM) by a Comanche medicine man. A discussion is offered on the cultural partnerships, experiences and benefits achieved through the cultural accommodations of these spiritual beliefs and practices within this healthcare system. The theory of Culture Care Diversity and Universality (Culture Care Theory), including the Sunrise Enabler, is applied in discussion of these past experiences to explore the relationships among and between the participating cultures. The intent of the partnerships within this program was not to 'learn Indian healing ceremonies' but to share the philosophy of TIM with all people (clients and professionals) as a means to enhance their own way of living. Examples of actual nursing decisions and actions are provided including outcomes from the program within the healthcare system and globally.
Faustine K. Nkulu Kalengayi
Full Text Available Background: Screening newly arrived migrants from countries with high burden of communicable diseases of public health significance is part of the Swedish national strategy against the spread of these diseases. However, little is known about its implementation. Objective: This study aimed at exploring caregivers’ experiences in screening newly arrived migrants to generate knowledge that could inform policy and clinical practice. Design: Using an interpretive description framework, we conducted semistructured interviews between November and December 2011 in four Swedish counties, with 15 purposively selected nurses with experience in screening migrants. Data were analyzed using thematic analysis. Results: Participants described a range of challenges including discordant views between migrants and the nurses about medical screening, inconsistencies in rules and practices, and conflicting policies. Participants indicated that sociocultural differences resulted in divergent expectations with migrants viewing the participants as agents of migration authorities. They also expressed concern over being given a new assignment without training and being expected to share responsibilities with staff from other agencies without adequate coordination. Finally, they indicated that existing policies can be confusing and raise ethical issues. All these were compounded by language barriers, making their work environment extremely complex and stressful. Conclusions: These findings illuminate complex challenges that could limit access to, uptake, and delivery of health screening and undermine public health goals, and highlight the need for a multilevel approach. This entails avoiding the conflation of migration with health issues, harmonizing existing policies to make health care services more accessible and acceptable to migrants, and facilitating health professionals’ work in promoting public health, improving interagency collaboration and the skills of all
Kolb, Noah Allan; Smith, Albert Gordon; Singleton, John Robinson; Beck, Susan L; Howard, Diantha; Dittus, Kim; Karafiath, Summer; Mooney, Kathi
The purpose of this study was to evaluate a new care model to reduce chemotherapy-induced neuropathic symptoms. Neuropathic symptom usual care was prospectively compared to an automated symptom-monitoring and coaching system, SymptomCare@Home (SCH), which included nurse practitioner follow-up triggered by moderate to severe symptoms. Patients beginning chemotherapy were randomized to usual care (UC) or to the SCH intervention. This sub-analysis included only taxane/platin therapies. Participants called the automated telephone symptom-monitoring system daily to report numbness and tingling. The monitoring system recorded patient-reported neuropathic symptom severity, distress, and activity interference on a 0-10 scale. UC participants were instructed to call their oncologist for symptom management. SCH participants with symptom severity of ≥ 4 received automated self-care strategies, and a nurse practitioner (NP) provided guideline-based care. There were 252 participants, 78.6% of which were female. Mean age was 55.1 years. Mean follow-up was 90.2 ± 39.9 days (81.1 ± 40.3 calls). SCH participants had fewer days of moderate (1.8 ± 4.0 vs. 8.6 ± 17.3, p < 0.001) and severe chemotherapy-induced peripheral neuropathy symptoms (0.3 ± 1.0 vs. 1.1 ± 5.2, p = 0.006). SCH participants had fewer days with moderate and severe symptom-related distress (1.4 ± 3.7 vs. 6.9 ± 15.0, p < 0.001; 0.2 ± 0.9 vs. 1.5 ± 6.1, p = 0.001) and trended towards less activity interference (3.3 ± 1.9 vs. 3.8 ± 2.1, p = 0.08). Other neuropathic symptoms were addressed in 5.8-15.4% of SCH follow-up calls. The SCH system effectively identified neuropathic symptoms and their severity and, paired with NP follow-up, reduced symptom prevalence, severity, and distress compared to usual care.
Full Text Available Background: The shortage of nurses in public healthcare facilities in South Africa is well documented; finding creative solutions to this problem remains a priority. Objective: This study sought to establish the amount of time that clinical nurse practitioners (CNPs in one district of the Western Cape spend on clinical services and the implications for staffing and skills mix in order to deliver quality patient care. Methods: A descriptive cross-sectional study was conducted across 15 purposively selected clinics providing primary health services in 5 sub-districts. The frequency of activities and time CNPs spent on each activity in fixed and mobile clinics were recorded. Time spent on activities and health facility staff profiles were correlated and predictors of the total time spent by CNPs with patients were identified. Results: The time spent on clinical activities was associated with the number of CNPs in the facilities. CNPs in fixed clinics spent a median time of about 13 minutes with each patient whereas CNPs in mobile clinics spent 3 minutes. Fixed-clinic CNPs also spent more time on their non-core functions than their core functions, more time with patients, and saw fewer patients compared to mobile-clinic CNPs. Conclusions: The findings give insight into the time CNPs in rural fixed and mobile clinics spend with their patients, and how patient caseload may affect consultation times. Two promising strategies were identified – task shifting and adjustments in health workerd eployment – as ways to address staffing and skills mix, which skills mix creates the potential for using healthcare workers fully whilst enhancing the long-term health of these rural communities.
