Sample records for advanced practice registered
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Jokiniemi, Krista; Haatainen, Kaisa; Pietilä, Anna-Maija
2015-12-01
The aim of this study is to describe the factors hindering and facilitating the implementation of the advanced practice registered nurses role at Finnish university hospitals, and to examine the implications for its future development. A descriptive qualitative approach, using thematic individual interviews, was conducted in 2011 with a sample of 11 advanced practice registered nurses. The data were analysed using qualitative content analysis. The advanced practice registered nurses role barriers had an impact on the role development needs. In turn, the facilitating factors helped encounter the challenges of the role, therefore having an impact on both the current role achievement, as well as contributing to the future role development. The factors hindering and facilitating the advanced practice registered nurses role need to be acknowledged to support the role implementation and planning of the future of the role. © 2014 Wiley Publishing Asia Pty Ltd.
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... nurse with a graduate degree in advanced practice nursing. This type of provider may also be referred to as an ARNP (Advanced Registered Nurse Practitioner) or APRN (Advanced Practice Registered Nurse). Types of health care providers is a related topic.
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Education and Practice Barriers for Certified Registered Nurse Anesthetists.
Malina, Debra P; Izlar, Janice J
2014-05-31
Of the recognized advanced practice registered nursing (APRN) specialties, Certified Registered Nurse Anesthetists (CRNAs) have historically experienced the most vigorous and organized resistance from outside entities regarding rights to practice to the full scope of their education and experience. Opposition to nurse anesthetists practicing to the full scope of their education and training is present in the clinical arena and educational milieu.
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Code of Federal Regulations, 2012 CFR
2012-01-01
...; Public Calendar/Master Calendar and Federal Register. 1011.4 Section 1011.4 Commercial Practices CONSUMER... meetings; Public Calendar/Master Calendar and Federal Register. Advance notice of Agency activities is... Calendar/Master Calendar. (1) The printed Public Calendar and the Master Calendar maintained in the Office...
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Code of Federal Regulations, 2014 CFR
2014-01-01
...; Public Calendar/Master Calendar and Federal Register. 1011.4 Section 1011.4 Commercial Practices CONSUMER... meetings; Public Calendar/Master Calendar and Federal Register. Advance notice of Agency activities is... Calendar/Master Calendar. (1) The printed Public Calendar and the Master Calendar maintained in the Office...
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Code of Federal Regulations, 2013 CFR
2013-01-01
...; Public Calendar/Master Calendar and Federal Register. § 1011.4 Section § 1011.4 Commercial Practices... notice of meetings; Public Calendar/Master Calendar and Federal Register. Advance notice of Agency...) Public Calendar/Master Calendar. (1) The printed Public Calendar and the Master Calendar maintained in...
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-11-01
... hours respondents respondent responses response Interviews Physicians 6 1 6 1 6 Advanced practice nurses (NPs) 9 1 9 1 9 and registered nurses Medical technicians 9 1 9 1 9 Subtotal 24 1 24 1 24 Survey Physicians 120 1 120 .5 60 Advanced practice nurses (NPs) 240 1 240 .5 120 and registered nurses Medical...
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The Path to Advanced Practice Licensure for Clinical Nurse Specialists in Washington State.
Schoonover, Heather
The aim of this study was to provide a review of the history and process to obtaining advanced practice licensure for clinical nurse specialists in Washington State. Before 2016, Washington State licensed certified nurse practitioners, certified nurse midwives, and certified nurse anesthetists under the designation of an advanced registered nurse practitioner; however, the state did not recognize clinical nurse specialists as advanced practice nurses. The work to drive the rule change began in 2007. The Washington Affiliate of the National Association of Clinical Nurse Specialists used the Power Elite Theory to guide advocacy activities, building coalitions and support for the desired rule changes. On January 8, 2016, the Washington State Nursing Care Quality Assurance Commission voted to amend the state's advanced practice rules, including clinical nurse specialists in the designation of an advanced practice nurse. Since the rule revision, clinical nurse specialists in Washington State have been granted advanced registered nurse practitioner licenses. Driving changes in state regulatory rules requires diligent advocacy, partnership, and a deep understanding of the state's rule-making processes. To be successful in changing rules, clinical nurse specialists must build strong partnerships with key influencers and understand the steps in practice required to make the desired changes.
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Moon, Chooza; Phelan, Cynthia H; Lauver, Diane R; Bratzke, Lisa C
Sleep-related breathing disorders (SRBDs), including obstructive sleep apnea and central sleep apnea, are common among patients with cardiovascular disease (CVD), but clinicians often do not pay enough attention to SRBDs. The purpose of this narrative review is to update advanced practice registered nurses on the literature focusing on the relationship between SRBDs and CVD (eg, hypertension, heart failure, coronary artery disease, arrhythmias, and stroke) and on treatments that can improve SRBDs in patients with CVD. We conducted an electronic search of the literature published between 1980 and 2016 from PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Academic Search Premier, and related health resource Web sites to address the aims of this study. Fifty-six primary research articles (42 observational studies and 14 experimental and quasi-experimental studies) were selected based on our study aims and inclusion criteria. The studies revealed that individuals with CVD are at a greater risk for SRBDs and that SRBDs can worsen CVD. The findings from the studies also suggest that positive airway treatment could improve both SRBDs and CVD. This review found a close relationship between SRBDs and CVD. Advanced practice registered nurses are in key positions to identify and help patients manage SRBDs. In particular, advanced practice registered nurses can educate staff and establish standards of practice to improve outcomes for patients with CVD.
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Delineating advanced practice nursing in New Zealand: a national survey.
Carryer, J; Wilkinson, J; Towers, A; Gardner, G
2018-03-01
A variety of advanced practice nursing roles and titles have proliferated in response to the changing demands of a population characterized by increasing age and chronic illness. Whilst similarly identified as advanced practice roles, they do not share a common practice profile, educational requirements or legislative direction. The lack of clarity limits comparative research that can inform policy and health service planning. To identify advanced practice roles within nursing titles employed in New Zealand and practice differences between advanced practice and other roles. Replicating recent Australian research, 3255 registered nurses/nurse practitioners in New Zealand completed the amended Advanced Practice Delineation survey tool. The mean domain scores of the predominant advanced practice position were compared with those of other positions. Differences between groups were explored using one-way ANOVA and post hoc between group comparisons. Four nursing position bands were identified: nurse practitioner, clinical nurse specialist, domain-specific and registered nurse. Significant differences between the bands were found on many domain scores. The nurse practitioner and clinical nurse specialist bands had the most similar practice profiles, nurse practitioners being more involved in direct care and professional leadership. Similar to the position of clinical nurse consultant in Australia, those practicing as clinical nurse specialists were deemed to reflect the threshold for advanced practice nursing. The results identified different practice patterns for the identified bands and distinguish the advanced practice nursing roles. By replicating the Australian study of Gardener et al. (2016), this NZ paper extends the international data available to support more evidence-based nursing workforce planning and policy development. © 2017 International Council of Nurses.
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Han, Robin M; Carter, Patricia; Champion, Jane Dimmitt
2018-02-01
This systematic review explores relationships between advanced practice registered nurses' (APRN) job satisfaction and intent to leave. There exists a dearth of APRN providers compared with the ever-growing need for their services. Furthermore, the organizational costs associated with the APRN turnover are extremely high. It, therefore, behooves practice administrators to understand what factors most contribute to APRN job satisfaction and retention. A search of research databases CINAHL, PubMed, and PsycINFO, using keywords "Advanced Practice Registered Nurse," "job satisfaction," "intent to leave," "anticipated turnover," and "Nurse Practitioner" to yield articles included in this review. The strength of existing evidence for this topic is weak. Studies have found that extrinsic factors, such as administrative support and salary, significantly contribute to job dissatisfaction, whereas intrinsic factors, such as autonomy and finding work meaningful, most significantly contribute to job satisfaction. Additional research is needed to better understand the factors relating to APRN job satisfaction and dissatisfaction, and how those factors influence practitioners' intent to leave. Efforts to improve APRN job satisfaction will have positive implications for provider retention, practices, and patients. Administrators should consider the job satisfaction factors identified herein when implementing practice improvement and retention efforts.
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Using advanced mobile devices in nursing practice--the views of nurses and nursing students.
Johansson, Pauline; Petersson, Göran; Saveman, Britt-Inger; Nilsson, Gunilla
2014-09-01
Advanced mobile devices allow registered nurses and nursing students to keep up-to-date with expanding health-related knowledge but are rarely used in nursing in Sweden. This study aims at describing registered nurses' and nursing students' views regarding the use of advanced mobile devices in nursing practice. A cross-sectional study was completed in 2012; a total of 398 participants replied to a questionnaire, and descriptive statistics were applied. Results showed that the majority of the participants regarded an advanced mobile device to be useful, giving access to necessary information and also being useful in making notes, planning their work and saving time. Furthermore, the advanced mobile device was regarded to improve patient safety and the quality of care and to increase confidence. In order to continuously improve the safety and quality of health care, advanced mobile devices adjusted for nursing practice should be further developed, implemented and evaluated in research. © The Author(s) 2013.
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Impact of postgraduate education on advanced practice nurse activity - a national survey.
Wilkinson, J; Carryer, J; Budge, C
2018-03-22
There is a wealth of international evidence concerning the contribution post-registration master's level education makes to advancing the discipline of nursing. There are approximately 277 nurse practitioners registered in NZ, but they account for only a small portion of nurses who have undertaken master's level education. The additional contribution these nurses make to the work environment through advanced practice activities has not, hitherto, been documented. To report the extent of advanced practice nurse activity associated with various levels of nursing education in a sample of nurses working in clinical practice in New Zealand. A replication of recent Australian research was done via a national cross-sectional survey of 3255 registered nurses and nurse practitioners in New Zealand using an online questionnaire to collect responses to the amended Advanced Practice Delineation survey tool. In addition, demographic data were collected including position titles and levels of postgraduate education. A positive association was found between postgraduate education at any level and more time spent in advanced practice activities. Independent of level of postgraduate education, the role a nurse holds also effects the extent of involvement in advanced practice activities. There is an additional contribution made to the work environment by nurses with master's level education which occurs even when they are not employed in an advanced practice role. These findings are of significance to workforce policy and planning across the globe as countries work to sustain health services by increasing nursing capacity effectively within available resources. © 2018 International Council of Nurses.
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Caring for Young Children Exposed to Marijuana.
Ruiz, Natasha M; Shapiro, Susan E
This article reviews the research report, Marijuana Exposure Among Children Younger Than Six Years in the United States (), and, using a case study approach, applies the findings to advanced practice registered nurses. B. extracted data from the National Poison Data System showing an increasing trend in marijuana exposure in children, especially in states where marijuana has been legalized for either medicinal use or recreational use. Advanced practice registered nurses need to be comfortable recognizing and managing marijuana intoxication in the pediatric population, as well as educating parents in providing safe environments for their children.
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Cady, Rhonda G; Kelly, Anne M; Finkelstein, Stanley M; Looman, Wendy S; Garwick, Ann W
2014-01-01
Care coordination is an essential component of the pediatric health care home. This study investigated the attributes of relationship-based advanced practice registered nurse care coordination for children with medical complexity enrolled in a tertiary hospital-based health care home. Retrospective review of 2,628 care coordination episodes conducted by telehealth over a consecutive 3-year time period for 27 children indicated that parents initiated the majority of episodes and the most frequent reason was acute and chronic condition management. During this period, care coordination episodes tripled, with a significant increase (p < .001) between years 1 and 2. The increased episodes could explain previously reported reductions in hospitalizations for this group of children. Descriptive analysis of a program-specific survey showed that parents valued having a single place to call and assistance in managing their child's complex needs. The advanced practice registered nurse care coordination model has potential for changing the health management processes for children with medical complexity. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.
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Beyond A-Level in the Teaching of French.
ERIC Educational Resources Information Center
Sanders, Carol, Ed.
The papers in this volume discuss practical approaches to some of the current problems of degree-level language teaching. Section one discusses non-literary registers in advanced language teaching including the use of texts in teaching, suggestions for a course in practical sociolinguistics, and exercises for advancing from paraphrase to an…
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The role of the nurse executive in fostering and empowering the advanced practice registered nurse.
Talbert, Tukea L
2012-06-01
The nurse executive plays a critical role in the design, oversight, and outcomes of the delivery of care and a key role in the success of the integration of advanced practice registered nurses (APRNs) into an organization. The critical areas that nurse executives must consider to foster and empower APRNs are: (1) knowledge and self preparation, especially of political initiatives that affect the role, (2) visionary leadership and development of clear role expectations and appropriate credentialing, (3) strategies to reduce disconnection between the APRN and their practice setting, and (4) appropriate education and marketing of the role to stakeholders. Copyright © 2012 Elsevier Inc. All rights reserved.
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Rhodes, Catherine A; Bechtle, Mavis; McNett, Molly
2015-01-01
Advanced practice registered nurses (APRNs) are integral to the provision of quality, cost-effective health care throughout the continuum of care. To promote job satisfaction and ultimately decrease turnover, an APRN incentive plan based on productivity and quality was formulated. Clinical productivity in the incentive plan was measured by national benchmarks for work relative value units for nonphysician providers. After the first year of implementation, APRNs were paid more for additional productivity and quality and the institution had an increase in patient visits and charges. The incentive plan is a win-win for hospitals that employ APRNs.
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Full Practice Authority for Advanced Practice Registered Nurses is a Gender Issue
Rudner Lugo, Nancy
2016-05-04
In the United States, Advanced Practice Registered Nurse (APRN) regulations are determined at the state level, through legislation and rule making. The lack of an evidence base to APRN regulation has resulted in a patchwork of varied regulations and requirements for nurse practitioners. The author begins this article by reviewing the history of the Equal Rights Amendment (ERA) in the United States and describing her study that assessed APRN fullpractice authority in states that ratified the ERA versus states that opposed it. She presents the study findings, limitations of the comparison, and discussion of the findings and implications. In conclusion, the findings demonstrated that progress toward full APRN practice will require building strategies for political support and framing the need to update APRN regulations in a manner that aligns with each state’s social and political values.
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Jacob, Elisabeth R; McKenna, Lisa; D'Amore, Angelo
2016-01-01
In Australia, like other countries, two levels of nurse are registered for entry to practice. Educational changes for second level nurses in Australia have led to questions regarding roles and career options. This paper reports on interviews with nursing course coordinators to examine educator expectations of roles and career pathways of registered and enrolled nurses. Coordinators of eight degree (registered) and diploma (enrolled) nursing programs were interviewed to determine their opinions on roles and careers that students were prepared for. Transcripts were thematically analysed. Educators reported similar graduate roles, although high acuity care was primarily the role of registered nurses. Career expectations differed with enrolled nurses having limited advancement opportunity, and registered nurses greater career options. Health organisations were unprepared to accommodate increased practice scope of enrolled nurses and limited work practice through policies stipulating who could perform procedures. Organisational health policies need to accommodate increased enrolled nurse skill base. Education of practising nurses is necessary regarding increased scope of enrolled nurse practice to ensure they are used to their full potential. Increasing patient acuity requires more registered nurses, as enrolled nurses are unprepared to care for complex or deteriorating patients. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Report on the APNA National Psychiatric Mental Health Advanced Practice Registered Nurse Survey.
Delaney, Kathleen R; Drew, Barbara L; Rushton, Amy
2018-06-01
Further exploration of the practice roles of psychiatric mental health (PMH) advanced practice registered nurses (APRNs) is warranted. In March of 2016, the American Psychiatric Nurses Association (APNA) conducted a national survey to gather data on the demographics, practice roles, and activities of certified PMH APRNs. The e-mail survey contained 46 questions consistent with minimum data set requirements of the Forum of State Nursing Workforce Centers. The data indicate that PMH APRNs are a clinically active workforce; the majority deliver a wide variety of mental health services including diagnosis and management of both acute and chronic mental illness, prescribing, and providing psychotherapy. PMH APRNs are delivering care to clients dealing with a range of serious mental illnesses across the life span in a variety of roles. It will be critical to monitor the activities and outcomes of this expanding behavioral health care workforce.
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Behrens, Sue A
Despite utilization of the advanced practice registered nurse (APRN) in the United States health care system, there is little information about the introduction, utilization, and challenges of the APRN role globally, especially in the Middle East. This article will look at how one hospital in the United Arab Emirates introduced the APRN role to a health care environment of a country where it has not been recognized historically. Cultural challenges and barriers for the implementation of the role include regulatory, societal, and institutional. Innovation and collaboration are necessary to address these challenges and barriers and to pave the way for a successful advanced practice model pilot, as well as for the future use of the role. Innovation is also one of the key performance indicators for the country's health care. However, the idea of advanced practice is a new concept that has been outside the mainstream health care practice for the United Arab Emirates. To help with the implementation, a road map was developed to outline the steps necessary to provide a safe practice environment. The plan included aligning with the ministry of health nursing and midwifery council, as well as the Health Authority of Abu Dhabi, to help them learn more about the US model of advanced practice, along with benefits, and outcomes of the role. Developing the role of the APRN will benefit the future state of the health care infrastructure for not only the United Arab Emirates but throughout the Middle East.
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Estes, Krista; Gilliam, Eric; Knapfel, Sarah; Lee, Chanmi; Skiba, Diane
2016-01-01
The use of eHealth has grown in recent years and is projected to continue to increase exponentially. In order to empower and prepare advanced practice providers to integrate eHealth into their clinical practice, curricular changes need to occur. The iTEAM grant provides a unique opportunity to prepare advanced practice disciplines to provide collaborative care using eHealth. Through the integration of a simulated telehealth using a standardized patient, Doctor of Pharmacy and Advanced Practice Registered Nursing students learned how to apply health information technology and coordinate care in an interprofessional manner. Opportunities and challenges to guide future efforts to integrate eHealth-learning experiences into the curriculum are identified.
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Carlson, Elisabeth; Bengtsson, Mariette
2014-04-01
The expected shortage of registered nurses with an advanced degree as specialists in geriatric care or gerontology is imminent. Previous studies report that clinical practice where student nurses are supervised by registered nurses has a direct impact on how students perceive nursing as a profession and future career choice. Considering the anticipated need for well-educated and specialised nurses it is therefore, relevant as well as necessary to describe clinical learning with a focus on preceptorship in geriatric nursing care. This paper is a report of a study describing registered nurses' experience of precepting undergraduate student nurses during clinical practice in nursing homes and home-based care. A qualitative design, based on seven focus group interviews, was employed with 30 registered nurses with preceptor experience from nursing homes and home-based care for the elderly. Our findings present three precepting strategies that are unique to elderly care: preparing students for end of life care, facilitating a respectful approach to the older person and promoting creativity and independent work. The findings are discussed using a socio-cultural perspective and illustrate how communities of elderly practice can be valuable learning environments. © 2013.
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Survey of advanced practice registered nurses disciplinary action.
Hudspeth, Randall
2007-04-02
The nursing profession continues to struggle to find the most appropriate approach to credentialing Advanced Practice Registered Nurses (APRNs). One early step in addressing this struggle is determining the incidence of APRN disciplinary actions by boards of nursing. This article presents data from 2003 and 2004 describing the incidence of APRN disciplinary actions by United States boards of nursing. Fifty-one boards of nursing, all members of the National Council of State Boards of Nursing, were asked to report the numbers of APRN discipline cases for 2003 and 2004 which had been resolved, using a tool that differentiated disciplinary cases into four data categories: chemical impairment, exceeding scope of practice, unprofessional conduct, and safety or abuse of patients. Thirty-eight (74.5%) of 51 boards of nursing reported discipline data for a total of 125,882 APRNs showing 688 disciplinary actions were taken during 2003 and 2004. This indicates that APRNs experience a low incidence of discipline related to chemical impairment, exceeding scope of practice, unprofessional conduct, and safety or abuse of patients.
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Strategies for Pursuing a Master's Degree.
Thomas, Cynthia M; McIntosh, Constance E; Mensik, Jennifer S
2016-01-01
Health care has become very complex and is in a constant state of change. As a result of the evolving change and increasing complexity, a more educated nursing workforce is needed (Dracup K. Master's nursing programs. American Association of Colleges of Nursing. 2015; Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. 2010). It is now becoming necessary for registered nurses to earn an advanced degree to work at the highest level of their practice authority (Dracup K. Master's nursing programs. American Association of Colleges of Nursing. 2015; Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. 2010.). Preparing to reenter college may be an overwhelming prospect for some registered nurses seeking an advanced degree. However, there are some simple strategies that may help sort out the many degree options, financial obligations, decisions about brick and mortar versus online learning, commitment to degree completion, and changing career paths. This article will provide the registered nurse valuable information that will assist in the exciting process of returning to college.
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Advancing Your Career: Concepts of Professional Nursing. Second Edition.
ERIC Educational Resources Information Center
Kearney, Rose
This textbook, intended for registered nurses (RN's) returning to school, is designed to provide practicing RN's with professional concepts to advance their careers. The book contains 22 chapters organized in five sections. Each chapter includes chapter objectives, key terms, key points, chapter exercises, references, and a bibliography. Section I…
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The Role of Certified Registered Nurse Anesthetists in Patient Education
2000-10-01
As advanced practice nurses, certified registered nurse anesthetists (CRNAs) have a responsibility to engage in patient education about health...Categories and themes include; engaging in perioperative patient education , focusing on explanations about anesthesia and surgery, prior nursing...experiences make patient education easier, documenting patient education is important and uncertainty about where to document it. Common topics and themes
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Barriers to NP Practice that Impact Healthcare Redesign.
Hain, Debra; Fleck, Laureen M
2014-05-31
As healthcare reform evolves, nurse practitioners (NP) will play key roles in improving health outcomes of diverse populations. According to the Institute of Medicine (IOM) 2011 report, The Future of Nursing: Leading Change Advancing Health, nurses should be change advocates by caring for populations within complex healthcare systems. The IOM reports asserts, "advanced practice registered nurses (APRNs) should be able to practice to the fullest extent of their education and training" (IOM, 2011, s8). However, existing barriers in the healthcare arena limit APRN practice. This article will discuss some of these barriers and provide suggestions for possible ways to decrease the barriers.
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Revisioning a clinical nurse specialist curriculum in 3 specialty tracks.
Arslanian-Engoren, Cynthia; Sullivan, Barbara-Jean; Struble, Laura
2011-01-01
The objective of the present study was to revise 3 clinical nurse specialist (CNS) educational tracks with current National Association of Clinical Nurse Specialist core competencies and educational expectations. National curricula recommendations include core competencies by the 3 spheres of influence. Advanced practice registered nurses consensus model educational requirements include a minimum of 500 faculty-supervised clinical hours; separate graduate courses in pharmacology, pathophysiology, and advanced physical assessment; and content in differential diagnosis disease management, decision making, and role preparation. This educational initiative was designed to (1) align with core competencies and advanced practice registered nurse consensus model recommendations, (2) create an innovative learning environment, (3) meet the needs of diverse student populations, (4) align with emerging doctor of nursing practice programs, (5) create a high-efficiency and high-quality environment to manage human and fiscal resources, and (6) reduce duplication of efforts. Courses were revised that did not meet current CNS educational preparation expectations. A total of 11 didactic and clinical sequences courses were developed for the 3 tracks to (1) ensure minimum numbers of clinical hours; (2) expand content on health promotion and risk reduction, advanced practice nurse role, and the healthcare delivery system; (3) consolidate clinical courses; and (4) resequence foundational content before beginning clinical courses. Revisioning a CNS curriculum in 3 specialty tracks is challenging but doable using innovative and creative approaches. The innovative process used to revise our CNS curriculum will assist nurse educators faced with similar program delivery challenges to meet future directions for educating CNS students in advanced nursing practice. Copyright © 2011 Lippincott Williams & Wilkins.
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Profile of advanced nursing practice in Spain: A cross-sectional study.
Sevilla Guerra, Sonia; Miranda Salmerón, Josep; Zabalegui, Adelaida
2018-03-01
In this study, we described the profile of advanced nursing practice in Spain. A cross-sectional study design was used to explore the extent and patterns of advanced nursing practice activity within the domains of expert care planning, integrated care, interprofessional collaboration, education, research, evidence-based practice, and professional leadership. Data were collected in 2015/2016. Purposive sampling yielded a sample of 165 specialist and expert nurses employed by a dual tertiary and community hospital in an urban setting. The study included specialist and expert nurses who had a higher practice profile than registered general nurses. The performance of activities according to age, current position, years of experience, nursing grade, and education was compared. Practice domains were more strongly influenced by the predictors of nursing position and professional career ladder. Age and experience predictors were found to be weak predictors of advanced practice domains. This study offers essential information of the nursing workforce, and clarifies both the advanced nursing practice profile and nomenclature in the context of study. © 2017 John Wiley & Sons Australia, Ltd.
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Educational Requirements for Entry-Level Practice in the Profession of Nutrition and Dietetics
ERIC Educational Resources Information Center
Abad-Jorge, Ana
2012-01-01
The profession of nutrition and dietetics has experienced significant changes over the past 100 years due to advances in nutrition science and healthcare delivery. Although these advances have prompted changes in educational requirements in other healthcare professions, the requirements for entry-level registered dietitians have not changed since…
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Nursing Practice, Research and Education in the West: The Best Is Yet to Come.
Young, Heather M; Bakewell-Sachs, Susan; Sarna, Linda
This paper celebrates the 60th anniversary of the Western Institute of Nursing, the nursing organization representing 13 states in the Western United States, and envisions a preferred future for nursing practice, research, and education. Three landmark calls to action contribute to transforming nursing and healthcare: the Patient Protection and Affordable Care Act of 2010; the Institute of Medicine report Future of Nursing: Leading Change, Advancing Health; and the report Advancing Healthcare Transformation: A New Era for Academic Nursing. Challenges abound: U.S. healthcare remains expensive, with poorer outcomes than other developed countries; costs of higher education are high; our profession does not reflect the diversity of the population; and health disparities persist. Pressing health issues, such as increases in chronic disease and mental health conditions and substance abuse, coupled with aging of the population, pose new priorities for nursing and healthcare. Changes are needed in practice, research, and education. In practice, innovative, cocreated, evidence-based models of care can open new roles for registered nurses and advanced practice registered nurses who have knowledge, leadership, and team skills to improve quality and address system change. In research, data can provide a foundation for clinical practice and expand our knowledge base in symptom science, wellness, self-management, and end-of-life/palliative care, as well as behavioral health, to demonstrate the value of nursing care and reduce health disparities. In education, personalized, integrative, and technology-enabled teaching and learning can lead to creative and critical thinking/decision-making, ethical and culturally inclusive foundations for practice, ensure team and communication skills, quality and system improvements, and lifelong learning. The role of the Western Institute of Nursing is more relevant than ever as we collectively advance nursing, health, and healthcare through education, clinical practice, and research.
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E-Mentoring: Confidence Intervention for Senior Nursing Students Preparing for Readiness to Practice
ERIC Educational Resources Information Center
LaRose, Patrick S., Sr.
2013-01-01
The role of the registered nurse has evolved over the years as technology has changed and the practice of nursing has advanced. There are many factors that influence how a new nurse enters practice; however, confidence appears to play a large role in the way nursing students see themselves and how this self perception regulates transition to…
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A synthesis of Vroom's model with other social theories: an application to nursing education.
Gyurko, Charlene C
2011-07-01
In 2009, the National League for Nursing reported that there are over 3.4 million persons in the United States employed in nursing in the roles of Registered Nurses (RNs) and Advanced Practice Nurses (APRNs). In 2007, the Bureau of Labor Statistics also reported that in 2006, there were over 749,000 Licensed Practical Nurses (LPNs) working in the United States with a projected increase of 14% by 2016. Buerhaus et al, in 2009, stated that between 2016 and 2025, it is estimated that the U.S. will need over 260,000 registered nurses (RNs) Using the conceptual framework of Vroom's expectancy theory on motivation as well as theories addressing student and career development, this paper demonstrates a synthesis of Vroom's model with other educational theories and its application to nursing education, specifically the prediction of motivation to advance one's nursing education. By putting Vroom's theory into a context, Vroom's fairly simple model could help nurse educators predict the factors that make for success in midcareer educational advancement--and even possibly manipulate those factors to increase that success. In today's economy, that practical part seems too good to lose. Copyright © 2010 Elsevier Ltd. All rights reserved.
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[Brazilian technological output in the area of nursing: advances and challenges].
Koerich, Micheline Henrique Araujo da Luz; Vieira, Raquel Heloisa Guedes; Silva, Daniela Eda; Erdmann, Alacoque Lorenzini; Meirelles, Betina Horner Shlindwein
2011-12-01
This article aims to analyze the patents registered in the nursing area, since these patents may be used as an indicator of the technological development in the area. It presents and discusses national technological productions, tracked through the "nursing" keyword, patented in the period from 1990-2009. This is a retrospective documental research, using, as a source, data from the National Industrial Property Institute (INPI). The information gathered is discussed in relation to the appropriation of the technologies, the incentive to develop them and register them as a source of knowledge in the nursing field, aiming the practice of care. Light and light hard technology productions are increasing in the nursing field. However, these are not registered and patented. The technological advance in the nursing field is emergent and needs policies for its development.
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Clinical practice: new challenges for the advanced practice nurse.
Bartel, J C; Buturusis, B
2000-12-01
This report describes the challenges for advanced practice nurses (APNs) relative to supply and demand issues. The article also includes opportunities with the Balanced Budget Act, physician acceptance of Advanced Practice Nurses, and expanding practice opportunities. The challenges include the nursing shortage (both in nursing students and faculty), the aging of the nursing workforce, and a lag in nursing salaries; increased demand for nursing based on aging baby boomers, increasing patient acuity and technology, and new arenas for practice. The Balanced Budget Act of 1997 provided new opportunities for advanced practice nurses, including enhanced autonomy to provide services and bill independently of physicians. With these changes come new opportunities for advanced practice nurse entrepreneurs in the areas of independent practice, including opportunities to positively impact the health of families and communities in alignment with the Federal government's vision for "Healthy People 2010." As physician acceptance of advanced practice nurses continues to grow and in light of the changes in medical practice and education (residency reduction), opportunities to expand collaborative practice arrangements also exist. APNs are best suited to make the most of these changes. One example of an opportunity for independent practice, a Community Wellness Center, is developed as an entrepreneurial venture benefiting both the APN and the health of a community. Who better than registered nurses (RNs), especially those practicing at the advanced level, can ensure that these opportunities and challenges are addressed in an ethical manner and focused on the needs and health of the community?
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Pain Management: Knowledge and Attitudes of Senior Nursing Students and Practicing Registered Nurses
ERIC Educational Resources Information Center
Messmer, Sherry
2009-01-01
Despite scientific advances in pain management, inadequate pain relief in hospitalized patients continues to be an on-going phenomenon. Although nurses do not prescribe medication for pain, the decision to administer pharmacological or other interventions for pain relief is part of nursing practice. Nurses play a critical role in the relief of…
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Agents for Change: Nonphysician Medical Providers and Health Care Quality
Boucher, Nathan A; McMillen, Marvin A; Gould, James S
2015-01-01
Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NPMPs), such as physician assistants and advanced practice nurses (eg, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, and certified nurse midwives), may be the first caregivers to encounter the patient and can act as agents for change for an organization’s quality-improvement mandate. NPMPs are well positioned to both initiate and ensure optimal adherence to best practices and care processes from the moment of initial contact because they have robust clinical training and are integral to trainee/staff education and the timely delivery of care. The health care quality aspects that the practicing NPMP can affect are objective, appreciative, and perceptive. As bedside practitioners and participants in the administrative and team process, NPMPs can fine-tune care delivery, avoiding the problem areas defined by the Institute of Medicine: misuse, overuse, and underuse of care. This commentary explores how NPMPs can affect quality by 1) supporting best practices through the promotion of guidelines and protocols, and 2) playing active, if not leadership, roles in patient engagement and organizational quality-improvement efforts. PMID:25663213
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Gould, Rebecca A; Canter, Deborah
2008-11-01
Fewer than 50% of registered dietitians (RDs) supervise personnel and 76% have no budget authority. Because higher salaries are tied to increasing levels of authority and responsibility, RDs must seek management and leadership roles to enjoy the increased remuneration tied to such positions. Advanced-level practice in any area of dietetics demands powerful communication abilities, proficiency in budgeting and finance, comfort with technology, higher-order decision-making/problem-solving skills, and well-honed human resource management capabilities, all foundational to competent management practice. As RDs envision the future of the dietetics profession, practitioners must evaluate management competence in both hard and soft skills. Just as research is needed to support evidenced-based clinical practice, the same is needed to support management practice across the profession. Dietetics educators and preceptors should be as enthusiastic about management practice as they are clinical practice when educating and mentoring future professionals. Such encouragement and support can mean that new RDs and dietetic technicians, registered, will understand what it takes to advance to higher levels of responsibility, authority, and subsequent enhanced remuneration. In the ever-changing social, legal, ethical, political, economic, technological, and ecological environments of work, food and nutrition professionals who are willing to step forward and assume the risks and responsibilities of management also will share in the rewards, and propel the profession to new heights of recognition and respect.
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Branstetter, M Laurie; Smith, Lynette S; Brooks, Andrea F
2014-07-01
Over the past decade, the federal government has mandated healthcare providers to incorporate electronic health records into practice by 2015. This technological update in healthcare documentation has generated a need for advanced practice RN programs to incorporate information technology into education. The National Organization of Nurse Practitioner Faculties created core competencies to guide program standards for advanced practice RN education. One core competency is Technology and Information Literacy. Educational programs are moving toward the utilization of electronic clinical tracking systems to capture students' clinical encounter data. The purpose of this integrative review was to evaluate current research on advanced practice RN students' documentation of clinical encounters utilizing electronic clinical tracking systems to meet advanced practice RN curriculum outcome goals in information technology as defined by the National Organization of Nurse Practitioner Faculties. The state of the science depicts student' and faculty attitudes, preferences, opinions, and data collections of students' clinical encounters. Although electronic clinical tracking systems were utilized to track students' clinical encounters, these systems have not been evaluated for meeting information technology core competency standards. Educational programs are utilizing electronic clinical tracking systems with limited evidence-based literature evaluating the ability of these systems to meet the core competencies in advanced practice RN programs.
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Chamblee, Tracy B; Dale, Juanita Conkin; Drews, Barbie; Spahis, Joanna; Hardin, Teri
2015-01-01
The literature has a gap related to professional development for APRNs. In the United States, many health care organizations use clinical advancement programs for registered nurses, but APRNs are not often included in these programs. If APRNs are included, advancement opportunities are very limited. At CMC, implementation of a professional portfolio resulted in increased satisfaction among APPs regarding their ability to showcase professional growth and expertise, as well as the uniqueness of their advanced practice. Use of the professional portfolio led to improved recognition by APS and organizational leaders of APP performance excellence during the annual performance evaluation, as well as improved recognition among APP colleagues in terms of nominations for honors and awards.
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Medical marijuana: Legal and regulatory considerations.
Kaplan, Louise
2015-10-16
Nearly half of the United States has legalized medical marijuana. Advanced practice registered nurses (APRNs) in six states can authorize patients for medical marijuana use. Knowledge of legal and regulatory aspects of medical marijuana laws will protect an APRN's license and the public.
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76 FR 14826 - Antidisruptive Practices Authority
Federal Register 2010, 2011, 2012, 2013, 2014
2011-03-18
... Authority AGENCY: Commodity Futures Trading Commission. ACTION: Advance notice of proposed rulemaking... authorities with respect to, among others, all registered entities and intermediaries subject to the... granting the Commission authority to promulgate such ``rules and regulations as, in the judgment of the...
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Steinmuller, Patricia L; Kruskall, Laura J; Karpinski, Christine A; Manore, Melinda M; Macedonio, Michele A; Meyer, Nanna L
2014-04-01
Sports nutrition and dietetics addresses relationships of nutrition with physical activity, including weight management, exercise, and physical performance. Nutrition plays a key role in the prevention and treatment of obesity and chronic disease and for maintenance of health, and the ability to engage in physical activity, sports, and other aspects of physical performance. Thus, the Sports, Cardiovascular, and Wellness Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed the Revised 2014 Standards of Practice and Standards of Professional Performance as a resource for Registered Dietitian Nutritionists working in sports nutrition and dietetics to assess their current skill levels and to identify areas for further professional development in this emerging practice area. The revised document reflects advances in sports nutrition and dietetics practice since the original standards were published in 2009 and replaces those standards. The Standards of Practice represents the four steps in the Nutrition Care Process as applied to the care of patients/clients. The Standards of Professional Performance covers six standards of professional performance: quality in practice, competence and accountability, provision of services, application of research, communication and application of knowledge, and utilization and management of resources. Within each standard, specific indicators provide measurable action statements that illustrate how the standards can be applied to practice. The indicators describe three skill levels (competent, proficient, and expert) for Registered Dietitian Nutritionists working in sports nutrition and dietetics. The Standards of Practice and Standards of Professional Performance are complementary resources for Registered Dietitian Nutritionists in sports nutrition and dietetics practice. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
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Colvin, Loretta; Cartwright, Ann; Collop, Nancy; Freedman, Neil; McLeod, Don; Weaver, Terri E.; Rogers, Ann E.
2014-01-01
Study Objectives: To survey Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) utilization, roles and educational background within the field of sleep medicine. Methods: Electronic surveys distributed to American Academy of Sleep Medicine (AASM) member centers and APRNs and PAs working within sleep centers and clinics. Results: Approximately 40% of responding AASM sleep centers reported utilizing APRNs or PAs in predominantly clinical roles. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders. Most APRNs and PAs were prepared at the graduate level (89%), with sleep-specific education primarily through “on the job” training (86%). All APRNs surveyed were Nurse Practitioners (NPs), with approximately double the number of NPs compared to PAs. Conclusions: APRNs and PAs were reported in sleep centers at proportions similar to national estimates of NPs and PAs in physicians' offices. They report predominantly clinical roles, involving common sleep disorders. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders. Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. Efforts to provide formal and standardized educational opportunities for APRNs and PAs that focus on their clinical roles within sleep centers could help fill a current educational gap. Citation: Colvin L, Cartwright Ann, Collop N, Freedman N, McLeod D, Weaver TE, Rogers AE. Advanced practice registered nurses and physician assistants in sleep centers and clinics: a survey of current roles and educational background. J Clin Sleep Med 2014;10(5):581-587. PMID:24812545
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Screening women for intimate partner violence: Creating proper practice habits.
Knox, Beth
2018-05-17
Intimate partner violence continues to be a challenge for advanced practice registered nurses to address and manage in their daily practice. This article reviews current healthcare concerns in heterosexual, bisexual, transgender, and lesbian women, and explores screening guidelines and resources for developing successful screening habits. Additionally, the article discusses how the Transtheoretical Model and Stages of Change offers insight into the behavior of women who experience intimate partner violence and provides safety strategies for these women.
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Gould, Rebecca A; Canter, Deborah
2012-05-01
Fewer than 50% of registered dietitians (RDs) supervise personnel and 76% have no budget authority. Because higher salaries are tied to increasing levels of authority and responsibility, RDs must seek management and leadership roles to enjoy the increased remuneration tied to such positions. Advanced-level practice in any area of dietetics demands powerful communication abilities, proficiency in budgeting and finance, comfort with technology, higher-order decision-making/problem-solving skills, and well-honed human resource management capabilities, all foundational to competent management practice. As RDs envision the future of the dietetics profession, practitioners must evaluate management competence in both hard and soft skills. Just as research is needed to support evidenced-based clinical practice, the same is needed to support management practice across the profession. Dietetics educators and preceptors should be as enthusiastic about management practice as they are clinical practice when educating and mentoring future professionals. Such encouragement and support can mean that new RDs and dietetic technicians, registered, will understand what it takes to advance to higher levels of responsibility, authority, and subsequent enhanced remuneration. In the ever-changing social, legal, ethical, political, economic, technological, and ecological environments of work, food and nutrition professionals who are willing to step forward and assume the risks and responsibilities of management also will share in the rewards, and propel the profession to new heights of recognition and respect. Copyright © 2012. Published by Elsevier Inc.
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The development of professional practice standards for Australian general practice nurses.
Halcomb, Elizabeth; Stephens, Moira; Bryce, Julianne; Foley, Elizabeth; Ashley, Christine
2017-08-01
The aim of this study was to explore the current role of general practice nurses and the scope of nursing practice to inform the development of national professional practice standards for Australian general practice nurses. Increasing numbers of nurses have been employed in Australian general practice to meet the growing demand for primary care services. This has brought significant changes to the nursing role. Competency standards for nurses working in general practice were first developed in Australia in 2005, but limited attention has been placed on articulating the contemporary scope of practice for nurses in this setting. Concurrent mixed methods design. Data collection was conducted during 2013-2014 and involved two online surveys of Registered and Enrolled Nurses currently working in general practice, a series of 14 focus groups across Australia and a series of consultations with key experts. Data collection enabled the development of 22 Practice Standards separated into four domains: (i) Professional Practice; (ii) Nursing Care; (iii) General Practice Environment and (iv) Collaborative Practice. To differentiate the variations in enacting these Standards, performance indicators for the Enrolled Nurse, Registered Nurse and Registered Nurse Advanced Practice are provided under each Standard. The development of national professional practice standards for nurses working in Australian general practice will support ongoing workforce development. These Standards are also an important means of articulating the role and scope of the nurses' practice for both consumers and other health professionals, as well as being a guide for curriculum development and measurement of performance. © 2017 John Wiley & Sons Ltd.
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Mick, D J; Ackerman, M H
2000-01-01
This purpose of this study was to differentiate between the roles of clinical nurse specialists and acute care nurse practitioners. Hypothesized blending of the clinical nurse specialist and acute care nurse practitioner roles is thought to result in an acute care clinician who integrates the clinical skills of the nurse practitioner with the systems knowledge, educational commitment, and leadership ability of the clinical nurse specialist. Ideally, this role blending would facilitate excellence in both direct and indirect patient care. The Strong Model of Advanced Practice, which incorporates practice domains of direct comprehensive care, support of systems, education, research, and publication and professional leadership, was tested to search for practical evidence of role blending. This descriptive, exploratory, pilot study included subjects (N = 18) solicited from an academic medical center and from an Internet advanced practice listserv. Questionnaires included self-ranking of expertise in practice domains, as well as valuing of role-related tasks. Content validity was judged by an expert panel of advanced practice nurses. Analyses of descriptive statistics revealed that clinical nurse specialists, who had more experience both as registered nurses and in the advanced practice nurse role, self-ranked their expertise higher in all practice domains. Acute care nurse practitioners placed higher importance on tasks related to direct comprehensive care, including conducting histories and physicals, diagnosing, and performing diagnostic procedures, whereas clinical nurse specialists assigned greater importance to tasks related to education, research, and leadership. Levels of self-assessed clinical expertise as well as valuing of role-related tasks differed among this sample of clinical nurse specialists and acute care nurse practitioners. Groundwork has been laid for continuing exploration into differentiation in advanced practice nursing roles. As the clinical nurse specialist role changes and the acute care nurse practitioner role emerges, it is imperative that advanced practice nurses describe their contribution to health care. Associating advanced practice nursing activities with outcomes will help further characterize these 2 advanced practice roles.
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78 FR 20321 - Agency Information Collection Activities: Proposed Collection; Comment Request
Federal Register 2010, 2011, 2012, 2013, 2014
2013-04-04
...; Title of Information Collection: Evaluation of the Graduate Nurse Education Demonstration Program; Use: The Graduate Nurse Education (GNE) Demonstration is mandated under Section 5509 of the Affordable Care... costs for the provision of qualified clinical training to advance practice registered nurses.'' Section...
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Identification and Management of Human Trafficking Victims in the Emergency Department.
Hachey, Lisa M; Phillippi, Julia C
Health care practitioners serve an important role in identification and assistance of human trafficking victims. Advanced practice registered nurses, including certified nurse midwives, clinical nurse specialists, and nurse practitioners, are in a unique position to interact with persons trafficked and seen in the clinical setting, yet they require knowledge to identify the signs of human trafficking. Lack of training and education has been identified as a barrier for health care professionals to recognize human trafficking victims and implement needed health care services (; ). Barriers to identification and management include gap in knowledge about the process to screen for trafficking, to assist victims, and to make referrals. A patient-centered, trauma-informed approach can provide a safe environment to sensitively screen patients for human trafficking. Advanced practice registered nurses should be able to assess for trafficking indicators, collaborate with multidisciplinary service providers, and ensure understanding and availability of federal, state, and local resources to manage the care of victims of trafficking.
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Evolution of Elections Management in Tanzania
ERIC Educational Resources Information Center
Norman, A. S.; Mdegella, O. M.; Lubawa, R. M.
2011-01-01
This paper provides a discussion on the evolution of elections management in Tanzania with a focus on technological advancement in administering registration of voters. The paper provides the merits that permanent voters register has brought over the thumb practice. It traces the management of elections during colonialism, after independence…
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Exploring factors affecting registered nurses' pursuit of postgraduate education in Australia.
Ng, Linda; Eley, Robert; Tuckett, Anthony
2016-12-01
The aim of this study was to explore the factors influencing registered nurses' pursuit of postgraduate education in specialty nursing practice in Australia. Despite the increased requirement for postgraduate education for advanced practice, little has been reported on the contributory factors involved in the decision to undertake further education. The Nurses' Attitudes Towards Postgraduate Education instrument was administered to 1632 registered nurses from the Nurses and Midwives e-Cohort Study across Australia, with a response rate of 35.9% (n = 568). Data reduction techniques using principal component analysis with varimax rotation were used. The analysis identified a three-factor solution for 14 items, accounting for 52.5% of the variance of the scale: "facilitators," "professional recognition," and "inhibiting factors." Facilitators of postgraduate education accounted for 28.5% of the variance, including: (i) improves knowledge; (ii) increases nurses' confidence in clinical decision-making; (iii) enhances nurses' careers; (iv) improves critical thinking; (v) improves nurses' clinical skill; and (vi) increased job satisfaction. This new instrument has potential clinical and research applications to support registered nurses' pursuit of postgraduate education. © 2016 John Wiley & Sons Australia, Ltd.
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2018-02-01
The Academy of Nutrition and Dietetics (Academy) is the world's largest organization of food and nutrition professionals and the association that represents credentialed nutrition and dietetics practitioners-nutrition and dietetics technicians, registered (NDTRs) and registered dietitian nutritionists (RDNs). An NDTR's scope of practice in nutrition and dietetics has flexible boundaries to capture the depth and breadth of the individual's practice. The NDTR's practice expands with advances in many areas, including nutrition, food production, food safety, food systems management, health care, public health, community health, and information and communication technology. The Revised 2017 Scope of Practice for the NDTR reflects the position of the Academy on the essential role of the NDTR in the management and delivery of food and nutrition services. The scope of practice for the NDTR is composed of education and credentialing, practice resources, Academy Standards of Practice and Standards of Professional Performance, codes of ethics, accreditation standards, state and federal regulations, national guidelines, and organizational policy and procedures. The Revised 2017 Scope of Practice for the NDTR is used in conjunction with the Revised 2017 Standards of Practice in Nutrition Care and the Standards of Professional Performance for NDTRs. The Standards of Practice address activities related to direct patient and client care. The Standards of Professional Performance address behaviors related to the technical role of NDTRs. These standards reflect the minimum competent level of nutrition and dietetics practice and professional performance for NDTRs. A companion document addresses the scope of practice for the RDN. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
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The History of Evidence-Based Practice in Nursing Education and Practice.
Mackey, April; Bassendowski, Sandra
Beginning with Florence Nightingale in the 1800s and evolving again within the medical community, evidence-based practice continues to advance along with the nursing discipline. Evidence-based practice is foundational to undergraduate and graduate nursing education and is a way for the nursing discipline to minimize the theory to practice gap. This article discusses the concept of evidence-based practice from a historical perspective as it relates to nursing in the educational and practice domains. The concept evidence-based practice is defined, and the similarities and differences to evidence-based medicine are discussed. It is crucial that registered nurses be proactive in their quest for research knowledge, so the gap between theory and practice continues to close. Utilizing nursing best practice guidelines, reviewing and implementing applicable research evidence, and taking advantage of technological advances are all ways in which nursing can move forward as a well-informed discipline. Copyright © 2016 Elsevier Inc. All rights reserved.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Page, Barbara A, E-mail: barbpage09@gmail.com; Bernoth, Maree; Davidson, Rob
2014-09-15
The purpose of this study was to explore the factors influencing the implementation or the lack of implementation of advanced practitioner role in Australia. This study uses an interpretative phenomenological approach to explore the in-depth real life issues, which surround the advanced practitioner as a solution to radiologist workforce shortages in Australia. Research participants are radiographers, radiation therapists and health managers registered with the Australian Institute of Radiography (AIR) and holding senior professional and AIR Board positions with knowledge of current advanced practice. In total, seven interviews were conducted revealing education, governance, technical, people issues, change management, government, costs andmore » timing as critical factors influencing advanced practice in Australia. Seven participants in this study perceived an advanced practice role might have major benefits and a positive impact on the immediate and long-term management of patients. Another finding is the greater respect and appreciation of each other's roles and expertise within the multidisciplinary healthcare team. Engagement is required of the critical stakeholders that have been identified as ‘blockers’ (radiologists, health departments) as well as identified allies (e.g. emergency clinicians, supportive radiologists, patient advocacy groups). The research supports that the AIR has a role to play for the professional identity of radiographers and shaping the advanced practice role in Australia.« less
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Federal Register 2010, 2011, 2012, 2013, 2014
2012-03-22
...] Medicare Program; Solicitation for Proposals for the Medicare Graduate Nurse Education Demonstration... informs interested parties of an opportunity to apply to participate in the Medicare Graduate Nurse... advanced practice registered nurses (APRNs) in order to meet the health care needs of the growing Medicare...
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Transitioning into new clinical areas of practice: An integrative review of the literature.
Kinghorn, Grant R; Halcomb, Elizabeth J; Froggatt, Terry; Thomas, Stuart Dm
2017-12-01
To critically synthesise research related to the transition of registered nurses into new areas of clinical practice. Global workforce shortages and rising healthcare demands have encouraged registered nurses to move into new clinical settings. While a body of literature reports on the transition of newly qualified nurses, evidence surrounding the transition of more experienced registered nurses to new clinical areas remains poorly explored. An integrative review was conducted, guided by Whittemore and Knafl (Journal of Advanced Nursing, 52, 2005, 546) framework. An electronic database search was conducted for papers published between 1996-2016. Papers were then subjected to a methodological quality appraisal, with findings synthesised using thematic analysis into core themes. Ten articles met the inclusion criteria. Three themes emerged, namely Support, Professional Development and Emotional Impact. These themes suggest that transitioning nurses experience challenges in adapting to new clinical areas and developing necessary skills. Such challenges prompted various emotional and physical responses. While formal and informal support systems were regarded as valuable by transitioning nurses, they were inconsistent across the new clinical areas. There is some evidence to highlight the initial shock and emotional stress experienced by registered nurses during transition to a new clinical area. However, the influence of formal and informal support systems for such registered nurses is far from conclusive. Further research is needed, to examine registered nurse transition into a variety of clinical areas to inform workforce support, policy and practices. The demand of health care is growing while global shortages of nursing workforce remain. To ensure retention and enhance the transition experience of registered nurses, it is important for nurse leaders, managers and policymakers to understand the transition experience and factors that impact this experience. © 2017 John Wiley & Sons Ltd.
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Looman, Wendy S.; Erickson, Mary M.; Garwick, Ann W.; Cady, Rhonda G.; Kelly, Anne; Pettey, Carrie; Finkelstein, Stanley M.
2012-01-01
Meaningful use of electronic health records to coordinate care requires skillful synthesis and integration of subjective and objective data by practitioners to provide context for information. This is particularly relevant in the coordination of care for children with complex special health care needs. The purpose of this paper is to present a conceptual framework and example of meaningful use within an innovative telenursing intervention to coordinate care for children with complex special health care needs. The TeleFamilies intervention engages an advanced practice nurse in a full-time care coordinator role within an existing hospital-based medical home for children with complex special health care needs. Care coordination is facilitated by the synthesis and integration of internal and external data using an enhanced electronic health record and telehealth encounters via telephone and videoconferencing between the advanced practice nurse and the family at home. The advanced practice nurse’s ability to maintain an updated plan of care that is shared across providers and systems and build a relationship over time with the patient and family supports meaningful use of these data. PMID:22948406
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Beto, Judith A; Ramirez, Wendy E; Bansal, Vinod K
2014-07-01
Chronic kidney disease is classified in stages 1 to 5 by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative depending on the level of renal function by glomerular filtration rate and, more recently, using further categorization depending on the level of glomerular filtration rate and albuminuria by the Kidney Disease Improving Global Outcomes initiative. Registered dietitian nutritionists can be reimbursed for medical nutrition therapy in chronic kidney disease stages 3 to 4 for specific clients under Center for Medicare and Medicaid Services coverage. This predialysis medical nutrition therapy counseling has been shown to both potentially delay progression to stage 5 (renal replacement therapy) and decrease first-year mortality after initiation of hemodialysis. The Joint Standards Task Force of the American Dietetic Association (now the Academy of Nutrition and Dietetics), the Renal Nutrition Dietetic Practice Group, and the National Kidney Foundation Council on Renal Nutrition collaboratively published 2009 Standards of Practice and Standards of Professional Performance for generalist, specialty, and advanced practice registered dietitian nutritionists in nephrology care. The purpose of this article is to provide an update on current recommendations for screening, diagnosis, and treatment of adults with chronic kidney disease for application in clinical practice for the generalist registered dietitian nutritionist using the evidence-based library of the Academy of Nutrition and Dietetics, published clinical practice guidelines (ie, National Kidney Foundation Council on Renal Nutrition, Renal Nutrition Dietetic Practice Group, Kidney Disease Outcomes Quality Initiative, and Kidney Disease Improving Global Outcomes), the Nutrition Care Process model, and peer-reviewed literature. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
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Pharmacists' self-perceptions in relation to the 'Advanced Pharmacy Practice Framework'.
Ali, A S; Fejzic, J; Grant, G D; Nissen, L M
2016-01-01
The Australian Pharmacy Practice Framework was developed by the Advanced Pharmacy Practice Steering Committee and endorsed by the Pharmacy Board of Australia in October 2012. The Steering Committee conducted a study that found practice portfolios to be the preferred method to assess and credential Advanced Pharmacy Practitioner, which is currently being piloted by the Australian Pharmacy Council. Credentialing is predicted to open to all pharmacists practising in Australia by November 2015. To explore how Australian pharmacists self-perceived being advanced in practice and how they related their level of practice to the Australian Advanced Pharmacy Practice Framework. This was an explorative, cross-sectional study with mixed methods analysis. Advanced Pharmacy Practice Framework, a review of the recent explorative study on Advanced Practice conducted by the Advanced Pharmacy Practice Framework Steering Committee and semi-structured interviews (n = 10) were utilized to create, refine and pilot the questionnaire. The questionnaire was advertised across pharmacy-organizational websites via a purposive sampling method. The target population were pharmacists currently registered in Australia. Seventy-two participants responded to the questionnaire. The participants were mostly female (56.9%) and in the 30-40 age group (26.4%). The pharmacists self-perceived their levels of practice as either entry, transition, consolidation or advanced, with the majority selecting the consolidation level (38.9%). Although nearly half (43.1%) of the participants had not seen the Framework beforehand, they defined Advanced Pharmacy Practice similarly to the definition outlined in the Framework, but also added specialization as a requirement. Pharmacists explained why they were practising at their level of practice, stating that not having more years of practice, lacking experience, or postgraduate/post-registration qualifications, and more involvement and recognition in practice were the main reasons for not considering themselves as an Advanced Pharmacy Practitioner. To be considered advanced by the Framework, pharmacists would need to fulfill at least 70% of the Advanced Practice competency standards at an advanced level. More than half of the pharmacists (64.7%) that self-perceived as being advanced managed to fulfill 70% or more of these Advanced Practice competency standards at the advanced level. However, none of the self-perceived entry level pharmacists managed to match at least 70% of the competencies at the entry level. Participants' self-perception of the term Advanced Practice was similar to the definition in the Advanced Pharmacy Practice Framework. Pharmacists working at an advanced level were largely able to demonstrate and justify their reasons for being advanced practitioners. However, pharmacists practising at the other levels of practice (entry, transition, consolidation) require further guidance regarding their advancement in practice. Copyright © 2016 Elsevier Inc. All rights reserved.
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Orientation to Health Occupations: Curriculum Guide for Health Occupations, Phase 3.
ERIC Educational Resources Information Center
Benedict, Mary; And Others
The document outlines a curriculum designed to prepare students for advanced health occupations. It is divided into four sections which offer basic information for: registered nurse and licensed practical nurse (32 units); dental assistant (19 units); medical assistant (26 units); and ward clerk (10 units). Each unit is divided into several topics…
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Evaluation of a Person-Centered, Theory-Based Intervention to Promote Health Behaviors.
Worawong, Chiraporn; Borden, Mary Jo; Cooper, Karen M; Pérez, Oscar A; Lauver, Diane
Effective promotion of health behaviors requires strong interventions. Applying person-centered approaches and concepts synthesized from two motivational theories could strengthen the effects of such interventions. The aim of the study was to report the effect sizes, fidelity, and acceptability of a person-centered, health behavior intervention based on self-regulation and self-determination theories. Using a pre- and postintervention design, with a 4-week follow-up, advanced practice registered nurses made six weekly contacts with 52 volunteer participants. Most participants were educated White women. Advanced practice registered nurses elicited participant motives and particular goals for either healthy diet or physical activity behaviors. Minutes and type of activity and servings of fat and fruit/vegetables were assessed. Effect sizes for engaging in moderate aerobic activity and in fruit/vegetable and fat intake were 0.53, 0.82, and -0.57, respectively. The fidelity of delivery was 80-97% across contacts, and fidelity of participants' receipt of intervention components was supported. Participant acceptance of the intervention was supported by positive ratings on aspects of relevance and usefulness. To advance the science of health behavior change and improve client health status, person-centered approaches and concepts synthesized from motivational theories can be applied and tested with a randomized, controlled design and diverse samples to replicate and extend this promising behavioral intervention.
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Starks, Shaquita A; Outlaw, Freida; Graff, J Carolyn; Likes, Wendy; White-Means, Shelley; Melaro, Laura; Wicks, Mona N
2018-06-01
To identify factors affecting the quality of life (QOL) of African American women (AAW) family caregivers of individuals with kidney failure. Ferrans' Conceptual Model of QOL provided the framework for this literature review. Included studies were (a) peer- reviewed, (b) published within the last ten years, (c) written in English, and (d) examined QOL of AAW family caregivers. Using CINAHL© and PubMed©, we found 14 studies that described factors associated with these caregivers' QOL. Few studies document the QOL of AAW who are family caregivers, especially in the context of kidney failure. Psychiatric Mental Health Advanced Practice Registered Nurses need to learn about the factors influencing the QOL of these caregivers. No studies were found within the last ten years that explored the QOL of AAW family caregivers of individuals with kidney failure. Findings reflected the QOL of AAW family caregivers in the context of other chronic conditions. Various factors such as stress, insomnia, and employment were linked to an impaired QOL. Implications for practice, research and education for PMH-APRNs are suggested. PMH-APRNs are uniquely trained to address many factors that affect the QOL of these caregivers and may provide holistic care aimed at promoting satisfactory QOL for these caregivers.
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Developing an advanced practice nurse-led liver clinic.
McAfee, Jean L
2012-01-01
End-stage liver disease (ESLD) is a leading cause of digestive disease deaths in the United States and continues to increase exponentially every year. Best practice does not currently recognize or utilize a clinic practice model for ESLD management. Advanced practice registered nurses (APRNs) can impact ESLD disease management by implementing an outpatient clinic care model to focus on treatment compliance, patient education, improvement of patient outcomes, and reduction in hospital admission rates for ESLD patients. A review of 15 research articles was completed to determine the impact APRNs can make on chronic care of ESLD patients. Results from the review support APRN analysis, assessment, diagnosis, treatment, intervention, and evaluation of ESLD patients. The literature reviewed also demonstrates that ESLD patients have improved symptom management when maintained in an outpatient setting, allowing for decreased hospital and insurance expenditures. Following evaluation of the evidence, it was concluded that an APRN-led ESLD clinic merits further study.
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Imai, K
2001-03-01
The present study examines job-related factors leading to low self-esteem in nurses. The lowering of self-esteem suggests that such nurses had difficulty in fully accepting themselves and their circumstances. Subjects were registered nurses (RN) and licensed practical nurses (LPN) at hospitals, and unemployed registered nurses (UEN) seeking employment. Questionnaires were provided at 53 hospitals and a Nurse Bank in Kanagawa Prefecture. The responses of 552 RN, 146 LPN and 433 UEN were analyzed. Questions were asked about personal life, past or present nursing experience, working conditions, nursing skills, satisfaction with work performance and self-esteem. Factors giving rise to low self-esteem were determined using logistic regression analysis and logistic discriminant analysis. Employment status and qualifications were determined to be the most important factors determining the self-esteem of nurses. The next most important factors were 'a limited number of years of experience (less than five years)' and 'dissatisfaction with discretion and responsibility as a nurse' (P < 0.01). Adjusted odds ratio for a reduction in self-esteem for LPN was 4.07 times higher than for UEN, and 2.2 times higher than for RN by logistic regression analysis. LPN are treated as unskilled workers, and thus significant differences were apparent in their performance of certain job tasks. These differences were analyzed using discriminant analysis, and were referred to as follows, 1: Advanced assessment skills, 2: Advanced technical skills, 3: Advanced communication skills, and 4: Nursing plan and documentation (positive discrimination rate was 70.8%). Job dissatisfaction is closely associated with the level of professional training. Continuous education and a feedback system for various levels of nurses are needed.
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Egues, Aida L
2013-01-01
The purpose of this qualitative descriptive study was to explore the meaning of the experiences of mentoring influences on the personal and professional growth of Hispanic registered nurses (RNs). Focus group methodology was employed in the New York City metropolitan area with monolingual English or bilingual English/Spanish RNs (N = 20) who perceived themselves to be at all levels of practice. The findings offer a summary of the experiences of mentoring for the 20 Hispanic RNs that includes little advancement support; hesitancy to being mentored; dependency on the self for personal and professional growth; and educational, practice, and socioeconomic barriers. This study suggests that mentoring of Hispanic nurses needs to be reexamined to improve and sustain a culture of mentoring that may enhance the education, recruitment, and retention of Hispanic RNs.
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Elliott, Naomi; Begley, Cecily; Kleinpell, Ruth; Higgins, Agnes
2014-05-01
To report a secondary analysis of data collected from the case study phase of a national study of advanced practitioners and to develop leadership outcome-indicators appropriate for advanced practitioners. In many countries, advanced practitioners in nursing and midwifery have responsibility as leaders for health care development, but without having leadership outcome measures available they are unable to demonstrate the results of their activities. In Ireland, a sequential mixed method research study was used to develop a validated tool for the evaluation of clinical specialists and advanced practitioners. Despite strong evidence of leadership activities, few leadership-specific outcomes were generated from the primary analysis. Secondary analysis of a multiple case study data set. Data set comprised 23 case studies of advanced practitioner/clinical specialists from 13 sites across each region in Ireland from all divisions of the Nursing Board Register. Data were collected 2008-2010. Data sources included non-participant observation (n = 92 hours) of advanced practitioners in practice, interviews with clinicians (n = 21), patients (n = 20) and directors of nursing/midwifery (n = 13) and documents. Analysis focused on leadership outcome-indicator development in line with the National Health Service's Good Indicators Guide. The four categories of leadership outcomes for advanced practitioner developed were as follows: (i) capacity and capability building of multidisciplinary team; (ii) measure of esteem; (iii) new initiatives for clinical practice and healthcare delivery; and (iv) clinical practice based on evidence. The proposed set of leadership outcome-indicators derived from a secondary analysis captures the complexity of leadership in practice. They add to existing clinical outcomes measuring advanced practice. © 2013 John Wiley & Sons Ltd.
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Returns to nursing education: rural and nonrural practice.
Pan, S; Straub, L
1997-01-01
This study uses data from a national sample of registered nurses to compare earnings of nurses in rural and nonrural practice. The comparisons, conditioned by the nurses' education level, are analogous to the concept of "returns to human capital investment" used in labor economics. A general linear model is applied within a framework of labor economics analysis. Results show that nurses with more education receive less for their investment if they practice in rural areas. Work experience and employment setting are also related to lower annualized earnings for rural practice. One exception to the otherwise consistent findings is that returns to advanced practice nursing are higher in rural areas. Results and policy implications are discussed.
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Political advocacy and practice barriers: a survey of Florida APRNs.
Kung, Ying Mai; Rudner Lugo, Nancy
2015-03-01
This study examined factors aligned with advocacy among advanced practice registered nurses (APRNs) by examining the relationships among demographics, years of RN and APRN experience, education levels, affiliations with professional organizations, perceptions of barriers to practice, political activism, and willingness to speak to the media. This was a secondary analysis of online survey data (N = 884) from APRNs in Florida. All APRNs with an e-mail address with the state nursing board or a Florida Coalition of Advanced Practice Nurses' membership organization received an e-mail requesting their participation to the survey. Having a high educational level and involvement in a professional organization are each individually statistically associated with perceiving practice barriers, engaging in political activism, and willingness to speak with media. Emerging nurse leaders need an understanding of policy issues, an appreciation of the potential of the profession, and enhanced advocacy skills. To address the nation's health needs, APRNs need to recognize practice barriers, develop advocacy skills, and take action for policy changes to enhance the legal authority to practice to full extent of APRNs' education and training. ©2014 American Association of Nurse Practitioners.
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Farrell, Kathleen; Payne, Camille; Heye, Mary
2015-01-01
The emergence of interprofessional collaboration and practice as a means to provide patient-centered care and to decrease the current fragmentation of health care services in the 21st century provides a clear and unique opportunity for the advanced practice registered nurse (APRN) to assume a key role. For APRNs and other health care providers, to participate effectively as team members requires an interprofessional mindset. Development of interprofessional skills and knowledge for the APRN has been hindered by a silo approach to APRN role socialization. The Institute of Medicine Report (IOM; 2010) states that current health care systems should focus on team collaboration to deliver accessible, high-quality, patient-centered health care that addresses wellness and prevention of illness and adverse events, management of chronic illness, and increased capacity of all providers on the team. The purpose of this article is to demonstrate the need to incorporate interprofessional education (IPE) into the socialization models used in advanced practice nursing programs. IPE requires moving beyond profession-specific educational efforts to engage students of different health care professions in interactive learning. Being able to work effectively as member of a clinical team while a student is a fundamental part of that learning (Interprofessional Education Collaborative Expert Panel, 2011). The objective of IPE curriculum models in graduate nursing programs is to educate APRNs in the development of an interprofessional mindset. Interprofessional collaboration and coordination are needed to achieve seamless transitions for patients between providers, specialties, and health care settings (IOM, 2010). Achieving the vision requires the continuous development of interprofessional competencies by APRNs as part of the learning process, so that upon entering the workforce, APRNs are ready to practice effective teamwork and team-based care. Socialization of the professional APRN role must integrate interprofessional competencies and interactions to prepare APRNs accordingly. Copyright © 2015 Elsevier Inc. All rights reserved.
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Critical Appraisal Tools and Reporting Guidelines for Evidence-Based Practice.
Buccheri, Robin K; Sharifi, Claire
2017-12-01
Nurses engaged in evidence-based practice (EBP) have two important sets of tools: Critical appraisal tools and reporting guidelines. Critical appraisal tools facilitate the appraisal process and guide a consumer of evidence through an objective, analytical, evaluation process. Reporting guidelines, checklists of items that should be included in a publication or report, ensure that the project or guidelines are reported on with clarity, completeness, and transparency. The primary purpose of this paper is to help nurses understand the difference between critical appraisal tools and reporting guidelines. A secondary purpose is to help nurses locate the appropriate tool for the appraisal or reporting of evidence. A systematic search was conducted to find commonly used critical appraisal tools and reporting guidelines for EBP in nursing. This article serves as a resource to help nurse navigate the often-overwhelming terrain of critical appraisal tools and reporting guidelines, and will help both novice and experienced consumers of evidence more easily select the appropriate tool(s) to use for critical appraisal and reporting of evidence. Having the skills to select the appropriate tool or guideline is an essential part of meeting EBP competencies for both practicing registered nurses and advanced practice nurses (Melnyk & Gallagher-Ford, 2015; Melnyk, Gallagher-Ford, & Fineout-Overholt, 2017). Nine commonly used critical appraisal tools and eight reporting guidelines were found and are described in this manuscript. Specific steps for selecting an appropriate tool as well as examples of each tool's use in a publication are provided. Practicing registered nurses and advance practice nurses must be able to critically appraise and disseminate evidence in order to meet EBP competencies. This article is a resource for understanding the difference between critical appraisal tools and reporting guidelines, and identifying and accessing appropriate tools or guidelines. © 2017 Sigma Theta Tau International.
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Goals and potential career advancement of licensed practical nurses in Japan.
Ikeda, Mari; Inoue, Katsuya; Kamibeppu, Kiyoko
2008-10-01
To investigate the effects of personal and professional variables on career advancement intentions of working Licensed Practical Nurses (LPNs). In Japan, two levels of professional nursing licensures, the LPN and the registered nurse (RN), are likely to be integrated in the future. Therefore, it is important to know the career advancement intentions of LPNs. Questionnaires were sent to a sample of 356 LPNs. Analysis of variance (anova) and discriminative analysis were used. We found that those who had a positive image of LPNs along with a positive image of RNs were identified as showing interest in career advancement. The results of anova showed that age had a negative effect; however, discriminative analysis suggested that age is not as significant compared with other variables. Our results indicate that the 'image of RNs', and 'role-acceptance factors' have an effect on career advancement intentions of LPNs. Our results suggest that Nursing Managers should create a supportive working environment where the LPN would feel encouraged to carry out the nursing role, thereby creating a positive image of nursing in general which would lead to career motivation and pursuing RN status.
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Fraser, Robin C.; Clayton, David G.
1981-01-01
This paper presents the results of a point prevalent evaluation of the comparative reliability and validity of age-sex registers, practice medical records and family practitioner committee (FPC) registers from five teaching practices. They all exhibited similar levels of acceptable accuracy for patient names, sex and age, but the distribution of wrong addresses varied greatly: practice medical records 3·9 per cent, age-sex registers 8·2 per cent and FPC registers 17·1 per cent. The presence of a patient entry in all three registers was associated with a high degree of probability (95·3 per cent) that this individual would be a bona fide practice patient. The register population inflation rates were FPC records 5·5 per cent, practice records 9·8 per cent and age-sex registers 10·6 per cent, but there were large variations between individual practices. A statistically significant contribution to inflation rates came from the age groups 0 to 1 and 21 to 40 (p<0·0005). The register population deflation rates were minimal. The significance of these findings is discussed and the need for practices to determine the accuracy of their individual age-sex registers is stressed. A convenient and economic method for so doing is suggested. We also suggest ways of making it easier to construct and use age-sex registers, since they can be a most versatile and useful aid to research in general practice. ImagesFigure 1. PMID:7320986
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Primary health care registered nurses' types in implementation of health promotion practices.
Maijala, Virpi; Tossavainen, Kerttu; Turunen, Hannele
2016-09-01
Aim This study aimed to identify and reach consensus among primary health care participants [registered nurses (RNs) who receive clients, directors of nursing, senior physicians, health promotion officers, and local councillors] on the types of service provider that RNs who receive clients represent in the implementation of health promotion practices in primary health care in Eastern Finland. There is an increasing focus on public health thinking in many countries as the population ages. To meet the growing needs of the health promotion practices of populations, advance practice has been recognized as effective in the primary health care setting. The advance practice nurses share many common features, such as being RNs with additional education, possessing competencies to work independently, treating clients in both acute and primary care settings, and applying a variety of health promotion practices into nursing. The two-stage modified Delphi method was applied. In round one, semi-structured interviews were conducted among primary health care participants (n=42) in 11 health centres in Eastern Finland. In round two, a questionnaire survey was conducted in the same health centres. The questionnaire was answered by 64% of those surveyed (n=56). For data analysis, content analysis and descriptive statistics were used. Findings This study resulted in four types of service provider that RNs who receive clients represented in the implementation of health promotion practices in the primary health care setting in Eastern Finland. First, the client-oriented health promoter demonstrated four dimensions, which reached consensus levels ranging between 82.1 and 89.3%. Second, the developer of health promotion practices comprised four dimensions, which reached consensus levels between 71.4 and 85.7%. Third, the member of multi-professional teams of health promotion practices representing three dimensions, with consensus levels between 69.6 and 82.1%. Fourth, the type who showed interest towards health policy reached a consensus level of 55.4% in this study.
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Clinical trials of GMP products in the gene therapy field.
Bamford, Kathleen B
2011-01-01
Advances in gene therapy are increasingly leading to clinical assessment in many fields of medicine with diverse approaches. The basic science stems from approaches aimed at different functions such as correcting a missing/abnormal gene, altering the proportion or expression of normal genes to augment a physiological process or using this principle to destroy malignant or infected cells. As the technology advances, it is increasingly important to ensure that clinical trials answer the questions that need to be asked. In this chapter we review examples of published clinical trials, resources for accessing information about registered trials, the process of regulating trials, good clinical practice, and good manufacturing practice as well as summarising the approach taken by regulatory authorities in reviewing applications for the introduction of products for use in the clinic.
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Competence for older people nursing in care and nursing homes: An integrative review.
Kiljunen, Outi; Välimäki, Tarja; Kankkunen, Päivi; Partanen, Pirjo
2017-09-01
People living in care and nursing homes are vulnerable individuals with complex needs; therefore, a wide array of nursing competence is needed to ensure their well-being. When developing the quality of care in these units, it is essential to know what type of competence is required for older people nursing. The aim of this integrative review was to identify the competence needed for older people nursing in licensed practical nurses' and registered nurses' work in care and nursing homes. Integrative literature review. We performed an integrative review using Whittemore and Knafl's method. The CINAHL, MEDLINE, PsycINFO, SocINDEX and Scopus databases were searched for studies published from 2006 to April 2016. We assessed the quality of the studies using Joanna Briggs Institute critical appraisal tools and analysed the data by applying qualitative content analysis. Ten articles were included in the review. Most of the studies focused on registered nurses' work. We identified five competence areas that are needed for older people nursing in registered nurses' work in care and nursing homes: attitudinal and ethical, interactional, evidence-based care, pedagogical, and leadership and development competence. Empirical evidence of competence requirements related to licensed practical nurses' work in these facilities was scarce. The competence required for registered nurses and licensed practical nurses should be clearly identified to support competence management in the care and nursing home context. Well-educated nursing staff are needed in care and nursing homes to provide high-quality care because comprehensive and advanced nurse competence is required to meet the needs of older people. © 2016 John Wiley & Sons Ltd.
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Phelan, Cynthia H.; Lauver, Diane R.; Bratzke, Lisa C.
2016-01-01
Purpose/ Objectives Sleep-related breathing disorders (SRBDs), including obstructive sleep apnea and central sleep apnea, are common among patients with cardiovascular disease (CVD), but clinicians often do not pay enough attention to SRBDs. The purpose of this narrative review is to update advanced practice registered nurses (APRNs) on the literature focusing on the relationship between SRBDs and CVD (e.g., hypertension, heart failure, coronary artery disease, arrhythmias, and stroke) and on treatments that can improve SRBDs in patients with CVD. Description of the project We conducted an electronic search of the literature published between1980 and 2016 from PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Academic Search Premier, and related health resources websites to address the aims of this study. Outcomes Fifty-six primary research articles (42 observational studies and 14 experimental and quasi-experimental studies) were selected based on our study aims and inclusion criteria. The studies revealed that individuals with CVD are at a greater risk for SRBDs and that SRBDs can worsen CVD. The findings from the studies also suggest that positive airway treatment could improve both SRBDs and CVD. Conclusions This review found a close relationship between SRBDs and CVD. APRNs are in key positions to identify and help patients manage SRBDs. In particular, APRNs can educate staff and establish standards of practice to improve outcomes for CVD patients. PMID:27753673
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Nurse-midwifery: art and science.
Dole, Debora M; Nypaver, Cynthia F
2012-06-01
The gap in the health of the nations' people seems to be widening and reflects existing social inequalities affecting the ongoing health of individuals. From a historical and practical perspective, certified nurse-midwives (CNMs) are one group of advanced practice registered nurses uniquely situated to address existing disparities related to maternal-child health. This article provides an overview of the historical development, current status, and use of CNMs in the United States health care system; the impact of CNMs on maternal-child health outcomes; and future trends in the education of CNMs. Copyright © 2012 Elsevier Inc. All rights reserved.
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McConnell, Eleanor Schildwachter; Lekan, Deborah; Hebert, Catherine; Leatherwood, Lisa
2007-01-01
Learning in practice disciplines suffers when gaps exist between classroom instruction and students' observations of routine clinical practices.(1) Academic institutions, therefore, have a strong interest in fostering the rapid and effective translation of evidence-based care techniques into routine practice. Long-term care (LTC) practice sites are particularly vulnerable to gaps between classroom teaching and how daily care is implemented, owing to the recent rapid advances in the scientific bases of care for frail older adults, the relative isolation of most LTC sites from academic settings,(2) and the relatively small number of registered nurses (RNs) available in LTC settings who can facilitate translation of research-based practices into care.(3) The aim of this project was to demonstrate the feasibility and value of an academic practice partnership to implement evidence-based approaches to solving resident care problems in LTC, as many scientifically proven practices hold promise for improving resident outcomes yet adoption is often slow.(4) We developed and implemented a clinical practice improvement process, based on diffusion of innovations theory and research,(5-8) to serve as a new model of academic-practice collaboration between a university school of nursing, LTC facility management and direct-care staff, as a means of developing high quality clinical sites for student rotations. The goal was to implement a sustainable evidence-based oral care program as an exemplar of how scientific evidence can be translated into LTC practice. This project focused on oral hygiene because the staff was dissatisfied with their existing resident oral care program, and an evidence-base for oral care in LTC existed that had not yet been incorporated into care routines. This article describes a systematic, replicable process for linking advanced practice registered nurse expertise with staff insights about care systems to reduce the gap between teaching and practice in long-term care settings. Our experience demonstrates that translation of research on oral care practices into LTC practice through academic-practice partnerships is feasible, is associated with positive resident outcomes, and illustrates a process that has broader applicability to other common problems in LTC, where incomplete implementation of an extant research base for practice may inhibit student learning.
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Effective Strategies for Achieving Scope of Practice Reform in Pennsylvania.
Carthon, J Margo Brooks; Wiltse Nicely, Kelly; Altares Sarik, Danielle; Fairman, Julie
2016-05-01
Current regulatory impediments prohibit advanced practice registered nurses from practicing to their full capacity. To examine the process of successful removal of scope of practice barriers in Pennsylvania under the Rx4PA legislation introduced in 2007. We used qualitative research techniques, including purposeful sampling of participants. Twelve stakeholder informed interviews were conducted between October 2013 and May 2014. Participants were closely involved with the development of the Rx4PA legislation. Thematic content analysis was performed to analyze our interviews. Interviews identified overarching themes, including the importance of leveraging years of grass roots advocacy, identifying political allies, and recognizing mutually beneficial compromises. The combination of timing, careful political maneuvering, and compromise were key to scope of practice reform in Pennsylvania and may be useful strategies for other states seeking similar practice changes. © The Author(s) 2016.
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Effective Strategies for Achieving Scope of Practice Reform in Pennsylvania
Carthon, J. Margo Brooks; Nicely, Kelly Wiltse; Sarik, Danielle Altares; Fairman, Julie
2017-01-01
Background Current regulatory impediments prohibit advanced practice registered nurses from practicing to their full capacity. Purpose To examine the process of successful removal of scope of practice barriers in Pennsylvania under the Rx4PA legislation introduced in 2007. Method We used qualitative research techniques, including purposeful sampling of participants. Twelve stakeholder informed interviews were conducted between October 2013 and May 2014. Participants were closely involved with the development of the Rx4PA legislation. Thematic content analysis was performed to analyze our interviews. Discussion Interviews identified overarching themes, including the importance of leveraging years of grass roots advocacy, identifying political allies, and recognizing mutually beneficial compromises. Conclusions The combination of timing, careful political maneuvering, and compromise were key to scope of practice reform in Pennsylvania and may be useful strategies for other states seeking similar practice changes. PMID:27502393
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Breastfeeding Counseling, Barriers and Facilitators of Lactation in the Military Community
1998-05-01
play in health promotion and disease prevention. The advanced practice registered nurse employs complex strategies, interventions, and teaching to... teaching of breastfeeding, and regard by peers as experts in the content area. A pilot study was conducted at a mid-sized military hospital to assess the...admissions for infection in infants. Pediatrics, 65, 1,121-1,124. Freed, G. (1993). Breast-feeding: Time to teach what we preach. Journal of the American
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Economic benefits of less restrictive regulation of advanced practice nurses in North Carolina.
Conover, Chris; Richards, Robert
2015-01-01
With looming provider shortages and increased demand for health care, many states are looking for low-cost ways to alleviate the shortages. The purpose of this study was to assess the economic impact of less restrictive regulations for advanced practice registered nurses (APRNs) in North Carolina. We use economic impact analysis to demonstrate the economic impacts of making state scope-of-practice regulations on APRNs less restrictive in North Carolina. Outcomes include economic output, value-added, payroll compensation, employment, and tax revenue for North Carolina and for various subregions. If North Carolina adopted the same approach to APRN regulation as the least restrictive states, its economy will benefit from substantial increases in economic output and employment. The state will also see increases in tax revenue. In addition to substantially shrinking the size of projected physician shortages, allowing full scope-of-practice for APRNs will bring significant economic benefits to the state of North Carolina. Our analysis should be helpful to policy makers considering ways to deal with provider shortages. Copyright © 2015 Elsevier Inc. All rights reserved.
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[The Role of Nursing Education in the Advancement of the Nursing Profession].
Chang Yeh, Mei
2017-02-01
The present article discusses the role of nursing education in the advancement of the nursing profession in the context of the three facets of knowledge: generation, dissemination, and application. Nursing is an applied science and the application of knowledge in practice is the ultimate goal of the nursing profession. The reform of the healthcare delivery model requires that nurses acquire and utilize evidence-based clinical knowledge, critical thinking, effective communication, and team collaboration skills in order to ensure the quality of patient care and safety. Therefore, baccalaureate education has become the minimal requirement for pre-licensure nursing education. Schools of nursing are responsible to cultivate competent nurses to respond to the demands on the nursing workforce from the healthcare system. Attaining a master's education in nursing helps cultivate Advanced Practice Registered Nurses (APRNs) to further expand the roles and functions of the nursing profession in order to promote the quality of care in clinical practice. Nursing faculty and scholars of higher education institutions generate nursing knowledge and develop professional scholarship through research. Attaining a doctoral education in nursing cultivates faculties and scholars who will continually generate and disseminate nursing knowledge into the future.
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2013-01-01
Background As in other countries, the Irish Regulator for Pre-Hospital practitioners, the Pre-Hospital Emergency Care Council (PHECC), will introduce a Continuous Professional Competence (CPC) framework for all Emergency Medical Technicians (EMTs), Paramedics and Advanced Paramedics (APs). This framework involves EMTs participating in regular and structured training to maintain professional competence and enable continuous professional developments. To inform the development of this framework, this study aimed to identify what EMTs consider the optimum educational outcomes and activity and their attitude towards CPC. Methods All EMTs registered in Ireland (n = 925) were invited via email to complete an anonymous online survey. Survey questions were designed based on Continuous Professional Development (CPD) questionnaires used by other healthcare professions. Quantitative and qualitative analyses were performed. Results Response rate was 43% (n = 399). 84% of participants had been registered in Ireland for less than 24 months, while 59% had been registered EMTs for more than one year. Outcomes were: evidence of CPC should be a condition for EMT registration in Ireland (95%), 78% believed that EMTs who do not maintain CPC should be denied the option to re-register. Although not required to do so at the time of survey, 69% maintained a professional portfolio and 24% had completed up to 20 hours of CPC activities in the prior 12 months. From a list of 22 proposed CPC activities, 97% stated that practical scenario-based exercises were most relevant to their role. E-learning curricula without practical components were considered irrelevant (32%), but the majority of participants (91%) welcomed access to e-learning when supplemented by related practical modules. Conclusion EMTs are supportive of CPC as a key part of their professional development and registration. Blended learning, which involves clinical and practical skills and e-learning, is the optimum approach. PMID:24345064
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Polster, Debra; Villines, Dana
The aims of this study were to describe registered nurses' levels of personal innovativeness and registered nurses' perceived organizational innovativeness and determine the relationship between these 2 variables. There is limited research to describe the levels of innovation of nurses within a hospital. The levels of innovation can determine the likelihood of adoption of evidence-based practices at the bedside. As change agents, clinical nurse specialists can determine successful implementation strategies tailored to nurse levels of innovation. This was a descriptive study at a midwest, urban, teaching, 408-bed Magnet hospital. Surveys were completed by 217 nurses. The participants reported high personal innovativeness ((Equation is included in full-text article.)= 32.1; SD, 6.4), and the institution was perceived as innovative, with 90.3% of scores categorized as positive innovativeness. The statistically significant correlation was in the medical-surgical unit (r = -0.52, P < .01). There is no correlation between personal innovativeness and organizational innovativeness except for medical-surgical nurses (P = .03). They are likely to perceive the organization more innovative than themselves. Determining adopter characteristics can be valuable to the clinical nurse specialist by adapting strategic interventions to advance nursing practice. Exploring levels of adoption can be an innovative strategy to transform nursing at the bedside and throughout the organization.
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The role of physician oversight on advanced practice nurses' professional autonomy and empowerment.
Petersen, Polly A; Way, Sandra M
2017-05-01
Little is known about the effects of physician oversight on advanced practice registered nurses (APRNs). Examination of these relationships provides insight into the strength of independent practice. The purpose of this study was to examine whether APRNs' perceptions of autonomy and empowerment varied according to type of physician oversight, whether facilitative or restrictive. A cross-sectional survey design was used to examine whether APRNs' perceptions of autonomy and empowerment varied according to physician oversight, geographical location, and practice setting. Five hundred questionnaires were mailed in March 2013 with 274 returned. Participants were asked about autonomy, empowerment, demographics, physician oversight, geographical location, and practice setting. Among surveyed respondents, physician oversight was related to increased empowerment, regardless of whether the oversight was defined in facilitative or restrictive terms; both had similar positive effects on empowerment. If APRNs are to be part of the solution to the growing problem of healthcare access, it is important to study factors that contribute to their success. We speculate that increasing opportunities for collaboration and interaction with physicians, and possibly other healthcare professionals, could facilitate APRN empowerment, optimizing their contribution. ©2017 American Association of Nurse Practitioners.
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ERIC Educational Resources Information Center
National Advisory Council on Nurse Education and Practice, Rockville, MD.
The National Advisory Council on Nurse Education and Practice (NACNEP) initiated an examination of basic registered nurse workforce issues in December 1994. NACNEP took into account the environment in which registered nurses (RNs) would practice, the appropriate educational qualifications needed, and the status of the registered nurse population…
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Everyday Excellence: A Framework for Professional Nursing Practice in Long-Term Care
Lyons, Stacie Salsbury; Specht, Janet Pringle; Karlman, Susan E.
2009-01-01
Registered nurses make measurable contributions to the health and wellness of persons living in nursing homes. However, most nursing homes do not employ adequate numbers of professional nurses with specialized training in the nursing care of older adults to positively impact resident outcomes. As a result, many people never receive excellent geriatric nursing while living in a long-term care facility. Nurses have introduced various professional practice models into health care institutions as tools for leading nursing practice, improving client outcomes, and achieving organizational goals. Problematically, few professional practice models have been implemented in nursing homes. This article introduces an evidence-based framework for professional nursing practice in long-term care. The Everyday Excellence framework is based upon eight guiding principles: Valuing, Envisioning, Peopling, Securing, Learning, Empowering, Leading, and Advancing Excellence. Future research will evaluate the usefulness of this framework for professional nursing practice. PMID:20077966
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Computer screening for palliative care needs in primary care: a mixed-methods study.
Mason, Bruce; Boyd, Kirsty; Steyn, John; Kendall, Marilyn; Macpherson, Stella; Murray, Scott A
2018-05-01
Though the majority of people could benefit from palliative care before they die, most do not receive this approach, especially those with multimorbidity and frailty. GPs find it difficult to identify such patients. To refine and evaluate the utility of a computer application (AnticiPal) to help primary care teams screen their registered patients for people who could benefit from palliative care. A mixed-methods study of eight GP practices in Scotland, conducted in 2016-2017. After a search development cycle the authors adopted a mixed-methods approach, combining analysis of the number of people identified by the search with qualitative observations of the computer search as used by primary care teams, and interviews with professionals and patients. The search identified 0.8% of 62 708 registered patients. A total of 27 multidisciplinary meetings were observed, and eight GPs and 10 patients were interviewed. GPs thought the search identified many unrecognised patients with advanced multimorbidity and frailty, but were concerned about workload implications of assessment and care planning. Patients and carers endorsed the value of proactive identification of people with advanced illness. GP practices can use computer searching to generate lists of patients for review and care planning. The challenges of starting a conversation about the future remain. However, most patients regard key components of palliative care (proactive planning, including sharing information with urgent care services) as important. Screening for people with deteriorating health at risk from unplanned care is a current focus for quality improvement and should not be limited by labelling it solely as 'palliative care'. © British Journal of General Practice 2018.
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Advanced and specialist nursing practice: attitudes of nurses and physicians in Israel.
Brodsky, Eithan; Van Dijk, Dina
2008-01-01
With the introduction of new and advanced nursing roles, the nursing profession is undergoing dynamic change. Realizing changes will be easier to accomplish if the nursing community and other healthcare professionals welcome the process. Recently the nursing staff mix in Israel has been undergoing a transformation: encouraging registered nurses to enhance their status by acquiring academic degrees and advanced professional training, and initiating the adoption of new nursing roles. Our goal is to evaluate Israeli nurses' and physicians' attitudes to the introduction of new nursing roles and to expanding the scope of nursing practice. Two hundred and fifteen nurses and 110 physicians from three large general hospitals and 15 community clinics filled in a questionnaire. In general the majority of the nurses supported expansion of nursing practice, and such expansion did not cause significant opposition among physicians. However when the task affected patients' health, physicians were less willing to permit nurses to perform skills previously their responsibility alone. In addition, using multiple logistic regressions, support of the expansion of nursing practice was significantly higher among nurses in management or training positions, and among academically accredited nurses. Support for expanded roles was prominent among hospital physicians, graduates from Israeli schools of medicine, and less-tenured physicians. We suggest that confirmation by various groups of physicians and nurses of standardized definitions of the new boundaries in the scope of nursing practice roles could successfully promote development of new roles and facilitate integration of the Israeli healthcare system into the global context of change. Inter- and intra-professional collaboration, agreement, and understanding regarding advanced nursing practice roles and their introduction into the healthcare system might improve the relationship between healthcare professions and ultimately increase quality of care and patient satisfaction.
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Becoming a registered nurse: the nurse extern experience.
Starr, Kimberly; Conley, Virginia M
2006-01-01
Little is known about the perceptions of nursing students externing in newly developed hospital-based programs that focus on socialization and transition to the registered nurse (RN) role rather than on institutional recruitment and retention goals. This qualitative study explored student nurse externs' expectations, experiences, and benefits of participation in a student-focused externship program. Externs wanted to gain experience with skills and learn what it was like to be an RN. Goals were met or exceeded by becoming comfortable in the externship role, growing in skill performance and confidence, and becoming members of the healthcare team. The experience fostered growth from the novice to advanced beginner level of nursing practice. Externs saw the program participation as a valuable way to gain experience and learn what it was like to be an RN.
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Single-event upset in advanced commercial power PC microprocessors
NASA Technical Reports Server (NTRS)
Irom, F.; Farmanesh, F.; Swift, G. M.; Johnston, A. H.
2003-01-01
Single-event upset from heavy ions in measured for advanced commercial microprocessors, comparing upset sensitivity in registers and d-cache for several generations of devices. Multiple-bit upsets and asymmetry in registers upset cross sections are also discussed.