Ferreira, Tadeu Sartini; Moreira, Clarice Zinato; Guo, James; Noce, Franco
To assess the effect of a 12-hour shift on mood states and sleepiness at the beginning and end of the shift. Quantitative, cross-sectional and descriptive study.It was conducted with 70 neonatal intensive care unit nurses. The Brunel Mood Scale (BRUMS), Karolinska Sleepiness Scale (KSS), and a socio-demographic profile questionnaire were administered. When the KSS and BRUMS scores were compared at the beginning of the shift associations were found with previous sleep quality (p ≤ 0.01), and quality of life (p ≤ 0.05). Statistical significant effects on BRUMS scores were also associated with previous sleep quality, quality of life, liquid ingestion, healthy diet, marital status, and shift work stress. When the beginning and end of the shift were compared, different KSS scores were seen in the group of all nurses and in the night shift one. Significant vigor and fatigue scores were observed within shift groups. A good night's sleep has positive effects on the individual`s mood states both at the beginning and the end of the shift. The self-perception of a good quality of life also positively influenced KSS and BRUMS scores at the beginning and end of the shift. Proper liquid ingestion led to better KSS and BRUMS scores. Evaluar el efecto de un turno de 12 horas en estados de ánimo y somnolencia al principio y al final del turno. Estudio cuantitativo, transversal y descriptivo.Se realizó con 70 enfermeras de unidades de cuidados intensivos neonatales. Se administró la Escala de Humor Brunel (BRUMS), la Escala de Somnolencia de Karolinska (KSS) y un cuestionario de perfil sociodemográfico. Cuando se compararon las puntuaciones de KSS y BRUMS al comienzo del turno se encontraron asociaciones con calidad de sueño previa (p ≤ 0,01) y calidad de vida (p ≤ 0,05). Los efectos estadísticos significativos en las puntuaciones de BRUMS también se asociaron con la calidad previa del sueño, la calidad de vida, la ingestión de líquidos, la dieta saludable, el
Bloomer, MJ; Endacott, R; Copnell, B; O’Connor, M
publisher: Elsevier articletitle: ‘Something normal in a very, very abnormal environment’ – Nursing work to honour the life of dying infants and children in neonatal and paediatric intensive care in Australia journaltitle: Intensive and Critical Care Nursing articlelink: http://dx.doi.org/10.1016/j.iccn.2015.09.001 content_type: article copyright: Copyright © 2015 Elsevier Ltd. All rights reserved.
Strand, Haakan; Fox-Young, Stephanie; Long, Phil; Bogossian, Fiona
This paper reports on a pilot project aimed at exploring postgraduate distance students' experiences using personal video capture technology to complete competency assessments in physical examination. A pre-intervention survey gathered demographic data from nurse practitioner students (n=31) and measured their information communication technology fluency. Subsequently, thirteen (13) students were allocated a hand held video camera to use in their clinical setting. Those participating in the trial completed a post-intervention survey and further data were gathered using semi-structured interviews. Data were analysed by descriptive statistics and deductive content analysis, and the Unified Theory of Acceptance and Use of Technology (Venkatesh et al., 2003) were used to guide the project. Uptake of the intervention was high (93%) as students recognised the potential benefit. Students were video recorded while performing physical examinations. They described high level of stress and some anxiety, which decreased rapidly while assessment was underway. Barriers experienced were in the areas of facilitating conditions (technical character e.g. upload of files) and social influence (e.g. local ethical approval). Students valued the opportunity to reflect on their recorded performance with their clinical mentors and by themselves. This project highlights the demands and difficulties of introducing technology to support work-based learning. Copyright © 2011 Elsevier Ltd. All rights reserved.
Hussein, A S; Ghanim, A M; Abu-Hassan, M I; Manton, D J
Molar-incisor hypomineralisation (MIH) is a global dental problem, yet little is known about the knowledge of the general dental practitioners (GDPs) and dental nurses (DNs) regarding this defect in South East Asia. To assess and compare the knowledge of the GDPs and DNs in Malaysia regarding the frequency of occurrence of MIH within their practice, its diagnosis, putative aetiological factors and management. A questionnaire was distributed to GDPs and DNs during a nationwide dental conference in Melaka, Malaysia and who were asked to answer questions about demographic variables, knowledge, attitudes and practices in the management of MIH. Descriptive statistics and bivariate analysis were performed. A 5% level of statistical significance was applied for the analyses. A response rate of 58.2% (131/225) was obtained. Most respondents were aware of MIH and encountered it in their practice (GDPs = 82.5%, DNs = 82.4%). The condition was observed by respondents less in primary molars compared to first permanent molars. Full agreement between GDPs and DNs did not exist concerning the aetiological factors and management of MIH. Glass ionomer cements were the most popular material used in treating MIH. Most respondents (GDPs = 93%, DNs = 76.5%) indicated that they had not received sufficient information about MIH and were willing to have clinical training in the diagnosis and therapeutic modalities of MIH. MIH is identified and encountered by most respondents. Agreement did not exist between GDPs and DNs concerning MIH frequency of occurrence within their practice, its diagnosis, aetiological factors and management.
Aberese-Ako, M.; Agyepong, I.A.; Gerrits, T.; van Dijk, H.
Background and Objectives: This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital. Methodology: The study used ethnographic methods including participant
Shimizu, Aya; Mori, Akiko
To evaluate maternal perceptions of family-centred support with hospitalised preterm infants and their relationship between mothers and nurses in the neonatal intensive care unit (NICU). Mothers who gave birth to preterm infants tend to suffer more stress and need individual support based on family-centred care. However, there may be a shortage of support for mothers to obtain parent-crafting skills before bringing their infants home. This cross-sectional study used path analysis and multiple group analysis to evaluate a structural equation model of the relationship between maternal perception based on family-centred support in parent-crafting training and the mothers-nurses collaboration. We analysed data from 98 mothers (valid response proportion, 41.0%) whose infants were hospitalised in the NICU of two types of perinatal centres in Japan. We used three revised standardised questionnaires in Japanese: Measure of Process of Care in the NICU (Neo-MPOC 20), Enabling Practice Scale in the NICU (Neo-EPS) and the author-developed Mother and Infant Questionnaire. Path analysis revealed that the relationship between mothers and nurses was linked to three factors related to the perinatal centres' support: consideration of parents' feelings, ability to deal with specific needs and coordination in dealing with situations that interact with provision of parent-friendly visual information. Separate path analyses for each perinatal centre showed the same pattern, although the standard coefficients were different. Maternal perceptions of family-centred support with hospitalised preterm infants promoted better collaboration between mothers and nurses to obtain parent-crafting skills at two types of perinatal units in Japan. Clear visual information materials might promote better maternal understanding of their infants, help in acquisition of parent-crafting skills and improve mother-nurse collaboration, with the result that mothers are better able to care for their infants
Seid, Sheka Shemsi; Sendo, Endalew Gemechu
In Ethiopia, one in 17 children dies before 1 year of age and one in 11 children dies before 5 years. Research that examines the factors influencing the implementation of the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) strategy in Ethiopia is limited. This study aimed to identify the factors compelling the execution of IMNCI by nurses in four districts of West Arsi zone of Ethiopia. A mixed-method cross-sectional study was conducted from February to March 2016 in West Arsi zone of Oromia regional state, Ethiopia. A total of 185 Integrated Management of Childhood Illness (IMCI)-trained registered nurses working at Under-Five Clinic were purposively chosen for the study among 291 registered nurses based at health centers and hospitals in the Arsi zone. The study was complemented by a qualitative method. More than half (57.8%) of the nurses interviewed had been trained (51.35% of them attended in-service training). The most common issues encountered in the implementation of IMCI were: lack of trained staff (56.2%), lack of essential drugs and supplies (37.3%), and irregular supportive supervision (89.2%). The qualitative data supplemented the factors that influence IMNCI implementation, including drug unavailability, lack of human resources, and lack of effective supportive supervision and follow-up visits. Therefore, interventions aiming at training nurses, with emphasis on performing supportive consistent supervision and supporting the system of health care by enhancing admittance to indispensable drugs and supplies, are recommended to help IMCI implementation.
Sasaki, Hatoko; Yonemoto, Naohiro; Mori, Rintaro; Nishida, Toshihiko; Kusuda, Satoshi; Nakayama, Takeo
Although communication among health providers has become a critical part of improving quality of care, few studies on this topic have been conducted in Japan. This study aimed to examine the reliability and validity of the Intensive Care Unit Nurse-Physician Questionnaire (ICU N-P-Q) for use among nurses and physicians in neonatal ICUs (NICUs) in Japan. A Japanese translation of the ICU N-P-Q was administered to physicians and nurses working at 40 NICUs across Japan, which were participating in the Improvement of NICU Practice and Team Approach Cluster randomized controlled trial (INTACT). We used the principal components analysis to evaluate the factor structure of the instruments. Convergent validity was assessed by examining correlations between the subscales of Communication and Conflict Management of the ICU N-P-Q and the subscales and total score of the Nurse-Physician Collaboration Scale (NPCS). Correlations between the subscales of Communication and Conflict Management by correlation with scales that refer to performance, including Job Satisfaction and Unit Effectiveness, were calculated to test the criterion validity. In total, 2006 questionnaires were completed by 316 physicians and 1690 nurses. The exploratory factor analysis revealed 15 factors in the physicians' questionnaire and 12 in the nurses' questionnaire. Convergent validity was confirmed, except for 'Between-group Accuracy' and 'Cooperativeness' in the physicians' scale, and for 'Between-group Accuracy' and 'Sharing of Patient Information' in the nurses' scale. Correlations between the subscales of communication and outcomes were confirmed in the nurses' questionnaire but were not fully supported in the physicians' questionnaire. Although the psychometric property behaved somewhat differently by occupation, the present findings provide preliminary support for the utility of the common item structure with the original scale, to measure the degree and quality of communication and collaboration
... Home > Complications & Loss > Loss & grief > Neonatal death Neonatal death E-mail to a friend Please fill in ... cope with your baby’s death. What is neonatal death? Neonatal death is when a baby dies in ...
Prasad, Sadhana; Dunn, Wendy; Hillier, Loretta M; McAiney, Carrie A; Warren, Rex; Rutherford, Paul
This article describes the implementation of the Care for Seniors model of care, an innovative approach to improving care coordination and integration, and provides preliminary evidence of effective use of specialist resources and acute care services. Retrospective. Primary care; cross-sector. Older adults living in a rural area in southwestern Ontario, Canada. Number of new geriatrician referrals and follow-up visits before and after the launch of the Care for Seniors program, number of Nurse Practitioner visits in a primary care setting, in-home, retirement home and hospital, number of discharges home from hospital and length of hospital stay between. In the 2 years before the launch of the program, the total number of visits to the geriatrician for individuals from this FHT was relatively low, 21 and 15, respectively for 2005-06 and 2006-07, increasing to 73 for the 2011-12 year. Although the absolute number of individuals supported by the NP-Geri has remained relatively the same, the numbers seen in the primary care office or in the senior's clinic has declined over time, and the number of home visits has increased, as have visits in the retirement homes. The percentage of individuals discharged home increased from 19% in 2008-09 to 31% in 2009-10 and 26% in 2011-12 and the average length of stay decreased over time. This model of care represents a promising collaboration between primary care and specialist care for improving care to frail older adults living in rural communities, potentially improving timely access to health care and crisis intervention. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
unit lacked sufficient NICU equipment. The aims of the ... staff on duty, admission room care for all neonates from the Leratong .... home (29%) or from another facility (4%). ..... The work load, coupled with shortage of trained nurses during.