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The case for full practice authority.
Holmes, Olivia; Kinsey-Weathers, Shanieka
2016-03-01
The Institute of Medicine (IOM) recommended in its 2010 report on the future of nursing that advanced practice registered nurses (APRNs) should factor prominently in providing care to the millions of Americans who access healthcare services under the Affordable Care Act (ACA). The IOM also recommended that APRNs practice to the full extent of their education and training.However, many states have laws in place that limit full practice authority for APRNs, specifically NPs, in providing basic health services such as primary care. These laws place restrictions on independent practice and Medicaid and Medicare reimbursement, which prevent nurses from “responding effectively to rapidly changing health care settings and an evolving health care system.” Less than half of the United States has adopted full practice authority licensure and practice laws (see APRN practice authority at a glance). This article discusses how the primary care needs of millions of Americans can be met by granting full practice authority to APRNs nationwide and provides evidence to support the high level of care these practitioners can provide independently.
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Creating quality practice environments: not easy, but essential.
Winslow, Wendy
2004-01-01
Quality practice environments for registered nurses correlate positively with job satisfaction, productivity, recruitment, retention and client outcomes. However, when registered nurses work in environments that do not enable them to consistently meet their nursing practice standards, patient safety is jeopardized. This article describes the development of Canada's first guidelines for a quality practice environment for registered nurses in all practice environments. It is a tool healthcare leaders can use to improve the practice environment of all health professionals and to promote patient safety.
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Charuhas Macris, Paula; Schilling, Karen; Palko, Raymond
2018-04-01
Oncology nutrition encompasses nutrition care for individuals along the cancer care continuum. Nutrition is a vital component of prevention, treatment, and healthy survivorship. The practice of an oncology registered dietitian nutritionist (RDN) reflects the setting and population served with diverse cancer diagnoses, including expanded roles and responsibilities reflecting the RDN's interests and organization's activities. Provision of nutrition services in oncology requires that RDNs have advanced knowledge in the focus area of oncology nutrition. Thus, the Oncology Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed Standards of Practice and Standards of Professional Performance as tools for RDNs currently in practice or interested in working in oncology nutrition, to address their current skill level and to identify areas for additional professional development in this practice area. The Standards of Practice address and apply the Nutrition Care Process and workflow elements, which are screening, assessment, diagnosis, intervention, evaluation/monitoring, and discharge planning and transitions of care. The Standards of Professional Performance consist of the following six domains of professionalism including: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements and describe three skill levels (competent, proficient, and expert) for RDNs working in oncology nutrition. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
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Schoneboom, Bruce A; Perry, Susan M; Barnhill, William Keith; Giordano, Nicholas A; Wiltse Nicely, Kelly L; Polomano, Rosemary C
2016-01-01
Chronic noncancer pain (CNCP) in military and veteran populations mirrors the experience of chronic pain in America; however, these two populations have unique characteristics and comorbid conditions such as traumatic brain injuries, postconcussive syndrome, posttraumatic stress disorder, and behavioral health disorders that complicate the diagnosis and treatment of chronic pain. Military members and veterans may also be stigmatized about their conditions and experience problems with integration back into healthy lifestyles and society as a whole following deployments and after military service. The military and veteran health care systems have made chronic pain a priority and have made substantial strides in addressing this condition through advances in practice, education, research, and health policy. Despite this progress, significant challenges remain in responding to the wide-spread problem of chronic pain. The purpose of this article is to: (a) examine the state of CNCP in military and veteran populations; (b) discuss progress made in pain practice, education, research, and health policy; and (c) examine research, evidence-based practice guidelines, and expert consensus reports that are foundational to advancing pain care and improving health for military service members and veterans with CNCP. In addition, recommendations are proposed to address this widespread health problem through the expanded use of advanced practice registered nurses, the implementation of models of care, and use of national resources to educate health care providers, support practice, and promote effective pain care. Copyright © 2016 Elsevier Inc. All rights reserved.
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Pediatric nurse practitioners: influences on career choice.
Freed, Gary L; Dunham, Kelly M; Martyn, Kristy; Martin, Jean; Moran, Lauren M; Spera, Laura
2014-01-01
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.
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Rosenthal, Meagen; Tsao, Nicole W; Tsuyuki, Ross T; Marra, Carlo A
2016-01-01
Legislative changes are affording pharmacists the opportunity to provide more advanced pharmacy services. However, many pharmacists have not yet been able to provide these services sustainably. Research from implementation science suggests that before sustained change in pharmacy can be achieved an improved understanding of pharmacy context, through the professional culture of pharmacy and pharmacists' personality traits, is required. The primary objective of this study was to investigate possible relationships between cultural factors, and personality traits, and the uptake of advanced practice opportunities by pharmacists in British Columbia, Canada. The study design was a cross-sectional survey of registered, and practicing, pharmacists from one Canadian province. The survey gauged respondents' characteristics, practice setting, and the provision of advanced pharmacy services, and contained the Organizational Culture Profile (OCP), a measure of professional culture, as well as the Big Five Inventory (BFI), a measure of personality traits. A total of 945 completed survey instruments were returned. The majority of respondents were female (61%), the average age of respondents was 42 years (SD: 12), and the average number of years in practice was 19 (SD: 12). A significant positive relationship was identified for respondents perceiving greater value in the OCP factors competitiveness and innovation and providing a higher number of all advanced services. A positive relationship was observed for respondents scoring higher on the BFI traits extraversion and the immunizations provided, and agreeableness and openness and medication reviews completed. This is the first work to identify statistically significant relationships between the OCP and BFI, and the provision of advanced pharmacy services. As such, this work serves as a starting place from which to develop more detailed insight into how the professional culture of pharmacy and pharmacists personality traits may influence the adoption of advanced pharmacy services. Copyright © 2016 Elsevier Inc. All rights reserved.
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Doran, Diane; Duffield, Christine; Rizk, Paul; Nahm, Sang; Chu, Charlene H
2014-01-01
The purpose was to describe the number, demographic characteristics, work patterns, exit rates, and work perceptions of nurses in Ontario, Canada, in 4 specialty classifications: advanced practice nurse (APN)-clinical nurse specialist (CNS), APN-other, primary healthcare nurse practitioner [RN(extended class [EC])], and registered nurse (RN) with specialty certification. The objectives were to (1) describe how many qualified nurses are available by specialty class; (2) create a demographic profile of specialist nurses; (3) determine the proportions of specialist and nonspecialist nurses who leave (a) direct patient care and (b) nursing practice annually; (4) determine whether specialist and nonspecialist nurses differ in their self-ratings of work environment, job satisfaction, and intention to remain in nursing. Employment patterns refer to nurses' employment status (eg, full-time, part-time, casual), work duration (ie, length of employment in nurses and in current role), and work transitions (ie, movement in and out of the nursing workforce, and movement out of current role). A longitudinal analysis of the Ontario nurses' registration database from 2005 to 2010 and a survey of specialist nurses in Canada was conducted. The setting was Canada. The database sample consisted of 3 specialist groups, consisting of RN(EC), CNS, and APN-other, as well as 1 nonspecialist RN staff nurse group. The survey sample involved 359 nurses who were classified into groups based on self-reported job title and RN specialty-certification status. Data sources included College of Nurses of Ontario registration database and survey data. The study measures were the Nursing Work Index, a 4-item measure of job satisfaction, and 1-item measure of intent to leave current job. Nurses registered with the College of Nurses of Ontario were tracked over the study period to identify changes in their employment status with comparisons made between nurses employed in specialist roles and those registered as general staff nurses. Analysis involved descriptive summaries, mean comparisons with independent-samples t test, and χ(2) tests for categorical data. Exit rates from direct practice were highest for APN-other (7.6%) and CNS (6.2%) and lowest for RN(EC) (1.0%) and staff nurses (1.2%). χ(2) Tests indicated yearly exit rates of both APN-other and CNS nurse groups were significantly higher than those of staff nurses in all years evaluated (α = .025). Every specialist employment group scored significantly higher than staff nurses on measures of work environment and satisfaction outcomes. We provided a description of specialist nurses in Ontario and examined the relationship between specialization and employment patterns of nurses to inform nurse retention strategies in the future. Employment in specialist nursing positions is significantly associated with differences in transitions or exits from nursing among the specialist and nonspecialist groups. Registered nurses (EC) displayed improved retention characteristics compared with staff nurses. Advanced practice nurse-other and APN-CNS exit rates from nursing practice in Ontario were comparable to staff nurses, but exit rates from direct clinical practice roles were higher than those of staff nurses. Targeted strategies are required to retain CNS and APN-other in direct clinical practice roles.
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NASA Technical Reports Server (NTRS)
Mata, Carlos T.
2003-01-01
Anadigm(registered trademark) today announced that ASRC Aerospace Corporation has designed Anadigm's dynamically reconfigurable Field Programmable Analog Array (FPAA) technology into an advanced data acquisition system developed under contract for NASA. ASRC Aerospace designed in the Anadigm(registered trademark) FPAA to provide complex analog signal conditioning in its intelligent, self-calibrating, and self-healing advanced data acquisition system (ADAS). The ADAS has potential applications in industrial, manufacturing, and aerospace markets. This system offers highly reliable operation while reducing the need for user interaction. Anadigm(registered trademark)'s dynamically reconfigurable FPAAs can be reconfigured in-system by the designer or on the fly by a microprocessor. A single device can thus be programmed to implement multiple analog functions and/or to adapt on-the-fly to maintain precision operation despite system degradation and aging. In the case of the ASRC advanced data acquisition system, the FPAA helps ensure that the system will continue to operating at 100% functionality despite changes in the environment, component degradation, and/or component failures.
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Schaefer, Julie T; Zullo, Melissa D
2017-09-01
Researchers have been advocating for a new weight-inclusive paradigm that focuses on health rather than weight. One important component of this model is intuitive eating. Although registered dietitian nutritionists (RDNs) are the nation's food and nutrition experts, RDNs' knowledge of and attitudes toward intuitive eating and use of traditional or restrictive strategies are unknown. The purpose of this study was to characterize RDNs' knowledge of and attitudes toward an intuitive eating lifestyle and describe use of traditional weight management and nonrestrictive lifestyle practices with clients. This was a cross-sectional study. A validated survey was distributed using online survey software to 88,834 RDNs. There were 18,622 respondents who completed the survey (25%). The majority of RDNs were knowledgeable about intuitive eating, answering 71% of items correctly. The majority of RDNs had a positive view on each attitude item. RDNs who work in weight management reported using nonrestrictive/intuitive eating practices more than traditional/restrictive practices. RDNs who were women (P<0.001), had advanced education (P<0.001), worked in a private practice setting (P<0.001), completed at least one certificate of training in weight management (P<0.001), had more experience in weight management counseling (P<0.001), and had greater intuitive eating knowledge (P<0.001) were more likely to report greater use of nonrestrictive/intuitive eating practices. This study provides evidence that RDNs are using an intuitive eating approach more often than traditional weight management practices. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
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Academy of Nutrition and Dietetics: Scope of Practice for the Dietetic Technician, Registered.
2013-06-01
The Scope of Practice for the Dietetic Technician, Registered provides standards and tools to guide competence in performing nutrition and dietetics practice. Composed of statutory and individual components, the DTR's scope of practice is determined by state statute and the DTR's education, training, credentialing, and demonstrated and documented competence in practice. The Scope of Practice for the Dietetic Technician, Registered reflects the Academy's position on the DTR scope of practice and the essential technical assistance role of the DTR in providing safe timely person-centered care for the delivery of quality food and nutrition services.
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Davidson, Patricia; Ross, Tamara; Castor, Chimene
2018-05-01
There are 30.3 million people with diabetes and 86 million with prediabetes in the United States, underscoring the growing need for comprehensive diabetes care and nutrition for the management of diabetes and diabetes-related conditions. Management of diabetes is also critical for the prevention of diabetes-related complications such as cardiovascular and renal disease. The Diabetes Care and Education Dietetic Practice Group along with the Academy of Nutrition and Dietetics Quality Management Committee have updated the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitian Nutritionists (RDNs) in Diabetes Care. The SOP and SOPP for RDNs in Diabetes Care provide indicators that describe three levels of practice: competent, proficient, and expert. The SOP utilizes the Nutrition Care Process and clinical workflow elements for care and management of those with diabetes and prediabetes. The SOPP describes six domains that focus on professionalism: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Specific indicators outlined in the SOP and SOPP depict how these standards apply to practice. The SOP and SOPP are complementary resources for RDNs caring for individuals with diabetes or specializing in diabetes care or practicing in other diabetes-related areas, including research. The SOP and SOPP are intended to be used for RDN self-evaluation for ensuring competent practice and for determining potential education and training needs for advancement to a higher practice level in a variety of settings. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
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Erickson, Mary; Lunos, Scott; Finkelstein, Stanley M.; Looman, Wendy; Celebreeze, Margaret; Garwick, Ann
2015-01-01
Effective care coordination is a key quality and safety strategy for populations with chronic conditions, including children with medical complexity (CMC). However, gaps remain in parent report of the need for care coordination help and receipt of care coordination help. New models must close this gap while maintaining family-centered focus. A three-armed randomized controlled trial conducted in an established medical home utilized an advanced practice registered nurse intervention based on Presler’s model of clinic-based care coordination. The model supported families of CMC across settings using telephone only or telephone and video telehealth care coordination. Effectiveness was evaluated from many perspectives and this paper reports on a subset of outcomes that includes family-centered care (FCC), need for care coordination help and adequacy of care coordination help received. FCC at baseline and end of study showed no significant difference between groups. Median FCC scores of 18.0–20.0 across all groups indicated high FCC within the medical home. No significant differences were found in the need for care coordination help within or between groups and over time. No significant difference was found in the adequacy of help received between groups at baseline. However, this indicator increased significantly over time for both intervention groups. These findings suggest that in an established medical home with high levels of FCC, families of CMC have unmet needs for care coordination help that are addressed by the APRN telehealth care coordination model. PMID:25424455
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Cady, Rhonda G; Erickson, Mary; Lunos, Scott; Finkelstein, Stanley M; Looman, Wendy; Celebreeze, Margaret; Garwick, Ann
2015-07-01
Effective care coordination is a key quality and safety strategy for populations with chronic conditions, including children with medical complexity (CMC). However, gaps remain in parent report of the need for care coordination help and receipt of care coordination help. New models must close this gap while maintaining family-centered focus. A three-armed randomized controlled trial conducted in an established medical home utilized an advanced practice registered nurse intervention based on Presler's model of clinic-based care coordination. The model supported families of CMC across settings using telephone only or telephone and video telehealth care coordination. Effectiveness was evaluated from many perspectives and this paper reports on a subset of outcomes that includes family-centered care (FCC), need for care coordination help and adequacy of care coordination help received. FCC at baseline and end of study showed no significant difference between groups. Median FCC scores of 18.0-20.0 across all groups indicated high FCC within the medical home. No significant differences were found in the need for care coordination help within or between groups and over time. No significant difference was found in the adequacy of help received between groups at baseline. However, this indicator increased significantly over time for both intervention groups. These findings suggest that in an established medical home with high levels of FCC, families of CMC have unmet needs for care coordination help that are addressed by the APRN telehealth care coordination model.
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Colvin, Loretta; Cartwright, Ann; Collop, Nancy; Freedman, Neil; McLeod, Don; Weaver, Terri E; Rogers, Ann E
2014-05-15
To survey Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) utilization, roles and educational background within the field of sleep medicine. Electronic surveys distributed to American Academy of Sleep Medicine (AASM) member centers and APRNs and PAs working within sleep centers and clinics. Approximately 40% of responding AASM sleep centers reported utilizing APRNs or PAs in predominantly clinical roles. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders. Most APRNs and PAs were prepared at the graduate level (89%), with sleep-specific education primarily through "on the job" training (86%). All APRNs surveyed were Nurse Practitioners (NPs), with approximately double the number of NPs compared to PAs. APRNs and PAs were reported in sleep centers at proportions similar to national estimates of NPs and PAs in physicians' offices. They report predominantly clinical roles, involving common sleep disorders. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders. Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. Efforts to provide formal and standardized educational opportunities for APRNs and PAs that focus on their clinical roles within sleep centers could help fill a current educational gap.
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Alternative Practice Dental Hygiene in California: Past, Present, and Future
MERTZ, ELIZABETH; GLASSMAN, PAUL
2012-01-01
This study examines the development of the registered dental hygienist in alternative practice in California through an analysis of archival documents, stakeholder interviews, and two surveys of the registered dental hygienist in alternative practice. Designing, testing and implementing a new practice model for dental hygienists took 23 years. Today, registered dental hygienists in alternative practice have developed viable alternative methods for delivering preventive oral health care services in a range of settings with patients who often have no other source of access to care. PMID:21337961
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Anwar, Mohammed Saqib; Baker, Richard; Walker, Nicola; Mainous, Arch G; Bankart, M John
2012-05-01
The recorded detection of chronic disease by practices is generally lower than the prevalence predicted by population surveys. To determine whether patient-reported access to general practice predicts the recorded detection rates of chronic diseases in that setting. A cross-sectional study involving 146 general practices in Leicestershire and Rutland, England. The numbers of patients recorded as having chronic disease (coronary heart disease, chronic obstructive pulmonary disease, hypertension, diabetes) were obtained from Quality and Outcomes Framework (QOF) practice disease registers for 2008-2009. Characteristics of practice populations (deprivation, age, sex, ethnicity, proportion reporting poor health, practice turnover, list size) and practice performance (achievement of QOF disease indicators, patient experience of being able to consult a doctor within 2 working days and book an appointment >2 days in advance) were included in regression models. Patient characteristics (deprivation, age, poor health) and practice characteristics (list size, turnover, QOF achievement) were associated with recorded detection of more than one of the chronic diseases. Practices in which patients were more likely to report being able to book appointments had reduced recording rates of chronic disease. Being able to consult a doctor within 2 days was not associated with levels of recorded chronic disease. Practices with high levels of deprivation and older patients have increased rates of recorded chronic disease. As the number of patients recorded with chronic disease increased, the capacity of practices to meet patients' requests for appointments in advance declined. The capacity of some practices to detect and manage chronic disease may need improving.
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Raterink, Ginger
2016-02-01
Critical thinking, clinical decision making, and critical reflection have been identified as skills required of nurses in every clinical situation. The Educating Nurses: A Call for Radical Transformation report suggested that critical reflection is a key to improving the educational process. Reflective journaling is a tool that helps develop such skills. This article presents the tool of reflective journaling and the use of this process by educators working with students. It describes the use of reflective journaling in graduate nursing education, as well as a scoring process to evaluate the reflection and provide feedback. Students and faculty found the journaling to be helpful for reflection of a clinical situation focused on critical thinking skill development. The rubric scoring tool provided faculty with a method for feedback. Reflective journaling is a tool that faculty and students can use to develop critical thinking skills for the role of the advanced practice RN. A rubric scoring system offers a consistent format for feedback. Copyright 2016, SLACK Incorporated.
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Shaw-Battista, Jenna; Young-Lin, Nichole; Bearman, Sage; Dau, Kim; Vargas, Juan
2015-01-01
Ultrasound is an important aid in the clinical diagnosis and management of normal and complicated pregnancy and childbirth. The technology is widely applied to maternity care in the United States, where comprehensive standard ultrasound examinations are routine. Targeted scans are common and used for an increasing number of clinical indications due to emerging research and a greater availability of equipment with better image resolution at lower cost. These factors contribute to an increased demand for obstetric ultrasound education among students and providers of maternity care, despite a paucity of data to inform education program design and evaluation. To meet this demand, from 2012 to 2015 the University of California, San Francisco nurse-midwifery education program developed and implemented an interprofessional obstetric ultrasound course focused on clinical applications commonly managed by maternity care providers from different professions and disciplines. The course included matriculating students in nursing and medicine, as well as licensed practitioners such as registered and advanced practice nurses, midwives, and physicians and residents in obstetrics and gynecology and family medicine. After completing 10 online modules with a pre- and posttest of knowledge and interprofessional competencies related to teamwork and communication, trainees attended a case-based seminar and hands-on skills practicum with pregnant volunteers. The course aimed to establish a foundation for further supervised clinical training prior to independent practice of obstetric ultrasound. Course development was informed by professional guidelines and clinical and education research literature. This article describes the foundations, with a review of the challenges and solutions encountered in obstetric ultrasound education development and implementation. Our experience will inform educators who wish to facilitate obstetric ultrasound competency development among new and experienced maternity care providers in academic and clinical settings. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. © 2015 by the American College of Nurse-Midwives.
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16 CFR 300.4 - Registered identification numbers.
Code of Federal Regulations, 2011 CFR
2011-01-01
... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Registered identification numbers. 300.4 Section 300.4 Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS RULES AND REGULATIONS UNDER THE WOOL PRODUCTS LABELING ACT OF 1939 Labeling § 300.4 Registered...
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Nurses' self-efficacy and academic degree advancement.
Winslow, Susan; DeGuzman, Pamela; Kulbok, Pamela; Jackson, Stephanie
2014-01-01
The last decade has brought about a synergy of influences for registered nurses to advance their academic preparation. Literature indicates that there is correlation between self-efficacy and goal establishment and success. The purpose of this project was to evaluate the relationship between self-efficacy and advancing academic aspirations of registered nurses. Findings indicated that there was a trend toward a difference in the self-efficacy of nurses who began their career with a diploma or associate degree and went on for academic advancement and those who did not.
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The perceived impact of the European registration system for genetic counsellors and nurses.
Paneque, Milena; Moldovan, Ramona; Cordier, Christophe; Serra-Juhé, Clara; Feroce, Irene; Pasalodos, Sara; Haquet, Emmanuelle; Lambert, Debby; Bjørnevoll, Inga; Skirton, Heather
2017-09-01
The aim of the European Board of Medical Genetics has been to develop and promote academic and professional standards necessary in order to provide competent genetic counselling services. The aim of this study was to explore the impact of the European registration system for genetic nurses and counsellors from the perspectives of those professionals who have registered. Registration system was launched in 2013. A cross-sectional, online survey was used to explore the motivations and experiences of those applying for, and the effect of registration on their career. Fifty-five Genetic Nurses and Counsellors are registered till now, from them, thirty-three agreed to participate on this study. The main motivations for registering were for recognition of their work value and competence (30.3%); due to the absence of a registration system in their own country (15.2%) and the possibility of obtaining a European/international certification (27.3%), while 27.3% of respondents registered to support recognition of the genetic counselling profession. Some participants valued the registration process as an educational activity in its own right, while the majority indicated the greatest impact of the registration process was on their clinical practice. The results confirm that registrants value the opportunity to both confirm their own competence and advance the genetic counselling profession in Europe.
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O'Brien, Joanne; Keaveny, Joseph; Pollard, Valerie; Nugent, Linda Elizabeth
The purpose of this study was to examine the management of patient's neuropathic pain with capsaicin 8% in a nurse-led clinic when administered by 1 registered advanced nurse practitioner without physician supervision. A longitudinal, single-group, descriptive research design was used to assess pain scores and quality of life 3 times over 3 months after treatment. Patients with a diagnosis of neuropathic pain were assessed and treated with capsaicin 8% by 1 advanced nurse practitioner with prescriptive authority in a nurse-led clinic. Pain scores were collected at baseline, and self-assessed pain, activity level, and quality of life were assessed at 1 week, 4 weeks, and 3 months after treatment. Twenty-four patients were recruited, and data were analyzed using Friedman's test. In post hoc analysis, Wilcoxon signed-rank test was used with Bonferroni correction. Pain scores differed from pretreatment to posttreatment at each of the 3 time points, at rest (χ3 = 20.54, P = .001) and on movement (χ3 = 23.644, P = .001), and remained significant after Bonferroni correction. Overall, 62.5% (n = 15) of patients achieved at least a 30% reduction in self-reported pain at rest from pretreatment to 3 months, and 54% (n = 13) achieved the same reduction in pain on movement. Most improvements in patient's quality of life occurred between 1 and 4 weeks. Patient satisfaction was high, with 83% stating that they would be happy to have the treatment repeated. Single-dose capsaicin 8% decreased neuropathic pain after being administered in an outpatient setting by an experienced registered advanced nurse practitioner. Further multicenter research led by advanced nurse practitioners is needed to support high-quality, safe treatment of neuropathic pain with high-concentration capsaicin in nurse-led chronic pain clinics.
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McGilton, Katherine S; Profetto-McGrath, Joanne; Robinson, Angela
2013-11-01
This pilot study was conducted in response to the call in 2009 by the International Association of Gerontology and Geriatrics to focus on effective leadership structures in nursing homes and to develop leadership capacity. Few researchers have evaluated interventions aimed at enhancing the leadership ability of registered nurses in long-term care. The aim of the pilot study was to test the feasibility of a three-part supportive supervisory intervention to improve supervisory skills of registered nurses in long-term care. A repeated measures group design was used. Quantitative data were collected from healthcare aides, licensed practical nurses (i.e., supervised staff), and registered nurses (i.e., supervisors). Focus groups with care managers and supervisors examined perceptions of the intervention. There were nonsignificant changes in both the registered nurse supervisors' job satisfaction and the supervised staff's perception of their supervisors' support. Supervised staff scores indicated an increase in the use of research utilization but did not reflect an increase in job satisfaction. Focus group discussions revealed that the supervisors and care managers perceived the workshop to be valuable; however, the weekly self-reflection, coaching, and mentoring components of the intervention were rare and inconsistent. While the primary outcomes were not influenced by the Supportive Supervision Intervention, further effort is required to understand how best to enhance the supportive supervisory skills of RNs. Examples of how to improve the possibility of a successful intervention are advanced. Effective supervisory skills among registered nurses are crucial for improving the quality of care in long-term care homes. Registered nurses are receptive to interventions that will enhance their roles as supervisors. © 2013 Sigma Theta Tau International.
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Conscientious objection: a call to nursing leadership.
Ford, Natalie J; Fraser, Kimberly D; Marck, Patricia B
2010-09-01
In this paper we argue that nurse leaders need to work actively to create morally supportive environments for nurses in Canada that provide adequate room to exercise conscientious objection. Morally supportive environments engender a safe atmosphere to engage in open dialogue and action regarding conflict of conscience. The CNA's 2008 Code of Ethics for Registered Nurses has recognized the importance of conscientious objection in nursing and has created key guidelines for the registered nurse to follow when a conflict in conscience is being considered or declared. Nurse leaders need to further develop the understanding of conflicts of conscience through education, well-written guidelines for conscientious objection in workplaces and engagement in research to uncover underlying barriers to the enactment of conscientious objections. With advancements in technology, changing healthcare policies and increasing scope of practice, both reflection and dialogue on conscientious objection are critical for the continuing moral development of nurses in Canada.
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Hsiao, Chiu-Yueh; Lee, Shu-Hsin; Chen, Suh-Jen; Lin, Shu-Chin
2013-08-01
Advances in genetics have had a profound impact on health care. Yet, many nurses, as well as other health care providers, have limited genetic knowledge and feel uncomfortable integrating genetics into their practice. Very little is known about perceived genetic knowledge and clinical comfort among Taiwanese nurses enrolled in a Registered Nurse to Bachelor of Science in Nursing program. To examine perceived knowledge and clinical comfort with genetics among Taiwanese nurses enrolled in a Registered Nurse to Bachelor of Science in Nursing program and to assess how genetics has been integrated into their past and current nursing programs. The study also sought to examine correlations among perceived knowledge, integration of genetics into the nursing curriculum, and clinical comfort with genetics. A descriptive, cross-sectional study. Taiwanese nurses enrolled in a Registered Nurse to Bachelor of Science in Nursing program were recruited. A total of 190 of 220 nurses returned the completed survey (86.36% response rate). Descriptive statistics and the Pearson product-moment correlation were used for data analysis. Most nurses indicated limited perceived knowledge and clinical comfort with genetics. Curricular hours focused on genetics in a current nursing program were greater than those in past nursing programs. The use of genetic materials, attendance at genetic workshops and conferences, and clinically relevant genetics in nursing practice significantly related with perceived knowledge and clinical comfort with genetics. However, there were no correlations between prior genetic-based health care, perceived knowledge, and clinical comfort with genetics. This study demonstrated the need for emphasizing genetic education and practice to ensure health-related professionals become knowledgeable about genetic information. Given the rapidly developing genetic revolution, nurses and other health care providers need to utilize genetic discoveries to optimize health outcomes. Copyright © 2012 Elsevier Ltd. All rights reserved.
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38 CFR 21.7674 - Measurement of practical training courses.
Code of Federal Regulations, 2010 CFR
2010-07-01
.... (1) Courses for the objective of registered nurse or registered professional nurse will be measured...) Courses offered by institutions of higher learning which lead to the objective of practical nurse, practical trained nurse, or licensed practical nurse will be measured on credit hours or clock hours of...
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38 CFR 21.4275 - Practical training courses; measurement.
Code of Federal Regulations, 2010 CFR
2010-07-01
....C. 3688(b); Pub. L. 99-576) (b) Nursing courses. (1) Courses for the objective of registered nurse or registered professional nurse will be measured on the basis of credit hours or clock hours of... practical nurse, practical trained nurse, or licensed practical nurse will be measured on credit hours or...
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38 CFR 21.7674 - Measurement of practical training courses.
Code of Federal Regulations, 2014 CFR
2014-07-01
.... (1) Courses for the objective of registered nurse or registered professional nurse will be measured...) Courses offered by institutions of higher learning which lead to the objective of practical nurse, practical trained nurse, or licensed practical nurse will be measured on credit hours or clock hours of...
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38 CFR 21.7674 - Measurement of practical training courses.
Code of Federal Regulations, 2013 CFR
2013-07-01
.... (1) Courses for the objective of registered nurse or registered professional nurse will be measured...) Courses offered by institutions of higher learning which lead to the objective of practical nurse, practical trained nurse, or licensed practical nurse will be measured on credit hours or clock hours of...
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38 CFR 21.7674 - Measurement of practical training courses.
Code of Federal Regulations, 2012 CFR
2012-07-01
.... (1) Courses for the objective of registered nurse or registered professional nurse will be measured...) Courses offered by institutions of higher learning which lead to the objective of practical nurse, practical trained nurse, or licensed practical nurse will be measured on credit hours or clock hours of...
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38 CFR 21.4275 - Practical training courses; measurement.
Code of Federal Regulations, 2013 CFR
2013-07-01
....C. 3688(b); Pub. L. 99-576) (b) Nursing courses. (1) Courses for the objective of registered nurse or registered professional nurse will be measured on the basis of credit hours or clock hours of... practical nurse, practical trained nurse, or licensed practical nurse will be measured on credit hours or...
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38 CFR 21.7674 - Measurement of practical training courses.
Code of Federal Regulations, 2011 CFR
2011-07-01
.... (1) Courses for the objective of registered nurse or registered professional nurse will be measured...) Courses offered by institutions of higher learning which lead to the objective of practical nurse, practical trained nurse, or licensed practical nurse will be measured on credit hours or clock hours of...
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38 CFR 21.4275 - Practical training courses; measurement.
Code of Federal Regulations, 2012 CFR
2012-07-01
....C. 3688(b); Pub. L. 99-576) (b) Nursing courses. (1) Courses for the objective of registered nurse or registered professional nurse will be measured on the basis of credit hours or clock hours of... practical nurse, practical trained nurse, or licensed practical nurse will be measured on credit hours or...
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38 CFR 21.4275 - Practical training courses; measurement.
Code of Federal Regulations, 2011 CFR
2011-07-01
....C. 3688(b); Pub. L. 99-576) (b) Nursing courses. (1) Courses for the objective of registered nurse or registered professional nurse will be measured on the basis of credit hours or clock hours of... practical nurse, practical trained nurse, or licensed practical nurse will be measured on credit hours or...
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38 CFR 21.4275 - Practical training courses; measurement.
Code of Federal Regulations, 2014 CFR
2014-07-01
....C. 3688(b); Pub. L. 99-576) (b) Nursing courses. (1) Courses for the objective of registered nurse or registered professional nurse will be measured on the basis of credit hours or clock hours of... practical nurse, practical trained nurse, or licensed practical nurse will be measured on credit hours or...
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Australian immunisation registers: established foundations and opportunities for improvement.
Chin, L K; Crawford, N W; Rowles, G; Buttery, J P
2012-04-19
The National Immunisation Program Schedule in Australia is formulated and funded nationally under the population-wide Medicare system. The policy is implemented by the eight state and territory jurisdictions. The national immunisation registers consist of the Australian Childhood Immunisation Register (ACIR), and, more recently, the National Human Papillomavirus (HPV) Vaccination Program Register. Moreover, a variety of jurisdiction-based registers and primary care practice software systems exist, which interact with the national registers. General practitioners can obtain reports listing patients under seven years attending their practice and recorded as 'not fully immunised', and immunisation coverage rates for their practice linked to government incentives through Medicare. A 2011 report documents national coverage of 91.8% fully immunised at 12 months, and 92.6% at 24 months. The HPV register provides information on vaccination coverage with the potential to link with a register of cervical cancer screening results. Limitations of current national register include inability to easily access immunisation histories beyond seven years of age, and issues of underreporting and timeliness, which impact significantly the immunisation coverage estimates. The linkage of these registers with healthcare outcome data will further enhance public health outcomes by enabling rapid, population-level vaccine safety and effectiveness investigations in a nation with a track record as an 'early adopter' of new childhood vaccines.
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A Competency Framework for the Practice of Psychology: Procedures and Implications.
Hunsley, John; Spivak, Howard; Schaffer, Jack; Cox, Darcy; Caro, Carla; Rodolfa, Emil; Greenberg, Sandra
2016-09-01
Several competency models for training and practice in professional psychology have been proposed in the United States and Canada. Typically, the procedures used in developing and finalizing these models have involved both expert working groups and opportunities for input from interested parties. What has been missing, however, are empirical data to determine the degree to which the model reflects the views of members of the profession as a whole. Using survey data from 466 licensed or registered psychologists (approximately half of whom completed one of two versions of the survey), we examined the degree to which psychologists, both those engaged primarily in practice and those involved in doctoral training, agreed with the competency framework developed by the Association of State and Provincial Psychology Boards' Practice Analysis Task Force (Rodolfa et al., 2013). When distinct time points in training and licensure or registration were considered (i.e., entry-level supervised practice in practicum settings, advanced-level supervised practice during internship, entry level independent practice, and advanced practice), there was limited agreement by survey respondents with the competency framework's proposal about when specific competencies should be attained. In contrast, greater agreement was evident by respondents with the competency framework when the reference point was focused on entry to independent practice (i.e., the competencies necessary for licensure or registration). We discuss the implications of these findings for the development of competency models, as well as for the implementation of competency requirements in both licensure or registration and training contexts. © 2016 Wiley Periodicals, Inc.
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New graduate registered nurses' knowledge of patient safety and practice: A literature review.
Murray, Melanie; Sundin, Deborah; Cope, Vicki
2018-01-01
To critically appraise available literature and summarise evidence pertaining to the patient safety knowledge and practices of new graduate registered nurses. Responsibility for patient safety should not be limited to the practice of the bedside nurses, rather the responsibility of all in the healthcare system. Previous research identified lapses in safety across the health care, more specifically with new practitioners. Understanding these gaps and what may be employed to counteract them is vital to ensuring patient safety. A focused review of research literature. The review used key terms and Boolean operators across a 5-year time frame in CINAHL, Medline, psycINFO and Google Scholar for research articles pertaining to the area of enquiry. Eighty-four articles met the inclusion criteria, 39 discarded due to irrelevant material and 45 articles were included in the literature review. This review acknowledges that nursing has different stages of knowledge and practice capabilities. A theory-practice gap for new graduate registered nurses exists, and transition to practice is a key learning period setting new nurses on the path to becoming expert practitioners. Within the literature, there was little to no acknowledgement of patient safety knowledge of the newly registered nurse. Issues raised in the 1970s remain a concern for today's new graduate registered nurses. Research has recognised several factors affecting transition from nursing student to new graduate registered nurse. These factors are leaving new practitioners open to potential errors and risking patient safety. Understanding the knowledge of a new graduate registered nurse upon entering clinical practice may assist in organisations providing appropriate clinical and theoretical support to these nurses during their transition. © 2017 John Wiley & Sons Ltd.
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Clinical leadership development and education for nurses: prospects and opportunities
Joseph, M Lindell; Huber, Diane L
2015-01-01
With the implementation of the Affordable Care Act, elevated roles for nurses of care coordinator, clinical nurse leader, and advanced practice registered nurse have come to the forefront. Because change occurs so fast, matching development and education to job requirements is a challenging forecasting endeavor. The purpose of this article is to envision clinical leadership development and education opportunities for three emerging roles. The adoption of a common framework for intentional leadership development is proposed for clinical leadership development across the continuum of care. Solutions of innovation and interdependency are framed as core concepts that serve as an opportunity to better inform clinical leadership development and education. Additionally, strategies are proposed to advance knowledge, skills, and abilities for crucial implementation of improvements and new solutions at the point of care. PMID:29355179
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Frequency Dependence of Single-event Upset in Advanced Commerical PowerPC Microprocessors
NASA Technical Reports Server (NTRS)
Irom, Frokh; Farmanesh, Farhad F.; Swift, Gary M.; Johnston, Allen H.
2004-01-01
This paper examines single-event upsets in advanced commercial SOI microprocessors in a dynamic mode, studying SEU sensitivity of General Purpose Registers (GPRs) with clock frequency. Results are presented for SOI processors with feature sizes of 0.18 microns and two different core voltages. Single-event upset from heavy ions is measured for advanced commercial microprocessors in a dynamic mode with clock frequency up to 1GHz. Frequency and core voltage dependence of single-event upsets in registers is discussed.
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Register-Recall Systems: Tools for Chronic Disease Management in General Practice.
Georgiou, Andrew; Burns, Joan; Penn, Danielle; Infante, Fernando; Harris, Mark
2004-09-01
The Divisions Diabetes and Cardiovascular Disease Quality Improvement Project (DDCQIP) is a national project that aims to promote quality improvement initiatives among Divisions of General Practice. DDCQIP has investigated the growth of Division-based diabetes and cardiovascular disease register-recall systems and the role they play in promoting evidence-based structured care within general practice. In the period 2000-2002, an increase in the number of GPs using register-recall systems and the rise in the number of active registered patients have made it possible to monitor quality of care and health outcome indicators, and contributed to the growth of a Division-based population health program.
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Ruohoalho, Johanna; Østvoll, Eirik; Bratt, Mette; Bugten, Vegard; Bäck, Leif; Mäkitie, Antti; Ovesen, Therese; Stalfors, Joacim
2018-06-01
Surgical quality registers provide tools to measure and improve the outcome of surgery. International register collaboration creates an opportunity to assess and critically evaluate national practices, and increases the size of available datasets. Even though millions of yearly tonsillectomies and tonsillotomies are performed worldwide, clinical practices are variable and inconsistency of evidence regarding the best clinical practice exists. The need for quality improvement actions is evident. We aimed to systematically investigate the existing tonsil surgery quality registers found in the literature, and to provide a thorough presentation of the planned Nordic Tonsil Surgery Register Collaboration. A systematic literature search of MEDLINE and EMBASE databases (from January 1990 to December 2016) was conducted to identify registers, databases, quality improvement programs or comprehensive audit programs addressing tonsil surgery. We identified two active registers and three completed audit programs focusing on tonsil surgery quality registration. Recorded variables were fairly similar, but considerable variation in coverage, number of operations included and length of time period for inclusion was discovered. Considering tonsillectomies and tonsillotomies being among the most commonly performed surgical procedures in otorhinolaryngology, it is surprising that only two active registers could be identified. We present a Nordic Tonsil Surgery Register Collaboration-an international tonsil surgery quality register project aiming to provide accurate benchmarks and enhance the quality of tonsil surgery in Denmark, Finland, Norway and Sweden.
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Code of Federal Regulations, 2010 CFR
2010-07-01
... at maturity, upon prior call, or for prerefunding or advance refunding. 306.26 Section 306.26 Money... Payment § 306.26 Redemption of registered securities at maturity, upon prior call, or for prerefunding or... to a call for redemption before maturity need not be assigned, unless the owner desires that payment...
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29 CFR 552.6 - Companionship services for the aged or infirm.
Code of Federal Regulations, 2014 CFR
2014-07-01
..., such as registered nurses, licensed practical nurses, or certified nursing assistants; the... which require and are performed by trained personnel, such as a registered or practical nurse. While...
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Principles of health information systems in developing countries.
Krickeberg, Klaus
The setting of this article is an all-embracing Health Information System (HIS)* of the type that exists mainly in developing and transition countries. It was inspired by work in Vietnam and other places. The article discusses the basic principles on which a well-functioning HIS needs to rest regardless of the technical means employed (paper, electronic devices). Eleven principles for designing or reforming a HIS are identified, including: explicit description of the underlying units (target population) and variables; no list of indicators to be fixed in advance; only one register per target population; technical coordination between registers and reports; correction algorithms; local use of data and indicators; autonomy of health institutions regarding the information that concerns them; and novel use of registers for various studies. Apart from their technical role, these principles give shape to the philosophy that underlies this article, and make clear that a HIS is not only a tool for collecting indicators; it is intimately tied to clinical and preventive practice, as well as to health management and health economy. In fact, it permeates the entire health system. It can potentially play a much more extended, varied, and useful role than simply that of providing health services to a community.
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Nurses' knowledge and educational needs regarding genetics.
Seven, Memnun; Akyüz, Aygül; Elbüken, Burcu; Skirton, Heather; Öztürk, Hatice
2015-03-01
Nurses now require a basic knowledge of genetics to provide patient care in a range of settings. To determine Turkish registered nurses' current knowledge and educational needs in relation to genetics. A descriptive, cross-sectional study. Turkish registered nurses working in a university hospital in Turkey were recruited. All registered nurses were invited to participate and 175 completed the study. The survey instrument, basic knowledge of health genetics, confidence in knowledge and the nurses' need for genetics education were used to collect data. The majority (81.1%, n=142) of participants indicated that genetics was not taught during their degree program, although 53.1% to 96% of respondents felt confident in defining different genetic concepts. The average genetics knowledge score was 6.89±1.99 of a possible 11 (range 0-11). The majority (70.3%) expressed a strong wish to attend a continuing nursing education program in genetics. The study shows that although Turkish nurses are not sufficiently knowledgeable to apply genetics in practice, they are willing to have more education to support their care of patients. Nurses need to have more education related to genetics in accordance with advances in human genetics to optimize health care. Copyright © 2014 Elsevier Ltd. All rights reserved.
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Is a Baccalaureate in Nursing Worth It? The Return to Education, 2000–2008
Spetz, Joanne; Bates, Timothy
2013-01-01
Objective. A registered nurse (RN) license can be obtained by completing a baccalaureate degree (BSN), an associate degree (AD), or a diploma program. The aim of this article is to examine the return to baccalaureate education from the perspective of the nurse. Data Sources. National Sample Survey of Registered Nurses, 2000, 2004, and 2008. Study Design. The effect of education on RN wages is estimated using multivariate regression, both for initial education and for completing a second degree. The coefficients are used to calculate lifetime expected earnings. Multinomial logistic regression is used to examine the relationship between education and job title. Principal Findings. Lifetime earnings for nurses whose initial education is the BSN are higher than those of AD nurses only if the AD program requires 3 years and the discount rate is 2 percent. For individuals who enter nursing with an AD, lifetime earnings are higher if they complete a BSN. The BSN is associated with higher likelihood of being an advanced practice registered nurse, having an academic title, and having a management title. Conclusions. Because baccalaureate education confers benefits both for RNs and their patients, policies to encourage the pursuit of BSN degrees need to be supported. PMID:24102422
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Educational Progression of Licensed Practical Nurses to Registered Nursing Programs. Project Report.
ERIC Educational Resources Information Center
Hosch, India, Comp.
A project was conducted to develop a structural mechanism for articulation between colleges and vocational schools in West Virginia. Such articulation would permit licensed practical nurses (LPNs) desiring to become registered nurses to transfer credits for their licensed practical nursing courses and thereby eliminate unnecessary repetition of…
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Lodge, Keri-Michèle; Milnes, David; Gilbody, Simon M
2011-03-01
Background Identifying patients with learning disabilities within primary care is central to initiatives for improving the health of this population. UK general practitioners (GPs) receive additional income for maintaining registers of patients with learning disabilities as part of the Quality and Outcomes Framework (QOF), and may opt to provide Directed Enhanced Services (DES), which requires practices to maintain registers of patients with moderate or severe learning disabilities and offer them annual health checks.Objectives This paper describes the development of a register of patients with moderate or severe learning disabilities at one UK general practice.Methods A Read code search of one UK general practice's electronic medical records was conducted in order to identify patients with learning disabilities. Confirmation of diagnoses was sought by scrutinising records and GP verification. Cross-referencing with the practice QOF register of patients with learning disabilities of any severity, and the local authority's list of clients with learning disabilities, was performed.Results Of 15 001 patients, 229 (1.5%) were identified by the Read code search as possibly having learning disabilities. Scrutiny of records and GP verification confirmed 64 had learning disabilities and 24 did not, but the presence or absence of learning disability remained unclear in 141 cases. Cross-referencing with the QOF register (n=81) and local authority list (n=49) revealed little overlap.Conclusion Identifying learning disability and assessing its severity are tasks GPs may be unfamiliar with, and relying on Read code searches may result in under-detection. Further research is needed to define optimum strategies for identifying, cross-referencing and validating practice-based registers of patients with learning disabilities.
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2011-01-01
Background Identifying patients with learning disabilities within primary care is central to initiatives for improving the health of this population. UK general practitioners (GPs) receive additional income for maintaining registers of patients with learning disabilities as part of the Quality and Outcomes Framework (QOF), and may opt to provide Directed Enhanced Services (DES), which requires practices to maintain registers of patients with moderate or severe learning disabilities and offer them annual health checks. Objectives This paper describes the development of a register of patients with moderate or severe learning disabilities at one UK general practice. Methods A Read code search of one UK general practice's electronic medical records was conducted in order to identify patients with learning disabilities. Confirmation of diagnoses was sought by scrutinising records and GP verification. Cross-referencing with the practice QOF register of patients with learning disabilities of any severity, and the local authority's list of clients with learning disabilities, was performed. Results Of 15 001 patients, 229 (1.5%) were identified by the Read code search as possibly having learning disabilities. Scrutiny of records and GP verification confirmed 64 had learning disabilities and 24 did not, but the presence or absence of learning disability remained unclear in 141 cases. Cross-referencing with the QOF register (n=81) and local authority list (n=49) revealed little overlap. Conclusion Identifying learning disability and assessing its severity are tasks GPs may be unfamiliar with, and relying on Read code searches may result in under-detection. Further research is needed to define optimum strategies for identifying, cross-referencing and validating practice-based registers of patients with learning disabilities. PMID:22479290
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Jones, Shelley L
2015-08-01
The role of the outreach diabetes case manager in New Brunswick, Canada, was first developed in the Moncton Area of Horizon Health Network in response to a physician-identified gap between patients' diagnoses of diabetes and their attendance at the local diabetes education centre. This model of collaborative interprofessional practice increases support for primary care providers and people living with diabetes in that they are being provided the services of certified diabetes educators who can address knowledge gaps with respect to evidence-based guidelines and best practice, promote advancement of diabetes and chronic-disease management therapies and support adherence to treatment plans and self-management practices. This report chronicles a review of the implementation, expansion and evaluation of the outreach diabetes case manager model in the province of New Brunswick, Canada, along with the rationale for development of the role for registered nurses in other jurisdictions. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.
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Soul mate: exploring the concept of soul.
Fenske, Joan M
2011-09-01
This article describes an "advanced practice" registered nurse's skill in using multiple theoretical frameworks to make meaning of her severely developmentally disabled son's untimely death. Aspects of religion, spirituality, and philosophy are presented plus how related practices, such as used within Alcoholics Anonymous, are incorporated into everyday life are referenced. Creating unique rituals and ceremonies demonstrates the power of the mind as a partner in the healing process when grief seems insurmountable. This article, titled "Soul Mate" discusses how individuals create their own healing narratives when confronted with grief and tragedy. Nursing interventions, sensitive to this process, support and promote the grief process. Eliciting, recognizing, and accepting a patient's unique self-made rituals and ceremonies as they cope with a beloved's death and dying enhances their nursing interventions. © 2011 The Author(s)
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The holistic worldview in action: evolution of holistic nurses certification programs.
Erickson, Helen Lorraine; Erickson, Margaret Elizabeth; Sandor, M Kay; Brekke, Mary E
2013-12-01
The American Holistic Nurses Credentialing Corporation (AHNCC), the only national credentialing body for holistic nurses, has a responsibility to offer valid, reliable, and rigorous certification examinations and to grow and evolve as indicated by social and professional changes. This article describes four major changes in the work of AHNCC since 2004: a detection of an evolution in the domain of holistic nursing through review of the literature; clarification and specification of levels of practice by educational level; development of the nurse coach role in nursing, designed within the precepts of holistic nursing; and AHNCC's response to the social paradigm shift for health care, and nursing's advanced practice registered nurse consensus model. Each of these is discussed in detail describing the circumstances that perpetuated AHNCC's consideration and the actions taken by AHNCC.
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Xu, Lijuan; Song, Rhayun
2016-08-01
The purpose of the study was to determine how work-family-school role conflict and social support influence psychological well-being among registered nurses pursuing an advanced degree. A cross-sectional, correlational study design was used. Convenience sampling was used to recruit 320 registered nurses pursuing an advanced nursing degree at 13 hospitals in Korea, from June to October 2011. Data were analyzed using structural equation modeling with the AMOS program. Confirmatory factor analyses were conducted to evaluate the measurement model prior to the testing of study hypotheses before and after controlling for extraneous variables. The fit parameters of the modified model (χ(2)/df=2.01, GFI=0.91, AGFI=0.89, CFI=0.92, SRMR=0.068, and RMSEA=0.065) indicated its suitability as the research model. This model explained 45% of the variance in work-related psychological well-being and 52% of the variance in general psychological well-being. Both social support and work-family-school role conflict exerted significant effects on work-related psychological well-being and general psychological well-being. The findings of the present study imply that work-family-school role conflict influences the psychological well-being of registered nurses pursuing an advanced degree. It is necessary for nursing administrators to develop strategies to help registered nurses to manage their multiple roles and improve both their work-related psychological well-being and their general psychological well-being. Copyright © 2015 Elsevier Inc. All rights reserved.
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2014-01-01
Background Physician recommendations for cancer screening and prevention are associated with patient compliance. However, time constraints may limit physicians’ ability to provide all recommended preventive services, especially with increasing demand from the Affordable Care Act in the United States. Team-based practice that includes advanced practice registered nurses and physician assistants (APRN/PA) may help meet this demand. This study investigates the relationship between an APRN/PA visit and receipt of guideline-consistent cancer screening and prevention recommendations. Methods Data from the 2010 National Health Interview Survey were analyzed with multivariate logistic regression to assess provider type seen and receipt of guideline-consistent cancer screening and prevention recommendations (n = 26,716). Results In adjusted analyses, women who saw a primary care physician (PCP) and an APRN/PA or a PCP without an APRN/PA in the past 12 months were more likely to be compliant with cervical and breast cancer screening guidelines than women who did not see a PCP or APRN/PA (all p < 0.0001 for provider type). Women and men who saw a PCP and an APRN/PA or a PCP without an APRN/PA were also more likely to receive guideline consistent colorectal cancer screening and advice to quit smoking and participate in physical activity than women and men who did not see a PCP or APRN/PA (all p < 0.01 for provider type). Conclusions Seeing a PCP alone, or in conjunction with an APRN/PA is associated with patient receipt of guideline-consistent cancer prevention and screening recommendations. Integrating APRN/PA into primary care may assist with the delivery of cancer prevention and screening services. More intervention research efforts are needed to explore how APRN/PA will be best able to increase cancer screening, HPV vaccination, and receipt of behavioral counseling, especially during this era of healthcare reform. PMID:24685149
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Re-Envisioning a DNP Program for Quality and Sustainability.
Killien, Marcia; Thompson, Hilaire; Kieckhefer, Gail; Bekemeier, Betty; Kozuki, Yoriko; Perry, Cynthia K
When the University of Washington, School of Nursing determined that its post-BSN-DNP degree program, with multiple specialty tracks and programs of study, was not sustainable, the curriculum was re-envisioned. The revised program is consistent with the American Association of Colleges of Nursing (AACN) Essentials of Doctoral Education for Advanced Nursing Practice and the national Licensure Accreditation, Certification, and Education (LACE) model. The re-envisioned program was conceptualized as a single degree in which students preparing for any specialty would have the same number of required credits with the majority of courses (DNP core) required for all students. Two major pathways, 1) advanced practice registered nursing and 2) advanced systems and population health were identified. The model allows for specialties to be added or discontinued without major disruption to the core curriculum. The consolidated curriculum reduced instructional costs to the school by approximately 26% and reduced and made more equitable the tuition costs for the majority of students. The revised consolidated program is innovative, maintains quality, attracts students, and aligns with resources. This article discusses how we achieved revision and consolidation of a post-BSN DNP program with multiple specialty tracks that is innovative, high quality, sustainable, and replicable by other schools of nursing. Copyright © 2016 Elsevier Inc. All rights reserved.
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Lukewich, Julia; Edge, Dana S.; VanDenKerkhof, Elizabeth; Williamson, Tyler; Tranmer, Joan
2016-01-01
Background: As the organization of primary care continues to evolve toward more interdisciplinary team structures, demonstrating effectiveness of care delivery is becoming important, particularly for nonphysician providers. Nurses are the most common nonphysician provider within primary care. The purpose of this study was to examine the relation between primary care delivery models that incorporate registered nurses and clinical outcomes of patients with type 2 diabetes. Methods: Patient data from the Canadian Primary Care Sentinel Surveillance Network were matched with survey data from 15 Family Health Team practices in southeastern Ontario. Included patients were adults with type 2 diabetes mellitus who had at least 1 primary care encounter at a Family Health Team practice that completed the organizational survey between Apr. 1, 2013, and Mar. 31, 2014. The clinical outcomes explored included hemoglobin A1c, fasting plasma glucose, blood pressure, low-density lipoprotein cholesterol and urine albumin:creatinine ratio. Results: Of the 15 practices, 13 (86.7%) had at least 1 registered nurse. The presence of 1 or more registered nurses in the practice was associated with increased odds of patients' having their hemoglobin A1c, fasting plasma glucose, blood pressure and low-density lipoprotein cholesterol values meet recommended targets. Practices with the lowest ratios of patients with diabetes to registered nurse had a significantly greater proportion of patients with hemoglobin A1c and fasting plasma glucose values on target than did practices with the highest ratios of patients to registered nurse (p < 0.01 and p = 0.03, respectively). Interpretation: The findings suggest that registered nurse staffing within primary care practice teams contributes to better diabetic care, as measured by diabetes management indicators. This study sets the groundwork for further exploration of nursing and organizational contributions to patient care in the primary care setting. PMID:27398372
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Nursing Practice Environment and Registered Nurses' Job Satisfaction in Nursing Homes
ERIC Educational Resources Information Center
Choi, JiSun; Flynn, Linda; Aiken, Linda H.
2012-01-01
Purpose: Recruiting and retaining registered nurses (RNs) in nursing homes is problematic, and little research is available to guide efforts to make nursing homes a more attractive practice environment for RNs. The purpose of this study was to examine relationships between aspects of the nursing practice environment and job satisfaction among RNs…
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16 CFR 1.10 - Advance notice of proposed rulemaking.
Code of Federal Regulations, 2011 CFR
2011-01-01
... shall publish in the Federal Register an advance notice of such proposed proceeding. (b) The advance... Committee on Interstate and Foreign Commerce of the House of Representatives. (d) The Commission may, in...
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Liu, T I; So, R
1996-12-01
A survey of female commercial sex workers (CSW) in Iloilo City, Philipines, was conducted in October and November 1995 to determine the level of knowledge, attitudes, and preventive practices regarding HIV/AIDS to guide future education programs. CSWs in the Philippines were categorized as registered or freelance. Registered CSWs included "hospitality girls" from licensed bars, night clubs, and massage parlors who have registered with the local social hygiene clinic (SHC). Freelance CSWs are not registered. 110 registered and 46 freelance CSWs were surveyed. We compared demographic data, scores from a basic knowledge test, and preventive practices between registered and freelance CSWs. Demographic data indicate that registered CSWs often originate from provinces outside of the Visayan Islands (25%) and most have never been married (93%). Freelance CSWs included more married (11%) and separated (11%) women from nearby cities. Knowledge test scores of registered and freelance CSWs were not significantly different. 90-96% of CSWs correctly answered questions regarding modes of transmission. However, 25% still believed it is possible to contract AIDS from using a public restroom. Registered and freelance CSWs believed their risks for AIDS to be equally great. However, 38% of freelance CSWs admit to never or almost never using condoms compared to 15% of registered CSWs. Licensed establishments and a support staff at the social hygiene clinic may provide a relatively structured working environment, giving registered CSWs security and confidence to insist on condom use. In most cases, condom use seems to depend on male customer compliance, and CSWs, especially freelancers, cannot afford to insist on condom use. The CSWs indicated that they learned most about AIDS through health personnel and television.
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Fox, Mary T; Sidani, Souraya; Butler, Jeffrey I; Tregunno, Deborah
2017-06-01
Background Cultivating hospital environments that support older people's care is a national priority. Evidence on geriatric nursing practice environments, obtained from studies of registered nurses (RNs) in American teaching hospitals, may have limited applicability to Canada, where RNs and registered practical nurses (RPNs) care for older people in predominantly nonteaching hospitals. Purpose This study describes nurses' perceptions of the overall quality of care for older people and the geriatric nursing practice environment (geriatric resources, interprofessional collaboration, and organizational value of older people's care) and examines if these perceptions differ by professional designation and hospital teaching status. Methods A cross-sectional survey, using Dillman's tailored design, that included Geriatric Institutional Assessment Profile subscales, was completed by 2005 Ontario RNs and registered practical nurses to assess their perceptions of the quality of care and geriatric nursing practice environment. Results Scores on the Geriatric Institutional Assessment Profile subscales averaged slightly above the midpoint except for geriatric resources which was slightly below. Registered practical nurses rated the quality of care and geriatric nursing practice environment higher than RNs; no significant differences were found by hospital teaching status. Conclusions Nurses' perceptions of older people's care and the geriatric nursing practice environment differ by professional designation but not hospital teaching status. Teaching and nonteaching hospitals should both be targeted for geriatric nursing practice environment improvement initiatives.
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Pediatric Care Coordination: Lessons Learned and Future Priorities.
Cady, Rhonda G; Looman, Wendy S; Lindeke, Linda L; LaPlante, Bonnie; Lundeen, Barbara; Seeley, Amanda; Kautto, Mary E
2015-09-30
A fundamental component of the medical home model is care coordination. In Minnesota, this model informed design and implementation of the state's health care home (HCH) model, a key element of statewide healthcare reform legislation. Children with medical complexity (CMC) often require care from multiple specialists and community resources. Coordinating this multi-faceted care within the HCH is challenging. This article describes the need for specialized models of care coordination for CMC. Two models of care coordination for CMC were developed to address this challenge. The TeleFamilies Model of Pediatric Care Coordination uses an advanced practice registered nurse care (APRN) coordinator embedded within an established HCH. The PRoSPer Model of Pediatric Care Coordination uses a registered nurse/social worker care coordinator team embedded within a specialty care system. We describe key findings from implementation of these models, and conclude with lessons learned. Replication of the models is encouraged to increase the evidence base for care coordination for the growing population of children with medical complexities.
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Arving, Cecilia; Wadensten, Barbro; Johansson, Birgitta
2014-06-01
Purpose of the research was to describe registered nurses' (RNs) (n = 53) thoughts on the blended learning format in a 'specialist nursing programme in cancer care'. The study was conducted in autumn 2007 and 2008. A content analysis of answers to open-ended questions in a web-based questionnaire and a focus group interview were carried out. The analysis revealed that the RNs appreciated blended learning. The web lectures facilitated learning and gave RNs access to the education at any time. However, according to the RNs, knowledge is gained through interaction between RNs and teachers, and this aspect needed to be improved. The RNs also thought that the content of the seminars on campus should focus on evidence-based nursing knowledge and practical skills, not just taught as stable facts and procedures. The result from the present study could help to improve the design and content of advanced nursing courses using a blended learning format.
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The Career Advancement for Registered Nurse Excellence Program.
Fusilero, Jane; Lini, Linda; Prohaska, Priscilla; Szweda, Christine; Carney, Katie; Mion, Lorraine C
2008-12-01
Nurse administrators focus on factors that influence nurses' levels of satisfaction to reduce turnover and improve retention. One important determinant of nurses' satisfaction is the opportunity for professional development. On the basis of feedback from the nurses, a professional development program, Career Advancement for Registered Nurse Excellence, was instituted. The authors describe one approach to create opportunities to improve professional nurse development and the necessity for ongoing assessment of its impact on nurses' job satisfaction.
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76 FR 24343 - Advanced Biofuel Payment Program; Correction
Federal Register 2010, 2011, 2012, 2013, 2014
2011-05-02
...-AA75 Advanced Biofuel Payment Program; Correction AGENCY: Rural Business-Cooperative Service; Rural... Federal Register of February 11, 2011, establishing the Advanced Biofuel Payment Program authorized under... this Program, the Agency will enter into contracts with advanced biofuel producers to pay such...
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Weng, Yi-Hao; Chen, Chiehfeng; Kuo, Ken N; Yang, Chun-Yuh; Lo, Heng-Lien; Chen, Kee-Hsin; Chiu, Ya-Wen
2015-01-01
Background Although evidence-based practice (EBP) has been widely investigated, few studies have investigated its correlation with a clinical nursing ladder system. The current national study evaluates whether EBP implementation has been incorporated into the clinical ladder system. Methods A cross-sectional questionnaire survey was conducted nationwide of registered nurses among regional hospitals of Taiwan in January to April 2011. Subjects were categorized into beginning nurses (N1 and N2) and advanced nurses (N3 and N4) by the clinical ladder system. Multivariate logistic regression model was used to adjust for possible confounding demographic factors. Results Valid postal questionnaires were collected from 4,206 nurses, including 2,028 N1, 1,595 N2, 412 N3, and 171 N4 nurses. Advanced nurses were more aware of EBP than beginning nurses (p < 0.001; 90.7% vs. 78.0%). In addition, advanced nurses were more likely to hold positive beliefs about and attitudes toward EBP (p < 0.001) and possessed more sufficient knowledge of and skills in EBP (p < 0.001). Furthermore, they more often implemented EBP principles (p < 0.001) and accessed online evidence-based retrieval databases (p < 0.001). The most common motivation for using online databases was self-learning for advanced nurses and positional promotion for beginning nurses. Multivariate logistic regression analyses showed advanced nurses were more aware of EBP, had higher knowledge and skills of EBP, and more often implemented EBP than beginning nurses. Linking Evidence to Action The awareness of, beliefs in, attitudes toward, knowledge of, skills in, and behaviors of EBP among advanced nurses were better than those among beginning nurses. The data indicate that a clinical ladder system can serve as a useful means to enhance EBP implementation. PMID:25588625
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Understanding skill acquisition among registered nurses: the 'perpetual novice' phenomenon.
Wilson, Barbara; Harwood, Lori; Oudshoorn, Abe
2015-12-01
To determine whether the perpetual novice phenomenon exists beyond nephrology nursing where it was first described. The perpetual novice is a state in which nurses are unable to progress from a novice to an expert in one or more essential clinical skills which are used in their practice area. Maintaining clinical competence is essential to quality patient care outcomes. An exploratory, sequential, mixed methods design was used, comprised of a quantitative component followed by in-depth interviews. Registered nurses employed in one of four roles were recruited from two university-affiliated hospitals in London, Ontario, Canada: Clinical Educator, Clinical Nurse Specialist, Advanced Practice Nurse and Nurse Practitioner. Participants were first asked to complete and return a survey and demographic questionnaire. Following the return of the completed surveys, ten participants were interviewed to enhance the results of the surveys. The results of the surveys confirmed that the perpetual novice phenomenon exists across multiple nursing care areas. Four contributing factors, both personal and structural in nature, emerged from the interviews: (1) opportunities for education, (2) the context of learning, (3) personal motivation and initiative to learn and (4) the culture of the units where nurses worked. The perpetual novice phenomenon exists due to a combination of both personal factors as well as contextual factors in the work environment. The results assist in directing future educational interventions and provide nursing leaders with the information necessary to create work environments that best enable practicing nurses to acquire and maintain clinical competence. © 2015 John Wiley & Sons Ltd.
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Public Opinions Regarding Advanced Dental Hygiene Practitioners in a High-Need State.
Walsh, Sarah E; Chubinski, Jennifer; Sallee, Toby; Rademacher, Eric W
2016-10-01
Purpose: The new Advanced Dental Hygiene Practitioner (ADHP) profession is expected to increase access to oral health care for the general population, particularly in rural and underserved areas. In order for this strategy to be successful, the public must feel comfortable with the care provided by ADHPs and seek out their services, yet consumer receptivity has been overlooked in the literature. The current study explores comfort with ADHPs for one high-need state: Kentucky. Methods: Consumer receptivity to the ADHP was assessed using a large, random sample telephone survey. As a point of comparison, respondents were first asked about their comfort with care provided by two other advanced practice clinicians already licensed in the state: advanced practice registered nurses (APRN) and physician assistants (PA). Results: After hearing a brief description of the profession, nearly 3 in 4 Kentucky adults said they would be somewhat (35.4%) or very (38.2%) comfortable seeing an ADHP for routine dental care. The total proportion of Kentucky adults who were comfortable seeking care from an ADHP (73.6%) was slightly less than the proportion indicating comfort seeing an APRN (79.7%) or PA (81.3%). Conclusion: Overall, this study demonstrates that adults are receptive to new models of care delivery and report high levels of comfort with ADHPs. Consumer concerns are unlikely to be a barrier to expanded licensure for dental hygienists in high-need areas like Kentucky. Copyright © 2016 The American Dental Hygienists’ Association.
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Korbelik, Juraj; Rand, Jacquie S; Morton, John M
2011-10-15
OBJECTIVE-To compare early socialization practices between litters of breeders registered with the Canine Control Council (CCC) and litters of nonregistered breeders advertising puppies for sale in a local newspaper. DESIGN-Retrospective cohort study. Animals-80 litters of purebred and mixed-breed dogs from registered (n = 40) and non-registered (40) breeders. PROCEDURES-Registered breeders were randomly selected from the CCC website, and nonregistered breeders were randomly selected from a weekly advertising newspaper. The litter sold most recently by each breeder was then enrolled in the study. Information pertaining to socialization practices for each litter was obtained through a questionnaire administered over the telephone. RESULTS-Registered breeders generally had more breeding bitches and had more litters than did nonregistered breeders. Litters of registered breeders were more likely to have been socialized with adult dogs, people of different appearances, and various environmental stimuli, compared with litters of nonregistered breeders. Litters from registered breeders were also much less likely to have been the result of an unplanned pregnancy. CONCLUSIONS AND CLINICAL RELEVANCE-Among those breeders represented, litters of registered breeders received more socialization experience, compared with litters of nonregistered breeders. People purchasing puppies from nonregistered breeders should focus on socializing their puppies between the time of purchase and 14 weeks of age. Additional research is required to determine whether puppies from nonregistered breeders are at increased risk of behavioral problems and are therefore more likely to be relinquished to animal shelters or euthanized, relative to puppies from registered breeders.
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An Overview of Evidence-Based Program Registers (EBPRs) for Behavioral Health
Burkhardt, Jason T.; Schröter, Daniela C.; Magura, Stephen; Means, Stephanie N.; Coryn, Chris L.S.
2015-01-01
Evaluations of behavioral health interventions have identified many that are potentially effective. However, clinicians and other decision makers typically lack the time and ability to effectively search and synthesize the relevant research literature. In response to this opportunity, and to increasing policy and funding pressures for the use of evidence-based practices, a number of “what works” websites have emerged to assist decision makers in selecting interventions with the highest probability of benefit. However, these registers as a whole are not well understood. This article, which represents phase one of a concurrent mixed methods study, presents a review of the scopes, structures, dissemination strategies, uses, and challenges faced by evidence-based registers in the behavioral health disciplines. The major findings of this study show that in general, registers of evidence-based practices are able, to a degree, to identify the most effective practices and meet the needs of decision makers. However, much needs to be done to improve the ability of the registers to fully realize their purpose. PMID:25450777
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ERIC Educational Resources Information Center
Gilpatrick, Eleanor
To secure information about the characteristics of the practical nurse population and their opinions about registered nurse preparation, questionnaires were distributed to 2,923 practical nurses employed by the New York City Municipal Hospitals. Usable questionnaires numbered 2,361 or 81 percent of the employed PN population. Approximately 9…
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16 CFR 301.26 - Registered identification numbers.
Code of Federal Regulations, 2011 CFR
2011-01-01
... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Registered identification numbers. 301.26... numbers. (a) Registered numbers for use as the required identification in lieu of the name on fur product... (d) of this section. (b)(1) Registered identification numbers shall be used only by the person or...
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16 CFR 303.20 - Registered identification numbers.
Code of Federal Regulations, 2011 CFR
2011-01-01
... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Registered identification numbers. 303.20... identification numbers. (a) Registered numbers for use as the required identification in lieu of the name on... the form set out in paragraph (d) of this section. (b)(1) Registered identification numbers shall be...
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Code of Federal Regulations, 2010 CFR
2010-01-01
... meetings, selected staff meetings, advisory committee meetings, and other activities such as speeches and... Safety Act (15 U.S.C. 2076(j)(8)). (b) Federal Register. Federal Register is the publication through... by the Government in the Sunshine Act (as provided in 16 CFR part 1013) or other applicable law, or...
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Code of Federal Regulations, 2011 CFR
2011-01-01
... meetings, selected staff meetings, advisory committee meetings, and other activities such as speeches and... Safety Act (15 U.S.C. 2076(j)(8)). (b) Federal Register. Federal Register is the publication through... by the Government in the Sunshine Act (as provided in 16 CFR part 1013) or other applicable law, or...
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I was never recruited: challenges in cross-Canada nurse mobility.
Hall, Linda McGillis; Peterson, Jessica; Sheri, Sheri; Andrews, Gavin; Lalonde, Michelle; Harris, Alexandra; MacDonald-Rencz, Sandra
2013-01-01
The internal migration of nurses within Canada has had limited study. This paper reports the results of a survey of registered nurses and licensed practical nurses who had migrated between the provinces and territories in Canada. Factors contributing to internal nurse mobility included seeking full-time work, opportunities for career advancement and flexible scheduling options. Few nurses received incentives to move between the provinces/territories to work. A number of challenges with internal migration are identified, including complexities related to licensing and limitations in available job information. Implications for nursing health human resources policy related to nurse retention in Canada are identified and discussed.
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12 CFR 208.37 - Government securities sales practices.
Code of Federal Regulations, 2011 CFR
2011-01-01
...-institutional customer means any customer other than: (i) A bank, savings association, insurance company, or registered investment company; (ii) An investment adviser registered under section 203 of the Investment... Securities-Related Activities § 208.37 Government securities sales practices. (a) Scope. This subpart is...
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Basic principles to consider when opening a nurse practitioner-owned practice in Texas.
Watson, Michael
2015-12-01
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.
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Penny, Robyn A; Bradford, Natalie K; Langbecker, Danette
2018-03-01
To synthesise evidence of registered nurses' and midwives' experiences with videoconferencing and identify perceptions of the appropriateness, meaningfulness and feasibility of this technology in professional and clinical practice. Videoconferencing is a form of telehealth that can facilitate access to high-quality care to improve health outcomes for patients and enable clinicians working in isolation to access education, clinical supervision, peer support and case review. Yet use of videoconferencing has not translated smoothly into routine practice. Understanding the experiences of registered nurses and midwives may provide practitioners, service managers and policymakers with vital information to facilitate use of the technology. A qualitative meta-synthesis of primary qualitative studies undertaken according to Joanna Briggs Institute methodology. A systematic search of 19 databases was used to identify qualitative studies that reported on registered nurses' or midwives' experiences with videoconferencing in clinical or professional practice. Two reviewers independently appraised studies, extracted data and synthesised findings to construct core concepts. Nine studies met the criteria for inclusion. Five key synthesised findings were identified: useful on a continuum; broader range of information; implications for professional practice; barriers to videoconferencing; and technical support, training and encouragement. While videoconferencing offers benefits, it comes with personal, organisational and professional consequences for nurses and midwives. Understanding potential benefits and limitations, training and support required and addressing potential professional implications all influence adoption and ongoing use of videoconferencing. Registered nurses and midwives are well placed to drive innovations and efficiencies in practice such as videoconferencing. Nursing and midwifery practice must be reframed to adapt to the virtual environment while retaining valued aspects of professional practice. This includes ensuring professional standards keep pace with the development of knowledge in this area and addressing the findings highlighted in this meta-synthesis. © 2017 John Wiley & Sons Ltd.
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Wardle, Jon
2013-12-01
As access to published materials becomes more readily available, the ability to plagiarise material, deliberately or unwittingly has become easier than ever. This article explores important recent decisions in Australia and the United Kingdom regarding registered health practitioners who have engaged in plagiarism, both related and unrelated to their clinical practice, and explores the ways in which regulatory authorities in these countries have viewed scholarly misconduct committed by registered health professionals. This article also examines the implications of plagiarism for the registered health professions, and makes suggestions for strategies to reduce its influence and incidence in modern clinical practice.
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Computer held chronic disease registers in general practice: a validation study.
Coulter, A; Brown, S; Daniels, A
1989-01-01
Lists of patients receiving repeat prescriptions for epilepsy, diabetes, thyroid disease and asthma were compared with chronic disease registers stored on seven practice computers. Diabetes was the most accurately recorded disease: the names of 72% of patients receiving medication for this condition appeared on the relevant disease registers. Agreement between the two data sources was 68% for thyroid disease, 58% for asthma and 49% for epilepsy. The levels of accuracy are not yet high enough for the computerised chronic disease registers to provide an accurate estimate of the prevalence of these conditions, but new system developments suggest a more optimistic outlook for the future. PMID:2592887
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42 CFR 484.4 - Personnel qualifications.
Code of Federal Regulations, 2012 CFR
2012-10-01
... registered nurse by the State in which practicing. Social work assistant. A person who: (1) Has a... physician; or (b) Is a registered nurse; or (c) Has training and experience in health service administration... applicable, as an occupational therapist by the State in which practicing. Occupational therapy assistant. A...
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42 CFR 484.4 - Personnel qualifications.
Code of Federal Regulations, 2014 CFR
2014-10-01
... registered nurse by the State in which practicing. Social work assistant. A person who: (1) Has a... physician; or (b) Is a registered nurse; or (c) Has training and experience in health service administration... applicable, as an occupational therapist by the State in which practicing. Occupational therapy assistant. A...
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42 CFR 484.4 - Personnel qualifications.
Code of Federal Regulations, 2011 CFR
2011-10-01
... registered nurse by the State in which practicing. Social work assistant. A person who: (1) Has a... physician; or (b) Is a registered nurse; or (c) Has training and experience in health service administration... applicable, as an occupational therapist by the State in which practicing. Occupational therapy assistant. A...
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42 CFR 484.4 - Personnel qualifications.
Code of Federal Regulations, 2013 CFR
2013-10-01
... registered nurse by the State in which practicing. Social work assistant. A person who: (1) Has a... physician; or (b) Is a registered nurse; or (c) Has training and experience in health service administration... applicable, as an occupational therapist by the State in which practicing. Occupational therapy assistant. A...
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ERIC Educational Resources Information Center
Spendlove, David; Barton, Amanda; Hallett, Fiona; Shortt, Damien
2012-01-01
In 2009, the General Teaching Council for England (GTCE) introduced a revised Code of Conduct and Practice (2009) for registered teachers. The code also applies to all trainee teachers who are provisionally registered with the GTCE and who could be liable to a charge of misconduct during their periods of teaching practice. This paper presents the…
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1996-01-01
The American Nurses Association (ANA) is committed to safeguarding the public, protecting and advancing the careers of professional nurses, supporting individual and collective efforts by registered nurses to protect their clients and enhancing the professional development and job security of registered nurses. As the nation's health care system is restructured, ANA is actively engaged in initiatives to strengthen the economic and general welfare of registered nurses, the safety and care for the public, and, in partnership with the state nurses associations (SNAs), oppose efforts to replace registered nurses with inappropriate substitutes.
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Johnsen, Hege Mari; Slettebø, Åshild; Fossum, Mariann
2016-05-01
The home healthcare context can be unpredictable and complex, and requires registered nurses with a high level of clinical reasoning skills and professional autonomy. Thus, additional knowledge about registered nurses' clinical reasoning performance during patient home care is required. The aim of this study is to describe the cognitive processes and thinking strategies used by recently graduated registered nurses while caring for patients in home healthcare clinical practice. An exploratory qualitative think-aloud design with protocol analysis was used. Home healthcare visits to patients with stroke, diabetes, and chronic obstructive pulmonary disease in seven healthcare districts in southern Norway. A purposeful sample of eight registered nurses with one year of experience. Each nurse was interviewed using the concurrent think-aloud technique in three different patient home healthcare clinical practice visits. A total of 24 home healthcare visits occurred. Follow-up interviews were conducted with each participant. The think-aloud sessions were transcribed and analysed using three-step protocol analysis. Recently graduated registered nurses focused on both general nursing concepts and concepts specific to the domains required and tasks provided in home healthcare services as well as for different patient groups. Additionally, participants used several assertion types, cognitive processes, and thinking strategies. Our results showed that recently graduated registered nurses used both simple and complex cognitive processes involving both inductive and deductive reasoning. However, their reasoning was more reactive than proactive. The results may contribute to nursing practice in terms of developing effective nursing education programmes. Copyright © 2016 Elsevier Ltd. All rights reserved.
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77 FR 43828 - Proposed Data Collections Submitted for Public Comment and Recommendations
Federal Register 2010, 2011, 2012, 2013, 2014
2012-07-26
... Form Registered Nurse 2,000 1 5/60 167 (Infection Preventionist). 57.101: Facility Contact Registered Nurse 2,000 1 10/60 333 Information. (Infection Preventionist). 57.103: Patient Safety Registered Nurse... Safety Registered Nurse 5,700 1 1.5 8,550 Component--Outpatient (Infection Dialysis Center Practices...
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Exploring sources of knowledge utilized in practice among Jordanian registered nurses.
Al-Ghabeesh, Suhair Husni; Abu-Moghli, Fathieh; Salsali, Mahvash; Saleh, Mohammad
2013-10-01
Understanding sources of knowledge used in everyday practice is very helpful in improving the quality of health care services. There is a consensus in the literature that nurses mostly relied in their practice on experiential knowledge gained through their interactions with other members of health care professionals and patients. The general aim of this study is to explore the sources of knowledge Jordanian registered nurses use during their practice. A descriptive correlational design was used to collect data from 539 Jordanian registered nurses from 10 hospitals using a self-administered questionnaire. The mean year of experience of the sample was 7.08 years. Of the 615 questionnaires distributed, 555 were returned. This yields a response rate of 87.6%. Results revealed that the top five ranked sources used by Jordanian registered nurses include: the information that nurses learned during nursing education, personal experience in nursing over time, what was learned through providing care to patients, information gained through discussion between physicians and nurses about patients, and information from policy and procedure manuals. Jordanian registered nurses recognize the value of research and that research utilization (RU) is an important issue and must not be ignored. The study has many implications for practice, education and research. Health care managers and decision makers need to play a more visible and instrumental role in encouraging RU to improve patients' quality of life. © 2012 John Wiley & Sons Ltd.
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Newton, Louise; Pront, Leeanne; Giles, Tracey M
2016-06-01
To examine the literature reporting the experiences and perceptions of registered nurses who supervise international nursing students in the clinical and classroom setting. Nursing education relies on clinical experts to supervise students during classroom and clinical education, and the quality of that supervision has a significant impact on student development and learning. Global migration and internationalisation of nursing education have led to increasing numbers of registered nurses supervising international nursing students. However, a paucity of relevant literature limits our understanding of these experiences. An integrative literature review. Comprehensive database searches of CINAHL, Informit, PubMed, Journals@Ovid, Findit@flinders and Medline were undertaken. Screening of 179 articles resulted in 10 included for review. Appraisal and analysis using Whittemore and Knafl's (Journal of Advanced Nursing, 52, 2005, 546) five stage integrative review recommendations was undertaken. This review highlighted some unique challenges for registered nurses supervising international nursing students. Identified issues were, a heightened sense of responsibility, additional pastoral care challenges, considerable time investments, communication challenges and cultural differences between teaching and learning styles. It is possible that these unique challenges could be minimised by implementing role preparation programmes specific to international nursing student supervision. Further research is needed to provide an in-depth exploration of current levels of preparation and support to make recommendations for future practice, education and policy development. An awareness of the specific cultural learning needs of international nursing students is an important first step to the provision of culturally competent supervision for this cohort of students. There is an urgent need for education and role preparation for all registered nurses supervising international nursing students, along with adequate recognition of the additional time required to effectively supervise these students. © 2016 John Wiley & Sons Ltd.
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Primary care practice and health professional determinants of immunisation coverage.
Grant, Cameron C; Petousis-Harris, Helen; Turner, Nikki; Goodyear-Smith, Felicity; Kerse, Ngaire; Jones, Rhys; York, Deon; Desmond, Natalie; Stewart, Joanna
2011-08-01
To identify primary care factors associated with immunisation coverage. A survey during 2005-2006 of a random sample of New Zealand primary care practices, with over-sampling of practices serving indigenous children. An immunisation audit was conducted for children registered at each practice. Practice characteristics and the knowledge and attitudes of doctors, nurses and caregivers were measured. Practice immunisation coverage was defined as the percentage of registered children from 6 weeks to 23 months old at each practice who were fully immunised for age. Associations of practice, doctor, nurse and caregiver factors with practice immunisation coverage were determined using multiple regression analyses. One hundred and twenty-four (61%) of 205 eligible practices were recruited. A median (25th-75th centile) of 71% (57-77%) of registered children at each practice was fully immunised. In multivariate analyses, immunisation coverage was higher at practices with no staff shortages (median practice coverage 76% vs 67%, P = 0.004) and where doctors were confident in their immunisation knowledge (72% vs 67%, P= 0.005). Coverage was lower if the children's parents had received information antenatally, which discouraged immunisation (67% vs 73%, P = 0.008). Coverage decreased as socio-economic deprivation of the registered population increased (P < 0.001) and as the children's age (P = 0.001) and registration age (P = 0.02) increased. CONCLUSIONS Higher immunisation coverage is achieved by practices that establish an early relationship with the family and that are adequately resourced with stable and confident staff. Immunisation promotion should begin antenatally. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
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A national medical register: balancing public transparency and professional privacy.
Healy, Judith M; Maffi, Costanza L; Dugdale, Paul
2008-02-18
The first aim of a medical registration scheme should be to protect patients. Medical registration boards currently offer variable information to the public on doctors' registration status. Current reform proposals for a national registration scheme should include free public access to professional profiles of registered medical practitioners. Practitioner profiles should include: practitioner's full name and practice address; type of qualifications; year first registered, and duration and type of registration; any conditions on registration and practice; any disciplinary action taken; and participation in continuing professional education.
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Stress management techniques in the prison setting.
Kristofersson, Gisli Kort; Kaas, Merrie J
2013-01-01
The percentage of incarcerated individuals in the United States is currently close to an all time high, and more stressful places than prisons are hard to find. Because registered nurses and advance practice nurses are often the only healthcare providers readily available to prison inmates, nurses need a repertoire of effective strategies to minimize prisoners' stress-related symptoms and behaviors. The purpose of this critical literature review was to identify the state of knowledge about using stress management techniques (SMTs) in the prison setting for reducing psychological problems and/or behavioral problems in male and female adult prison populations. A comprehensive, systematic integrated literature search was performed using multiple relevant databases to identify studies using various SMTs for incarcerated adults. Although clinical practice recommendations for the use of SMTs in the prison setting cannot be made with strong certainty, nurses working in the prison setting should continue to incorporate muscle relaxation, Transcendental Meditation, and certain Eastern meditative practices in the care of their clients because of the safety and possible positive impacts and practicality these methods have in this setting.
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Brazil, Kevin; Cloutier, Michelle M; Tennen, Howard; Bailit, Howard; Higgins, Pamela S
2008-04-01
The purpose of this study was to examine the challenges of integrating an asthma disease management (DM) program into a primary care setting from the perspective of primary care practitioners. A second goal was to examine whether barriers differed between urban-based and nonurban-based practices. Using a qualitative design, data were gathered using focus groups in primary care pediatric practices. A purposeful sample included an equal number of urban and nonurban practices. Participants represented all levels in the practice setting. Important themes that emerged from the data were coded and categorized. A total of 151 individuals, including physicians, advanced practice clinicians, registered nurses, other medical staff, and nonmedical staff participated in 16 focus groups that included 8 urban and 8 nonurban practices. Content analyses identified 4 primary factors influencing the implementation of a DM program in a primary care setting. They were related to providers, the organization, patients, and characteristics of the DM program. This study illustrates the complexity of the primary care environment and the challenge of changing practice in these settings. The results of this study identified areas in a primary care setting that influence the adoption of a DM program. These findings can assist in identifying effective strategies to change clinical behavior in primary care practices.
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Mack, Rachel
2018-06-01
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.
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Humphreys, John; Harvey, Gill; Coleiro, Michelle; Butler, Brook; Barclay, Anna; Gwozdziewicz, Maciek; O'Donoghue, Donal; Hegarty, Janet
2012-08-01
Research has demonstrated a knowledge and practice gap in the identification and management of chronic kidney disease (CKD). In 2009, published data showed that general practices in Greater Manchester had a low detection rate for CKD. A 12-month improvement collaborative, supported by an evidence-informed implementation framework and financial incentives. 19 general practices from four primary care trusts within Greater Manchester. Number of recorded patients with CKD on practice registers; percentage of patients on registers achieving nationally agreed blood pressure targets. The collaborative commenced in September 2009 and involved three joint learning sessions, interspersed with practice level rapid improvement cycles, and supported by an implementation team from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Greater Manchester. At baseline, the 19 collaborative practices had 4185 patients on their CKD registers. At final data collection in September 2010, this figure had increased by 1324 to 5509. Blood pressure improved from 34% to 74% of patients on practice registers having a recorded blood pressure within recommended guidelines. Evidence-based improvement can be implemented in practice for chronic disease management. A collaborative approach has been successful in enabling teams to test and apply changes to identify patients and improve care. The model has proved to be more successful for some practices, suggesting a need to develop more context-sensitive approaches to implementation and actively manage the factors that influence the success of the collaborative.
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McKissick, Holly D; Cady, Rhonda G; Looman, Wendy S; Finkelstein, Stanley M
The purpose of this analysis was to evaluate the effects of an advanced practice nurse-delivered telehealth intervention on health care use by children with medical complexity (CMC). Because CMC account for a large share of health care use costs, finding effective ways to care for them is an important challenge requiring exploration. This was a secondary analysis of data from a randomized clinical trial with a control group and two intervention groups. The focus of the analysis was planned and unplanned clinical and therapy visits by CMC over a 30-month data collection period. Nonparametric tests were used to compare visit counts among and within the three groups. The number of unplanned visits decreased over time across all groups, with the greatest decrease in the video telehealth intervention group. Planned visits were higher in the video telehealth group across all time periods. Advanced practice registered nurse-delivered telehealth care coordination may support a shift from unplanned to planned health care service use among CMC. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
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Glanville, Julie M; Duffy, Steven; McCool, Rachael; Varley, Danielle
2014-07-01
Since 2005, International Committee of Medical Journal Editors (ICMJE) member journals have required that clinical trials be registered in publicly available trials registers before they are considered for publication. The research explores whether it is adequate, when searching to inform systematic reviews, to search for relevant clinical trials using only public trials registers and to identify the optimal search approaches in trials registers. A search was conducted in ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP) for research studies that had been included in eight systematic reviews. Four search approaches (highly sensitive, sensitive, precise, and highly precise) were performed using the basic and advanced interfaces in both resources. On average, 84% of studies were not listed in either resource. The largest number of included studies was retrieved in ClinicalTrials.gov and ICTRP when a sensitive search approach was used in the basic interface. The use of the advanced interface maintained or improved sensitivity in 16 of 19 strategies for Clinicaltrials.gov and 8 of 18 for ICTRP. No single search approach was sensitive enough to identify all studies included in the 6 reviews. Trials registers cannot yet be relied upon as the sole means to locate trials for systematic reviews. Trials registers lag behind the major bibliographic databases in terms of their search interfaces. For systematic reviews, trials registers and major bibliographic databases should be searched. Trials registers should be searched using sensitive approaches, and both the registers consulted in this study should be searched.
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Kiesewetter, Barbara; Raderer, Markus; Steger, Günther G; Bartsch, Rupert; Pirker, Robert; Zöchbauer-Müller, Sabine; Prager, Gerald; Krainer, Michael; Preusser, Matthias; Schmidinger, Manuela; Zielinski, Christoph C
2016-01-01
The European Society for Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale (MCBS) has been designed to stratify the therapeutic benefit of a certain drug registered for the treatment of cancer. However, though internally validated, this tool has not yet been evaluated for its feasibility in the daily practice of a major center of medical oncology. The practicability of the MCBS for advanced oncological diseases at the Clinical Division of Oncology, Medical University of Vienna, which constitutes one of the largest oncological centres in Europe, was analysed in a three-step approach. First, retrospectively collected data were analysed to gain an overview of treatments in regular use. Second, data were scored by using the MCBS. Third, the ensuing results were evaluated within corresponding programme directorships to assess feasibility in a real-life clinical context. In the majority of tumour entities, the MCBS results reported earlier are consistent with daily clinical practice. Thus, in metastatic breast cancer or advanced lung cancer, there was a high level of clinical benefit for first-line treatment standards, and these results reflected well real-life experience. However, analyses based on the first version of the MCBS are limited if it comes to salvage treatment in tumour entities in which optimal sequencing of potential treatment options is of major importance, as in metastatic colorectal or renal cell cancer. In contrast to this, it is remarkable that certain novel therapies such as nivolumab assessed for heavily pretreated advanced renal cancer reached the highest level of clinical benefit due to prolongation in survival and a favourable toxicity profile. The MCBS clearly underlines the potential benefit of these compounds. The MCBS is an excellent tool for daily clinical practice of a tertiary referral centre. It supports treatment decisions based on the clinical benefit to be expected from a novel approach such as immunotherapy in as yet untested indications.
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49 CFR 1103.1 - Register of practitioners.
Code of Federal Regulations, 2010 CFR
2010-10-01
... 49 Transportation 8 2010-10-01 2010-10-01 false Register of practitioners. 1103.1 Section 1103.1 Transportation Other Regulations Relating to Transportation (Continued) SURFACE TRANSPORTATION BOARD, DEPARTMENT OF TRANSPORTATION RULES OF PRACTICE PRACTITIONERS General Information § 1103.1 Register of...
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Design Method For Ultra-High Resolution Linear CCD Imagers
NASA Astrophysics Data System (ADS)
Sheu, Larry S.; Truong, Thanh; Yuzuki, Larry; Elhatem, Abdul; Kadekodi, Narayan
1984-11-01
This paper presents the design method to achieve ultra-high resolution linear imagers. This method utilizes advanced design rules and novel staggered bilinear photo sensor arrays with quadrilinear shift registers. Design constraint in the detector arrays and shift registers are analyzed. Imager architecture to achieve ultra-high resolution is presented. The characteristics of MTF, aliasing, speed, transfer efficiency and fine photolithography requirements associated with this architecture are also discussed. A CCD imager with advanced 1.5 um minimum feature size was fabricated. It is intended as a test vehicle for the next generation small sampling pitch ultra-high resolution CCD imager. Standard double-poly, two-phase shift registers were fabricated at an 8 um pitch using the advanced design rules. A special process step that blocked the source-drain implant from the shift register area was invented. This guaranteed excellent performance of the shift registers regardless of the small poly overlaps. A charge transfer efficiency of better than 0.99995 and maximum transfer speed of 8 MHz were achieved. The imager showed excellent performance. The dark current was less than 0.2 mV/ms, saturation 250 mV, adjacent photoresponse non-uniformity ± 4% and responsivity 0.7 V/ μJ/cm2 for the 8 μm x 6 μm photosensor size. The MTF was 0.6 at 62.5 cycles/mm. These results confirm the feasibility of the next generation ultra-high resolution CCD imagers.