Chen, Chiao-Min; Lin, Kai-Hui; Su, Hsiu-Ya; Lin, Mei-Hsiang; Hsu, Chu-Ling
Nesting and positioning is a common nursing skill used in the developmental care of premature infants. This skill maintains premature infants in a comfortable position, facilitates the monitoring of stable vital signs, and enables spontaneous motor activity for normal neuromuscular and skeletal joint function. This project was designed to improve nursing staff cognition and skills regarding nesting and positioning for premature infants in the NICU. Strategies used in this project were: develop an infant position assessment tool; record a demonstration video about nesting and positioning skills to provide learning efficacy among the nursing staff; and modify an education program for new nurses. After implementation, nurse cognition regarding premature infant nesting and positioning increased from 58.3% to 92.3%. The rate of correct technique use similarly rose from 63.3% to 91.4%. This is a valid intervention for improving the correctness of nesting and positioning in nursing care. This project standardized education in terms of nesting and positioning practice goals and enhanced quality care for premature infants.
Magluta, Cynthia; Gomes, Maria A de Sousa Mendes; Wuillaume, Susana M
Clinical guidelines are tools that systematize scientific evidence and help to achieve proper care. Several difficulties are reported regarding the effective use, such as the shortcomings in the level of knowledge and attitudes by the professionals, the service structure and the preferences appointed by patients. An analysis of these difficulties was the objective of this study in the context of government Neonatal Intensive Care Units (NICU) in Brazil. A semi-structured survey was carried out with 53 managers (medical and nursing) of the 15 NICU in a convenient sample of two groups of government units in Brazil. The managers chose their answers from a list of difficulties to implement the guidelines based on the analytical model of Cabana and graded the difficulties found on a 5-point scale with no reference to quality. Respondents have reported several difficulties with the following priority: lack of professionals to provide care, being perceived as more critical within the nursing and physiotherapy crews, minor participation of professionals in the discussion process and inadequate infrastructure. The lack of acquaintance with the guidelines by the professionals has been reported by few of the surveyed. These findings show some common ground to literature pointing the importance of adequate infrastructure. Managers showed a low valuation of both the level of knowledge and the professionals' adhesion to the guidelines. © 2011 Blackwell Publishing Ltd.
Fondiller, Shirley H.; And Others
Looks at the lives and accomplishments of four leaders in professional nursing: (1) Loretta Ford, who championed the cause of nurse practitioners; (2) Mable Staupers, a pioneer in community health and nursing; (3) Janet Geister, a leader in private nursing; and (4) Isabel Stewart, who led the movement to standardize nursing education. (JOW)
Tecnologia educacional em saúde: contribuições para a enfermagem pediátrica e neonatal Tecnología educativa en salud: contribuciones para la enfermería pediátrica y neonatal Educational technology in health: contributions for pediatric and neonatal nursing
Luciana Mara Monti Fonseca
pediatric and neonatal nursing teaching and practice, is pointed out. Technological resources in educational materials have been used in a progressively motivating and interactive pedagogical relationship, aiming to offer a more motivating learning for students, nursing teams, children and their families. This report describes the experience of a research and study group in the development of materials targeting permanent training and education in the area of pediatric and neonatal nursing. Health education for children and their relatives on different themes that permeates this care was also targeted. The developed educational materials permit students, health professionals and clients to experience the teaching and learning process in a stimulating way, facilitating the clarification of doubts and transforming learning through attractive, innovative and illustrative situations.
Koyamaibole, Lanieta; Kado, Joseph; Qovu, Josaia D; Colquhoun, Samantha; Duke, Trevor
To describe the implementation of bubble-CPAP in a referral hospital in a developing country and to investigate: the feasibility of nurses implementing bubble-CPAP and the impact of bubble-CPAP on need for mechanical ventilation and mortality. Retrospective evaluation of prospectively collected data from two time periods: 18 months before and 18 months after the introduction of bubble-CPAP. The introduction of bubble-CPAP was associated with a 50 per cent reduction in the need for mechanical ventilation; from 113 of 1,106 (10.2 per cent) prior to bubble-CPAP to 70 of 1,382 (5.1%) after introduction of CPAP (chi2, pCPAP there were 79 deaths (case fatality of 7.1 per cent). In the 18 months after bubble-CPAP there were 74 deaths (CF 5.4 per cent), relative risk: 0.75 (0.55-1.02, chi2, p=0.065). Nurses could safely apply bubble-CPAP after 1-2 months of on-the-job training. Equipment for Bubble-CPAP cost 15 per cent of the cost of the cheapest mechanical ventilator. The introduction of bubble-CPAP substantially reduced the need for mechanical ventilation, with no difference in mortality. In models of neonatal care for resource-limited countries, bubble-CPAP may be the first type of ventilatory support that is recommended. Its low cost and safety when administered by nurses makes it ideal for this purpose. Bubble-CPAP has the potential for being available at even lower cost than the current commercially available bubble systems used in this study.
Amalgamation of Marginal Gains (AMG) as a potential system to deliver high-quality fundamental nursing care: A qualitative analysis of interviews from high-performance AMG sports and healthcare practitioners.
Pentecost, Claire; Richards, David A; Frost, Julia
To investigate the components of the Amalgamation of Marginal Gains (AMG) performance system to identify a set of principles that can be built into an innovative fundamental nursing care protocol. Nursing is urged to refocus on its fundamental care activities, but little evidence exists to guide practising nurses. Fundamental care is a combination of many small behaviours aimed at meeting a person's care needs. AMG is a successful system of performance management that focusses on small (or marginal) gains, and might provide a new delivery framework for fundamental nursing care. Qualitative interview study. We undertook in-depth interviews with healthcare and sports professionals experienced in AMG. We analysed data using open coding in a framework analysis, and then interrogated the data using Normalisation Process Theory (NPT). We triangulated findings with AMG literature to develop an intervention logic model. We interviewed 20 AMG practitioners. AMG processes were as follows: focusing on many details to optimise performance, identification of marginal gains using different sources, understanding current versus optimum performance, monitoring at micro and macro level and strong leadership. Elements of normalisation were as follows: whole team belief in AMG to improve performance, a collective desire for excellence using evidence-based actions, whole team engagement to identify choose and implement changes, and individual and group responsibility for monitoring performance. We have elicited the processes described by AMG innovators in health care and sport and have mapped the normalisation potential and work required to embed such a system into nursing practice. The development of our logic model based on AMG and NPT may provide a practical framework for improving fundamental nursing care and is ripe for further development and testing in clinical trials. © 2017 The Authors Journal of Clinical Nursing Published by John Wiley & Sons Ltd.