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Shannon, Kay; McKenzie-Green, Barbara
2016-01-01
Challenges facing healthcare assistants in aged residential care are a focus of global debate. These challenges involve remuneration, education, skill mix, work conditions and organisational structures. We enter the discussion by acknowledging current work, education and remuneration for healthcare assistants. We then consider the supervisory relationships between registered nurses (RNs), enrolled nurses (ENs) and healthcare assistants, educational levels for RNs, ENs and healthcare assistants, and the interplay between organisation and practice in aged residential care. We suggest that improving work for the healthcare assistant has the potential to lead change in all role levels. Discussion paper. We argue that adjustments to work structures, education and skill advancement of RNs, ENs and healthcare assistants could improve staff working conditions and clarify practice boundaries. The ultimate result is likely to be an improvement to quality of care and the life of residents in aged residential care.
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The subject of pedagogy from theory to practice--the view of newly registered nurses.
Ivarsson, Bodil; Nilsson, Gunilla
2009-07-01
The aim was to describe, from the newly registered nurses' perspective, specific events when using their pedagogical knowledge in their everyday clinical practice. The design was qualitative and the critical incident technique was used. Data was collected via interviews with ten newly registered nurses who graduated from the same University program 10 months earlier and are now employed at a university hospital. Two categories emerged in the analyses. The first category was "Pedagogical methods in theory" with the sub-categories Theory and the application of the course in practice, Knowledge of pedagogy and Information as a professional competence. The second category was "Pedagogical methods in everyday clinical practice" with sub-categories Factual knowledge versus pedagogical knowledge, Information and relatives, Difficulties when giving information, Understanding information received, Pedagogical tools, Collaboration in teams in pedagogical situations, and Time and giving information. By identifying specific events regarding pedagogical methods the findings can be useful for everyone from teachers and health-care managers to nurse students and newly registered nurses, to improve teaching methods in nurse education.
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75 FR 12807 - Agency Information Collection Activity Under OMB Review
Federal Register 2010, 2011, 2012, 2013, 2014
2010-03-17
... and advanced propulsion technologies. The Federal Register notice with a 60-day comment period... program supports the development and deployment of clean fuel and advanced propulsion technologies for...
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Reidy, Jennifer; Halvorson, Jennifer; Makowski, Suzana; Katz, Delila; Weinstein, Barbara; McCluskey, Christine; Doering, Alex; DeCarli, Kathryn; Tjia, Jennifer
2017-04-01
The success of a facilitator-based model for advance care planning (ACP) in LaCrosse, Wisconsin, has inspired health systems to aim for widespread documentation of advance directives, but limited resources impair efforts to replicate this model. One promising strategy is the development of interactive, Internet-based tools that might increase access to individualized ACP at minimal cost. However, widespread adoption and implementation of Internet-based ACP efforts has yet to be described. We describe our early experiences in building a systematic, population-based ACP initiative focused on health system-wide deployment of an Internet-based tool as an adjunct to a facilitator-based model. With the sponsorship of our healthcare system's population health leadership, we engaged a diverse group of clinical stakeholders as champions to design an Internet-based ACP tool and facilitate local practice change. We describe how we simultaneously began to train clinicians in ACP conversations, engage patients and health system employees in thinking about ACP, redesign clinic workflows to accommodate ACP discussions, and integrate the Internet-based tool into the electronic medical record (EMR). Over 18 months, our project engaged two subspecialty clinics in a systematic ACP process and began work with a large primary care practice with a large Medicare Accountable Care Organization at-risk population. Overall, 807 people registered at the Internet site and 85% completed ACPs. We learned that changing culture and systems to promote ACP requires a comprehensive vision with simultaneous, interconnected strategies targeting patient education, clinician training, EMR documentation, and community awareness.
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Craft, Judy A; Hudson, Peter B; Plenderleith, Mark B; Gordon, Christopher J
2017-06-01
To explore new graduate registered nurses' reflections of bioscience courses during their nursing programme and the relationship between bioscience content and their clinical practice. Undergraduate nursing students internationally find bioscience courses challenging, which may be due to the volume of content and level of difficulty of these courses. Such challenges may be exacerbated by insufficient integration between bioscience theory and nursing clinical practice. A descriptive, cross-sectional mixed methods study was conducted. A 30-item questionnaire with five written response questions which explored recently registered nurses' reflections on bioscience courses during their nursing degree was employed. Descriptive analyses were reported for individual items. Thematic analysis of qualitative responses was grouped to reveal emerging themes. Registered nurses' (n = 22) reflections revealed that bioscience courses were a significant challenge during their undergraduate programme, and they lacked confidence explaining the biological basis of nursing. Participants would like improved knowledge of the relevant bioscience for nursing and agreed that bioscience courses should be extended into the undergraduate final year. The importance of relating bioscience content to nursing practice was elaborated extensively throughout written responses. Although registered nurses reflected that bioscience courses were difficult with large volumes of content, having more bioscience with greater relevance to nursing applications was considered important in their current clinical practice. It is suggested that bioscience academics develop greater contextual links between bioscience content and clinical practice relevant to nursing. After working as a registered nurse, there was appreciation of bioscience relevance for clinical practice, and the nurses believed they would have benefitted from more nursing-related bioscience during their undergraduate programme. Focussed integration of bioscience with clinical nursing courses should be driven by academics, nurse educators and clinical nurses to provide a biological basis for patient care to nursing students. © 2016 John Wiley & Sons Ltd.
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Bradbury-Jones, Caroline; Broadhurst, Karen
2015-09-01
To investigate student nurses' and midwives' knowledge, confidence and educational needs regarding recognition and responses to domestic abuse. Domestic abuse is a serious global problem and has greater, negative effects on long-term health than more obvious diseases, such as diabetes. Nurses and midwives are well-placed to recognize and respond to domestic abuse but many lack confidence in this area. There is firm evidence that training can increase the confidence of Registered Nurses and midwives in responding to domestic abuse. But the issue of undergraduate preparation is significantly under-investigated. A qualitative study. Nursing and midwifery students were recruited using purposive sampling. We facilitated eight focus groups with a total of 55 students (student midwives N = 32; student nurses n = 23). Data were collected between May-November 2014. Students in the study viewed the issue of domestic abuse as important and they possessed sound theoretical knowledge of its nature and consequences. However, they lacked confidence in recognizing and responding to abuse and were concerned about the implications of this for their future practice as registered practitioners. Interactive learning opportunities that engaged with service users and involved experts from practice were viewed as important educational requirements. Most students in the study felt insufficiently prepared to deal with the issue of domestic abuse. They perceived this as a cyclical state of disempowerment that would impact negatively on their practice and on their own ability to support nursing and midwifery students of the future. © 2015 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.
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29 CFR 1990.141 - Advance notice of proposed rulemaking.
Code of Federal Regulations, 2014 CFR
2014-07-01
... CARCINOGENS Regulation of Potential Occupational Carcinogens § 1990.141 Advance notice of proposed rulemaking... carcinogen, the Secretary will normally publish, in the Federal Register, a notice which includes at least...
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29 CFR 1990.141 - Advance notice of proposed rulemaking.
Code of Federal Regulations, 2013 CFR
2013-07-01
... CARCINOGENS Regulation of Potential Occupational Carcinogens § 1990.141 Advance notice of proposed rulemaking... carcinogen, the Secretary will normally publish, in the Federal Register, a notice which includes at least...
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29 CFR 1990.141 - Advance notice of proposed rulemaking.
Code of Federal Regulations, 2012 CFR
2012-07-01
... CARCINOGENS Regulation of Potential Occupational Carcinogens § 1990.141 Advance notice of proposed rulemaking... carcinogen, the Secretary will normally publish, in the Federal Register, a notice which includes at least...
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17 CFR 210.2-07 - Communication with audit committees.
Code of Federal Regulations, 2010 CFR
2010-04-01
... registered public accounting firm; (3) Other material written communications between the registered public... Accountants § 210.2-07 Communication with audit committees. (a) Each registered public accounting firm that... critical accounting policies and practices to be used; (2) All alternative treatments within Generally...
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Flinkman, Mervi; Salanterä, Sanna
2015-11-01
To describe why young registered nurses (RNs) had previously left an organisation and why they intend to leave the profession. Currently, many young registered nurses, including those in Finland, are considering leaving their job or have an intention to leave the profession. An in-depth, descriptive approach was adopted. Data were collected in 2012 from interviews with 15 registered nurses (under the age of 30 years). The interviews were semi-structured and analysed using conventional content analysis. The main questions addressed were: 'Why had the young registered nurses left their previous organisation?' and 'Why do young registered nurses have an intention to leave the profession?' The findings centre on three themes: poor nursing practice environments; lack of support, orientation and mentoring, and nursing as a 'second best' or serendipitous career choice. The first years of nursing are particularly stressful for newly-graduated and inexperienced registered nurses. An in-depth, qualitative approach reveals more complex reasons behind the turnover of registered nurses and intention to leave the profession than questionnaire surveys. Young registered nurses need social support from nurse managers and experienced colleagues to successfully transition into nursing practice environments. Adequate orientation and mentoring programmes are needed to facilitate this transition. © 2014 John Wiley & Sons Ltd.
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Wheeler, Rebecca M; Foster, Jennifer W
2013-01-01
This study compared the perspectives of internationally educated nurses (IENs) and registered nurses (RNs) educated in the United States regarding participation in hospital governance structures and professional advancement. Nurses' participation in hospital governance is reported to contribute to empowerment. No research has examined how IENs' perceptions about participation in governance compared with those of U.S. RNs. Semistructured interviews were held with 82 nurses in 2 urban hospitals. Forty nurses were reinterviewed to follow up on themes. Internationally educated nurses and US RNs shared similar perspectives. Nurses in both samples did not value participation in governance, lacked guidance about how to advance, and preferred to at the bedside. Strategies to encourage nurses to participate in and value governance and professional advancement opportunities should be explored and adopted.
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Casciano, Roman; Chulikavit, Maruit; Perrin, Allison; Liu, Zhimei; Wang, Xufang; Garrison, Louis P
2012-01-01
Everolimus (Afinitor) and sunitinib (Sutent) were recently approved to treat patients with advanced, progressive pancreatic neuroendocrine tumors (pNETs). (Afinitor is a registered trademark of Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; Sutent is a registered trademark of Pfizer Inc., New York, NY, USA.) This analysis examined the projected cost-effectiveness of everolimus vs sunitinib in this setting from a US payer perspective. A semi-Markov model was developed to simulate a cohort of patients with advanced, progressive pNET and to estimate the cost per life-year gained (LYG) and per quality-adjusted life-year (QALY) gained when treating with everolimus vs sunitinib. Efficacy data were based on a weight-adjusted indirect comparison of the agents using phase 3 trial data. Model health states included: stable disease with no adverse events, stable disease with adverse events, disease progression, and death. Therapy costs were based on wholesale acquisition cost. Other costs such as physician visits, tests, hospitalizations, and adverse event costs were obtained from literature and/or primary research. Utility inputs were based on primary research. Sensitivity analyses were conducted to test the model's robustness. In the base-case analysis, everolimus was associated with an incremental 0.448 LYG (0.304 QALYs) at an incremental cost of $12,673, resulting in an incremental cost-effectiveness ratio (ICER) of $28,281/LYG ($41,702/QALY gained). The ICER fell within the cost per QALY range for many widely used oncology drugs. Sensitivity analyses demonstrated that, overall, there is a trend that everolimus is cost-effective compared to sunitinib in this setting. Results of the indirect analysis were not statistically significant (p > 0.05). Assumptions that treatment patterns are the same across therapies may not represent real-world practice. While the analysis is limited by its reliance on an indirect comparison of two phase 3 studies, everolimus is expected to be cost-effective relative to sunitinib in advanced, progressive pNET.
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Huhman, Marian; Quick, Brian L; Payne, Laura
2016-05-01
A primary objective of health care reform is to provide affordable and quality health insurance to individuals. Currently, promotional efforts have been moderately successful in registering older, more mature adults yet comparatively less successful in registering younger adults. With this challenge in mind, we conducted extensive formative research to better understand the attitudes, subjective norms, and perceived behavioral control of community college students. More specifically, we examined how each relates to their intentions to enroll in a health insurance plan, maintain their current health insurance plan, and talk with their parents about their parents having health insurance. In doing so, we relied on the revised reasoned action approach advanced by Fishbein and his associates (Fishbein & Ajzen, 2010; Yzer, 2012, 2013). Results showed that the constructs predicted intentions to enroll in health insurance for those with no insurance and for those with government-sponsored insurance and intentions to maintain insurance for those currently insured. Our study demonstrates the applicability of the revised reasoned action framework within this context and is discussed with an emphasis on the practical and theoretical contributions.
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Upgrading Licensed Practical Nurse to Registered Nurse Program, September 1971 - June 1973. Report.
ERIC Educational Resources Information Center
Holloway, Sally
Twenty Licensed Practical Nurses (LPN) became Registered Nurses (RN) in a pilot program giving partial academic credit for their LPN training and building on their existing skills. The program revolved around three needs: (1) trained nurses; (2) eliminating the notion that jobs were dead-end; and (3) achieving upward mobility for hospital staff.…
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2016-04-29
In 2014, aides provided more hours of care in the major sectors of long-term care than the other staffing types shown. Aides accounted for 60% of all staffing hours in nursing homes, compared with licensed practical or vocational nurses (21%), registered nurses (13%), activities staff members (5%), and social workers (2%). Aides accounted for 75% of all staffing hours in residential care communities, in contrast to activities staff members (11%), registered nurses (7%), licensed practical or vocational nurses (6%), and social workers (1%). In adult day services centers, aides provided 41% of all staffing hours, followed by activities staff members (32%), registered nurses (12%), licensed practical or vocational nurses (9%), and social workers (6%).
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37 CFR 2.46 - Principal Register.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false Principal Register. 2.46 Section 2.46 Patents, Trademarks, and Copyrights UNITED STATES PATENT AND TRADEMARK OFFICE, DEPARTMENT OF COMMERCE RULES OF PRACTICE IN TRADEMARK CASES The Written Application § 2.46 Principal Register. All...
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Code of Federal Regulations, 2011 CFR
2011-04-01
... manufacturers, unlicensed registered blood establishments, and transfusion services. 606.171 Section 606.171...) BIOLOGICS CURRENT GOOD MANUFACTURING PRACTICE FOR BLOOD AND BLOOD COMPONENTS Records and Reports § 606.171 Reporting of product deviations by licensed manufacturers, unlicensed registered blood establishments, and...
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Code of Federal Regulations, 2012 CFR
2012-04-01
... manufacturers, unlicensed registered blood establishments, and transfusion services. 606.171 Section 606.171...) BIOLOGICS CURRENT GOOD MANUFACTURING PRACTICE FOR BLOOD AND BLOOD COMPONENTS Records and Reports § 606.171 Reporting of product deviations by licensed manufacturers, unlicensed registered blood establishments, and...
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Code of Federal Regulations, 2014 CFR
2014-04-01
... manufacturers, unlicensed registered blood establishments, and transfusion services. 606.171 Section 606.171...) BIOLOGICS CURRENT GOOD MANUFACTURING PRACTICE FOR BLOOD AND BLOOD COMPONENTS Records and Reports § 606.171 Reporting of product deviations by licensed manufacturers, unlicensed registered blood establishments, and...
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Code of Federal Regulations, 2013 CFR
2013-04-01
... manufacturers, unlicensed registered blood establishments, and transfusion services. 606.171 Section 606.171...) BIOLOGICS CURRENT GOOD MANUFACTURING PRACTICE FOR BLOOD AND BLOOD COMPONENTS Records and Reports § 606.171 Reporting of product deviations by licensed manufacturers, unlicensed registered blood establishments, and...
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12 CFR 309.3 - Federal Register publication.
Code of Federal Regulations, 2014 CFR
2014-01-01
... 12 Banks and Banking 5 2014-01-01 2014-01-01 false Federal Register publication. 309.3 Section 309.3 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE DISCLOSURE OF INFORMATION § 309.3 Federal Register publication. The FDIC publishes the following information in...
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12 CFR 309.3 - Federal Register publication.
Code of Federal Regulations, 2013 CFR
2013-01-01
... 12 Banks and Banking 5 2013-01-01 2013-01-01 false Federal Register publication. 309.3 Section 309.3 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE DISCLOSURE OF INFORMATION § 309.3 Federal Register publication. The FDIC publishes the following information in...
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2013-01-01
Background Difficulties with recruitment pose a major, increasingly recognised challenge to the viability of research. We sought to explore whether a register of volunteers interested in research participation, with data linkage to electronic health records to identify suitable research participants, would prove acceptable to healthcare staff, patients and researchers. Methods We undertook a qualitative study in which a maximum variation sampling approach was adopted. Focus groups and interviews were conducted with patients, general practitioners (GP), practice managers and health service researchers in two Scottish health boards. Analysis was primarily thematic to identify a range of issues and concerns for all stakeholder groups. Results The concept of a national research register was, in general, acceptable to all stakeholder groups and was widely regarded as beneficial for research and for society. Patients, however, highlighted a number of conditions which should be met in the design of a register to expedite confidence and facilitate recruitment. They also gave their perceptions on how a register should operate and be promoted, favouring a range of media. GPs and practice managers were primarily concerned with the security and confidentiality of patient data and the impact a register may have on their workload. Researchers were supportive of the initiative seeing advantages in more rapid access to a wider pool of patients. They did raise concerns that GPs may be able to block access to personal patient data held in general practice clinical systems and that the register may not be representative of the whole population. Conclusions This work suggests that patients, healthcare staff and researchers have a favourable view of the potential benefits of a national register to identify people who are potentially eligible and willing to participate in health related research. It has highlighted a number of issues for the developers to incorporate in the design of research registers. PMID:24139174
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Grant, Aileen; Ure, Jenny; Nicolson, Donald J; Hanley, Janet; Sheikh, Aziz; McKinstry, Brian; Sullivan, Frank
2013-10-18
Difficulties with recruitment pose a major, increasingly recognised challenge to the viability of research. We sought to explore whether a register of volunteers interested in research participation, with data linkage to electronic health records to identify suitable research participants, would prove acceptable to healthcare staff, patients and researchers. We undertook a qualitative study in which a maximum variation sampling approach was adopted. Focus groups and interviews were conducted with patients, general practitioners (GP), practice managers and health service researchers in two Scottish health boards. Analysis was primarily thematic to identify a range of issues and concerns for all stakeholder groups. The concept of a national research register was, in general, acceptable to all stakeholder groups and was widely regarded as beneficial for research and for society. Patients, however, highlighted a number of conditions which should be met in the design of a register to expedite confidence and facilitate recruitment. They also gave their perceptions on how a register should operate and be promoted, favouring a range of media. GPs and practice managers were primarily concerned with the security and confidentiality of patient data and the impact a register may have on their workload. Researchers were supportive of the initiative seeing advantages in more rapid access to a wider pool of patients. They did raise concerns that GPs may be able to block access to personal patient data held in general practice clinical systems and that the register may not be representative of the whole population. This work suggests that patients, healthcare staff and researchers have a favourable view of the potential benefits of a national register to identify people who are potentially eligible and willing to participate in health related research. It has highlighted a number of issues for the developers to incorporate in the design of research registers.
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78 FR 5449 - Federal Acquisition Regulation; Submission of OMB Review; Advance Payments
Federal Register 2010, 2011, 2012, 2013, 2014
2013-01-25
...; Submission of OMB Review; Advance Payments AGENCIES: Department of Defense (DOD), General Services... Paperwork Reduction Act, the Regulatory Secretariat will be submitting to the Office of Management and... requirement concerning advance payments. A notice was published in the Federal Register at 77 FR 43083, on...
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Using Registered Dental Hygienists to Promote a School-Based Approach to Dental Public Health
Wellever, Anthony; Kelly, Patricia
2017-01-01
We examine a strategy for improving oral health in the United States by focusing on low-income children in school-based settings. Vulnerable children often experience cultural, social, economic, structural, and geographic barriers when trying to access dental services in traditional dental office settings. These disparities have been discussed for more than a decade in multiple US Department of Health and Human Services publications. One solution is to revise dental practice acts to allow registered dental hygienists increased scope of services, expanded public health delivery opportunities, and decreased dentist supervision. We provide examples of how federally qualified health centers have implemented successful school-based dental models within the parameters of two state policies that allow registered dental hygienists varying levels of dentist supervision. Changes to dental practice acts at the state level allowing registered dental hygienists to practice with limited supervision in community settings, such as schools, may provide vulnerable populations greater access to screening and preventive services. We derive our recommendations from expert opinion. PMID:28661808
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Wieringa, N F; de Meijer, A H; Schutjens, M D; Vos, R
1992-12-01
The market of non-registered pharmaceutical products is growing fast in number and overall costs, not only in the Netherlands, but also in other European countries. These products often give the impression that the consumer may expect 'an effect as from a drug'. Legally, there is a clear distinction between 'drugs' and 'commodities' in the Netherlands; the question is whether legislation and practice concur. In an investigation we analysed texts of advertisements for non-registered pharmaceutical products published in a popular magazine. A method was developed, based on the legal definition of a drug and jurisprudence, to determine in a qualitative and quantitative way the application of medicinal claims. It transpired that in 65% of the analysed advertisements explicit or implicit claims were made. These products should therefore be subject to drugs legislation. Thus, in the Netherlands there is a gap between legislation and practice in advertising non-registered pharmaceutical products.
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75 FR 64643 - Reporting of Security-Based Swap Transaction Data
Federal Register 2010, 2011, 2012, 2013, 2014
2010-10-20
... information relating to pre-enactment security-based swaps to a registered security-based swap data repository... within 60 days after a registered security- based swap data repository commences operations to receive... repository,\\8\\ and security- based swap execution facility.\\9\\ The Commission has issued an advance notice of...
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49 CFR 604.15 - Registration of qualified human service organizations.
Code of Federal Regulations, 2010 CFR
2010-10-01
... Human Service Organizations and Duties for Recipients With Respect to Charter Registration Web site... low income, advanced age, or with disabilities), shall register on FTA's charter registration Web site... recipient if it: (1) Registers on the FTA Web site in accordance with paragraph (a) of this section at least...
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77 FR 19610 - Proposed Information Collection; Comment Request; Advance Monthly Retail Trade Survey
Federal Register 2010, 2011, 2012, 2013, 2014
2012-04-02
... #0; #0;Notices #0; Federal Register #0; #0; #0;This section of the FEDERAL REGISTER contains documents other than rules #0;or proposed rules that are applicable to the public. Notices of hearings #0;and investigations, committee meetings, agency decisions and rulings, #0;delegations of authority...
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Using nonfaculty registered nurses to facilitate high-fidelity human patient simulation activities.
Foster, Janet G; Sheriff, Susan; Cheney, Susan
2008-01-01
Maximizing faculty resources using nonfaculty registered nurses to supervise high-fidelity human-patient simulation is an innovative strategy for addressing the nursing faculty shortage and preparing graduates to practice safely in hospitals. The authors describe their use of nonfaculty registered nurses and its outcomes.
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Kusi-Appiah, Elizabeth; Dahlke, Sherry; Stahlke, Sarah
2018-05-18
The aim of this integrative review was to explore registered nurses', licensed practical nurses', and health care aides' perceptions of their own and each other's role contributions. In response to contemporary economic and political pressures, healthcare institutions across the world have endeavored to download job duties to less educated healthcare providers. As a result, nursing care is usually delivered by a team of nursing staff that have different roles. This means that there are fewer registered nurses and more licensed practical nurses and health care aides on nursing teams, despite evidence that increased numbers of registered nurses improve patient safety and care outcomes. This study was an integrative review using Whittemore and Knafl's stages for ensuring rigor. These stages include problem identification, literature searching, data evaluation, data analysis, and presentation. Four electronic databases were searched according to previously designed search strategies. The 14 retrieved articles were appraised using MMATs for quality. Data were extracted and analyzed thematically. The findings of the integrative review revealed that registered nurses, licensed practical nurses, and health care aides had little understanding about the roles of their fellow nursing team members and had difficulties describing their own roles. However, no studies concurrently examined registered nurses', licensed practical nurses' and health care aides' perceptions on their own or each other's roles and little was written about licensed practical nurses. More research is needed to examine the entire nursing team's perceptions about the various nursing roles. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
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Hahn, Joan Earle
2014-09-01
To describe the most frequently reported and the most central nursing interventions in an advance practice registered nurse (APRN)-led in-home preventive intervention model for adults aging with developmental disabilities using the Nursing Intervention Classification (NIC) system. A descriptive data analysis and a market basket analysis were conducted on de-identified nominal nursing intervention data from two home visits conducted by nurse practitioners (NPs) from October 2010 to June 2012 for 80 community-dwelling adults with developmental disabilities, ages 29 to 68 years. The mean number of NIC interventions was 4.7 in the first visit and 6.0 in the second visit and last visit. NPs reported 45 different intervention types as classified using a standardized language, with 376 in Visit One and 470 in Visit Two. Approximately 85% of the sample received the Health education intervention. The market basket analysis revealed common pairs, triples, and quadruple sets of interventions in this preventive model. The NIC nursing interventions that occurred together repeatedly were: Health education, Weight management, Nutrition management, Health screening, and Behavior management. Five NIC interventions form the basis of an APRN-led preventive intervention model for individuals aging with lifelong disability, with health education as the most common intervention, combined with interventions to manage weight and nutrition, promote healthy behaviors, and encourage routine health screening. Less frequently reported NIC interventions suggest the need to tailor prevention to individual needs, whether acute or chronic. APRNs employing prevention among adults aging with developmental disabilities must anticipate the need to focus on health education strategies for health promotion and prevention as well as tailor and target a patient-centered approach to support self-management of health to promote healthy aging in place. These NIC interventions serve not only as a guide for planning preventive interventions, but for designing nursing curricula to reduce health disparities among people with varying learning needs. © 2014 Sigma Theta Tau International.
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Physical activity in advanced cancer patients: a systematic review protocol.
Lowe, Sonya S; Tan, Maria; Faily, Joan; Watanabe, Sharon M; Courneya, Kerry S
2016-03-11
Progressive, incurable cancer is associated with increased fatigue, increased muscle weakness, and reduced physical functioning, all of which negatively impact quality of life. Physical activity has demonstrated benefits on cancer-related fatigue and physical functioning in early-stage cancer patients; however, its impact on these outcomes in end-stage cancer has not been established. The aim of this systematic review is to determine the potential benefits, harms, and effects of physical activity interventions on quality of life outcomes in advanced cancer patients. A systematic review of peer-reviewed literature on physical activity in advanced cancer patients will be undertaken. Empirical quantitative studies will be considered for inclusion if they present interventional or observational data on physical activity in advanced cancer patients. Searches will be conducted in the following electronic databases: CINAHL; CIRRIE Database of International Rehabilitation Research; Cochrane Database of Systematic Reviews (CDSR); Database of Abstracts of Reviews of Effects (DARE); Cochrane Central Register of Controlled Trials (CENTRAL); EMBASE; MEDLINE; PEDro: the Physiotherapy Evidence Database; PQDT; PsycInfo; PubMed; REHABDATA; Scopus; SPORTDiscus; and Web of Science, to identify relevant studies of interest. Additional strategies to identify relevant studies will include citation searches and evaluation of reference lists of included articles. Titles, abstracts, and keywords of identified studies from the search strategies will be screened for inclusion criteria. Two independent reviewers will conduct quality appraisal using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies (EPHPP) and the Cochrane risk of bias tool. A descriptive summary of included studies will describe the study designs, participant and activity characteristics, and objective and patient-reported outcomes. This systematic review will summarize the current evidence base on physical activity interventions in advanced cancer patients. The findings from this systematic review will identify gaps to be explored by future research studies and inform future practice guideline development of physical activity interventions in advanced cancer patients. PROSPERO CRD42015026281.
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Mc Hugh, Sheena M; O'Mullane, Monica; Perry, Ivan J; Bradley, Colin
2014-11-01
The aim of this study was to investigate the attitudes of general practitioners (GPs) to the development of a national diabetes register as a way of improving the quality of care. Qualitative study using semistructured interviews. General practice, Ireland. Purposive sample of 29 GPs and two practice nurses. Participants' practices varied by (a) location (rural/urban), (b) size (single-handed/group practice) and (c) extent of computerisation. The semistructured topic guide focused on experiences of change in the health system at a local and national level and attitudes towards the development of a national diabetes register. Analysis was conducted using the Framework approach. Participants were sceptical about the development of a national diabetes register. The main advantage was 'knowing the numbers' for epidemiological and policy purposes. However, participants questioned the benefits for their practice and patients. There were concerns that it would drain resources from other priorities and distract from patient management. These attitudes were strongly influenced by previous experience of change in the health system. Participants felt that remuneration would be necessary to ensure full engagement, reflecting wider frustrations with payment structures for general practice. There was a sense of wariness towards health service administration which was not specific to diabetes care but which coloured some participants' attitudes towards a national register. In contrast, participants referred to positive experiences of change at a local level, facilitated by a 'practice ethos' and professional leadership. This study highlights the growing sense of scepticism and inertia towards change within the health system. This inertia stems from previous experience and the competing demands of maintaining versus improving care in a system with dwindling resources. 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.
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Electroencephalographic imaging of higher brain function
NASA Technical Reports Server (NTRS)
Gevins, A.; Smith, M. E.; McEvoy, L. K.; Leong, H.; Le, J.
1999-01-01
High temporal resolution is necessary to resolve the rapidly changing patterns of brain activity that underlie mental function. Electroencephalography (EEG) provides temporal resolution in the millisecond range. However, traditional EEG technology and practice provide insufficient spatial detail to identify relationships between brain electrical events and structures and functions visualized by magnetic resonance imaging or positron emission tomography. Recent advances help to overcome this problem by recording EEGs from more electrodes, by registering EEG data with anatomical images, and by correcting the distortion caused by volume conduction of EEG signals through the skull and scalp. In addition, statistical measurements of sub-second interdependences between EEG time-series recorded from different locations can help to generate hypotheses about the instantaneous functional networks that form between different cortical regions during perception, thought and action. Example applications are presented from studies of language, attention and working memory. Along with its unique ability to monitor brain function as people perform everyday activities in the real world, these advances make modern EEG an invaluable complement to other functional neuroimaging modalities.
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Nursing leaders can deliver a new model of care.
Shalala, Donna E
2014-01-01
Millions more insured Americans. Increasing numbers of older patients. Higher rates of chronic illness. Fewer providers. How can our healthcare system not only manage these challenges but also improve performance and access to care while containing costs? The answer lies with our nurses. In some parts of the United States, nurses provide the full spectrum of primary and preventive care. They have successfully improved access and quality in rural areas. In other parts, nurses' hands are tied by antiquated laws and regulations that limit their ability to expand access to care. Our system cannot increase access when we have providers who are not allowed to perform to the top of their education, training, and capability. It is time to rethink how we deliver primary and preventive care and redefine the roles of doctors and nurses. This article examines the history of the Institute of Medicine's (IOM) Future of Nursing report (chaired by the author) and the resulting Future of Nursing Campaign for Action, which is working to institute the report's recommendations in all 50 states. The IOM report's recommendations are simple: 1. Remove outdated restrictions on nursing practice. 2. Promote nurse leadership on hospital boards and in all healthcare sectors. 3. Strengthen nurse education and training, and increase the number of nurses with advanced degrees. 4. Increase diversity in the nursing workforce to better reflect the patient population. 5. Improve data reporting and compilation to predict workforce needs. New York, Kentucky, and Minnesota are three recent states to remove barriers pre venting advanced practice registered nurses from practicing at the top of their license. Similar efforts in California, Florida, and Indiana failed initially but are expected to make progress in the near future. The article makes clear how and why the Center to Champion Nursing in America (an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation) is working to advance healthcare through nursing, and it explores the progress being made to remove unnecessary restrictions on nursing practice.
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McNulty, Cliodna A M; Hogan, Angela H; Ricketts, Ellie J; Wallace, Louise; Oliver, Isabel; Campbell, Rona; Kalwij, Sebastian; O'Connell, Elaine; Charlett, Andre
2014-05-01
To determine if a structured complex intervention increases opportunistic chlamydia screening testing of patients aged 15-24 years attending English general practitioner (GP) practices. A prospective, Cluster Randomised Controlled Trial with a modified Zelen design involving 160 practices in South West England in 2010. The intervention was based on the Theory of Planned Behaviour (TPB). It comprised of practice-based education with up to two additional contacts to increase the importance of screening to GP staff and their confidence to offer tests through skill development (including videos). Practical resources (targets, posters, invitation cards, computer reminders, newsletters including feedback) aimed to actively influence social cognitions of staff, increasing their testing intention. Data from 76 intervention and 81 control practices were analysed. In intervention practices, chlamydia screening test rates were 2.43/100 15-24-year-olds registered preintervention, 4.34 during intervention and 3.46 postintervention; controls testing rates were 2.61/100 registered patients prior intervention, 3.0 during intervention and 2.82 postintervention. During the intervention period, testing in intervention practices was 1.76 times as great (CI 1.24 to 2.48) as controls; this persisted for 9 months postintervention (1.57 times as great, CI 1.27 to 2.30). Chlamydia infections detected increased in intervention practices from 2.1/1000 registered 15-24-year-olds prior intervention to 2.5 during the intervention compared with 2.0 and 2.3/1000 in controls (Estimated Rate Ratio intervention versus controls 1.4 (CI 1.01 to 1.93). This complex intervention doubled chlamydia screening tests in fully engaged practices. The modified Zelen design gave realistic measures of practice full engagement (63%) and efficacy of this educational intervention in general practice; it should be used more often. The trial was registered on the UK Clinical Research Network Study Portfolio database. UKCRN number 9722.
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Matthews, Kylie L; Palmer, Michelle A; Capra, Sandra M
2018-04-30
Refeeding syndrome (RFS) prevalence rates vary across studies depending on the criteria used for assessment and identification. For registered dietitians, the assessment and management of RFS is highly reliant on daily serum electrolyte values; however, registered dietitians working within Australia do not currently possess laboratory test ordering privileges. We aimed to examine the opinions of registered dietitians regarding RFS identification, management and guidelines and the option of using extended scope of practice to order electrolyte monitoring autonomously. A multi-method action research approach was used, incorporating two projects. The first was a survey examining Australian registered dietitians' (n = 187) opinions regarding RFS identification, management and guidelines, and autonomous electrolyte monitoring. To establish if results were similar internationally, an interview was conducted with 22 registered dietitians working within 10 different countries. Data were analysed using chi-square tests and thematic analysis. Australian registered dietitians (75%) identify patients at risk of RFS at a high rate of more than once per fortnight, with 74% reporting that they have previously worked with a patient diagnosed with RFS. Results varied internationally, with respondents from eight countries reporting that RFS is a problem within acute care versus respondents from five countries having never treated a patient with RFS. The majority (≥89%) of registered dietitians desire new guidelines and the option to order patient electrolyte monitoring autonomously. Our findings suggest that more stringent tools for the identification of RFS are necessary. There was limited uniformity across countries, and updated practice guidelines are needed. © 2018 Dietitians Association of Australia.
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Khalil, Asma; Perry, Helen; Duffy, James; Reed, Keith; Baschat, Ahmet; Deprest, Jan; Hecher, Kurt; Lewi, Liesbeth; Lopriore, Enrico; Oepkes, Dick
2017-07-14
Twin-Twin Transfusion Syndrome (TTTS) is associated with an increased risk of perinatal mortality and morbidity. Several treatment interventions have been described for TTTS, including fetoscopic laser surgery, amnioreduction, septostomy, expectant management, and pregnancy termination. Over the last decade, fetoscopic laser surgery has become the primary treatment. The literature to date reports on many different outcomes, making it difficult to compare results or combine data from individual studies, limiting the value of research to guide clinical practice. With the advent and ongoing development of new therapeutic techniques, this is more important than ever. The development and use of a core outcome set has been proposed to address these issues, prioritising outcomes important to the key stakeholders, including patients. We aim to produce, disseminate, and implement a core outcome set for TTTS. An international steering group has been established to oversee the development of this core outcome set. This group includes healthcare professionals, researchers and patients. A systematic review is planned to identify previously reported outcomes following treatment for TTTS. Following completion, the identified outcomes will be evaluated by stakeholders using an international, multi-perspective online modified Delphi method to build consensus on core outcomes. This method encourages the participants towards consensus 'core' outcomes. All key stakeholders will be invited to participate. The steering group will then hold a consensus meeting to discuss results and form a core outcome set to be introduced and measured. Once core outcomes have been agreed, the next step will be to determine how they should be measured, disseminated, and implemented within an international context. The development, dissemination, and implementation of a core outcome set in TTTS will enable its use in future clinical trials, systematic reviews and clinical practice guidelines. This is likely to advance the quality of research studies and their effective use in order to guide clinical practice and improve patient care, maternal, short-term perinatal outcomes and long-term neurodevelopmental outcomes. Core Outcome Measures in Effectiveness Trials (COMET), 921 Registered on July 2016. International Prospective Register of Systematic Reviews (PROSPERO), CRD42016043999 . Registered on 2 August 2016.
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Noblett, K E; Meibalane, R
1995-10-01
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 < or = 3 attempts; (73.7% with 1 attempt, 15.8% with 2 attempts, and 7.9% with 3 attempts). In only 1 event were more than 3 attempts required. There were no complications observed. RCPs can successfully serve as primary providers of neonatal ETI at a Level-II nursery in a community hospital, and this practice may result in a cost reduction.
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More than a Network: Building Professional Communities for Educational Improvement
ERIC Educational Resources Information Center
Dolle, Jonathan R.; Gomez, Louis M.; Russell, Jennifer Lin; Bryk, Anthony S.
2013-01-01
This chapter is a case study of the Carnegie Foundation for the Advancement of Teaching's Pathways [TM] program. The goal of the Statway [Registered Trademark] and Quantway [Registered Trademark] pathways is to improve the success rate of community college students who place into developmental mathematics. What makes these programs unique is…
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ERIC Educational Resources Information Center
Tennessee State Board for Vocational Education, Murfreesboro. Vocational Curriculum Lab.
THE LESSON PLANS FOR A UNIT ON MENTAL NURSING IN THE PRACTICAL NURSE EDUCATION PROGRAM WERE DEVELOPED BY A GROUP OF REGISTERED NURSES HOLDING TENNESSEE TEACHING CERTIFICATES. STUDENTS SELECTED FOR THE PROGRAM SHOULD BE HIGH SCHOOL GRADUATES OR EQUIVALENT. THE LESSONS DESIGNED FOR USE BY A REGISTERED NURSE CERTIFIED FOR TEACHING GIVE OBJECTIVES,…
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ERIC Educational Resources Information Center
Belock, Shirley
The planning and design of a course for the inactive registered nurse desiring to return to active practice is reported in this practicum paper. Current literature was reviewed with emphasis on the needs in rural states, such as Vermont, and characteristics of the target group. The first three modules of the course were developed, entitled: The…
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A Survey of Registered Dietitians’ Concern and Actions Regarding Climate Change in the United States
Hawkins, Irana W.; Balsam, Alan L.; Goldman, Robert
2015-01-01
Dietary choices are a tool to reduce greenhouse gas emissions. While registered dietitians are on the front lines of food and nutrition recommendations, it is unclear how many are concerned with climate change and take action in practice in the United States. We explored concern about climate change among registered dietitians, and identified factors that may influence practice-related behaviors. Our study population included a random sample of all registered dietitians credentialed in the United States. Primary data were gathered using a cross-sectional survey. Of the 570 survey responses, 75% strongly agreed or agreed that climate change is an important issue while 34% strongly agreed or agreed that dietitians should play a major role in climate change mitigation strategies. Thirty-eight percent engaged in activities that promoted diet as a climate change mitigation strategy. Vegetarian (p = 0.002) and vegan dietitians (p = 0.007) were significantly more likely than non-vegetarian and non-vegan dietitians to engage in activities that promoted diet as a climate change mitigation strategy. Overall, concern for climate change among dietitians varied significantly by the region of the country in which the dietitian resided, and awareness that animal products are implicated in climate change. Registered dietitians in the United States are concerned with climate change. However, there is a discrepancy between concern and practice-based actions. These results suggest the need for educational and experiential opportunities connecting climate change mitigation to dietetics practice. PMID:26217666
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Realising dignity in care home practice: an action research project.
Gallagher, Ann; Curtis, Katherine; Dunn, Michael; Baillie, Lesley
2017-06-01
More than 400,000 older people reside in over 18,000 care homes in England. A recent social care survey found up to 50% of older people in care homes felt their dignity was undermined. Upholding the dignity of older people in care homes has implications for residents' experiences and the role of Registered Nurses. The study aimed to explore how best to translate the concept of dignity into care home practice, and how to support this translation process by enabling Registered Nurses to provide ethical leadership within the care home setting. Action research with groups of staff (Registered Nurses and non-registered caregivers) and groups of residents and relatives in four care homes in the south of England to contribute to the development of the dignity toolkit. Action research groups were facilitated by 4 researchers (2 in each care home) to discuss dignity principles and experiences within care homes. These groups reviewed and developed a dignity toolkit over six cycles of activity (once a month for 6 months). The Registered Nurses were individually interviewed before and after the activity. Hard copy and online versions of a dignity toolkit, with tailored versions for participating care homes, were developed. Registered Nurses and caregivers identified positive impact of making time for discussion about dignity-related issues. Registered Nurses identified ongoing opportunities for using their toolkit to support all staff. Nurses and caregivers expressed feelings of empowerment by the process of action research. The collaborative development of a dignity toolkit within each care home has the potential to enable ethical leadership by Registered Nurses that would support and sustain dignity in care homes. Action research methods empower staff to maintain dignity for older people within the care home setting through the development of practically useful toolkits to support everyday care practice. Providing opportunities for caregivers to be involved in such initiatives may promote their dignity and sense of being valued. The potential of bottom-up collaborative approaches to promote dignity in care therefore requires further research. © 2016 John Wiley & Sons Ltd.
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Tagtow, Angie; Robien, Kim; Bergquist, Erin; Bruening, Meg; Dierks, Lisa; Hartman, Barbara E; Robinson-O'Brien, Ramona; Steinitz, Tamara; Tahsin, Bettina; Underwood, Teri; Wilkins, Jennifer
2014-03-01
Sustainability is the ability of a system to be maintained over the long term. Resilience is the ability of a system to withstand disturbances and continue to function in a sustainable manner. Issues of sustainability and resilience apply to all aspects of nutrition and dietetics practice, can be practiced at both the program and systems level, and are broader than any one specific practice setting or individual intervention. Given an increasing need to apply principles of sustainability and resilience to nutrition and dietetics practice, as well as growing interest among the public and by Registered Dietitian Nutritionists of health issues related to food and water systems, the Hunger and Environmental Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed the Standards of Professional Performance as a tool for Registered Dietitian Nutritionists working in sustainable, resilient, and healthy food and water systems to assess their current skill levels and to identify areas for further professional development in this emerging practice area. This Standards of Professional Performance document covers six standards of professional performance: quality in practice, competence and accountability, provision of services, application of research, communication and application of knowledge, and utilization and management of resources. Within each standard, specific indicators provide measurable action statements that illustrate how sustainable, resilient, and healthy food and water systems principles can be applied to practice. The indicators describe three skill levels (competent, proficient, and expert) for Registered Dietitian Nutritionists working in sustainable, resilient, and healthy food and water systems. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
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Dodd, Rachael H; Forster, Alice S; Sellars, Sarah; Patnick, Julietta; Ramirez, Amanda J; Forbes, Lindsay J L
2017-06-05
Older women have poorer survival from breast cancer, which may be at least partly due to poor breast cancer awareness leading to delayed presentation and more advanced stage at diagnosis. In a randomised trial, an intervention to promote early presentation of breast cancer in older women increased breast cancer awareness at 1 year compared with usual care (24 versus 4%). We examined its effectiveness in routine clinical practice. We piloted the intervention delivered by practising health professionals to women aged about 70 in four breast screening services. We measured the effect on breast cancer awareness at 1 year compared with comparison services, where women did not receive the intervention. At 1 year, 25% of women in pilot services were breast cancer aware compared with 4% in comparison services (p = 0.001). The components of breast cancer awareness were knowledge of breast cancer non-lump symptoms (pilot: 63% vs comparison: 82% at 1 year; OR = 2.56, 95% CI 1.92-3.42), knowledge of age related risk (pilot: 8% vs comparison: 36% at 1 year; OR = 5.56, 95% CI 4.0-7.74) and reported breast checking (pilot: 70% vs comparison: 78% at 1 year; OR = 1.49, 95% CI 1.13-1.96). The intervention may be as effective in routine clinical practice as in a randomised controlled trial. This intervention has the potential to reduce patient delay in the diagnosis of breast cancer in older women. The PEP trial was registered with the International Standard Registered Clinical/soCial sTudy Number (ISRCTN) as a clinical trial ( ISRCTN31994827 ) on 3rd October 2007.
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Metcalfe, Rebecca; Laird, George; Nandwani, Rak
2015-12-01
Despite advances in lesbian, gay, bisexual and transgender equality in recent years, some men who have sex with men remain at increased risk of ill-health. Positive interventions in primary care include psychological support and strategies for risk reduction. It is important that men who have sex with men can disclose sexual orientation in primary care. To quantify disclosure of sexual orientation by men who have sex with men attending general practice and identify barriers to disclosure we surveyed a group of Scottish men. A questionnaire was distributed by voluntary organisations and the National Health Service in the West of Scotland, to rural and urban populations. Two hundred and four gave evaluable responses, with all ages represented. A total of 199 (98%) were registered with a General Practitioner and 167 (83%) attended in the previous year. A total of 81 (40%) stated staff were aware of their sexual orientation. A total of 93/121 (75%) men who have sex with men whose GP was unaware stated this was because they had never been asked. A total of 36/81(44%) men who have sex with men rated support from practices since disclosure as 'excellent' and qualitative responses were positive. It is reassuring that almost all respondents were registered with GPs and attending primary care services. However, only 40% had disclosed sexual orientation. This was not because of fear of negative impact on care but because men who have sex with men felt it was irrelevant to their attendance. GPs appear to be reluctant to raise the issue of sexual orientation without prompting. © The Author(s) 2015.
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Conducting a children's divorce group: one approach.
Rich, Beverly Waldman; Molloy, Pat; Hart, Bernadette; Ginsberg, Susan; Mulvey, Trudy
2007-08-01
The disruptive period around the time of the divorce can shatter a child's entire living milieu. An 8-week experiential children's group incorporating art and creative activities as well as a concurrent parent group is described. The aim of treatment was to bolster children's abilities to communicate with parents and other caretakers. Overall, participants were observed to effectively release painful affect, communicate more openly, and identify strengths in their family systems. Yalom's therapeutic group factors were incorporated into the treatment model. The research of Davies and Cummings related to children in the context of family therapy was also considered. Group leaders included advance practice registered nurses. Follow-up objective data collected from participants might provide further information about the efficacy of the interventions.
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Knight-Madden, Jennifer; Gray, Robert
2008-01-01
Background The number of physicians per 10,000 population is a basic health indicator used to determine access to health care. Studies from the United States of America and Europe indicate that their physician registration databases may be flawed. Clinical research activities have suggested that the current records of physicians registered to practice in Jamaica may not be accurate. Our objective was to determine whether the Medical Council of Jamaica (MCJ) accurately records and reports the identities, number and specialty designation of physicians in Jamaica. An additional aim was to determine the countries in which these physicians were trained. Methods Data regarding physicians practicing in Jamaica in 2005 were obtained from multiple sources including the MCJ and the telephone directory. Intense efforts at tracing were undertaken in a sub-sample of physicians, internists and paediatricians to further improve the accuracy of the data. Data were analysed using SPSS, version 11.5. Results The MCJ listed 2667 registered physicians of which 118 (4.4%) were no longer practicing in Jamaica. Of the subset of 150 physicians who were more actively traced, an additional 11 were found to be no longer in practice. Thus at least 129 (4.8%) of the physicians on the MCJ list were not actively practising in Jamaica. Twenty-nine qualified physicians who were in practice, but not currently on the Jamaican register, were identified from other data sources. This yielded an estimate of 2567 physicians or 9.68 physicians per 10,000 persons. Seven hundred and twenty six specialists were identified, 118 from the MCJ list only, 452 from other sources, in particular medical associations, and 156 from both the MCJ list and other sources. Sixty-six percent of registered doctors completed medical school at the University of the West Indies (UWI). Conclusion These data suggest that the MCJ list includes some physicians no longer practicing in Jamaica while underestimating the number of specialists. Difficulty in accurately estimating the number of practicing physicians has been reported in studies done in other countries but the under-reporting of the number of specialists is uncommon. Additional consideration should be given to strategies to ensure compliance with the annual registration that is mandated by law and to changing the law to include registration of specialist qualifications. PMID:19077244
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Perspectives on academic misconduct: implications for education and practice.
Klainberg, Marilyn B; McCrink, Andrea; Eckardt, Patricia; Schecter, Rose; Bongiorno, Anne; Sedhom, Laila
2014-01-01
From Harvard to high school, concern related to academic misconduct, specifically cheating and its impact on societal issues, has become a great concern for educational communities. While a significant number of studies on ethical behaviors in practice in other professions such as business have been published, little research exists on registered nurses in practice. Even fewer studies have, for registered nurses, addressed if there is an association between perceived academic misconduct as students and perceived unethical behaviors in the workplace. The purpose of this study was to determine the relationship between perceptions of registered professional nurses' (RNs) current workplace behaviors and the RNs' retrospective perceptions of their academic misconduct as students. A convenience sample of 1 66 RNs enrolled in master's degree programs at four university schools of nursing completed questionnaires regarding their beliefs and behaviors. The outcome of this study was significant. Results revealed a strong relationship between unethical behaviors of the RN in practice and their prior academic misconduct when they were students.
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The Effects of Marriage and Children on Women's Work.
ERIC Educational Resources Information Center
Buckley, John J.; Rowe, Brenda J. D.
A survey was conducted to analyze the effects of marriage and children on the work patterns of registered nurses in Maryland, with specific attention to these effects on work continuity and advancement and to which factors modify these effects. Questionnaires asking for complete work histories were mailed to a random sample of registered nurses in…
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Thomas, Nicola; Gallagher, Hugh; Jain, Neerja
2014-01-01
Chronic kidney disease (CKD) stages 3 to 5, affects 6-7% of the adult population and is an important risk factor for both advanced kidney disease and cardiovascular disease. This paper describes a quality improvement project that aimed to establish consistent implementation of best practice in people with stage 3-5 kidney disease who were managed in primary care. The intervention was a Care Bundle for CKD. The bundle included three evidence-based, high impact interventions based on National Institute for Care Excellence (NICE, 2008) guidance, with an additional and novel self-management element. 29 GP Practices in England and Wales began the study. They undertook training in clinical management of CKD and in facilitation of self-management, with the self-management content designed and led by patients. Practices were asked to report baseline and then monthly outcome data extracted from practice computer systems. The project team provided implementation and ongoing quality improvement support for participating Practices. Ten Practices dropped out of the study following the training. Data submissions were incomplete in six Practices who continued to apply the care bundle. At the project end, a decision was taken by the study team to perform the final analysis on those thirteen Practices which completed the project and submitted at least six sets of monthly Practice-level outcome data. In these Practices the Care Bundle was applied to under 20% of the registered CKD stage 3 to 5 population in 5 Practices, 20-29% in 3 Practices, 30-49% in 2 Practices and ≥50% in 3 Practices (998 patients in total). Of these, 671 patients (75%) agreed to the self-management component of the intervention. The reliability (at project end) in those who received the Bundle was 100%. The Bundle was applied to an additional 315 patients in the six Practices who completed the project but did not submit regular practice-level monthly data. In the thirteen remaining Practices, the achievement of NICE (2008) blood pressure targets at the start of the project was 74.8% in people with CKD stage 3-5 and no diabetes and 48% in people with CKD stage 3-5 and diabetes. At the project end these figures in the same Practices were 76.7% and 49.2% respectively. These improvements were achieved in spite of Practices increasing their recording of prevalence rate (that is, identifying and recording more patients with CKD on the Practice CKD Register). In conclusion, a care bundle can be implemented in primary care. However, maintaining engagement with primary care health care professionals and maximising exposure to an intervention in patients seen infrequently are significant challenges to generalisation and sustainability.
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78 FR 43848 - Submission for OMB Review; Comment Request
Federal Register 2010, 2011, 2012, 2013, 2014
2013-07-22
... performance of the functions of the agency, including whether the information will have practical utility; (b... and gender from the Minority Farm Register permission form, AD-2035. FSA manage the register and the...
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-11-21
...] Advancing Regulatory Science for Highly Multiplexed Microbiology/ Medical Countermeasure Devices; Public... Multiplexed Microbiology/ Medical Countermeasure Devices'' that published in the Federal Register of August 8... the October 13, 2011, meeting, including the performance evaluation of highly multiplexed microbiology...
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In-memory interconnect protocol configuration registers
DOE Office of Scientific and Technical Information (OSTI.GOV)
Cheng, Kevin Y.; Roberts, David A.
Systems, apparatuses, and methods for moving the interconnect protocol configuration registers into the main memory space of a node. The region of memory used for storing the interconnect protocol configuration registers may also be made cacheable to reduce the latency of accesses to the interconnect protocol configuration registers. Interconnect protocol configuration registers which are used during a startup routine may be prefetched into the host's cache to make the startup routine more efficient. The interconnect protocol configuration registers for various interconnect protocols may include one or more of device capability tables, memory-side statistics (e.g., to support two-level memory data mappingmore » decisions), advanced memory and interconnect features such as repair resources and routing tables, prefetching hints, error correcting code (ECC) bits, lists of device capabilities, set and store base address, capability, device ID, status, configuration, capabilities, and other settings.« less
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General practitioners' experiences as nursing home medical consultants.
Kirsebom, Marie; Hedström, Mariann; Pöder, Ulrika; Wadensten, Barbro
2017-03-01
To describe general practitioners' experiences of being the principal physician responsible for a nursing home. Fifteen general practitioners assigned to a nursing home participated in semi-structured qualitative interviews. Data were analysed using systematic text condensation. Medical assessment is the main duty of general practitioners. Advance care planning together with residents and family members facilitates future decisions on medical treatment and end-of-life care. Registered Nurses' continuity and competence are perceived as crucial to the quality of care, but inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety. The study highlights the importance of advance care planning together with residents and family members in facilitating future decisions on medical treatment and end-of-life care. To meet the increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care, there would seem to be a need to increase Registered Nurses' staffing and acquire more advanced medical equipment, as well as to create better possibilities for Registered Nurses and general practitioners to access each other's healthcare record systems. © 2016 Nordic College of Caring Science.
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Intraprofessional Practice Education using a community partnership model.
Hoffart, Caroline; Kuster-Orban, Cindy; Spooner, Crystal; Neudorf, Kim
2013-02-01
The Intraprofessional Practice Education (IPE) pilot project was designed to increase the number of high-quality practice education settings and to develop intraprofessional learning opportunities for nursing students from three different prelicensure programs. Students from the licensed practical nurse, registered nurse, and registered psychiatric nurse programs shared their practice education experience concurrently in a rural First Nations community. This project's framework, the Partnership Model for Community Health Nursing Education (PMCHNE), is described and includes an explanation of the planning and coordination that occurred prior to implementation of the pilot project. Various student practice education and cultural experiences are highlighted, and the results from the project's evaluation are discussed, including the utility of the PMCHNE and the benefits and challenges associated with implementing an IPE experience. Copyright 2013, SLACK Incorporated.
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Code of Federal Regulations, 2010 CFR
2010-10-01
... 45 Public Welfare 3 2010-10-01 2010-10-01 false Material to be published in the Federal Register... JUSTICE RULES OF PRACTICE PUBLIC INFORMATION-FREEDOM OF INFORMATION ACT § 502.2 Material to be published... state and concurrently publish the following materials in the Federal Register for the guidance of the...
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Empowering aged care nurses to deliver person-centred care: Enabling nurses to shine.
Marriott-Statham, Kelly; Mackay, Maria; Brennan, Ngaire; Mackay, Jacinta
2018-05-23
In this paper, the authors will describe the journey of registered nurses across a series of workshops as part of a research project that was undertaken in a regional aged care service in New South Wales, Australia. The aim of the project was to empower the participant registered nurses to positively influence the health care workplace culture within the residential care home by raising consciousness about their own practice. Registered nurses were actively involved in this reconnaissance phase of a participatory action research project through practice development principles and methods. Registered nurses determined the content and the outcomes of the overall program. The researchers evaluated the impact of a series of workshops, designed to develop skills and knowledge using nominal group technique. Results revealed registered nurses perceived they were empowered to flourish, and developed an understanding of the uniqueness of their role. A shared understanding of the role of the registered nurse in the aged care setting was fundamental in enabling them to feel empowered to lead their team and contribute positively to the workplace culture. Overall, the outcomes of this project have positively impacted workplace culture. Copyright © 2018. Published by Elsevier Ltd.
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Watkins, Chanell; Hart, Patricia L; Mareno, Nicole
2016-03-01
The first year turnover rate for newly licensed registered nurses is roughly 30% and increases to about 57% in the second year (Twibell et al., 2012). An effective preceptorship has been shown to better facilitate the first year transition (Hodges et al., 2008) and increase retention rates (Pine and Tart, 2007). The purpose of this study was to examine the relationships between newly licensed registered nurses' perceived preceptor role effectiveness, psychological empowerment and professional autonomy. A prospective, cross-sectional, descriptive research design was used. Sixty-nine newly licensed registered nurses were recruited and surveyed. Newly licensed registered nurses were found to have moderately high levels of perceived preceptor role effectiveness, psychological empowerment, and professional autonomy. Preceptor role effectiveness had significant, moderately, positive relationships with professional autonomy and psychological empowerment. There was also a significant relationship found between professional autonomy and psychological empowerment. Results show that preceptor role effectiveness is linked to increased professional autonomy and psychological empowerment. Therefore, effective preceptorships are necessary in easing the newly licensed registered nurse's transition to practice. Strategies to ensure effective preceptorships and enhance the NRLN's transition to practice are proposed. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Patients first! Engaging the hearts and minds of nurses with a patient-centered practice model.
Small, Deborah C; Small, Robert M
2011-05-31
Like every healthcare system today, the Cleveland Clinic health system is a combination of medical hospitals, institutes, and services in which the implementation of uniform care methodologies faces significant barriers. The guiding principle of the Cleveland Clinic, 'Patients First,' focuses on the principle of patient- and family-centered care (PFCC) but deliberately lacks details due to the wide scope of care delivered by the organization. The Stanley Shalom Zielony Institute of Nursing Excellence (the Nursing Institute) at the Cleveland Clinic was charged with standardizing nursing practice across a system with 11,000 registered nurses and 800 advanced practice nurses. The challenge involved providing firm direction on delivering PFCC that was appropriate for all clinical disciplines and could be implemented quickly across existing practices and technologies. Successful implementation required full engagement in the concept of PFCC by what the Institute for Healthcare Improvement has termed the 'hearts and minds' of nurses. To achieve these ends, development of a systemwide nursing practice model was initiated. In this article the authors identify the essence of PFCC, consider barriers to PFCC, review their process of developing PFCC, and describe how the Cleveland Clinic health system has implemented a PFCC nursing practice model. In doing so the authors explore how the concept of 'Passion for Nursing' was used to stimulate nurse engagement in PFCC.
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Kietpeerakool, Chumnan; Supoken, Amornrat; Laopaiboon, Malinee; Lumbiganon, Pisake
2016-01-23
Ovarian cancer is the third most common gynaecological cancer worldwide, with an age-standardised incidence rate of 6.1 per 10,000 women. Standard therapy for advanced epithelial ovarian cancer (EOC) includes a combination of cytoreductive surgery and platinum-based chemotherapy. Cytoreductive surgery aims to remove as much of the visible tumour as possible. As extensive intraperitoneal metastases are typical of advanced EOC, cytoreductive surgery is usually an extensive procedure with the risk of excessive bleeding. Tranexamic acid given perioperatively is effective in reducing blood loss and allogeneic blood transfusion requirements in a variety of surgical settings. Therefore, tranexamic acid seems to be a promising agent for minimising blood loss and the need for blood transfusion among women with advanced EOC undergoing cytoreductive surgery. To assess the effects of tranexamic acid for reducing blood loss associated with cytoreductive surgery in women with advanced EOC (stage III to IV). We searched the Cochrane Gynaecological, Neuro-oncology and Orphan Cancers Trial Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 5, 2015), MEDLINE, EMBASE and conference proceedings to May 2015. We also checked registers of clinical trials, citation lists of included studies, key textbooks and previous systematic reviews for potentially relevant studies. We included randomised controlled trials (RCTs) comparing tranexamic acid given during surgery versus placebo or no treatment, in adult women diagnosed with advanced EOC. Two review authors (CK, AS) independently selected potentially relevant trials, extracted data, assessed risk of bias, compared results and resolved disagreements by discussion. We found only one study that met our inclusion criteria. This was a randomised double blind, placebo-controlled multicentre study conducted to evaluate the effectiveness of a single dose of intravenous tranexamic acid (15 mg/kg body weight) versus placebo, given immediately before surgery for reducing blood loss and the need for red blood cell transfusion. The mean total estimated blood loss was 668.34 mL and 916.93 mL for participants assigned to tranexamic acid and placebo groups, respectively. The mean difference (MD) of total estimated blood loss between the groups did not show a clinically important effect (MD - 248.59 mL; 95% confidence interval (CI) - 550.9 to 53.79; one study, 100 participants; moderate quality evidence). The mean number of transfused units of blood components was not different between the two groups (low quality evidence). There were no noted differences in the incidence of reoperation, readmission or thromboembolic events (very low quality evidence). We considered the methodology of the included study to be at low risk of selection, detection, and reporting biases. However, we were concerned about an imbalance of some baseline characteristics between the groups, and as there was no protocol for blood transfusion, the rate of blood transfusion may vary depending on the practice of each participating hospital. Currently, there is insufficient evidence to recommend the routine use of tranexamic acid for reducing blood loss in women undergoing cytoreductive surgery for advanced EOC, as only limited data are available from a single, low quality RCT at low overall risk of bias.
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The impact of postgraduate education on registered nurses working in acute care.
Barnhill, Dianne; McKillop, Ann; Aspinall, Cathleen
2012-07-01
Since 2007, Health Workforce New Zealand has provided District Health Boards (DHBs) with funding to support nurses undertaking postgraduate education. As a result, a significant number of nurses, many working in general medical and surgical wards, have now completed a postgraduate qualification. Anecdotal evidence for one DHB indicated that there were mixed views with respect to how the increase in the number of nurses with postgraduate education had impacted on patient outcomes. Following a review of relevant literature the researchers aimed to ascertain from registered nurses working in acute medical and surgical wards their perception of the impact that further study had on their practice. A quantitative descriptive study was undertaken to answer the question of what impact postgraduate study had on the practice of those nurses working in medical and surgical wards of a District Health Board hospital? An anonymous postal survey was sent to registered nurses (N = 57), and senior nurses (N=25) working in acute medical and surgical areas of practice. The latter group consisted of 16 nurse managers and 9 nurse educators. The results showed that registered nurses, nurse managers and nurse educators all perceived the clinical practice of registered nurses as having improved in some degree as a consequence of postgraduate education. There is also a need for further research to be undertaken in other District Health Boards, especially in non-hospital based areas such as primary health care; and also to investigate ways of linking post graduate education with career pathways, as well as identifying and minimising potential barriers likely to prevent application of post graduate learning in the workplace.
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Advanced Metallic Seal for High Temperature Applications
NASA Technical Reports Server (NTRS)
Nolan, Terence; Swensen, Jeff; Layer, Jeff
2006-01-01
The U-Plex(Registered TradeMark) was designed to allow greater elastic deflection capability in a given gland volume than the now conventional E-seal(Regitered TradeMark). Greater deflection capability with the associated lower bending stresses provides several benefits. For pneumatic duct joints, the axial free height is increased to allow sealing of flanges with weld distortions significantly in excess of what could be tolerated with E-seals(Registered TradeMark), This performance is achieved while maintaining the reusability and ease of assembly typical of E-seal(Registered TradeMark) rigid duct joints.
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The transition from student to new registered nurse in professional practice.
Thomas, Cynthia M; Bertram, Evelyn; Allen, Roberta L
2012-01-01
This qualitative study presents the transition experience of new registered nurses during the first year of professional practice. Four themes emerged: feelings of frustration and being overwhelmed, preceptors, fear, and the orientation process. The orientation process, quality, competent preceptors, and reducing lateral violence are key strategies to successfully retain new nurses. Nurse educators have a crucial role during nurse orientation, training preceptors, and reducing violent behaviors in the workplace.
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Osbiston, Mark
2013-05-01
Interprofessional teamwork and collaboration are essential for facilitating perioperative patient centred care. Operating department practitioners (ODPs) and nurses are registered professional 'practitioner' members of the perioperative team. Standards of conduct, communication skills, ethical principles and confidentiality legislation associated with documented patient information underpin and guide perioperative practitioner practice. This article will discuss, from a student's theoretical and practice experience perspective, the registered professional 'practitioner' role in the context of the interprofessional team.
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Wilcock, Rachel; Crane, Laura; Hobson, Zoe; Nash, Gilly; Kirke-Smith, Mimi; Henry, Lucy A
2018-01-01
Performance at identification lineup was assessed in eighty-five 6- to 11-year-old typically developing children. Children viewed a live staged event involving 2 male actors, and were asked to identify the perpetrators from 2 separate lineups (one perpetrator-present lineup and one perpetrator-absent lineup). Half the children took part in lineups adapted by a registered intermediary (an impartial, trained professional who facilitates understanding and communication between vulnerable witnesses and members of the justice system), and half took part in "best-practice" lineups, according to the current guidance for eyewitness identification in England and Wales. Children receiving assistance from a registered intermediary (relative to children who received best-practice lineups) were more accurate in their identifications for perpetrator-present lineups, and there was some evidence that they were also more accurate for perpetrator-absent lineups. This provides the first empirical evidence for the effectiveness of registered intermediary support during identification lineups.
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Shine on: achieving career satisfaction as a registered nurse.
Perry, Beth
2008-01-01
This phenomenological study focuses on the experience of career satisfaction among registered nurses. Potential participants were asked, "Do you love your work as a nurse?" A random sample of eight nurses who answered yes to this question was questioned further during semistructured conversations. Conversations were recorded and transcribed. Data collected were in the form of descriptions of times during the participants' careers when they felt most professionally fulfilled. Through narrative and poetic analysis, themes of "upholding the vulnerable," "going the extra mile," and "attending to the essential ordinary" were identified. Nurse educators play an important role facilitating career satisfaction for registered nurses. Practical implications for continuing education for educators and practicing nurses are addressed.
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46 CFR 356.45 - Advance of funds.
Code of Federal Regulations, 2011 CFR
2011-10-01
... 46 Shipping 8 2011-10-01 2011-10-01 false Advance of funds. 356.45 Section 356.45 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION MISCELLANEOUS REQUIREMENTS FOR VESSELS OF 100 FEET OR GREATER IN REGISTERED LENGTH TO OBTAIN A FISHERY ENDORSEMENT TO THE VESSEL'S DOCUMENTATION Charters...
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General practitioners perceptions on advance care planning for patients living with dementia.
Brazil, Kevin; Carter, Gillian; Galway, Karen; Watson, Max; van der Steen, Jenny T
2015-04-23
Advance care planning (ACP) facilitates communication and understanding of preferences, nevertheless the use of ACPs in primary care is low. The uncertain course of dementia and the inability to communicate with the patient living with dementia are significant challenges for GPs to initiate discussions on goals of care. A cross-sectional survey, using a purposive, cluster sample of GPs across Northern Ireland with registered dementia patients was used. GPs at selected practices received the survey instrument and up to four mail contacts was implemented. One hundred and thirty-three GPs (40.6%) participated in the survey, representing 60.9% of surveyed practices. While most respondents regarded dementia as a terminal disease (96.2%) only 37.6% felt that palliative care applied equally from the time of diagnosis to severe dementia. While most respondents thought that early discussions would facilitate decision-making during advanced dementia (61%), respondents were divided on whether ACP should be initiated at the time of diagnoses. While most respondents felt that GPs should take the initiative to introduce and encourage ACP, most survey participants acknowledged the need for improved knowledge to involve families in caring for patients with dementia at the end of life and that a standard format for ACP documentation was needed. Optimal timing of ACP discussions should be determined by the readiness of the patient and family carer to face end of life. ACP discussions can be enhanced by educational strategies directed towards the patient and family carer that enable shared decision-making with their GP when considering options in future care.
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2014-01-01
Background Current evidence for optimal management of fetal nuchal cord detected after the head has birthed supports techniques that avoid ligation of the umbilical cord circulation. Routine audit found frequent unsafe management of nuchal cord by skilled birth attendants (SBAs) in migrant and refugee birth centres on the Thai-Burmese border. Method The audit cycle was used to enhance safe practice by SBA for the fetus with nuchal cord. In the three birth centres the action phase of the audit cycle was initially carried out by the doctor responsible for the site. Six months later a registered midwife, present six days per week for three months in one birth facility, encouraged SBAs to facilitate birth with an intact umbilical circulation for nuchal cord. Rates of cord ligation before birth were recorded over a 24 month period (1-July-2011 to 30-June-2013) and in-depth interviews and a knowledge survey of the SBAs took place three months after the registered midwife departure. Results The proportion of births with nuchal cord ligation declined significantly over the four six monthly quarters from 15.9% (178/1123) before the action phase of the audit cycle; to 11.1% (107/966) during the action phase of the audit cycle with the doctors; to 2.4% (28/1182) with the registered midwife; to 0.9% (9/999) from three to nine months after the departure of the registered midwife, (p < 0.001, linear trend). Significant improvements in safe practice were observed at all three SMRU birth facilities. Knowledge of fetal nuchal cord amongst SBAs was sub-optimal and associated with fear and worry despite improved practice. The support of a registered midwife increased confidence of SBAs. Conclusion The audit cycle and registered midwife interprofessional learning for SBAs led to a significant improvement in safe practice for the fetus with nuchal cord. The authors would encourage this type of learning in organizations with birth facilities on the Thai-Burmese border and in other similar resource limited settings with SBAs. PMID:24552462
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Omura, Mieko; Levett-Jones, Tracy; Stone, Teresa Elizabeth; Maguire, Jane; Lapkin, Samuel
2015-12-01
Interprofessional communication and teamwork are essential for medication safety; however, limited educational opportunities for health professionals and students to develop these skills exist in Japan. This study evaluated the impact of an interprofessional multimedia learning resource on registered nurses' and nursing students' intention to practice in a manner promoting medication safety. Using a quasi-experimental design, Japanese registered nurses and nursing students (n = 203) were allocated to an experimental (n = 109) or control group (n = 94). Behavioral intentions of medication safety and the predictor variables of attitudes, perceived behavioral control, and subjective norms were measured using a Japanese version of the Theory of Planned Behavior Medication Safety Questionnaire. Registered nurses in the experimental group demonstrated a greater intention to collaborate and practice in a manner that enhanced medication safety, evidenced by higher scores than the control group on all predictor variables. The results demonstrate the potential for interprofessional multimedia learning resources to positively impact the behaviors of Japanese registered nurses in relation to safe medication practices. Further research in other contexts and with other cohorts is warranted. © 2015 Wiley Publishing Asia Pty Ltd.
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Evaluation of a program to increase evidence-based practice change.
Larrabee, June H; Sions, Jacqueline; Fanning, Mary; Withrow, Mary Lynne; Ferretti, Andrea
2007-06-01
The study evaluated a nursing research program designed to achieve systematic evidence-based practice change. Specifically, change in nurse attitudes about use of research and research conduct, practice change projects, and nurse participation in research-related activities were evaluated. Evidence indicates that successful evidence-based practice change in an organization requires senior leadership support and a systematic program for practice change. Evaluation of program effectiveness provides evidence about opportunities for further improvement. Quantitative evaluation used a pretest-posttest design. The site was an academic medical center in rural West Virginia. Participants were registered nurses from all inpatients units, perioperative services, and emergency departments. Surveys used Alcock et al's Staff Nurses and Research Activities scale. Descriptive evaluation included the number of nurses who attended the workshop, practice change projects, scholarly products disseminated, and outcome of a Magnet review. First, knowledge about the availability of support services increased between 1999 and 2002 and was associated with higher attitude scores about research and research utilization. Second, registered nurses who reported participating in research-related activities had more positive scores on all attitudes than registered nurses who reported not participating. Nurse leaders may improve participation and attitudes about research and research utilization by internally marketing the support available for research-related activities.
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1984-09-01
Inhalation Toxicology, Mehlman, Crammer , and Shapiro, editors, 302-344, Pathotox Publishers, Inc., Park Forest South, Illinois (1977). 8. Shimkin, M. and G...Laboratory Studies. (3) Final Rule , Pesticide Programs; Good Laboratory Practice Standards; 48 Federal Register (FR) 53963-53969, 29 November 1983. (4...Final Rule , Toxic Substances Control; Good Laboratory Practice Standards; 48 Federal Register (FR) 53922-53944, 29 November 1983. b. Facilities were
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Noble, Christy; Shaw, John
2010-01-01
Objective To determine the perceptions of pharmacy interns and newly registered pharmacists and preceptors regarding the preparedness of graduates to enter professional practice. Methods A questionnaire was developed from the New Zealand Competence Standards for the Pharmacy Profession (pharmacist level), with additional questions on communication skills included. The instrument contained 16 items and was mailed to preceptors (n=141), interns (n=72), and newly-registered pharmacists (n=101). Microsoft Excel (pivot tables) was used to analyse the quantitative responses. The final question asked respondents to provide free-text comments about the questionnaire, graduates and the program and responses were analyzed quantitatively and thematically. Results The response rates were 54.6% (n = 77) for preceptors, 100% (n = 72) for interns and 45.5% (n = 46), for newly registered pharmacists. The majority of responses (87.6%; n=2,562) were in agreement that the degree had prepared graduates for practice. Overall, preceptor perceptions of graduates' preparedness for practice were less favorable than graduates' self-perceptions of their preparedness. Four themes were identified from the free-text comments: the need for improved skills, more professional attitudes, better English communication, and additional training in extemporaneous compounding. Conclusion Feedback elicited from graduates and preceptors was helpful in identifying the strengths and weaknesses of a new bachelor of pharmacy (BPharm) program and proved useful in both the accreditation and curriculum revision processes. PMID:21045950
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Extremely Preterm Infant Skin Care: A Transformation of Practice Aimed to Prevent Harm.
Johnson, Deanna E
2016-10-01
The skin of extremely preterm infants is underdeveloped and has poor barrier function. Skin maintenance interventions initiated in the neonatal intensive care unit (NICU) have immediate and lifelong implications when the potential for infection, allergen sensitization, and altered aesthetic outcomes are considered. In addition, the high-level medical needs of extremely preterm infants demand skin-level medical interventions that too often result in unintended skin harm. We describe the use of a harm prevention, or consequence-centered, approach to skin care, which facilitates safer practice for extremely premature infants. Neonatal and pediatric Advanced Practice Registered Nurses (APRN) came together for monthly meetings to review the evidence around best skin care practices for extremely preterm infants, with an emphasis on reduction of skin harm. Findings were focused on the population of interest and clinical implementation strategies. Skin care for extremely preterm infants remains overlooked by current literature. However, clinical practice pearls were extracted and applied in a manner that promotes safer skin care practices in the NICU. Gentle adhesives, such as silicone tapes and hydrogel-backed electrodes, can help to reduce medical adhesive-related skin injuries. Diaper wipes are not appropriate for use among extremely preterm infants, as many ingredients may contain potential allergens. Skin cleansers should be pH neutral to the skin and the prophylactic use of petrolatum-based emollients should be avoided. Further exploration and understanding of skin care practices that examine issues of true risk versus hypothetical risk of harm.
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How participation in surgical mortality audit impacts surgical practice.
Lui, Chi-Wai; Boyle, Frances M; Wysocki, Arkadiusz Peter; Baker, Peter; D'Souza, Alisha; Faint, Sonya; Rey-Conde, Therese; North, John B
2017-04-19
Surgical mortality audit is an important tool for quality assurance and professional development but little is known about the impact of such activity on professional practice at the individual surgeon level. This paper reports the findings of a survey conducted with a self-selected cohort of surgeons in Queensland, Australia, on their experience of participating in the audit and its impact on their professional practice, as well as implications for hospital systems. The study used a descriptive cross-sectional survey design. All surgeons registered in Queensland in 2015 (n = 919) were invited to complete an anonymous online questionnaire between September and October 2015. 184 surgeons completed and returned the questionnaire at a response rate of 20%. Thirty-nine percent of the participants reported that involvement in the audit process affected their clinical practice. This was particularly the case for surgeons whose participation included being an assessor. Thirteen percent of the participants had perceived improvement to hospital practices or advancement in patient care and safety as a result of audit recommendations. Analysis of the open-ended responses suggested the audit experience had led surgeons to become more cautious, reflective in action and with increased confidence in best practice, and recognise the importance of effective communication and clear documentation. This is the first study to examine the impact of participation in a mortality audit process on the professional practice of surgeons. The findings offer evidence for surgical mortality audit as an effective strategy for continuous professional development and for improving patient safety initiatives.
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75 FR 75666 - Advanced Placement (AP) Test Fee Program
Federal Register 2010, 2011, 2012, 2013, 2014
2010-12-06
... DEPARTMENT OF EDUCATION [CFDA No. 84.330B] Advanced Placement (AP) Test Fee Program AGENCY: Office... AP Test Fee fiscal year (FY) 2011 competition. SUMMARY: On September 1, 2010, we published in the Federal Register (75 FR 53681) a notice inviting applications for the AP Test Fee FY 2011 competition...
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Redox Biology Course Registration Form | Center for Cancer Research
The Redox Biology class is open to all NIH/NCI fellows and staff and will be held Septhember 27 - November 8, 2016. The last day to register is: September 21, 2016. The first 100 registrants will be accepted for the class. Those who plan to participate by Video TeleConference should also register so that you can receive the speaker handouts in advance.
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Klein, Tracy Ann
2012-01-01
The purpose of this study was to identify and implement a competency-based regulatory model that transitions clinical nurse specialists (CNSs) to autonomous prescriptive authority pursuant to change in state law. Prescriptive authority for CNSs may be optional or restricted under current state law. Implementation of the APRN Consensus Model includes full prescriptive authority for all advanced practice registered nurses. Clinical nurse specialists face barriers to establishing their prescribing authority when laws or practice change. Identification of transition models will assist CNSs who need to add prescriptive authority to their scope of practice. Identification and implementation of a competency-based transition model for expansion of CNS prescriptive authority. By January 1, 2012, 9 CNSs in the state exemplar have completed a practicum and been granted full prescriptive authority including scheduled drug prescribing. No complaints or board actions resulted from the transition to autonomous prescribing. Transition to prescribing may be facilitated through competency-based outcomes including practicum hours as appropriate to the individual CNS nursing specialty. Outcomes from this model can be used to develop and further validate educational and credentialing policies to reduce barriers for CNSs requiring prescriptive authority in other states.
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Measuring Certified Registered Nurse Anesthetist Organizational Climate: Instrument Adaptation.
Boyd, Donald; Poghosyan, Lusine
2017-08-01
No tool exists measuring certified registered nurse anesthetist (CRNA) organizational climate. The study's purpose is to adapt a validated tool to measure CRNA organizational climate. Content validity of the Certified Registered Nurse Anesthetist Organizational Climate Questionnaire (CRNA-OCQ) was established. Pilot testing was conducted to determine internal reliability consistency of the subscales. Experts rated the tool as content valid. The subscales had high internal consistency reliability (with respective Cronbach's alphas): CRNA-Anesthesiologist Relations (.753), CRNA-Physician Relations (.833), CRNA-Administration Relations (.895), Independent Practice (.830), Support for CRNA Practice (.683), and Professional Visibility (.772). Further refinement of the CRNA-OCQ is necessary. Measurement and assessment of CRNA organizational climate may produce evidence needed to improve provider and patient outcomes.
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Successful preceptorship of newly qualified nurses.
Price, Bob
There is widespread recognition that many newly qualified nurses find it difficult to make the transition from completing their university course to taking up their first registered nurse post. Preceptorship programmes during the first year of registered nurse practice have been recommended by the Department of Health. Preceptors have an important role in ensuring successful transition of the newly qualified nurse; however they also require practical guidance on how best to support the nurse. This article identifies aspects that need to be considered when guiding a registered nurse colleague rather than a student. Preceptorship concerns four main areas: orientation to patients and services provided locally, real-time clinical reasoning, skill review and refinement, and socialisation within the healthcare team. The article will explore each of these areas.
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Achieving 80% BSN by 2020: Lessons Learned From Kentucky's Registered Nurses.
Warshawsky, Nora E; Brandford, Arica; Barnum, Nancy; Westneat, Susan
2015-09-01
The aim of this study was to understand the educational status and plans of Kentucky's RN workforce in advancing nursing educational levels. The Institute of Medicine called for 80% of nurses to hold a minimum of a BSN by 2020. Nurse leaders from practice, academe, and the community need evidence to guide the development of effective strategies. An electronic survey was administered to Kentucky's RNs. This descriptive analysis was based on 1363 usable responses. Only 40% of Kentucky's RNs held at least a BSN. Another 17% were enrolled in a nursing degree program; half of those enrolled were pursuing a BSN. Of those not enrolled in a degree program, 61.5% reported no plans to return to school. The top barriers were lack of perceived benefit, financial concerns, family obligations, and planned retirement. The top motivating factor was career advancement. The gap between the current reality and the goal is wide. Nurse leaders will need to develop creative strategies that strengthen motivating factors and reduce barriers to accelerate movement toward increasing BSN rates.
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Lagarde, Mylene; Erens, Bob; Mays, Nicholas
2015-04-01
There have been growing concerns that general practitioner (GP) services in England, which are based on registration with a single practice located near the patient's home, are not sufficiently convenient for patients. To inform the decision as to whether to change registration rules allowing patients to register 'out-of-area' and to estimate the demand for this wider choice, we undertook a discrete choice experiment with 1706 respondents. Latent class models were used to analyse preferences for GP practice registration comparing preferences for neighbourhood and non-neighbourhood practices. We find that there is some appetite for registering outside the neighbourhood, but this preference is not uniformly shared across the population. Specifically individuals who are less mobile (e.g. older people and those with caring responsibilities), or satisfied with their local practice are less likely to be interested in registering at a practice outside their neighbourhood. Overall, people feel most strongly about obtaining an appointment with a GP as quickly as possible. Respondents regarded weekend opening as less important than other factors, and particularly less important than extended practice opening hours from Monday to Friday. Assuming a constant demand for GP services, a policy encouraging GP practices to extend their opening hours during the week is likely to decrease the average patient waiting time for an appointment and is likely to be preferred by patients. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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Mazurenko, O; Gupte, G; Shan, G
2014-12-01
This study examined the education and work experience of immigrant and American-trained registered nurses from 1988 to 2008. The USA increasingly relies on immigrant nurses to fill a significant nursing shortage. These nurses receive their training overseas, but can obtain licenses to practice in different countries. Although immigrant nurses have been in the USA workforce for several decades, little is known about how their education and work experience compares with USA-trained nurses. Yet much is presumed by policy makers and administrators who perpetuate the stereotype that immigrant nurses are not as qualified. We analysed the National Sample Survey of Registered Nurses datasets from 1988 to 2008 using the Cochran-Armitage trend tests. Our findings showed similar work experience and upward trends in education among both groups of nurses. However, American-trained nurses were more likely to further advance their education, whereas immigrant nurses were more likely to have more work experience and practice in a wider range of healthcare settings. Although we discovered differences between nurses trained in the USA and abroad, we theorize that these differences even out, as education and work experience each have their own distinct caregiving advantages. Immigrant nurses are not less qualified than their American-trained counterparts. However, healthcare providers should encourage them to further pursue their education and certifications. Even though immigrant nurses' education and work experience are comparable with their American counterparts, workforce development policies may be particularly beneficial for this group. © 2014 International Council of Nurses.
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Hingle, Melanie D; Kandiah, Jayanthi; Maggi, Annette
2016-09-01
The 2015 Dietary Guidelines for Americans encourage selection of nutrient-dense foods for health promotion and disease prevention and management. The purpose of this Academy of Nutrition and Dietetics practice paper is to provide an update regarding the science and practice of nutrient-dense food identification and selection. Characterization of tools used to identify nutrient density of foods is provided and recommendations for how registered dietitian nutritionists and nutrition and dietetics technicians, registered, might use available profiling tools to help consumers select nutrient-dense foods is discussed. Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
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Dixon, Jennifer; Smith, Peter; Gravelle, Hugh; Martin, Steve; Bardsley, Martin; Rice, Nigel; Georghiou, Theo; Dusheiko, Mark; Billings, John; Lorenzo, Michael De; Sanderson, Colin
2011-11-22
To develop a formula for allocating resources for commissioning hospital care to all general practices in England based on the health needs of the people registered in each practice Multivariate prospective statistical models were developed in which routinely collected electronic information from 2005-6 and 2006-7 on individuals and the areas in which they lived was used to predict their costs of hospital care in the next year, 2007-8. Data on individuals included all diagnoses recorded at any inpatient admission. Models were developed on a random sample of 5 million people and validated on a second random sample of 5 million people and a third sample of 5 million people drawn from a random sample of practices. All general practices in England as of 1 April 2007. All NHS inpatient admissions and outpatient attendances for individuals registered with a general practice on that date. All individuals registered with a general practice in England at 1 April 2007. Power of the statistical models to predict the costs of the individual patient or each practice's registered population for 2007-8 tested with a range of metrics (R(2) reported here). Comparisons of predicted costs in 2007-8 with actual costs incurred in the same year were calculated by individual and by practice. Models including person level information (age, sex, and ICD-10 codes diagnostic recorded) and a range of area level information (such as socioeconomic deprivation and supply of health facilities) were most predictive of costs. After accounting for person level variables, area level variables added little explanatory power. The best models for resource allocation could predict upwards of 77% of the variation in costs at practice level, and about 12% at the person level. With these models, the predicted costs of about a third of practices would exceed or undershoot the actual costs by 10% or more. Smaller practices were more likely to be in these groups. A model was developed that performed well by international standards, and could be used for allocations to practices for commissioning. The best formulas, however, could predict only about 12% of the variation in next year's costs of most inpatient and outpatient NHS care for each individual. Person-based diagnostic data significantly added to the predictive power of the models.
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Pesut, Barbara; McLean, Tammy; Reimer-Kirkham, Sheryl; Hartrick-Doane, Gweneth; Hutchings, Deanna; Russell, Lara B
2015-09-01
Collaborative education that prepares nursing and healthcare assistant students in supportive care for older adults living at home with advanced chronic illness is an important innovation to prepare the nursing workforce to meet the needs of this growing population. To explore whether a collaborative educational intervention could develop registered nursing and healthcare assistant students' capabilities in supportive care while enhancing care of clients with advanced chronic illness in the community. Mixed method study design. A rural college in Canada. Twenty-one registered nursing and 21 healthcare assistant students completed the collaborative workshop. Eight registered nursing students and 13 healthcare assistant students completed an innovative clinical experience with fifteen clients living with advanced chronic illness. Pre and post-test measures of self-perceived competence and knowledge in supportive care were collected at three time points. Semi-structured interviews were conducted to evaluate the innovative clinical placement. Application of Friedman's test indicated statistically significant changes on all self-perceived competence scores for RN and HCA students with two exceptions: the ethical and legal as well as personal and professional issues domains for HCA students. Application of Friedman's test to self-perceived knowledge scores showed statistically significant changes in all but one domain (interprofessional collaboration and communication) for RN students and all but three domains for HCA students (spiritual needs, ethical and legal issues, and inter-professional collaboration and communication). Not all gains were sustained until T-3. The innovative community placement was evaluated positively by clients and students. Collaborative education for nursing and healthcare assistant students can enhance self-perceived knowledge and competence in supportive care of adults with advanced chronic illness. An innovative clinical experience can maximize reciprocal learning while providing nursing services to a population that is not receiving home-based care. Copyright © 2015. Published by Elsevier Ltd.
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The value of registered nurses in ambulatory care settings: a survey.
Mastal, Margaret; Levine, June
2012-01-01
Ambulatory care settings employ 25% of the three million registered nurses in the United States. The American Academy of Ambulatory Care Nursing (AAACN) is committed to improving the quality of health care in ambulatory settings, enhancing patient outcomes, and realizing greater health care efficiencies. A survey of ambulatory care registered nurses indicates they are well positioned to lead and facilitate health care reform activities with organizational colleagues. They are well schooled in critical thinking, triage, advocating for patients, educating patients and families, collaborating with medical staff and other professionals, and care coordination. The evolving medical home concept and other health care delivery models reinforces the critical need for registered nurses to provide chronic disease management, care coordination, health risk appraisal, care transitions, health promotion, and disease prevention services. Recommendations are offered for organizational leaders, registered nurses, and AAACN to utilize nursing knowledge and skills in the pursuit of leading change and advancing health.
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[Implementation of evidence based medicine in primary care].
Rinnerberger, Andreas; Grafinger, Michaela; Melchardt, Thomas; Sönnichsen, Andreas
2009-01-01
The particular situation of primary care - i.e. decentralized setting, comprehensive medical care, and limited access to continuous medical education - makes it difficult to implement evidence-based medicine into daily practice. Therefore, the Institute of General Practice of the Paracelsus University (PMU) in Salzburg and Actavis GmbH Austria developed "REM" (Rechercheservice evidenzbasierte Medizin). This is a web-based enquiry service offered mainly to GPs who can submit questions arising in daily practice which are answered by the service according to current best evidence. In 8.5 months 176 physicians registered to participate. A total of 31 submitted at least one question. In total, REM processed 134 questions. The number of physicians registered and the frequency of enquiries show that REM can facilitate the implementation of evidence-based medicine in primary care. Nonetheless, only a small proportion of the physicians registered actually made use of the service. Improvements are necessary to promote interest in this new way of continuous medical education.
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Jenkins, Constance L; Elliott, Aaron R; Harris, Janet R
2006-08-01
The purposes of this study were to identify the ethical issues Department of the Army civilian and Army Nurse Corps certified registered nurse anesthetists (CRNAs) encountered in their anesthesia practice and how disturbed they were by these issues. This descriptive study used a secondary data analysis of a cross-sectional survey of Army Nurse Corps officers and Department of the Army civilian registered nurses (N = 5,293). The CRNA subset (n = 97) was obtained from questionnaires that indicated a primary practice setting as anesthesia. The most frequently occurring ethical issue identified was conflict in the nurse-physician relationship, whereas the most disturbing issue was working with incompetent/impaired colleagues. Unresolved ethical conflicts can negatively influence the nurses' morale, leading to avoidance of the issue and contributing to burnout. Identifying the ethical issues and disturbance level experienced by CRNAs should contribute to the development of an ethics education program that addresses issues encountered in CRNA practice.
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76 FR 37375 - Meeting of the Public Safety Officer Medal of Valor Review Board
Federal Register 2010, 2011, 2012, 2013, 2014
2011-06-27
... INFORMATION: The Public Safety Officer Medal of Valor Review Board carries out those advisory functions... who wish to participate must register at least seven (7) days in advance of the meeting/conference... registration. Anyone requiring special accommodations should contact Mr. Joy at least seven (7) days in advance...
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-08-02
.... Corporate Division Including On-Site Leased Workers From Manpower, Office Team and Advance Temporary... from Manpower and Office Team, Dundee, Michigan. The notice was published in the Federal Register on... Holcim (US) Inc., Corporate Division, including on-site leased workers from Manpower, Office Team Advance...