Browning, Laura; Ryan, Carey S; Thomas, Scott; Greenberg, Martin; Rolniak, Susan
We examined the relationship between perceived control and burnout among three nursing specialties: nurse practitioners, nurse managers, and emergency nurses. Survey data were collected from 228 nurses from 30 states. Findings indicated that emergency nurses had the least control and the highest burnout, whereas nurse practitioners had the most control and the least burnout. Mediational analyses showed that expected control, hostility, and stressor frequency explained differences between specialties in burnout. The implications of these findings for interventions that reduce burnout and promote nursing retention are discussed.
Promoção de vínculo afetivo na Unidade de Terapia Intensiva Neonatal: um desafio para as enfermeiras Promoción de vínculo afectivo en la Unidad de Terapia Intensiva Neonatal: un desafío para las enfermeras Promoting affective attachment at the neonatal intensive care unit: a challenge for nurses
Claudete Aparecida Conz
las enfermeras se perciben como un elemento de aproximación entre hijos y padres y creen que ejercen un papel importante en la formación de un vínculo afectivo entre ellos.The study was motivated by observations of the routine at neonatal intensive care units (NICU, thoughts about the dichotomy between theory, discourse, and the practice of many nurses towards the newborns' parents. The objectives were to learn about nurses' experiences regarding neonatal care to newborns and their parents, and to understand how nurses experience the process of affective attachment between newborns hospitalized at NICUs and their parents. This study was developed according to the social phenomenology approach of Alfred Schütz. Study subjects were eight practical nurses who had worked at NICU of public and private hospitals. Categories of experience emerged from the discourses, including Human Contact. The analysis revealed that nurses see themselves as the connection between parents and children, and believe they play an important role in creating the affective attachment between parent and child.
Benoit, Britney; Semenic, Sonia
To explore manager, educator, and clinical leader perceptions of barriers and facilitators to implementing Baby-Friendly practice in the neonatal intensive care unit (NICU). Qualitative, descriptive design. Two university-affiliated level-III NICUs in Canada. A purposive sample of 10 medical and nursing managers, nurse educators, lactation consultants, and neonatal nurse practitioners. In-depth, semistructured interviews transcribed and analyzed using qualitative content analysis. Participants valued breastfeeding and family-centered care yet identified numerous contextual barriers to Baby-Friendly care including infant health status, parent/infant separation, staff workloads and work patterns, gaps in staff knowledge and skills, and lack of continuity of breastfeeding support. Facilitators included breastfeeding education, breastfeeding champions, and interprofessional collaboration. Despite identifying numerous barriers, participants recognized the potential value of expanding the Baby-Friendly Hospital Initiative (BFHI) to the NICU setting. Recommendations include promoting BFHI as a facilitator of family-centered care, interdisciplinary staff education, increasing access to lactation consultants, and establishing a group of NICU champions dedicated to BFHI implementation. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.
Holm, Kristina Garne; Brødsgaard, Anne; Zachariassen, Gitte
participatory design and qualitative methods. Data were collected from observational studies, individual interviews, and focus group interviews. Two neonatal units participated. One unit was experienced in providing neonatal home care with home visits, and the other planned to offer neonatal home care......BACKGROUND: For the majority of preterm infants, the last weeks of hospital admission mainly concerns tube feeding and establishment of breastfeeding. Neonatal home care (NH) was developed to allow infants to remain at home for tube feeding and establishment of breastfeeding with regular home...... visits from neonatal nurses. For hospitals covering large regions, home visits may be challenging, time consuming, and expensive and alternative approaches must be explored. OBJECTIVE: To identify parental needs when wanting to provide neonatal home care supported by telemedicine. METHODS: The study used...
Fatores que tornam estressante o trabalho de médicos e enfermeiros em terapia intensiva pediátrica e neonatal: estudo de revisão bibliográfica Factors that cause stress in physicians and nurses working in a pediatric and neonatal intensive care unit: bibliographic review
Monalisa de Cássia Fogaça
Full Text Available OBJETIVOS: Revisão de literatura sobre estresse ocupacional e síndrome de burnout em médicos e enfermeiros que trabalham em unidade de terapia intensiva pediátrica e neonatal. MÉTODOS: Os artigos foram identificados a partir das bases de dados MedLine, LILACS e SciElo, usando as palavras-chave estresse, burnout, médicos, enfermagem, unidade de terapia intensiva, unidade de cuidados intensivos pediátricos e unidades de cuidados intensivos neonatais. O período pesquisado foi de 1990 a 2007. RESULTADOS: Médicos e enfermeiros que trabalham em unidade de terapia intensiva pediátrica e neonatal são candidatos a apresentarem estresse, alterações psicológicas e síndrome de Burnout. Pesquisas sobre o tema identificaram alterações importantes que acometem médicos e enfermeiros intensivistas: sobrecarga de trabalho, burnout, desejo de abandonar o trabalho e níveis elevados de cortisol entre outros fatores. CONCLUSÕES: Os profissionais que trabalham em unidade de terapia intensiva pediátrica e neonatal , pela especificidade do seu trabalho, estão expostos ao risco do estresse ocupacional e, conseqüentemente ao Burnout. Estes dados sugerem a necessidade de serem feitas pesquisas, com o objetivo de desenvolver medidas preventivas e modelos de intervenção.OBJECTIVES: Bibliographic review on occupational stress and burnout presence in physicians and nurses that work in pediatric and neonatal intensive care units. METHODS: The articles were selected from the MedLine, LILACS and SciElo data base using the key words: stress, burnout, physicians, nursing, intensive care unit, pediatric intensive care unit and neonatal intensive care unit. The studied period ranged from 1990 to 2007. RESULTS: Health professionals who work in pediatric and neonatal intensive care units are strong candidates for developing stress, psychological alterations and burnout syndrome. Researches on this subject identified important alterations suffered by these
Hämel, Kerstin; Vössing, Carina
Aim A comparative analysis of concepts and practices of GP-nurse collaborations in primary health centres in Slovenia and Spain. Cross-professional collaboration is considered a key element for providing high-quality comprehensive care by combining the expertise of various professions. In many countries, nurses are also being given new and more extensive responsibilities. Implemented concepts of collaborative care need to be analysed within the context of care concepts, organisational structures, and effective collaboration. Background review of primary care concepts (literature analysis, expert interviews), and evaluation of collaboration in 'best practice' health centres in certain regions of Slovenia and Spain. Qualitative content analysis of expert interviews, presentations, observations, and group discussions with professionals and health centre managers. Findings In Slovenian health centres, the collaboration between GPs and nurses has been strongly shaped by their organisation in separate care units and predominantly case-oriented functions. Conventional power structures between professions hinder effective collaboration. The introduction of a new cross-professional primary care concept has integrated advanced practice nurses into general practice. Conventional hierarchies still exist, but a shared vision of preventive care is gradually strengthening attitudes towards team-oriented care. Formal regulations or incentives for teamwork have yet to be implemented. In Spain, health centres were established along with a team-based care concept that encompasses close physician-nurse collaboration and an autonomous role for nurses in the care process. Nurses collaborate with GPs on more equal terms with conflicts centring on professional disagreements. Team development structures and financial incentives for team achievements have been implemented, encouraging teams to generate their own strategies to improve teamwork. Clearly defined structures, shared visions of
Ian Campbell's paper, originally delivered at a conference on the development of 'The reflective practitioner' while he was Unit General Manager of Sunderland Royal Infirmary, describes the liaison between general and nurse managers in the hospital. Management must give a hospital organisation direction and must set the parameters of corporate and individual performance, but it must also be responsive to the feedback received from practising clinicians. The key concept is quality of service, and in this managers and practitioners can work together towards a common goal.
Tawfik, D S; Sexton, J B; Kan, P; Sharek, P J; Nisbet, C C; Rigdon, J; Lee, H C; Profit, J
To examine burnout prevalence among California neonatal intensive care units (NICUs) and to test the relation between burnout and healthcare-associated infection (HAI) rates in very low birth weight (VLBW) neonates. Retrospective observational study of provider perceptions of burnout from 2073 nurse practitioners, physicians, registered nurses and respiratory therapists, using a validated four-item questionnaire based on the Maslach Burnout Inventory. The relation between burnout and HAI rates among VLBW (<1500 g) neonates from each NICU was evaluated using multi-level logistic regression analysis with patient-level factors as fixed effects. We found variable prevalence of burnout across the NICUs surveyed (mean 25.2±10.1%). Healthcare-associated infection rates were 8.3±5.1% during the study period. Highest burnout prevalence was found among nurses, nurse practitioners and respiratory therapists (non-physicians, 28±11% vs 17±19% physicians), day shift workers (30±3% vs 25±4% night shift) and workers with 5 or more years of service (29±2% vs 16±6% in fewer than 3 years group). Overall burnout rates showed no correlation with risk-adjusted rates of HAIs (r=-0.133). Item-level analysis showed positive association between HAIs and perceptions of working too hard (odds ratio 1.15, 95% confidence interval 1.04-1.28). Sensitivity analysis of high-volume NICUs suggested a moderate correlation between burnout prevalence and HAIs (r=0.34). Burnout is most prevalent among non-physicians, daytime workers and experienced workers. Perceptions of working too hard associate with increased HAIs in this cohort of VLBW infants, but overall burnout prevalence is not predictive.
O envolvimento do enfermeiro no processo de morrer de bebês internados em Unidade Neonatal El involucramiento del enfermero en el proceso de morir de niños hospitalizados en una unidad de neonatología Nurses experiences with death in the neonatal intensive care unit
Isabella Rocha Aguiar
úsqueda del equilibrio entre el cuidar del otro y de sí mismo.ABSTRACT OBJECTIVE: to understand Neonatal Intensive Care nurses experiences caring for dying neonates. METHODS: this was an qualitative exploratory study. Ten Neonatal Intensive Care Unit nurses from a school-affiliated hospital in Fortaleza, Ceará participated in this study. Data were collected during May and June, 2003. RESULTS: the following categories emerged from the analysis: feelings in the presence of death; interacting with the family in the process of dying; and, educational inadequacies coping with a terminally ill neonate. The feelings expressed by the nurses included loss, sadness, misery, weakness, and detachment. The nurses also see themselves involved with the grieving family, although the majority of them reported not having enough foundational knowledge with grief and thanatology. CONCLUSION: those nurses who deal with death in the workplace, such as the Neonatal Intensive Care Unit, are trying to keep a balance between caring for others and themselves.
Arthurs, Owen J.; Graves, Martin J.; Lomas, David J.; Edwards, Andrea; Austin, Topun
Improved neonatal survival rates and antenatal diagnostic imaging is generating a growing demand for postnatal MRI examinations. Neonatal brain MRI is now becoming standard clinical care in many settings, but with the exception of some research centres, the technique has not been optimised for imaging neonates and small children. Here, we review some of the challenges involved in neonatal MRI, including recent advances in overall MR practicality and nursing practice, to address some of the ways in which the MR experience could be made more neonate-friendly. (orig.)