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The Staff Nurse Clinical Leader at the Bedside: Swedish Registered Nurses' Perceptions.
Larsson, Inga E; Sahlsten, Monika J M
2016-01-01
Registered nurses at the bedside are accountable for and oversee completion of patient care as well as directly leading and managing the provision of safe patient care. These nurses have an informal leadership role that is not associated with any given position. Leadership is a complex and multifaceted concept and its meaning is unclear, especially in the staff nurse context. The aim was to describe registered nurses' perceptions of what it entails to be the leader at the bedside in inpatient physical care. A phenomenographic approach was employed. Interviews were performed with Swedish registered nurses ( n = 15). Five descriptive categories were identified: demonstrating clinical knowledge, establishing a good atmosphere of collaboration, consciously structuring the work in order to ensure patients' best possible nursing care, customized presence in the practical work with patients according to predetermined prerequisites, and monitoring coworkers' professional practice. Registered nurses informal role as leader necessitates a social process of deliberate effort to attain and maintain leader status and authority. Participants used deliberate communicative approaches and interactive procedures. Leader principles grounded in the core values of the nursing profession that ensure nursing values and person-centered attributes were a key aspect.
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State Law and Standing Orders for Immunization Services
Stewart, Alexandra M.; Lindley, Megan C.; Cox, Marisa A.
2015-01-01
Introduction This study determined whether state laws permit the implementation of standing orders programs (SOPs) for immunization practice. SOPs are an effective strategy to increase uptake of vaccines. Successful SOPs require a legal foundation authorizing delegation of immunization services performed by a wide range of providers, administered to broad patient populations, in several settings. Without legal permission to administer vaccines, non-physician health professionals (NPHPs) are unable to provide preventive services. Methods From 2012 through 2013, researchers analyzed the legal environment in 50 states and the District of Columbia to determine whether NPHPs are authorized to: (1) assess patient immunization status; (2) prescribe vaccines; and (3) administer vaccines under their own practice license or delegated authority. Laws governing the following NPHPs were included: (1) medical assistants; (2) midwives; (3) nurses in advanced practice; (4) registered, practical, and vocational nurses; (5) physician assistants; and (6) pharmacists. Additionally, the review determined which vaccines may be administered, permissible patient populations, and allowable practice settings for each category of NPHP. Results The laws are highly variable and no state authorizes all NPHPs to conduct all elements of immunization practice for all patients. The laws frequently indicate where NPHPs may or may not administer vaccines and outline permissible vaccines, eligible patients, and required level of supervision. Conclusions The variation in the laws could potentially present a challenge to successful implementation of public health goals to improve immunization rates. Expanded authorization of SOPs in all states could increase health practitioners’ ability to deliver recommended vaccines. PMID:26651424
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Neafsey, Patricia J; Anderson, Elizabeth; Coleman, Craig; Lin, Carolyn A; M’lan, Cyr E; Walsh, Stephen
2009-01-01
A randomized controlled efficacy trial targeting older adults with hypertension is providing a tailored education intervention with a Next Generation Personal Education Program (PEP-NG) in primary care practices in New England. Ten participating advanced practice registered nurses (APRNs) completed online knowledge and self-efficacy measures pre-onsite training and twice more after completing a continuing education program. Patient participants self-refer in response to study recruitment brochures and posters. Twenty-four participants from each APRN practice (total N = 240) are randomly assigned by the PEP-NG software to either control (data collection and four routine APRN visits) or tailored intervention (PEP-NG interface and four focused APRN visits) conditions. Patients access the PEP-NG interface via wireless tablet and use a stylus to answer demographic, knowledge, and self-efficacy questions as well as prescription and over-the-counter self-medication practice questions. The PEP-NG analyzes patient-reported information and delivers tailored educational content. Patients’ outcome measures are self-reported antihypertensive medication adherence, blood pressure, knowledge and self-efficacy concerning potential adverse self-medication practices, adverse self-medication behavior “risk” score and satisfaction with the PEP-NG and APRN provider relationship. APRN outcome measures are knowledge and self-efficacy concerning adverse self-medication practices, self-efficacy for communicating with older adults and satisfaction with the PEP-NG. Time–motion and cost–benefit analyses will be conducted. PMID:20016796
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Real-time dynamic display of registered 4D cardiac MR and ultrasound images using a GPU
NASA Astrophysics Data System (ADS)
Zhang, Q.; Huang, X.; Eagleson, R.; Guiraudon, G.; Peters, T. M.
2007-03-01
In minimally invasive image-guided surgical interventions, different imaging modalities, such as magnetic resonance imaging (MRI), computed tomography (CT), and real-time three-dimensional (3D) ultrasound (US), can provide complementary, multi-spectral image information. Multimodality dynamic image registration is a well-established approach that permits real-time diagnostic information to be enhanced by placing lower-quality real-time images within a high quality anatomical context. For the guidance of cardiac procedures, it would be valuable to register dynamic MRI or CT with intraoperative US. However, in practice, either the high computational cost prohibits such real-time visualization of volumetric multimodal images in a real-world medical environment, or else the resulting image quality is not satisfactory for accurate guidance during the intervention. Modern graphics processing units (GPUs) provide the programmability, parallelism and increased computational precision to begin to address this problem. In this work, we first outline our research on dynamic 3D cardiac MR and US image acquisition, real-time dual-modality registration and US tracking. Then we describe image processing and optimization techniques for 4D (3D + time) cardiac image real-time rendering. We also present our multimodality 4D medical image visualization engine, which directly runs on a GPU in real-time by exploiting the advantages of the graphics hardware. In addition, techniques such as multiple transfer functions for different imaging modalities, dynamic texture binding, advanced texture sampling and multimodality image compositing are employed to facilitate the real-time display and manipulation of the registered dual-modality dynamic 3D MR and US cardiac datasets.
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Career trajectories of nurses leaving the hospital sector in Ontario, Canada (1993-2004).
Alameddine, Mohamad; Baumann, Andrea; Laporte, Audrey; O'Brien-Pallas, Linda; Levinton, Carey; Onate, Kanecy; Deber, Raisa
2009-05-01
This paper is a report of an analysis of the career trajectories of nurses 1 year after leaving hospitals. Although hospitals are traditionally the largest employers of nurses, technological advances and budgetary constraints have resulted in many countries in relative shrinkage of the hospital sector and a shift of care (and jobs) into home/community settings. It has been often assumed that nurses displaced from hospitals will move to work in the other workplaces, especially the community sector. Employment patterns were tracked by examining a longitudinal database of all 201,463 nurses registered with the College of Nurses Ontario (Canada) between 1993 and 2004. Focusing on the employment categories Active (Working in nursing), Eligible-Seeking nursing employment or Dropout from the nursing labour market, year-to-year transition matrixes were generated by sector and sub-sector of employment, nurse type, age group and work status. For every nurse practising nursing in any non-hospital job or in the community a year after leaving hospitals, an average of 1.3 and four nurses, respectively, dropped out of Ontario's labour market. The proportion of nurses leaving hospitals transitioning to the Dropout category ranged from 63.3% (1994-95) to 38.6% (2001-02). The proportion dropping out of Ontario's market was higher for Registered Practical Nurses (compared to Registered Nurses), increased with age and decreased with degree of casualization in nurses' jobs. Downsizing hospitals without attention to the potentially negative impact on the nursing workforce can lead to retention difficulties and adversely affects the overall supply of nurses.
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McCloskey, Rose; Donovan, Cindy; Stewart, Connie; Donovan, Alicia
2015-09-01
Calls for improved conditions in nursing homes have pointed to the importance of optimizing the levels and skills of care providers. Understanding the work of care providers will help to determine if staff are being used to their full potential and if opportunities exist for improved efficiencies. To explore the activities of care providers in different nursing homes and to identify if variations exist within and across homes and shifts. A multi-centre cross-sectional observational work flow study was conducted in seven different nursing homes sites in one Canadian province. Data were collected by a research assistant who conducted 368 h of observation. The research assistant collected data by following an identical route in each site and recording observations on staff activities. Findings indicate staff activities vary across roles, sites and shifts. Licensed practical nurses (nursing assistants) have the greatest variation in their role while registered nurses have the least amount of variability. In some sites both registered nurses and licensed practical nurses perform activities that may be safely delegated to others. Care providers spend as much as 53.7% of their time engaged in non-value added activities. There may be opportunities for registered nurses and licensed practical nurses to delegate some of their activities to non-regulated workers. The time care providers spend in non-value activities suggest there may be opportunities to improve efficiencies within the nursing home setting. Copyright © 2015 Elsevier Ltd. All rights reserved.
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VanDenKerkhof, Elizabeth; Sears, Nancy; Edge, Dana S; Tregunno, Deborah; Ginsburg, Liane
2017-04-01
Practical nurses have experienced an increasing scope of practice, including an expectation to care for complex patients and function on interdisciplinary teams. Little is known about the degree to which patient safety principles are addressed in practical nursing education. To examine self-reported patient safety competencies of practical nurses. A cross-sectional online survey (July 2014) and face-to-face interviews (June 2015). Ontario, Canada. Survey participants were practical nurses newly registered with the College of Nurses of Ontario between January 2012 and December 2013. Interview participants were faculty and students in a practical nursing program in Ontario. Survey respondents completed the Health Professional Education in Patient Safety Survey online. Self-reported competencies in various patient safety domains were compared between classroom and clinical settings. Faculty members were interviewed about educational preparation of practical nurses and students were interviewed to provide insight into interpretation of survey questions. The survey response rate was 28.4% (n=1104/3883). Mean domain scores indicated a high level of confidence in patient safety competence (<4.0/5.0). Confidence was highest in respondents registered with the College of Nurses of Ontario >2years and in those who obtained their education outside of Canada. Faculty believed their approach to teaching and learning instilled a deep understanding of the limits to practical nurse autonomous practice. Practical nurses were confident in what they learned about patient safety in their educational programs. The high degree of patient safety competence may be a true reflection of practical nurses understanding of, and comfort with, the limits of their knowledge and, ultimately, the limits of their individual autonomous practice. Further exploration as to whether the questionnaire requires additional modification for use with practical nurse populations is warranted. However, this study provides the first examination of practical nurses' perspectives and perceptions about patient safety education. Copyright © 2017 Elsevier Ltd. All rights reserved.
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42 CFR 405.2401 - Scope and definitions.
Code of Federal Regulations, 2010 CFR
2010-10-01
... to time, but usually not less frequently than once every 60 days. Nurse-midwife means a registered professional nurse who meets the following requirements: (1) Is currently licensed to practice in the State as a registered professional nurse. (2) Is legally authorized under State law or regulations to...
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37 CFR 2.153 - Publication requirements.
Code of Federal Regulations, 2014 CFR
2014-07-01
... 37 Patents, Trademarks, and Copyrights 1 2014-07-01 2014-07-01 false Publication requirements. 2..., DEPARTMENT OF COMMERCE RULES OF PRACTICE IN TRADEMARK CASES Publication of Marks Registered Under 1905 Act § 2.153 Publication requirements. The owner of a mark registered under the provisions of the Trademark...
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37 CFR 2.153 - Publication requirements.
Code of Federal Regulations, 2013 CFR
2013-07-01
... 37 Patents, Trademarks, and Copyrights 1 2013-07-01 2013-07-01 false Publication requirements. 2..., DEPARTMENT OF COMMERCE RULES OF PRACTICE IN TRADEMARK CASES Publication of Marks Registered Under 1905 Act § 2.153 Publication requirements. The owner of a mark registered under the provisions of the Trademark...
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37 CFR 2.153 - Publication requirements.
Code of Federal Regulations, 2012 CFR
2012-07-01
... 37 Patents, Trademarks, and Copyrights 1 2012-07-01 2012-07-01 false Publication requirements. 2..., DEPARTMENT OF COMMERCE RULES OF PRACTICE IN TRADEMARK CASES Publication of Marks Registered Under 1905 Act § 2.153 Publication requirements. The owner of a mark registered under the provisions of the Trademark...
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37 CFR 2.153 - Publication requirements.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 37 Patents, Trademarks, and Copyrights 1 2011-07-01 2011-07-01 false Publication requirements. 2..., DEPARTMENT OF COMMERCE RULES OF PRACTICE IN TRADEMARK CASES Publication of Marks Registered Under 1905 Act § 2.153 Publication requirements. The owner of a mark registered under the provisions of the Trademark...
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Turnover of registered nurses in Israel: characteristics and predictors.
Toren, Orly; Zelker, Revital; Lipschuetz, Michal; Riba, Shoshana; Reicher, Sima; Nirel, Nurit
2012-05-01
In an era of global and local nursing shortages, nursing turnover has negative consequences in terms of diminished quality of care, increased costs and economic losses and decreased job satisfaction. To examine the turnover rate of registered nurses in Israel by assessing the varying degree of turnover between economic sectors, between hospital and community facilities, and/or between types of hospitals; and by examining potential predicting factors of turnover among registered nurses. A national phone survey was undertaken in Israel consisting of a random sampling of registered nurses of working age (up to age 60). The subjects comprised 10% of a national database of 32,000 registered nurses. The turnover rate among working nurses in Israel currently stands at 23%. In addition, 13% of employed nurses have taken a temporary leave of absence for a period greater than 6 months in the past 10 years, most up to 1 year. While job satisfaction rates were relatively high (72%), Professional satisfaction rates were 60% with no significant difference between hospital and community nurses. The turnover rate of registered nurses from a hospital setting to the community was significantly higher (p<.01) than that of community registered nurses to hospitals. Predicting factors of turnover were found to be: young age, part-time work, lack of advanced professional education, academic education and low satisfaction with the nursing profession. The shift of nursing workforce is mainly from hospitals to community health settings. There is a need to monitor and understand the characteristics of job and professional satisfaction among hospital nurses in order to implement crucial organizational interventions and retain hospital nursing staffs. Since young nurses, nurses working part time and nurses with no advanced professional and academic education, tend to move more than others, efforts should be targeted at these specific groups. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
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The law and the expanding nursing role.
Bullough, B
1976-01-01
Nursing has moved through two major phases in licensure. From 1900 to 1938 basic registration acts were passed and amended. In 1938 the goal became mandatory licensure for all those who nursed for hire. This move was linked with the stratification of the nursing role to include both practical and registered nurses. The third and current phase in licensure began in 1971 with the Idaho revision of the nurse practice act; 30 states have now revised their nurse practice acts to facilitate role expansion for registered nurses. Several approaches are being used in these laws including mandating new board regulations, expanding the definitions of nursing; increasing the power of physicians to delegate, and mandating the use of standardized protocols to guide the practice of nurses who are accepting new responsibilities. PMID:769567
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The law and the expanding nursing role.
Bullough, B
1976-03-01
Nursing has moved through two major phases in licensure. From 1900 to 1938 basic registration acts were passed and amended. In 1938 the goal became mandatory licensure for all those who nursed for hire. This move was linked with the stratification of the nursing role to include both practical and registered nurses. The third and current phase in licensure began in 1971 with the Idaho revision of the nurse practice act; 30 states have now revised their nurse practice acts to facilitate role expansion for registered nurses. Several approaches are being used in these laws including mandating new board regulations, expanding the definitions of nursing; increasing the power of physicians to delegate, and mandating the use of standardized protocols to guide the practice of nurses who are accepting new responsibilities.
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Moaveni, Azadeh; Gallinaro, Anna; Conn, Lesley Gotlib; Callahan, Sheilagh; Hammond, Melanie; Oandasan, Ivy
2010-12-01
This paper describes the results of a Delphi panel process to gain consensus on a role description and competency framework for family practice registered nurses (FP-RNs) in Ontario. Based on the findings from interviews and focus groups with family practice registered nurses and their inter-professional colleagues throughout Ontario, a core competency framework for FP-RNs emerged consisting of six distinct roles - Professional, Expert, Communicator, Synergist, Health Educator and Lifelong Learner - with accompanying enabling competency statements. This framework was refined and validated by a panel of experts from various nursing and family medicine associations and organizations through a Delphi consensus process. This core competency framework for FP-RNs was developed as a stepping stone for clarifying this very important and poorly understood role in family practice. As a result of this research, we expect a greater acknowledgement of the contributions and expertise of the FP-RN as well as the need to celebrate and profile this role. This work has already led to the establishment of a network of stakeholders from nursing organizations in Ontario who are considering opportunities to move the development and use of the competency framework forward.
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Registration of free-hand OCT daughter endoscopy to 3D organ reconstruction
Lurie, Kristen L.; Angst, Roland; Seibel, Eric J.; Liao, Joseph C.; Ellerbee Bowden, Audrey K.
2016-01-01
Despite the trend to pair white light endoscopy with secondary image modalities for in vivo characterization of suspicious lesions, challenges remain to co-register such data. We present an algorithm to co-register two different optical imaging modalities as a mother-daughter endoscopy pair. Using white light cystoscopy (mother) and optical coherence tomography (OCT) (daughter) as an example, we developed the first forward-viewing OCT endoscope that fits in the working channel of flexible cystoscopes and demonstrated our algorithm’s performance with optical phantom and clinical imaging data. The ability to register multimodal data opens opportunities for advanced analysis in cancer imaging applications. PMID:28018720
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Barriers to Research Utilization by Certified Registered Nurse Anesthetists
ERIC Educational Resources Information Center
Palmer, Timothy J.
2013-01-01
At present, no documentation pertaining to the factors influencing utilization of research into clinical practice by Certified Registered Nurse Anesthetists (CRNAs) exists. An investigation was undertaken to determine perceptions of CRNAs regarding factors within the context of the work setting, which may serve to influence their utilization of…
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A Survey of Registered Nurses in New York State.
ERIC Educational Resources Information Center
New York State Education Dept., Albany. Bureau of Postsecondary Research and Information Systems.
As part of the 1989 triennial registration of registered nurses (RNs) in New York State, a survey of professional, personal, and practice characteristics of nurses was conducted. Basic information from this survey is enhanced by information from earlier surveys to illustrate significant trends. Usable survey questionnaires were received from…
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Human Resource Management in Australian Registered Training Organisations
ERIC Educational Resources Information Center
Smith, Andrew; Hawke Geof
2008-01-01
This report forms part of a comprehensive research program that has examined issues related to building the organisational capability of vocational education and training providers. In particular, this report focuses on the current state of human resource management practice in both technical and further education and private registered training…
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Experiences of rural and remote nurses assisting with disasters.
Kulig, Judith C; Penz, Kelly; Karunanayake, Chandima; MacLeod, Martha L P; Jahner, Sharleen; Andrews, Mary Ellen
2017-05-01
Globally, disasters are on the rise. Nurses play a significant role in responding to such events but little is known about rural and remote nurses' experiences. A national cross-sectional survey of regulated nurses (registered nurses, registered psychiatric nurses, licensed practical nurses and nurse practitioners) in rural and remote Canada provided the data (n=2465) for the logistic regression of predictors of assisting with a disaster event within the last five years. The types of disaster events were also examined and open-ended responses were explored to reveal nurses' perspectives. Nurse type, age, region of employment, employment status, number of rural communities worked, distance to advanced referral centre, remote community, personal-professional boundaries, burnout and work engagement were significant factors related to assisting with a disaster event. Open-ended data alluded to the importance of pre-disaster preparation, and the difficulties experienced when personal-professional relationships are impacted during a disaster. Nursing education curricula needs to include information about disasters and the nurse's role. Continuing education opportunities and preparation for nurses should be offered in the workplace. Psychosocial supports to assist rural nurses who attend to disasters in their workplace will help them deal with issues such as the blurring of personal-professional relationships. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.
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Nursing electives: an innovative and creative learning opportunity.
Peate, Ian
Nursing elective can provide the nurse (learner or registered nurse) with a host of new opportunities to experience and observe practice from a variety of different perspectives. The nursing elective should be planned well in advance and much time and thought should be given to preparing for this activity. There are a number of resources (human and material) available to help with the planning of the event and as such careful and thorough planning at an early stage can make the activity much more successful. The funding of the elective event needs to be thought about early on in the planning stage if this is likely to be an issue. Practical considerations, such as insurance cover, honorary contracts, travel and other documents must also be considered carefully. The elective opportunity has the potential to provide the individual with a unique experience, a chance to delve deeper in relation to a particular area of interest as well as potentially experiencing the provision of health care through an alternative lens. The success of the elective largely depends upon the amount of effort the individual puts into it.
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Best, Helen; Newton, Tim
2005-06-01
The purpose of the study was to undertake analyses of registration data for the personal dental services (PDS) of Lambeth, Southwark and Lewisham primary care trusts and relate the analyses to the PDS goal of increasing uptake of dental services. Secondary analyses of registration statistics provided by the Dental Practice Board were undertaken for both 1 years pre-PDS (October 1997 to September 1998) and post-PDS (October 1998 to March 2003) periods. Three sets of analyses were undertaken to consider different aspects of changing registrations: (1) Absolute numbers of patients registered at each time interval; (2) Rates of change in numbers of patients registered for the entire period after the introduction of PDS; and (3) Rates of change in numbers of patients registered for the most recent 3 years of available data. There was a significant increase in the numbers of children registered under capitation, post-PDS as compared to the pre-PDS level (all ages and both genders combined). Post-PDS, the rate of increase for the children was approximately one additional child per practice per month (0.96, 95% CI 0.41-1.52). Similarly there was a significant trend for increasing adults registrations over time of about two and a half adults per practice per month (2.42, 95% CI 0.90-3.95). There was no evidence of a change in registrations for children or adults in total over the most recent period of 3 years. The analysis of the absolute numbers of registered patients each month indicated that the PDS practices had more children registered than before the implementation of the PDS scheme, but not adults. Overall post-implementation there was a trend for increasing registrations in both children and adults, but the most recent data indicated a plateau effect. Further consideration of facilitators to achieve PDS goals of improved uptake of services is required, particularly as they relate to local contexts.
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Dietetic practice: the past, present and future.
Hwalla, N; Koleilat, M
2004-11-01
The history of dietetics can be traced as far back as the writings of Homer, Plato and Hippocrates in ancient Greece. Although diet and nutrition continued to be judged important for health, dietetics did not progress much till the 19th century with the advances in chemistry. Early research focused focuses on vitamin deficiency diseases while later workers proposed daily requirements for protein, fat and carbohydrates. Dietetics as a profession was given a boost during the Second World War when its importance was recognized by the military. Today, professional dietetic associations can be found on every continent, and registered dietitians are involved in health promotion and treatment, and work alongside physicians. The growing need for dietetics professionals is driven by a growing public interest in nutrition and the potential of functional foods to prevent a variety of diet-related conditions.
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Advancing nursing practice: redefining the theoretical and practical integration of knowledge.
Christensen, Martin
2011-03-01
The aim of this paper is to offer an alternative knowing-how knowing-that framework of nursing knowledge, which in the past has been accepted as the provenance of advanced practice. The concept of advancing practice is central to the development of nursing practice and has been seen to take on many different forms depending on its use in context. To many it has become synonymous with the work of the advanced or expert practitioner; others have viewed it as a process of continuing professional development and skills acquisition. Moreover, it is becoming closely linked with practice development. However, there is much discussion as to what constitutes the knowledge necessary for advancing and advanced practice, and it has been suggested that theoretical and practical knowledge form the cornerstone of advanced knowledge. The design of this article takes a discursive approach as to the meaning and integration of knowledge within the context of advancing nursing practice. A thematic analysis of the current discourse relating to knowledge integration models in an advancing and advanced practice arena was used to identify concurrent themes relating to the knowing-how knowing-that framework which commonly used to classify the knowledge necessary for advanced nursing practice. There is a dichotomy as to what constitutes knowledge for advanced and advancing practice. Several authors have offered a variety of differing models, yet it is the application and integration of theoretical and practical knowledge that defines and develops the advancement of nursing practice. An alternative framework offered here may allow differences in the way that nursing knowledge important for advancing practice is perceived, developed and coordinated. What has inevitably been neglected is that there are various other variables which when transposed into the existing knowing-how knowing-that framework allows for advanced knowledge to be better defined. One of the more notable variables is pattern recognition, which became the focus of Benner's work on expert practice. Therefore, if this is included into the knowing-how knowing-that framework, the knowing-how becomes the knowledge that contributes to advancing and advanced practice and the knowing-that becomes the governing action based on a deeper understanding of the problem or issue. © 2011 Blackwell Publishing Ltd.
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Lladó Grove, Gabriela; Langager Høgh, Annette; Nielsen, Judith; Sandermann, Jes
2015-01-01
The concept of the Objective Structured Assessment of Technical Skills (OSATS) is to quantify surgical skills in an objective way and, thereby, produce an additional procedure-specific assessment tool. Since 2005, a 2-day practical course for upcoming specialist registrars in vascular surgery has been obligatory. The aim of this study is to describe the results from a tailored OSATS test as a tool for the evaluation of practical skills during an intensive training session in a simple simulator box for vascular anastomoses. Between 2005 and 2013, we registered the OSATS scores of all course participants. The following data were collected from the questionnaires: years as a candidate, months in vascular surgery or in another type of surgery, and the number of vascular anastomoses performed before the course. The assessment of surgical skills was conducted with an OSATS score template specifically made for this purpose. It consists of a 12-item table with a 5-point grading scale. OSATS score (points) and time for the procedure (OSATS time in min) were registered at baseline (OSATS I) and at the end of the course (OSATS II). OSATS scores were given in both OSATS I and OSATS II for the 83 trainees, and the mean difference was 8.1 points (95% CI: 6.7; 9.5, p < 0.001). OSATS time was given for 69 trainees, and the mean difference was 2.8 minutes (95% CI: 1.4; 4.2, p < 0.001). We found no relationship between years since graduation, months in any surgical specialty, or the experience with vascular anastomoses and outcomes. OSATS is a valuable tool for evaluating the advancement of technical skills during an intensive practical course in performing vascular anastomoses. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
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Planning for and positioning a solo RN first assistant practice.
DeFrancesco, Joyce
2004-11-01
Registered nurse first assistants who go into practice for themselves need to construct a budget for the business and determine how the practice will be organized by developing a business plan. After a practice is established, it is important to position the practice in the marketplace by creating a positive image in prospective clients' minds.
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Chernobyl-Related Cancer and Precancerous Lesions: Incidence Increase vs. Late Diagnostics
Jargin, Sergei V.
2014-01-01
The reported incidence of thyroid cancer in children and adolescents in Soviet Union before the Chernobyl accident was lower than in other developed countries. This is not clearly recognizable from the literature because comparisons of the high incidence figures 4 years after the accident and later have been made with those from the first years after the accident, when the registered incidence had already started to increase. Considering the low pre-accident registered incidence, there was an accumulated pool of undiagnosed thyroid tumors before the accident. The percentage of more advanced cancers, larger in size and less differentiated, was higher after the accident, when the pool of neglected cancers was diagnosed due to the screening and improved diagnostics. Some of these advanced tumors found by screening were interpreted as aggressive radiogenic cancers. The same tendency might be true also for other cancers, e.g. renal cell carcinoma. Furthermore, the screening-effect, false-positivity and registration of non-exposed patients as Chernobyl victims has obviously contributed to the registered incidence increase of malignancy. PMID:25249833
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75 FR 30859 - Meeting of the Public Safety Officer Medal of Valor Review Board
Federal Register 2010, 2011, 2012, 2013, 2014
2010-06-02
... INFORMATION: The Public Safety Officer Medal of Valor Review Board carries out those advisory functions... participate must register at least seven (7) days in advance of the meeting/conference call by contacting Mr.... Anyone requiring special accommodations should contact Mr. Joy at least seven (7) days in advance of the...
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Concepts of advanced practice: what does it mean?
Pearson, Helen
'Advanced practice nursing' may be a familiar concept, but a definition of advanced practice, its scope and its responsibilities, remains elusive. This article discusses the origins of advanced practice, and its practical meaning for nurses working in the NHS today.
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Competency frameworks for advanced practice nursing: a literature review.
Sastre-Fullana, P; De Pedro-Gómez, J E; Bennasar-Veny, M; Serrano-Gallardo, P; Morales-Asencio, J M
2014-12-01
This paper describes a literature review that identified common traits in advanced practice nursing that are specific to competency development worldwide. There is a lack of international agreement on the definition of advanced practice nursing and its core competencies. Despite the lack of consensus, there is an ongoing process worldwide to establish and outline the standards and competencies for advanced practice nursing roles. International agencies, such as the International Council of Nurses, have provided general definitions for advanced practice nursing. Additionally, a set of competency standards for this aim has been developed. A literature review and a directed search of institutional websites were performed to identify specific developments in advanced practice nursing competencies and standards of practice. To determine a competency map specific to international advanced practice nursing, key documents were analysed using a qualitative approach based on content analysis to identify common traits among documents and countries. The review process identified 119 relevant journal articles related to advanced practice nursing competencies. Additionally, 97 documents from grey literature that were related to advanced practice nursing competency mapping were identified. From the text analysis, 17 worldwide transversal competency domains emerged. Despite the variety of patterns in international advanced practice nursing development, essential competency domains can be found in most national frameworks for the role development of international advanced practice nursing. These 17 core competencies can be used to further develop instruments that assess the perceived competency of advanced practice nurses. The results of this review can help policy developers and researchers develop instruments to compare advanced practice nursing services in various contexts and to examine their association with related outcomes. © 2014 International Council of Nurses.
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Frost, Timothy P; Adams, Alex J
2017-11-01
As the role of the clinical pharmacist continues to develop and advance, it is critical to ensure pharmacists can operate in a practice environment and workflow that supports the full deployment of their clinical skills. When pharmacy technician roles are optimized, patient safety can be enhanced and pharmacists may dedicate more time to advanced clinical services. Currently, 17 states allow technicians to accept verbal prescriptions called in by a prescriber or prescriber's agent, or transfer a prescription order from one pharmacy to another. States that allow these activities generally put few legal limitations on them, and instead defer to the professional judgment of the supervising pharmacist whether to delegate these tasks or not. These activities were more likely to be seen in states that require technicians to be registered and certified, and in states that have accountability mechanisms (e.g., discipline authority) in place for technicians. There is little evidence to suggest these tasks cannot be performed safely and accurately by appropriately trained technicians, and the track record of success with these tasks spans four decades in some states. Pharmacists can adopt strong practice policies and procedures to mitigate the risk of harm from verbal orders, such as instituting read-back/spell-back techniques, or requiring the indication for each phoned-in medication, among other strategies. Pharmacists may also exercise discretion in deciding to whom to delegate these tasks. As the legal environment becomes more permissive, we foresee investment in more robust education and training of technicians to cover these activities. Thus, with the adoption of robust practice policies and procedures, delegation of verbal orders and prescription transfers can be safe and effective, remove undue stress on pharmacists, and potentially free up pharmacist time for higher-order clinical care. Copyright © 2016 Elsevier Inc. All rights reserved.
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Registered nurses' constructed meaning of concepts of solution and their use in clinical practice
NASA Astrophysics Data System (ADS)
Wilkes, Lesley M.; Batts, Judith E.
1991-12-01
Since the introduction of nursing into tertiary institutions in Australia in 1975, there has been increasing interest in the teaching of physical science to nurses. Various courses in physical science for nurse students have been developed. They vary in length and content but there is agreement that concepts taught should be closely related to nursing applications. The choice of relevant concepts tends to be made by individual curriculum developers. This paper reports an examination of the use of physical science concepts and their relevance from the perspective of registered nurses practising in general ward areas. Inherent in this study is the premise that for registered nurses to have ideas of the physical science underlying their practice they must have constructed meaning first for these concepts. Specific chemical concepts related to solutions are discussed in these terms.
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Nurses who work in rural and remote communities in Canada: a national survey.
MacLeod, Martha L P; Stewart, Norma J; Kulig, Judith C; Anguish, Penny; Andrews, Mary Ellen; Banner, Davina; Garraway, Leana; Hanlon, Neil; Karunanayake, Chandima; Kilpatrick, Kelley; Koren, Irene; Kosteniuk, Julie; Martin-Misener, Ruth; Mix, Nadine; Moffitt, Pertice; Olynick, Janna; Penz, Kelly; Sluggett, Larine; Van Pelt, Linda; Wilson, Erin; Zimmer, Lela
2017-05-23
In Canada, as in other parts of the world, there is geographic maldistribution of the nursing workforce, and insufficient attention is paid to the strengths and needs of those providing care in rural and remote settings. In order to inform workforce planning, a national study, Nursing Practice in Rural and Remote Canada II, was conducted with the rural and remote regulated nursing workforce (registered nurses, nurse practitioners, licensed or registered practical nurses, and registered psychiatric nurses) with the intent of informing policy and planning about improving nursing services and access to care. In this article, the study methods are described along with an examination of the characteristics of the rural and remote nursing workforce with a focus on important variations among nurse types and regions. A cross-sectional survey used a mailed questionnaire with persistent follow-up to achieve a stratified systematic sample of 3822 regulated nurses from all provinces and territories, living outside of the commuting zones of large urban centers and in the north of Canada. Rural workforce characteristics reported here suggest the persistence of key characteristics noted in a previous Canada-wide survey of rural registered nurses (2001-2002), namely the aging of the rural nursing workforce, the growth in baccalaureate education for registered nurses, and increasing casualization. Two thirds of the nurses grew up in a community of under 10 000 people. While nurses' levels of satisfaction with their nursing practice and community are generally high, significant variations were noted by nurse type. Nurses reported coming to rural communities to work for reasons of location, interest in the practice setting, and income, and staying for similar reasons. Important variations were noted by nurse type and region. The proportion of the rural nursing workforce in Canada is continuing to decline in relation to the proportion of the Canadian population in rural and remote settings. Survey results about the characteristics and practice of the various types of nurses can support workforce planning to improve nursing services and access to care.
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Federal Register 2010, 2011, 2012, 2013, 2014
2013-01-25
... Practice Manual. Revising the regulation to reflect current practice will provide clarity to practitioners... date of publication in the Federal Register. The sixty days between the date of publication and the... standing orders, and the Board's Practice Manual. The amendments to the rule clarify review procedures for...
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Role of the registered nurse in primary health care: meeting health care needs in the 21st century.
Smolowitz, Janice; Speakman, Elizabeth; Wojnar, Danuta; Whelan, Ellen-Marie; Ulrich, Suzan; Hayes, Carolyn; Wood, Laura
2015-01-01
There is widespread interest in the redesign of primary health care practice models to increase access to quality health care. Registered nurses (RNs) are well positioned to assume direct care and leadership roles based on their understanding of patient, family, and system priorities. This project identified 16 exemplar primary health care practices that used RNs to the full extent of their scope of practice in team-based care. Interviews were conducted with practice representatives. RN activities were performed within three general contexts: episodic and preventive care, chronic disease management, and practice operations. RNs performed nine general functions in these contexts including telephone triage, assessment and documentation of health status, chronic illness case management, hospital transition management, delegated care for episodic illness, health coaching, medication reconciliation, staff supervision, and quality improvement leadership. These functions improved quality and efficiency and decreased cost. Implications for policy, practice, and RN education are considered. Copyright © 2015 Elsevier Inc. All rights reserved.
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ULTOR(Registered TradeMark) Passive Pose and Position Engine For Spacecraft Relative Navigation
NASA Technical Reports Server (NTRS)
Hannah, S. Joel
2008-01-01
The ULTOR(Registered TradeMark) Passive Pose and Position Engine (P3E) technology, developed by Advanced Optical Systems, Inc (AOS), uses real-time image correlation to provide relative position and pose data for spacecraft guidance, navigation, and control. Potential data sources include a wide variety of sensors, including visible and infrared cameras. ULTOR(Registered TradeMark) P3E has been demonstrated on a number of host processing platforms. NASA is integrating ULTOR(Registerd TradeMark) P3E into its Relative Navigation System (RNS), which is being developed for the upcoming Hubble Space Telescope (HST) Servicing Mission 4 (SM4). During SM4 ULTOR(Registered TradeMark) P3E will perform realtime pose and position measurements during both the approach and departure phases of the mission. This paper describes the RNS implementation of ULTOR(Registered TradeMark) P3E, and presents results from NASA's hardware-in-the-loop simulation testing against the HST mockup.
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Identifying research priorities for effective retention strategies in clinical trials.
Kearney, Anna; Daykin, Anne; Shaw, Alison R G; Lane, Athene J; Blazeby, Jane M; Clarke, Mike; Williamson, Paula; Gamble, Carrol
2017-08-31
The failure to retain patients or collect primary-outcome data is a common challenge for trials and reduces the statistical power and potentially introduces bias into the analysis. Identifying strategies to minimise missing data was the second highest methodological research priority in a Delphi survey of the Directors of UK Clinical Trial Units (CTUs) and is important to minimise waste in research. Our aim was to assess the current retention practices within the UK and priorities for future research to evaluate the effectiveness of strategies to reduce attrition. Seventy-five chief investigators of NIHR Health Technology Assessment (HTA)-funded trials starting between 2009 and 2012 were surveyed to elicit their awareness about causes of missing data within their trial and recommended practices for improving retention. Forty-seven CTUs registered within the UKCRC network were surveyed separately to identify approaches and strategies being used to mitigate missing data across trials. Responses from the current practice surveys were used to inform a subsequent two-round Delphi survey with registered CTUs. A consensus list of retention research strategies was produced and ranked by priority. Fifty out of seventy-five (67%) chief investigators and 33/47 (70%) registered CTUs completed the current practice surveys. Seventy-eight percent of trialists were aware of retention challenges and implemented strategies at trial design. Patient-initiated withdrawal was the most common cause of missing data. Registered CTUs routinely used newsletters, timeline of participant visits, and telephone reminders to mitigate missing data. Whilst 36 out of 59 strategies presented had been formally or informally evaluated, some frequently used strategies, such as site initiation training, have had no research to inform practice. Thirty-five registered CTUs (74%) participated in the Delphi survey. Research into the effectiveness of site initiation training, frequency of patient contact during a trial, the use of routinely collected data, the frequency and timing of reminders, triggered site training and the time needed to complete questionnaires was deemed critical. Research into the effectiveness of Christmas cards for site staff was not of critical importance. The surveys of current practices demonstrates that a variety of strategies are being used to mitigate missing data but with little evidence to support their use. Six retention strategies were deemed critically important within the Delphi survey and should be a primary focus of future retention research.
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37 CFR 7.28 - Replacement of U.S. registration by registered extension of protection.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false Replacement of U.S. registration by registered extension of protection. 7.28 Section 7.28 Patents, Trademarks, and Copyrights UNITED STATES PATENT AND TRADEMARK OFFICE, DEPARTMENT OF COMMERCE RULES OF PRACTICE IN FILINGS PURSUANT...
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Bae, Sung-Heui; Yoon, Jangho
2014-01-01
Objectives To examine the degree to which states’ work hour regulations for nurses—policies regarding mandatory overtime and consecutive work hours—decrease mandatory overtime practice and hours of work among registered nurses. Methods We analyzed a nationally representative sample of registered nurses from the National Sample Survey of Registered Nurses for years 2004 and 2008. We obtained difference-in-differences estimates of the effect of the nurse work hour policies on the likelihood of working mandatory overtime, working more than 40 hours per week, and working more than 60 hours per week for all staff nurses working in hospitals and nursing homes. Principal Findings The mandatory overtime and consecutive work hour regulations were significantly associated with 3.9 percentage-point decreases in the likelihood of working overtime mandatorily and 11.5 percentage-point decreases in the likelihood of working more than 40 hours per week, respectively. Conclusions State mandatory overtime and consecutive work hour policies are effective in reducing nurse work hours. The consecutive work hour policy appears to be a better regulatory tool for reducing long work hours for nurses. PMID:24779701
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A genealogical survey of Australian registered dog breeds.
Shariflou, Mohammad R; James, John W; Nicholas, Frank W; Wade, Claire M
2011-08-01
Breeding practices were analysed for 32 registered dog breeds representing very small registries (120 Central Asian shepherd dogs) through to very large registries (252,521 German shepherd dogs) in Australia. The vast majority (91%) of registered kennels in Australia that were sampled did not regularly employ either close breeding or popular sire usage in their kennels and the weighted mean inbreeding coefficient of Australian pedigree dogs was <5%. Australian breed mean inbreeding coefficients ranged from 0% (Central Asian shepherd dog) to 10.1% (Bichon Frise). Breed effective population sizes ranged from 26 (Ibizan hound) to 1090 (Golden retriever), comparable with other species of domesticated animals. The relatively low levels of inbreeding suggest that pedigree dog disorders are unlikely to arise frequently from the use of popular sires or close breeding in Australian registered dog breeds. It is possible that deleterious allele fixation might be driven by founder effects, genetic drift or adverse selection practices, which were not assessed in this analysis. European popular sire definitions should be revisited for rare breeds. Copyright © 2011. Published by Elsevier Ltd.
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Bae, Sung-Heui; Yoon, Jangho
2014-10-01
To examine the degree to which states' work hour regulations for nurses-policies regarding mandatory overtime and consecutive work hours-decrease mandatory overtime practice and hours of work among registered nurses. We analyzed a nationally representative sample of registered nurses from the National Sample Survey of Registered Nurses for years 2004 and 2008. We obtained difference-in-differences estimates of the effect of the nurse work hour policies on the likelihood of working mandatory overtime, working more than 40 hours per week, and working more than 60 hours per week for all staff nurses working in hospitals and nursing homes. The mandatory overtime and consecutive work hour regulations were significantly associated with 3.9 percentage-point decreases in the likelihood of working overtime mandatorily and 11.5 percentage-point decreases in the likelihood of working more than 40 hours per week, respectively. State mandatory overtime and consecutive work hour policies are effective in reducing nurse work hours. The consecutive work hour policy appears to be a better regulatory tool for reducing long work hours for nurses. © Health Research and Educational Trust.
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The development of advanced nursing practice globally.
Sheer, Barbara; Wong, Frances Kam Yuet
2008-01-01
To examine the development of advanced nursing practice globally. Data were collected from documentary resources available in the International Nurse Practitioners/Advanced Practice Nurse Network (INP/APNN) of the International Council of Nurses. The areas examined were guided by the "key informant survey on advanced nursing practice self-administered questionnaire." Two core members of the INP/APNN who have rich experience in global advanced nursing development analyzed the data.A total of 14 countries and three regions from five continents were included in the analyses. The development of advanced nursing practice in these areas is facilitated by a need for better access to care in a cost-containment era and the enhancement of nursing education to postgraduate level. The mechanism for regulation of practice is in place in some countries. Confirms the development of advanced practice in nursing is a global trend. APNs can improve global health with points to enhanced education in nursing and regulation of advanced practice.
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Aggar, Christina; Gordon, Christopher J; Thomas, Tamsin H T; Wadsworth, Linda; Bloomfield, Jacqueline
2018-03-26
Australia has an increasing demand for a sustainable primary health care registered nursing workforce. Targeting graduate registered nurses who typically begin their nursing career in acute-care hospital settings is a potential workforce development strategy. We evaluated a graduate registered nurse Community Transition to Professional Practice Program which was designed specifically to develop and foster skills required for primary health care. The aims of this study were to evaluate graduates' intention to remain in the primary health care nursing workforce, and graduate competency, confidence and experiences of program support; these were compared with graduates undertaking the conventional acute-care transition program. Preceptor ratings of graduate competence were also measured. All of the 25 graduates (n = 12 community, n = 13 acute-care) who completed the questionnaire at 6 and 12 months intended to remain in nursing, and 55% (n = 6) of graduates in the Community Transition Program intended to remain in the primary health care nursing workforce. There were no differences in graduate experiences, including level of competence, or preceptors' perceptions of graduate competence, between acute-care and Community Transition Programs. The Community Transition to Professional Practice program represents a substantial step towards developing the primary health care health workforce by facilitating graduate nurse employment in this area. Copyright © 2018 Elsevier Ltd. All rights reserved.
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Asselin, J; Osunlana, A M; Ogunleye, A A; Sharma, A M; Campbell-Scherer, D
2016-04-01
Increasingly, research is directed at advancing methods to address obesity management in primary care. In this paper we describe the role of interdisciplinary collaboration, or lack thereof, in patient weight management within 12 teams in a large primary care network in Alberta, Canada. Qualitative data for the present analysis were derived from the 5As Team (5AsT) trial, a mixed-method randomized control trial of a 6-month participatory, team-based educational intervention aimed at improving the quality and quantity of obesity management encounters in primary care practice. Participants (n = 29) included in this analysis are healthcare providers supporting chronic disease management in 12 family practice clinics randomized to the intervention arm of the 5AsT trial including mental healthcare workers (n = 7), registered dietitians (n = 7), registered nurses or nurse practitioners (n = 15). Participants were part of a 6-month intervention consisting of 12 biweekly learning sessions aimed at increasing provider knowledge and confidence in addressing patient weight management. Qualitative methods included interviews, structured field notes and logs. Four common themes of importance in the ability of healthcare providers to address weight with patients within an interdisciplinary care team emerged, (i) Availability; (ii) Referrals; (iii) Role perception and (iv) Messaging. However, we find that what was key to our participants was not that these issues be uniformly agreed upon by all team members, but rather that communication and clinic relationships support their continued negotiation. Our study shows that firm clinic relationships and deliberate communication strategies are the foundation of interdisciplinary care in weight management. Furthermore, there is a clear need for shared messaging concerning obesity and its treatment between members of interdisciplinary teams. © 2016 World Obesity.
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Clinician researcher career pathway for registered nurses and midwives: A proposal.
Smith, Sheree; Gullick, Janice; Ballard, Jacqueline; Perry, Lin
2018-06-01
To consider clinician researcher career frameworks and propose a new pathway, integrating university and health service components to support research career progression within nursing and midwifery practice. Hospitals with research-active clinicians report fewer adverse events and better patient outcomes. Nursing clinician researcher career development is therefore an international priority, yet positions and expectations associated with this are not always well articulated, with nurses and midwives challenged to accommodate research and clinical careers. This discussion paper describes nurse/midwife clinician researcher career frameworks and a new pathway that aligns academic and nursing role descriptions. The new framework was informed by a brief literature search for international framework documents, three Australian state-based Nurses and Midwives Awards: the Australian Qualifications Framework, publically available University Academic (Research) Award schedules and academic staff descriptions, and state health department and health services publications. The implementation of research-based practice is a key element of nursing and midwifery roles and "advanced practice" position descriptions have well-defined research expectations. This paper considers structures to support their achievement. This paper provides a blueprint for clinician researcher career development. It elevates the research domain as an equal alongside clinical, managerial and educational clinical career development. © 2018 John Wiley & Sons Australia, Ltd.