Bryant, James E; Gaughan, Earl M
Abdominal surgery in foals under 30 days old has become more common with improved neonatal care. Early recognition of a foal at risk and better nursing care have increased the survival rates of foals that require neonatal care. The success of improved neonatal care also has increased the need for accurate diagnosis and treatment of gastrointestinal, umbilical, and bladder disorders in these foals. This chapter focuses on the early and accurate diagnosis of specific disorders that require abdominal exploratory surgery and the specific treatment considerations and prognosis for these disorders.
Koterba, A M; Drummond, W H; Kosch, P
The basic concepts of diagnosis and treatment in the abnormal neonatal foal are presented. Methods of restraint, sedation, and general nursing care are discussed, as well as more specific techniques of respiratory and circulatory system support.
Produção de conhecimento sobre o cuidado ao recém-nascido em UTI Neonatal: contribuição da enfermagem brasileira Generación de conocimientos sobre el cuidado al recién nacido en UTI Neonatal: contribución de la Enfermería brasileña Production of knowledge about the care given to newborns in neonatal IC: contribution of Brazilian nursing
Neonatología.The objective of this documentary study was to reflect on the state of the art of nursing in Brazil regarding care given to newborns in neonatal intensive care units (NICU. The data source used was the Brazilian Nursing Association base of theses and dissertations. Eighty-one studies were located. Data analysis was performed in two stages: first, the study's characterization was performed; second, the material was organized according to data evident in the study, resulting in thematic categories: care centered on the newborn's physiological aspects; care provided to the family accompanying their newborn in the NICU; and the health team providing care to the newborn in the NICU. It was found that nursing research seeks new forms of care and brings theory closer to practice, thus guaranteeing its support of the nursing profession and contributing to the production of knowledge in neonatology.
Deloian, Barbara J; Lewin, Linda Orkin; O'Connor, Mary E
To evaluate the baseline knowledge and knowledge gained of nurses, nursing students, midwives, and nurse practitioners who completed Breastfeeding Basics, an online educational program. This study reports on an anonymous evaluation of an online breastfeeding education program developed and maintained to promote evidence-based breastfeeding practice. Included in the study were 3736 nurses, 728 nurse practitioners/midwives, and 3106 nursing students from the United States who completed ≥ one pretest or posttest on the Breastfeeding Basics website between April 1999 and December 31, 2011. Baseline scores were analyzed to determine if nurses' baseline knowledge varied by selected demographic variables such as age, gender, professional level, personal or partner breastfeeding experience, and whether they were required to complete the website for a job or school requirement and to determine knowledge gaps. Pretest and posttest scores on all modules and in specific questions with low pretest scores were compared as a measure of knowledge gained. Lower median pretest scores were found in student nurses (71%), males (71%), those required to take the course (75%), and those without personal breastfeeding experience (72%). The modules with the lowest median pretest scores were Anatomy/Physiology (67%), Growth and Development of the Breastfed Infant (67%), the Breastfeeding Couple (73%), and the Term Infant with Problems (60%). Posttest scores in all modules increased significantly (p nurses and nursing students. Gaps exist in nurses' breastfeeding knowledge. Knowledge improved in all areas based on comparison of pretest and posttest scores. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.
van Zuuren, Florence J; van Manen, Eeke
During the last two decades there has been an enormous development in treatment possibilities in the field of neonatology, particularly for (extremely) premature infants. Although there are cross-cultural differences in treatment strategy, an overview of the literature suggests that every country is confronted with moral dilemmas in this area. These concern decisions to initiate or withhold treatment directly at birth and, later on, decisions to withdraw treatment with the possible consequence that the child will die. Given that the neonate cannot express his or her own will, who will decide? And on the basis of what information, values and norms? We explored some of these issues in daily practice by interviewing a small sample of health care practitioners in a Dutch university Neonatal Intensive Care Unit (NICU). It turned out that experiencing moral dilemmas is part of their daily functioning. Nurses underline the suffering of the newborn, whereas physicians stress uncertainty in treatment outcome. To make the best of it, nurses focus on their caring task, whereas physicians hope that future follow-up research will lead to more predictable outcomes. As for their own offspring, part of these professionals would hesitate to bring their own extremely premature newborn to a NICU. For the most oppressing dilemma reported - terminating an already initiated treatment - we propose the concept of 'evidence shift' to clarify the ambiguous position of uncertainty in decision making.
The role of the nurse in the neonatal intensive care unit: between the ideal, the real and the possible Actuación de la enfermera en la unidad de terapia intensiva neonatal: entre lo ideal, lo real y lo posible Atuação da enfermeira na unidade de terapia intensiva neonatal: entre o ideal, o real e o possível
Liciane Langona Montanholi
Full Text Available The nurse is one of the professionals responsible for the care directed toward the physical, mental and social development of newborns in the Neonatal Intensive Care Unit. This study aimed to comprehend the experience of nurses working in a Neonatal Intensive Care Unit. Data collection was performed in 2008, through interviews with 12 nurses working in public and private hospitals of the city of São Paulo. The units of meaning identified were grouped into three categories: Developing actions; Perceiving their actions and Expectations. The analysis was based on social phenomenology. It was concluded that the overload of activities, the reduced number of staff, the lack of materials, equipment and the need for professional improvement are the reality of the work of the nurse in this sector. To supervise the care is the possible; integral care of the newborn, involving the parents, is the ideal desired.El enfermero es uno de los profesionales responsables por el cuidado dirigido al desarrollo físico, psíquico y social del recién nacido en la Unidad de Terapia Intensiva Neonatal. Este trabajo objetivó comprender la experiencia de enfermeras que actúan en una Unidad de Terapia Intensiva Neonatal. La recolección de datos fue realizada en 2.008, por medio de entrevistas con 12 enfermeras que actuaban en hospitales públicos y privados de la ciudad de Sao Paulo. Las unidades de significado identificadas fueron agrupadas en tres categorías: Desarrollando acciones, Percibiendo sus acciones y Expectativas. El análisis fue fundamentado en la fenomenología social. Se concluye que la sobrecarga de actividades, el reducido número de personal, la falta de materiales, equipamientos y la necesidad de perfeccionamiento profesional son la realidad del trabajo de la enfermera en ese sector. Supervisar los cuidados, es posible; cuidar integralmente del recién nacido, envolviendo sus padres, es el ideal deseado.O enfermeiro é um dos profissionais respons
Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial
Full Text Available Abstract Background Early diagnosis of dementia benefits both patient and caregiver. Nevertheless, dementia in primary care is currently under-diagnosed. Some educational interventions developed to improve dementia diagnosis and management were successful in increasing the number of dementia diagnoses and in changing attitudes and knowledge of health care staff. However, none of these interventions focussed on collaboration between GPs and nurses in dementia care. We developed an EASYcare-based Dementia Training Program (DTP aimed at stimulating collaboration in dementia primary care. We expect this program to increase the number of cognitive assessments and dementia diagnoses and to improve attitudes and knowledge of GPs and nurses. Methods The DTP is a complex educational intervention that consists of two workshops, a coaching program, access to an internet forum, and a Computerized Clinical Decision Support System on dementia diagnostics. One hundred duos of GPs and nurses will be recruited, from which 2/3 will be allocated to the intervention group and 1/3 to the control group. The effects of implementation of the DTP will be studied in a cluster-randomised controlled trial. Primary outcomes will be the number of cognitive assessments and dementia diagnoses in a period of 9 months following workshop participation. Secondary outcomes are measured on GP and nurse level: adherence to national guidelines for dementia, attitude, confidence and knowledge regarding dementia diagnosis and management; on patient level: number of emergency calls, visits and consultations and patient satisfaction; and on caregiver level: informal caregiver burden and satisfaction. Data will be collected from GPs' electronic medical records, self-registration forms and questionnaires. Statistical analysis will be performed using the MANOVA-method. Also, exploratory analyses will be performed, in order to gain insight into barriers and facilitators for implementation and
Mousquès, Julien; Bourgueil, Yann; Le Fur, Philippe; Yilmaz, Engin
To assess the efficacy and the cost of a French team work experiment between nurses and GPs for managing type 2 diabetes patients. Based on a case control study design we compare the evolution of process (standard follow-up procedures) and final (glycemic control) outcomes, and of cost, between two consecutive periods between type 2 diabetes patients followed within the team work experiment (intervention group) or by "standard" GPs (controlled group). After a 11 months of follow-up, patients in the intervention group, compared with those in the controlled group, have more chances to remain or to become: correctly followed-up (with OR comprise between 2.1 and 6.8, p≤5%) and under glycemic control (with OR comprise between 1.8 and 2.7, p≤5%). The latter result is obtained only when a visit for education and counselling has been delivered by a nurse in supplement to systematic electronic patient registry and electronic clinical GPs reminder. All these results are obtained without difference in costs between the intervention and the controlled group. This experimentation of team working can be considered both effective and efficient. Our findings may have implications in the design of future larger primary care team work experiment to be launched by French health authorities. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Pastor Durán, Xavier
PROTOCOLOS TERAPEUTICOS. TUBERCULOSIS NEONATAL 1. CONCEPTO La tuberculosis neonatal es la infección del recién nacido producida por el bacilo de Koch. Es una situación rara pero grave que requiere un diagnóstico precoz y un tratamiento enérgico..
Assistência de enfermagem em unidade de internação neonatal: medidas para prevenção de infecções hospitalares Asistencia de enfermería en unidades de hospitalización neonatal: medidas para prevención de infecciones hospitalarias Nursing care in neonatal units: measures for the prevention of hospital infections
nursing care in terms of the environment, equipment, personnel and the newborn. In view of the problems related to hospital infection, the objective of the present investigation was lo determine the relationship between prescriptive measures for the Prevention of Infection and activities effectively carried out in a Neonatal Admission Unit. Participant observation and semi structured interviews were the strategies used for the investigation which allowed data collection. With this research we could see that prophylactic measures need to be taken together in a collection of activities based on adequate structure and facilities, performed by a cohesive professional team where everybody work towards the same goal. Measures taken isolated do not contribute to the effective accomplishment of prescriptions.
Norman, Linda; Buerhaus, Peter I; Donelan, Karen; McCloskey, Barbara; Dittus, Robert
This study assessed the characteristics of nursing students currently enrolled in nursing education programs, how students finance their nursing education, their plans for clinical practice and graduate education, and the rewards and difficulties of being a nursing student. Data are from a survey administered to a national sample of 496 nursing students. The students relied on financial aid and personal savings and earnings to finance their education. Parents, institutional scholarships, and government loans are also important sources, but less than 15% of the students took out bank loans. Nearly one quarter of the students, particularly younger and minority students, plan to enroll in graduate school immediately after graduation and most want to become advanced nursing practitioners. Most of the nursing students (88%) are satisfied with their nursing education and nearly all (95%) provided written answers to two open-ended questions. Comments collapsed into three major categories reflecting the rewards (helping others, status, and job security) and three categories reflecting the difficulties (problems with balancing demands, quality of nursing education, and the admissions process) of being a nursing student. Implications for public policymaking center on expanding the capacity of nursing education programs, whereas schools themselves should focus on addressing the financial needs of students, helping them strike a balance among their school, work, and personal/family responsibilities and modifying certain aspects of the curriculum.
Sizakele L.T. Khoza