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An opportunity to combat obesity lies in the at-risk college population.
Swanson, Wendi Mortimer
2016-04-01
Approximately 70% of United States [or U.S.] adults are either overweight or obese. Obesity increases the risk of chronic disease and strains healthcare access, quality, and cost. Weight gain occurs in college students threatening optimal weight maintenance. Physical activity is fundamental to preventing disease. College students incur multiple challenges in weight management. The purpose of the article is to describe the opportunity for Advanced Practice Registered Nurses (APRNs) to intentionally become wellness promoters. The literature was reviewed and interventions developed. Guided by Bandura's Social Cognitive Theory, focus was concentrated on environmental influences through a proposed Staying Active Campaign (SAC). College students are a vulnerable population at risk for unhealthful practices. Young adulthood is a critical period of weight gain that carries risk for later adulthood. College students desire and require assistance for successful weight management. Interventions can be directed by APRNs to achieve healthful weight management and create a campus-wide culture that reinforces healthful practices. Obesity in the college population is a twofold circumstance. Action by APRNs is needed to address obesity and advocate for the prevention of future obesity. The SAC decreases the confounding college environment and supports the students' ability to be physically active while establishing personal lifelong behaviors to emulate and share with others. ©2016 American Association of Nurse Practitioners.
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The effect of Reiki on work-related stress of the registered nurse.
Cuneo, Charlotte L; Curtis Cooper, Maureen R; Drew, Carolyn S; Naoum-Heffernan, Christine; Sherman, Tricia; Walz, Kathleen; Weinberg, Janice
2011-03-01
The Reiki Master Teacher group at a large academic, urban medical center studied the effects of Reiki on work-related stress in Registered Nurse Reiki I class participants. Research suggests that work-related stress is an influential factor in nursing burn out and retention. Reiki, an ancient form of Oriental "energy work" or healing, has been found to decrease stress. The Perceived Stress Scale tool was administered prior to the Reiki I class and after three weeks of practicing self-Reiki. Seventeen participants returned follow-up data. Results indicated that practicing Reiki more often resulted in reduced perceived stress levels. Data from this small pilot study supports educating nurses about Reiki practice to decrease work-related stress.
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Smith, Peter; Gravelle, Hugh; Martin, Steve; Bardsley, Martin; Rice, Nigel; Georghiou, Theo; Dusheiko, Mark; Billings, John; Lorenzo, Michael De; Sanderson, Colin
2011-01-01
Objectives To develop a formula for allocating resources for commissioning hospital care to all general practices in England based on the health needs of the people registered in each practice Design Multivariate prospective statistical models were developed in which routinely collected electronic information from 2005-6 and 2006-7 on individuals and the areas in which they lived was used to predict their costs of hospital care in the next year, 2007-8. Data on individuals included all diagnoses recorded at any inpatient admission. Models were developed on a random sample of 5 million people and validated on a second random sample of 5 million people and a third sample of 5 million people drawn from a random sample of practices. Setting All general practices in England as of 1 April 2007. All NHS inpatient admissions and outpatient attendances for individuals registered with a general practice on that date. Subjects All individuals registered with a general practice in England at 1 April 2007. Main outcome measures Power of the statistical models to predict the costs of the individual patient or each practice’s registered population for 2007-8 tested with a range of metrics (R2 reported here). Comparisons of predicted costs in 2007-8 with actual costs incurred in the same year were calculated by individual and by practice. Results Models including person level information (age, sex, and ICD-10 codes diagnostic recorded) and a range of area level information (such as socioeconomic deprivation and supply of health facilities) were most predictive of costs. After accounting for person level variables, area level variables added little explanatory power. The best models for resource allocation could predict upwards of 77% of the variation in costs at practice level, and about 12% at the person level. With these models, the predicted costs of about a third of practices would exceed or undershoot the actual costs by 10% or more. Smaller practices were more likely to be in these groups. Conclusions A model was developed that performed well by international standards, and could be used for allocations to practices for commissioning. The best formulas, however, could predict only about 12% of the variation in next year’s costs of most inpatient and outpatient NHS care for each individual. Person-based diagnostic data significantly added to the predictive power of the models. PMID:22110252
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78 FR 43227 - Meeting of the Public Safety Officer Medal of Valor Review Board
Federal Register 2010, 2011, 2012, 2013, 2014
2013-07-19
... those advisory functions specified in 42 U.S.C. 15202. Pursuant to 42 U.S.C. 15201, the President of the... must register at least seven (7) days in advance of the meeting/conference call by contacting Mr. Joy... accommodations should contact Mr. Joy at least seven (7) days in advance of the meeting. Please submit any...
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77 FR 51826 - Meeting of the Public Safety Officer Medal of Valor Review Board
Federal Register 2010, 2011, 2012, 2013, 2014
2012-08-27
... functions specified in 42 U.S.C. 15202. Pursuant to 42 U.S.C. 15201, the President of the United States is... participate must register at least seven (7) days in advance of the meeting/conference call by contacting Mr... requiring special accommodations should contact Mr. Joy at least seven (7) days in advance of the meeting...
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76 FR 56226 - Meeting of the Public Safety Officer Medal of Valor Review Board
Federal Register 2010, 2011, 2012, 2013, 2014
2011-09-12
... those advisory functions specified in 42 U.S.C. 15202. Pursuant to 42 U.S.C. 15201, the President of the..., members of the public who wish to participate must register at least seven (7) days in advance of the... least seven (7) days in advance of the meeting. Please submit any comments or written statements for...
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Zahran, Zainab
2013-09-01
To explore key motivational factors of Jordanian nurses to undertake a Master's degree and explore perceived impact on practice. In Jordan, there are postgraduate educational programmes offering a Master's degree in clinical nursing for registered nurses. These programmes are intended to prepare nurses to practise at an advanced level as potential clinical nurse specialists. Little is known about the motivation of nurses to undertake such Master's degree preparation programmes and their perceived impact on practice. Using an ethnographic design, narratives from semi-structured interviews with participants (n=37) from five Jordanian hospitals and two public universities were collected and thematically analysed. Four main themes emerged from the data: self development; broadening career opportunities; developing practice; and the perceived impact of Master's level nurses on practice. The majority of Jordanian nurses chose to undertake a Master's degree because of a desire for self and practice development. The majority of participants referred to M-level nurses in terms of knowledge transfer, highlighting their clinical teaching and in-service education activities. M-level nurses were also associated with managerial and supervisory roles in clinical practice. Controversy over the impact of M-level nurses in enhancing patient care is not limited to the Jordanian setting. Future research needs to focus on comparative studies between nurses with M-level qualifications and experienced nurses without either M-level qualifications or specialist courses to establish if there is any significant relationship between practice performance and educational preparation and experience. Evaluation research could be undertaken for the purpose of developing measurable and observable criteria related to educational and skill based outcomes. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Hutchinson, Marie; East, Leah; Stasa, Helen; Jackson, Debra
2014-01-01
Over recent decades, there has been considerable research and debate about essential features of advanced nursing practice and differences among various categories of advanced practice nurses. This study aimed to derive an integrative description of the defining characteristics of advanced practice nursing through a meta-summary of the existing literature. A three-phase approach involved (a) systematic review of the literature to identify the specific activities characterized as advanced practice nursing, (b) qualitative meta-summary of practice characteristics extracted from manuscripts meeting inclusion criteria; and (c) statistical analysis of domains across advanced practice categories and country in which the study was completed. A descriptive framework was distilled using qualitative and quantitative results. Fifty manuscripts met inclusion criteria and were retained for analysis. Seven domains of advanced nursing practice were identified: (a) autonomous or nurse-led extended clinical practice; (b) improving systems of care; (c) developing the practice of others; (d) developing/delivering educational programs/activities; (e) nursing research/scholarship; (f) leadership external to the organization; and (g) administering programs, budgets, and personnel. Domains were similar across categories of advanced nursing practice; the domain of developing/delivering educational programs/activities was more common in Australia than in the United States or United Kingdom. Similarity at the domain level was sufficient to suggest that advanced practice role categories are less distinct than often argued. There is merit in adopting a more integrated and consistent interpretation of advanced practice nursing.
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EXPANDING PRACTICE INTO AREAS. ALIGNED PHILOSOPHICALLY WITH MIDWIFERY.
King, Ruth
2016-07-01
The number of midwives practicing in Australia in 1999, were 11,985 and in 2014, 23,862 (Australian Institute of Health & Welfare, 2014 workforce report). Just over 3,000 are registered as a midwife only.
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Zhou, Guiyun; Stoltzfus, Jill C; Houldin, Arlene D; Parks, Susan M; Swan, Beth Ann
2010-11-01
To establish initial reliability and validity of a Web-based survey focused on oncology advanced practice nurses' (APNs') knowledge, attitudes, and practice behaviors regarding advanced care planning, and to obtain preliminary understanding of APNs' knowledge, attitudes, and practice behaviors and perceived barriers to advanced care planning. Descriptive, cross-sectional, pilot survey study. The eastern United States. 300 oncology APNs. Guided by the Theory of Planned Behavior, a knowledge, attitudes, and practice behaviors survey was developed and reviewed for content validity. The survey was distributed to 300 APNs via e-mail and sent again to the 89 APNs who responded to the initial survey. Exploratory factor analysis was used to examine the construct validity and test-retest reliability of the survey's attitudinal and practice behavior portions. Respondents' demographics, knowledge, attitudes, practice behaviors, and perceived barriers to advanced care planning practice. Exploratory factor analysis yielded a five-factor solution from the survey's attitudes and practice behavior portions with internal consistency using Cronbach alpha. Respondents achieved an average of 67% correct answers in the 12-item knowledge section and scored positively in attitudes toward advanced care planning. Their practice behavior scores were marginally positive. The most common reported barriers were from patients' and families' as well as physicians' reluctance to discuss advanced care planning. The attitudinal and practice behaviors portions of the survey demonstrated preliminary construct validity and test-retest reliability. Regarding advanced care planning, respondents were moderately knowledgeable, but their advanced care planning practice was not routine. Validly assessing oncology APNs' knowledge, attitudes, and practice behaviors regarding advanced care planning will enable more tailored approaches to improve end-of-life care outcomes.
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Hallinan, Christine M; Hegarty, Kelsey L
2016-01-01
The aims of the present study were to understand enablers to participation in postgraduate education for primary care nurses (PCNs), and to explore how postgraduate education has advanced their nursing practice. Cross-sectional questionnaires were mailed out in April 2012 to current and past students undertaking postgraduate studies in primary care nursing at The University of Melbourne, Victoria, Australia. Questionnaires were returned by 100 out of 243 nurses (response rate 41%). Ninety-one per cent (91/100) of the respondents were first registered as nurses in Australia. Fifty-seven per cent were hospital trained and 43% were university educated to attain their initial nurse qualification. The respondents reported opportunities to expand scope of practice (99%; 97/98), improve clinical practice (98%; 97/99), increase work satisfaction (93%; 91/98) and increase practice autonomy (92%; 89/97) as factors that most influenced participation in postgraduate education in primary care nursing. Major enablers for postgraduate studies were scholarship access (75%; 71/95) and access to distance education (74%; 72/98). Many respondents reported an increased scope of practice (98%; 95/97) and increased job satisfaction (71%; 70/98) as an education outcome. Only 29% (28/97) cited an increase in pay-rate as an outcome. Of the 73 PCNs currently working in general practice, many anticipated an increase in time spent on the preparation of chronic disease management plans (63%; 45/72), multidisciplinary care plans (56%; 40/72) and adult health checks (56%; 40/72) in the preceding 12 months. Recommendations emerging from findings include: (1) increased access to scholarships for nurses undertaking postgraduate education in primary care nursing is imperative; (2) alternative modes of course delivery need to be embedded in primary care nursing education; (3) the development of Australian primary care policy, including policy on funding models, needs to more accurately reflect the educational level of PCNs, PCN role expansion and the extent of interprofessional collaboration that is evident from research undertaken to date. Nurses with postgraduate education have the potential to increase their scope of practice, take on a greater teaching role and provide more preventive and chronic disease services in primary care. Policies aimed at increasing access to education for nurses working in primary care would strengthen the primary care nursing profession, and enhance the delivery of primary health care services in Australia.
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76 FR 41233 - Equity and Excellence Commission
Federal Register 2010, 2011, 2012, 2013, 2014
2011-07-13
... the meeting must register in advance because seating may be limited. Please contact Kimberly Watkins... devices, or materials in alternative format) should notify Watkins-Foote at (202) 260-8197 no later than...
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ERIC Educational Resources Information Center
Rolince, Patricia; Giesser, Nancy; Greig, Judith; Knittel, Kathleen; Mahowald, Jane F.; McAloney-Madden, Lisa; Schloss, Robert A.
2001-01-01
A collaborative group of 25 Northeast Ohio nursing deans/directors has developed an access model to provide new education and career mobility pathways into nursing. Model components describe the routes of licensed practical nurse to registered nurse and registered nurse to bachelor of science in nursing. Cost effectiveness and equity are…
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Job and industry turnover for registered and licensed vocational nurses.
Spetz, Joanne; Rickles, Jordan; Chapman, Susan; Ong, Paul M
2008-09-01
Most studies of nurse turnover focus on job turnover, which could reflect nurse advancement and thus not be detrimental to the workforce. The authors discuss findings from a study that involved 2 cohorts of graduates from registered nursing and licensed vocational nursing community college programs in California. The duration of employment in the healthcare industry, as well as with specific employers, is tracked, lending a more thorough analysis of nursing job and industry turnover than found in other studies.
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Core components of the rural nurse specialist role in New Zealand.
Bell, Jennie; Crawford, Ruth; Holloway, Kathy
2018-06-01
New Zealand has a rural population with unique healthcare needs. Traditionally, rural health care has been provided by medical general practitioners (GPs); however, as the number of GPs declines, the rural nurse specialist (RNS) role has emerged. The RNS is a registered nurse with advanced nursing skills that enable independent, autonomous practice within rural areas. The health needs of each rural community are specific to that area and the RNS role has been developed according to local healthcare needs. The purpose of this research was to provide a description of the RNS role in New Zealand. A descriptive exploratory approach was used in this qualitative study. The study was conducted in two parts. Phase 1 consisted of document content analysis of RNS position descriptions and phase 2 comprised four semi-structured interviews with RNSs. Data were analysed using thematic analysis. The Modified Strong Model of Advanced Practice was utilised as a framework for thematic analysis during both phases. Rural nurse specialists demonstrated a wide variance in the understanding of the term 'RNS'. The RNS role was found to include provision of care across a wide range of settings according to local needs. Advanced assessment skills were expected by employers and considered a major component of the role by RNSs. Advanced assessments skills were utilised to enhance communication and thus increase collaboration with other health professionals. The ability to effectively communicate and collaborate with other health professionals was found to be a high priority. However, RNSs perceived that collaboration and thus patient care was affected by a lack of role clarity. The nurse practitioner (NP) role in New Zealand was considered more effective, with greater role recognition for the NP. Education was considered essential to maintain advanced assessment skills. RNSs identified providing education in the form of health promotion relevant to local needs as important. There was a lack of information regarding publication and professional leadership, highlighting this as an area for development. Another issue was the importance of stress management in an isolated area. The RNS role requires advanced knowledge to provide independent patient care. Advanced skills utilised include assessment, diagnosis and treatment of patients. RNSs must have postgraduate education to develop the advanced skills required in this role. RNSs perceive the NP role as having better role clarity; therefore, all participants were considering becoming an NP. There are barriers to becoming an NP, thus an expansion of the current RNS role is recommended. Further recommendations from this study include increased professional leadership to improve RNS visibility and further continued interprofessional education to enhance collaboration.
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Incorporating Geriatric Medicine Providers into the Care of the Older Adult with Cancer.
Magnuson, Allison; Canin, Beverly; van Londen, G J; Edwards, Beatrice; Bakalarski, Pamela; Parker, Ira
2016-11-01
A significant proportion of cancer patients and survivors are age 65 and over. Older adults with cancer often have more complex medical and social needs than their younger counterparts. Geriatric medicine providers (GMPs) such as geriatricians, geriatric-trained advanced practice providers, and geriatric certified registered nurses have expertise in caring for older adults, managing complex medical situations, and optimizing function and independence for this population. GMPs are not routinely incorporated into cancer care for older adults; however, their particular skill set may add benefit at many points along the cancer care continuum. In this article, we review the role of geriatric assessment in the care of older cancer patients, highlight specific case scenarios in which GMPs may offer additional understanding and insight in the care of older adults with cancer, and discuss specific mechanisms for incorporating GMPs into oncology care.
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Waterborne Disease Case Investigation: Public Health Nursing Simulation.
Alexander, Gina K; Canclini, Sharon B; Fripp, Jon; Fripp, William
2017-01-01
The lack of safe drinking water is a significant public health threat worldwide. Registered nurses assess the physical environment, including the quality of the water supply, and apply environmental health knowledge to reduce environmental exposures. The purpose of this research brief is to describe a waterborne disease simulation for students enrolled in a public health nursing (PHN) course. A total of 157 undergraduate students completed the simulation in teams, using the SBAR (Situation-Background-Assessment-Recommendation) reporting tool. Simulation evaluation consisted of content analysis of the SBAR tools and debriefing notes. Student teams completed the simulation and articulated the implications for PHN practice. Student teams discussed assessment findings and primarily recommended four nursing interventions: health teaching focused on water, sanitation, and hygiene; community organizing; collaboration; and advocacy to ensure a safe water supply. With advanced planning and collaboration with partners, waterborne disease simulation may enhance PHN education. [J Nurs Educ. 2017;56(1):39-42.]. Copyright 2017, SLACK Incorporated.
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Nursing education at Western Governors University: a modern, disruptive approach.
Jones-Schenk, Jan
2014-01-01
Over 1 million working registered nurses (RNs) currently do not have a bachelor's degree in nursing and comprise the critical group needing to return to school in order to achieve the Institute of Medicine's goal of 80% bachelors of science in nursing (BSNs) by 2020. Western Governors University (WGU) has developed a transformative educational model, incorporating 4 operational pillars (competency-based learning, technology, disaggregated faculty roles, and a student-centric management system), to revolutionize RN-BSN education. This article describes a successful contemporary model, disrupting most all of the traditional aspects of university education for professional nursing practice. The program design is of particular value to working adults and addresses the flexibility they need to accommodate academic advancement. The WGU nursing program currently serves over 5,000 students seeking BSN and Master of Science in Nursing degrees in all 50 states. © 2014.
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Physician assistant wages and employment, 2000-2025.
Quella, Alicia; Brock, Douglas M; Hooker, Roderick S
2015-06-01
This study sought to assess physician assistant (PA) wages, make comparisons with other healthcare professionals, and project their earnings to 2025. The Bureau of Labor Statistics PA employment datasets were probed, and 2013 wages were used to explore median wage differences between large employer categories and 14 years of historical data (2000-2013). Median wages of PAs, family physicians and general practitioners, pharmacists, registered nurses, advanced practice nurses, and physical therapists were compared. Linear regression was used to project the PA median wage to 2025. In 2013, the median hourly wage for a PA employed in a clinical role was $44.70. From 2000 to 2013, PA wages increased by 40% compared with the cumulative inflation rate of 35.3%. This suggests that demand exceeds supply, a finding consistent with similar clinicians such as family physicians. A predictive model suggests that PA employment opportunities and remuneration will remain high through 2025.
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Delegation knowledge and practice among rehabilitation nurses.
White, Mary Joe; Gutierrez, Ann; Davis, Kerry; Olson, Rhonda; McLaughlin, Celeste
2011-01-01
Delegation is an essential process that allows nurses to function more effectively and efficiently. The Association of Rehabilitation Nurses' (ARN) Southeast Texas Chapter research committee developed a survey to study registered nurses (RN) practices and knowledge of delegation to unlicensed assistive personnel. State boards of nursing determine delegation practices, so the survey was sent only to Texas ARN members. Benners' Novice to Expert theory was used to study delegation practices based on years of experience, certification, and education. Survey Monkey was used with a questionnaire developed by the research committee. Descriptive statistics analyzed data from the survey's 73 respondents, and chi-square measured significance of differences based on years of experience and certification (yes or no). Data show that delegation knowledge does not necessarily translate to practice, especially when looking at specific tasks performed by certified rehabilitation registered nurses (CRRNs) and non-CRRNs. The data support continued study of this important issue; 93.7% of respondents say delegation requires further discussion.
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Advanced Mirror Technology Development (AMTD): Year Five Status
NASA Technical Reports Server (NTRS)
Stahl, H Philip
2017-01-01
The Advanced Mirror Technology Development (AMTD) project is in Phase 2 of a multiyear effort initiated in Fiscal Year (FY) 2012, to mature the Technology Readiness Level (TRL) of critical technologies required to enable 4-m-or-larger monolithic or segmented ultraviolet, optical, and infrared (UVOIR) space telescope primary-mirror assemblies for general astrophysics, ultra-high-contrast observations of exoplanets, and National Interest missions. Key accomplishments of 2016/17 include the completion of the Harris Corp approximately 150 Hz 1.5-meter Ultra-Low Expansion (ULE Registered trademark) mirror substrate using stacked core method to demonstrate lateral stability of the stacked core technology, as well as the characterization and validation by test of the mechanical and thermal performance of the 1.2-meter Zerodur (Registered trademark) mirror using the STOP model prediction and verification of CTE homogeneity.
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Cormier, H; Tremblay, B L; Paradis, A-M; Garneau, V; Desroches, S; Robitaille, J; Vohl, M-C
2014-08-01
Not all healthcare professionals are familiar with nutrigenomics. However, they recognise that nutrigenomics has great potential for the development of preventive health approaches. The present study aimed to provide an overall picture of the current situation about nutrigenomics in the practice of registered dietitians (RDs) from the province of Quebec (Canada). Three hundred and seventy-three RDs members of the Ordre professionnel des diététistes du Québec completed an online survey that included 34 questions, most of which were closed-ended questions. Overall, 76.9% of RDs knew about nutrigenomics. Among RDs with <5 years of experience, 49.2% knew about genetic testing related to nutrition compared to 11.7% for RDs with over 25 years of experience. Currently, 75.9% of RDs working in clinical nutrition in the public sector consider that they do not have the basic knowledge to integrate nutrigenomics in their practice compared to 62.9% for RDs in private practice. When asked about main limitations of genetic testing related to nutrition, RDs considered that genetic testing does not consider the other determinants of health, that genetic testing and their results have poor accuracy, and that there is a lack of scientific evidence. Concerns remained about ethical and legal aspects and its difficult application as a result of poor understanding and/or interpretation by professionals and/or customers. The high costs of these tests were also noted as a limitation. Registered dietitians know and are interested in nutrigenomics, especially those with less experience, although they do not feel adequately qualified to integrate findings from nutrigenomics into their practice. © 2014 The British Dietetic Association Ltd.
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Harrop, Emily; Noble, Simon; Edwards, Michelle; Sivell, Stephanie; Moore, Barbara; Nelson, Annmarie
2016-07-20
Few studies have explored in depth the experiences of patients with advanced cancer who are participating in clinical investigational medicinal product trials. However, integrated qualitative studies in such trials are needed to enable a broader evaluation of patient experiences in the trial, with important ethical and practical implications for the design and conduct of similar trials and treatment regimes in the future. Ten participants were recruited from the control and intervention arms of FRAGMATIC: a non-placebo trial for patients with advanced lung cancer. Participants were interviewed at up to three time points during their time in the trial. Interviews were analysed using Interpretive Phenomenological Analysis. Patients were motivated to join the trial out of hope of medical benefit and altruism. Understanding of randomisation was mixed and in some cases poor, as was appreciation of trial purpose and equipoise. The trial was acceptable to and evaluated positively by most participants; participants receiving the intervention focused on the potential treatment benefits they hoped they would receive, whilst participants in the control arm found alternative reasons, such as altruism, personal fulfilment and positive attention, to commit to and perceive benefits from the trial. However, whilst experiences were generally very positive, poor understanding, limited engagement with trial information and focus on treatment benefits amongst some participants give cause for concern. By exploring longitudinally the psychological, emotional and cognitive domains of trial participation, we consider potential harms and benefits of participation in non-placebo trials amongst patients with advanced lung cancer and identify several implications for future research with and care for patients with advanced cancer. ISRCTN80812769 . Registered on 8 July 2005.
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Kent, Pamela S; McCarthy, Maureen P; Burrowes, Jerrilynn D; McCann, Linda; Pavlinac, Jessie; Goeddeke-Merickel, Catherine M; Wiesen, Karen; Kruger, Sarah; Byham-Gray, Laura; Pace, Rory C; Hannahs, Valarie; Benner, Debbie
2014-09-01
Compelling evidence indicates that the incidence of chronic kidney disease (CKD) is increasing because of an aging population and a higher prevalence of cardiovascular disease, diabetes, and hypertension. Nutrition management of patients with CKD requires early disease recognition, appropriate interpretation of the markers and stages of CKD, and collaboration with other health care practitioners. Better management of CKD can slow its progression, prevent metabolic complications, and reduce cardiovascular related outcomes. Caring for patients with CKD necessitates specialized knowledge and skills to meet the challenges associated with this growing epidemic. The Academy of Nutrition and Dietetics Renal Dietitians Practice Group and the National Kidney Foundation Council on Renal Nutrition, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, have updated the 2009 Standards of Practice in Nutrition Care and Standards of Professional Performance as a tool for registered dietitian nutritionists working in nephrology nutrition to assess their current skill levels and to identify areas for additional professional development in this practice area. The Standards of Practice apply to the care of patients/clients with kidney disease. The Standards of Professional Performance consist of six domains of professionalism, including: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate how nephrology nutrition principles can be applied to practice. The indicators describe three skill levels (ie, competent, proficient, and expert) for registered dietitian nutritionists working in nephrology nutrition. Copyright © 2014 Academy of Nutrition and Dietetics and the National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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Kent, Pamela S; McCarthy, Maureen P; Burrowes, Jerrilynn D; McCann, Linda; Pavlinac, Jessie; Goeddeke-Merickel, Catherine M; Wiesen, Karen; Kruger, Sarah; Byham-Gray, Laura; Pace, Rory C; Hannahs, Valarie; Benner, Debbie
2014-09-01
Compelling evidence indicates that the incidence of chronic kidney disease (CKD) is increasing because of an aging population and a higher prevalence of cardiovascular disease, diabetes, and hypertension. Nutrition management of patients with CKD requires early disease recognition, appropriate interpretation of the markers and stages of CKD, and collaboration with other health care practitioners. Better management of CKD can slow its progression, prevent metabolic complications, and reduce cardiovascular related outcomes. Caring for patients with CKD necessitates specialized knowledge and skills to meet the challenges associated with this growing epidemic. The Academy of Nutrition and Dietetics Renal Dietitians Practice Group and the National Kidney Foundation Council on Renal Nutrition, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, have updated the 2009 Standards of Practice in Nutrition Care and Standards of Professional Performance as a tool for registered dietitian nutritionists working in nephrology nutrition to assess their current skill levels and to identify areas for additional professional development in this practice area. The Standards of Practice apply to the care of patients/clients with kidney disease. The Standards of Professional Performance consist of six domains of professionalism, including: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate how nephrology nutrition principles can be applied to practice. The indicators describe three skill levels (ie, competent, proficient, and expert) for registered dietitian nutritionists working in nephrology nutrition. Copyright © 2014 Academy of Nutrition and Dietetics and the National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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Newhouse, Robin; Byon, Ha Do; Storkman Wolf, Emily; Johantgen, Meg
2018-06-01
High-quality smoking cessation counseling guidelines for people who use tobacco are not fully integrated in acute-care services presenting missed opportunities to improve health outcomes. The role of the practice environment on enhancing or inhibiting guideline use is unknown. To examine the relationship between the nurse practice environment and nurses' use of smoking cessation counseling practices, and to evaluate the effect of the individual nurse and organization characteristics on nurse smoking cessation counseling practices. Cross-sectional secondary analysis of survey data from two multisite studies. The sample included responses from registered nurses (N = 844) in 45 hospitals (22 rural hospitals from the Eastern United States and 23 Magnet hospitals across the United States). Linear mixed model was used to adjust intradependency among the responses of individual nurses nested within hospitals. Data were abstracted from survey responses including nurse characteristics, the Smoking Cessation Counseling Scale (SCCS), and the Practice Environment Scale-Nursing Work Index (PES). Increasing positive relationships exist between PES and SCCS total and subscales scores. Also, SCCS total scores were significantly related with favorable PES total scores (SCCS score difference of 0.26 between favorable and unfavorable PES scores, SE = .08, p = .002) controlling for other covariates. Non-White respondents (vs. White) demonstrated a positive association with SCCS total scores (difference of .18, SE = .07, p = .010), but not in advanced counseling. Nurse practice environments are positively associated with the use of evidence-based smoking cessation practices by nurses. As practice environments become more favorable, higher level counseling practices occur more often. Healthcare leaders should focus on enhancing the practice environment using a quality improvement approach and framework for evidence translation. Quality improvement initiatives should be prioritized in which high-quality evidence is available to support nursing processes. © 2018 The Authors. Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International The Honor Society of Nursing.
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The Canadian Birth Place Study: describing maternity practice and providers' exposure to home birth.
Vedam, Saraswathi; Schummers, Laura; Stoll, Kathrin; Rogers, Judy; Klein, Michael C; Fairbrother, Nichole; Dharamsi, Shafik; Liston, Robert; Chong, Gua Khee; Kaczorowski, Janusz
2012-10-01
(1) to describe educational, practice, and personal experiences related to home birth practice among Canadian obstetricians, family physicians, and registered midwives; (2) to identify barriers to provision of planned home birth services, and (3) to examine inter-professional differences in attitudes towards planned home birth. the first phase of a mixed-methods study, a quantitative survey, comprised of 38 items eliciting demographic, education and practice data, and 48 items about attitudes towards planned home birth, was distributed electronically to all registered midwives (N=759) and obstetricians who provide maternity care (N=800), and a random sample of family physicians (n=3,000). Canada. This national investigation was funded by the Canadian Institutes for Health Research. Canadian registered midwives (n=451), obstetricians (n=245), and family physicians (n=139). almost all registered midwives had extensive educational and practice experiences with planned home birth, and most obstetricians and family physicians had minimal exposure. Attitudes among midwives and physicians towards home birth safety and advisability were significantly different. Physicians believed that home births are less safe than hospital births, while midwives did not agree. Both groups believed that their views were evidence-based. Midwives were the most comfortable with including planned home birth as an option when discussing choice of birth place with pregnant women. Both midwives and physicians expressed discomfort with inter-professional consultation related to planned home births. In addition, both family physicians and obstetricians reported discomfort with discussing home birth with their patients. A significant proportion of family physicians and obstetricians would have liked to attend a home birth as part of their education. the amount and type of education and exposure to planned home birth practice among maternity care providers were associated with attitudes towards home birth, comfort with discussing birth place options with women, and beliefs about safety. Barriers to home birth practice across professions were both logistical and philosophical. formal mechanisms for midwifery and medical education programs to increase exposure to the theory and practice of planned home birth may facilitate evidence based informed choice of birth place, and increase comfort with integration of care across birth settings. An increased focus among learners and clinicians on reliable methods for assessing the quality of the evidence about birth place and maternal-newborn outcomes may be beneficial. Copyright © 2012 Elsevier Ltd. All rights reserved.
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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 informed by the experiences of the United States and United Kingdom and for the most part there exists a parallel between the international experience and the Australian experience of nurse practitioners.This review will focus on orthopaedic nurse practitioners in an international context. However the local context of the primary reviewer which informs this review is Australian. Australia has mirrored the trends around nurse practitioner practice found elsewhere. In the last 20 years (post implementation of the 1986 Australian nursing career structure), the debate around advanced nursing practice and nurse practitioners, in an Australian context, has developed. The inaugural 'legal & policy' nurse practitioner framework was developed in New South Wales (NSW) in 1998, with the first Australian nurse practitioner authorised to practise in NSW in 2000. It is posited that evaluation of emerging roles began to be seen in the research literature from 1990 onwards. In response to a need for creative workforce re-engineering and against a context of limited health resources, nurse practitioners in Australia over the last 20 years have emerged as an alternative model of health care delivery. For the last 10 years there has been a proliferation of influential 'reports' written by nurse researchers, generated to review the progress of Australia's nurse practitioners, commissioned by the health departments of respective state governments and other service planners to guide health workforce planning.In a national context the Australian Nursing & Midwifery Council (ANMC) as the peak national nursing body, defines a nurse practitioner as a Registered Nurse (RN) who is educated and authorised to practice autonomously and collaboratively in an advanced and extended clinical role. The ANMC Competency Standards for the Nurse Practitioner encompass three generic standards which are further defined by nine competencies. The competency standards provide a framework for practice and licensure of nurse practitioners in Australia. In order for the nurse practitioner to be endorsed by the Australian Health Practitioner Regulation Agency (AHPRA) to practise as a nurse practitioner they must have met the competency standards and be endorsed to practise by the Nursing and Midwifery Board of Australia (NMBA) as a nurse practitioner under section 95 of the National Law. The nurse practitioner's endorsement in Australia is contextualised by their scope of practice, as is the case internationally.At September 2011, 450 endorsed nurse practitioners were nationally registered with AHPRA; 54 of these were endorsed to practise in South Australia. The first orthopaedic nurse practitioner was authorised in South Australia in 2005. To date there are eight endorsed orthopaedic nurse practitioners in Australia authorised to practise in a diverse range of orthopaedic settings that include acute care, community care, outpatient settings, rehabilitation, private practice and rural settings. The current scope of practice for Australian orthopaedic nurse practitioners spans the clinical range of trauma, arthroplasty, fragility fracture and ortho-geriatric care, surgical care: spinal/neurology and paediatric care. Orthopaedic nurse practitioners work within contemporary orthopaedic/musculoskeletal client disease models. These clinical models of care articulate the health care needs of populations living with musculoskeletal conditions, disorders and disease. Osteoarthritis and osteoporosis are 'highly prevalent long term [musculoskeletal] conditions known to predominantly affect the elderly and comprise the most common cause of disability in Australia'. Musculoskeletal trauma or injury as a result of an 'external force' such as vehicle accident, a fall, industrial or home environment accident or assault comprises a leading cause of hospital admission that requires orthopaedic management and care.There is some evidence to suggest that orthopaedic nursing is a 'specialty under threat' as orthopaedic-specific hospital wards are increasingly being absorbed into general surgical units; a trend observed in the United States in the mid 1990's in response to the American experience of 'downsizing' orthopaedic nursing services. Despite a limited evidence base, early citations with specific reference to orthopaedic nurses in the American context in particular started to populate the literature on or around this time. Several proponents of the specialty began to refer to a core nursing skill set that was 'highly orthopaedic' when describing 'specialist' orthopaedic nursing practice. More recently commentators point to differences in certain variables when patients are 'outlied' or managed in a non-orthopaedic ward environment by non-orthopaedic nurses.Despite 'in-principle' support for expanded scopes of practice for various health practitioner roles, the observation exists from within the specialty of orthopaedic nursing that progress in establishing the orthopaedic nurse practitioner role for this group of specialist clinicians has been slow and their journey has not been without challenge. The majority of orthopaedic nurse practitioners in Australia at least have emerged from extended practice roles similar to the generally well established experience of other nurse practitioners emerging from their own practice interest. The orthopaedic nurse practitioner is considered a 'pioneer' as they fill a 'gap' in clinical need and develop an orthopaedic nurse practitioner role. An emerging evidence base suggests that barriers such as a lack of role understanding, lack of 'team' support and a lack of resources at a system, organisational and practice level, constrain nurse practitioner practice and integration of the role into practice settings. Nurse practitioners function in an advanced clinical role. Some attempts have been made at quantifying the work of nurse practitioners. For example, Gardner et al in 2010 divided the work of nurse practitioners into three domains of practice: direct care, indirect care and service-related activities. Within these domains nurse practitioners perform a variety of tasks. Reporting on such activity by way of performance outcome measures is a variable practice amongst nurse practitioners however numbers seen/occasions of service, waiting times, effectiveness of interventions, referral patterns, patient/client satisfaction, clinical quality of care indicators are typical of the data maintained and reported by nurse practitioners to either justify their existence, embed their role service wide and/or contribute to workforce planning. Furthermore the orthopaedic nurse practitioner must effectively define and characterise the patient population to which they deliver care within the nurse practitioner's own scope of practice, ultimately to form an 'indicator' for the nurse practitioner role.The international literature pertaining to nurse practitioners or advanced practice nurses resonates with the many challenges faced by these nurses when it comes to role development and role implementation. Furthermore there is a body of evidence that validates the effectiveness of these roles. This becomes increasingly important in a context of building the health workforce of the future: a redefined workforce that must ensure adequate numbers of suitably qualified health workers who provide 'care the first time and every time'.A search of the Joanna Briggs Institute (JBI) Library of Systematic Reviews, Cochrane Library, PubMed and CINAHL has shown there are no existing or systematic reviews underway on this topic. The JBI undertook a systematic review commissioned by the Department of Health South Australia on Advanced Practice in Nursing and Midwifery and recommended a framework for advanced practice in a report released in early 2008. The framework defined advanced practice, levels of advanced practice, scope of practice, credentialing, education, preparation and regulation of advanced practitioners. The search identified a published systematic review protocol in the JBI Library for a qualitative systematic review by Ramis looking broadly at the experience of advanced practice nurses working in acute settings. The JBI Library of Systematic Reviews also contains a systematic review examining the effectiveness of nurse practitioners in residential aged care. Whilst these publications provide valuable context to this review neither specifically examines the clinical practice of orthopaedic nurse practitioners.Similarly a search of the Cochrane Library revealed a review on the topic of substitution of doctors by nurses in primary care. The focus of this particular intervention review was neither specific to nurse practitioners nor the acute care setting, but the topic of 'doctor substitution' complements the practice of nurse practitioners and may be a consideration in this review. Doctor substitution or care provided by a nurse other than an orthopaedic nurse practitioner is a natural comparator when examining the role and practice of orthopaedic nurse practitioners.Given the breadth of this topic a comprehensive approach has been chosen to systematically review the evidence as it relates to orthopaedic nurse practitioner role and practice.
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-05-31
... Patent Attorneys and Agents Admitted to Practice Before the United States Patent and Trademark Office... burden, invites the general public and other Federal agencies to take this opportunity to comment on the... William Griffin, Staff Attorney, Office of Enrollment and Discipline, United States Patent and Trademark...
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Ethical environment: reports of practicing nurses.
McDaniel, C
1998-06-01
Reports from the development of the Ethics Environment Questionnaire identify three critical features for ethical environments in health care settings of registered nurses. They are the ability of nurses to engage in discussions about patient care, support from administrators, and the development of policies-procedures that support their practice. Implications for clinical practicing nurses are explored.
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37 CFR 11.5 - Register of attorneys and agents in patent matters; practice before the Office.
Code of Federal Regulations, 2013 CFR
2013-07-01
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37 CFR 11.5 - Register of attorneys and agents in patent matters; practice before the Office.
Code of Federal Regulations, 2012 CFR
2012-07-01
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37 CFR 11.5 - Register of attorneys and agents in patent matters; practice before the Office.
Code of Federal Regulations, 2014 CFR
2014-07-01
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Barriers and Facilitators in Pain Management in Long-Term Care Institutions: A Qualitative Study
ERIC Educational Resources Information Center
Fox, Patricia; Solomon, Patricia; Raina, Parminder; Jadad, Alejandro R.
2004-01-01
The purpose of this study was to identify barriers to the management of pain in long-term care institutions. Formal caregivers practising in four long-term care institutions in Hamilton, Ontario participated in eight focus groups. Participants included 6 physicians, 19 registered nurses, 8 registered practical nurses, 13 health care aides and 8…
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Nurses' experiences working with nursing students in a hospital: a phenomenological enquiry.
Lapeña-Moñux, Yolanda Raquel; Cibanal-Juan, Luis; Orts-Cortés, M Isabel; Maciá-Soler, M Loreto; Palacios-Ceña, Domingo
2016-01-01
this paper explores the experiences of registered nurses working with Spanish nursing students within the hospital. a qualitative phenomenological approach was followed. Purposeful sampling was employed. Twenty-one registered nurses, from a public hospital located in Spain, were included in the study. Data were collected by means of unstructured and semi-structured interviews and were analysed using Giorgi's proposal. The Consolidated Criteria for Reporting Qualitative Research were followed. three main themes described the experience of registered nurses: "The nurse's relationship with nursing students"; most nurses emphasized the importance of the first contact with students and they considered students' attitude to be key. "Defining the role of the student in clinical practice"; it is necessary to unify the nurse's role and interventions to avoid misleading students and establish priorities in clinical practice. "Building bridges between clinical settings and the University"; the need to establish a common ground and connection between the university and hospital clinical settings was emphasized. Nurses felt that the training program should also be designed by the clinical settings themselves. understanding the meaning of nursing students with registered nurses might gain a deeper insight into their expectations.
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Barten, Di-Janne J A; Swinkels, Llse C S; Dorsman, Sara A; Dekker, Joost; Veenhof, Cindy; de Bakker, Dinny H
2015-06-27
A multidisciplinary, guideline-based Stepped-Care-Strategy (SCS), has recently been developed to improve the management of hip and knee osteoarthritis (OA). To date, it is unknown to what extent current Dutch OA care is consistent with the SCS, both with respect to the content of care as well as the sequence of care. Furthermore, there is a lack of clarity regarding the role of different health care providers in the performance of OA care according to the SCS. Therefore, the main purpose of this study is to describe the content of primary care in patients with hip/knee OA, including the compliance to the SCS and taking into account the introduction of patient self-referral to physical therapy. Data were used from NIVEL Primary Care Database. In total, 12.118 patients with hip/knee OA who visited their GP or physical therapist were selected. Descriptive statistics were used to compare the content of care in GP-referred and self-referred patients to physical therapy. Content of care performed by GPs mostly concerned consultations, followed by NSAID prescriptions and referrals to secondary care. Both prescriptions of acetaminophen and referrals to physical therapy respectively dietary therapy were rarely mentioned. Nevertheless, still 65% of the patients in physical therapy practice were referred by their GP. Compared to GP-referred patients, self-referred patients more often presented recurrent complaints and were treated less often by activity-related exercise therapy. Education was rarely registered as singular intervention, neither in GP-referred nor in self-referred patients. In accordance with the SCS, less advanced interventions are more often applied than more advanced interventions. To optimize the adherence to the SCS, GPs could reconsider the frequent use of NSAIDs instead of analgesics and the low referral rate to allied health care. Self-referral to physical therapy partially distorts both the low referral rate in general practice and the low application rate of education as singular intervention in physical therapy practice. Further research is recommended to evaluate the effects of task-shifting in OA care, taking into account the content of the SCS.
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5 CFR 470.307 - Notification responsibilities.
Code of Federal Regulations, 2011 CFR
2011-01-01
.... (b) OPM shall: (1) Notify each House of the Congress 180 days in advance of the beginning of each project; and (2) Publish each tentatively approved project plan as a notice in the Federal Register. (c...
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Harbman, Patricia; Bryant-Lukosius, Denise; Martin-Misener, Ruth; Carter, Nancy; Covell, Christine L; Donald, Faith; Gibbins, Sharyn; Kilpatrick, Kelley; McKinlay, James; Rawson, Krista; Sherifali, Diana; Tranmer, Joan; Valaitis, Ruta
2017-04-01
Clinical practice is the primary focus of advanced practice nursing (APN) roles. However, with unprecedented needs for health care reform and quality improvement (QI), health care administrators are seeking new ways to utilize all dimensions of APN expertise, especially related to research and evidence-based practice. International studies reveal research as the most underdeveloped and underutilized aspect of these roles. To improve patient care by strengthening the capacity of advanced practice nurses to integrate research and evidence-based practice activities into their day-to-day practice. An academic-practice partnership was created among hospital-based advanced practice nurses, nurse administrators, and APN researchers to create an innovative approach to educate and mentor advanced practice nurses in conducting point-of-care research, QI, or evidence-based practice projects to improve patient, provider, and/or system outcomes. A practice-based research course was delivered to 2 cohorts of advanced practice nurses using a range of teaching strategies including 1-to-1 academic mentorship. All participants completed self-report surveys before and after course delivery. Through participation in this initiative, advanced practice nurses enhanced their knowledge, skills, and confidence in the design, implementation, and/or evaluation of research, QI, and evidence-based practice activities. Evaluation of this initiative provides evidence of the acceptability and feasibility of academic-practice partnerships to educate and mentor point-of-care providers on how to lead, implement, and integrate research, QI and evidence-based activities into their practices. © 2016 John Wiley & Sons, Ltd.
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Predictive value of stroke discharge diagnoses in the Danish National Patient Register.
Lühdorf, Pernille; Overvad, Kim; Schmidt, Erik B; Johnsen, Søren P; Bach, Flemming W
2017-08-01
To determine the positive predictive values for stroke discharge diagnoses, including subarachnoidal haemorrhage, intracerebral haemorrhage and cerebral infarction in the Danish National Patient Register. Participants in the Danish cohort study Diet, Cancer and Health with a stroke discharge diagnosis in the National Patient Register between 1993 and 2009 were identified and their medical records were retrieved for validation of the diagnoses. A total of 3326 records of possible cases of stroke were reviewed. The overall positive predictive value for stroke was 69.3% (95% confidence interval (CI) 67.8-70.9%). The predictive values differed according to hospital characteristics, with the highest predictive value of 87.8% (95% CI 85.5-90.1%) found in departments of neurology and the lowest predictive value of 43.0% (95% CI 37.6-48.5%) found in outpatient clinics. The overall stroke diagnosis in the Danish National Patient Register had a limited predictive value. We therefore recommend the critical use of non-validated register data for research on stroke. The possibility of optimising the predictive values based on more advanced algorithms should be considered.
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Smith, Tony; Harris, Jillian; Woznitza, Nick; Maresse, Sharon; Sale, Charlotte
2015-09-01
Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as 'a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care'. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiences in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities.
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Transcultural nursing practice described by registered nurses and baccalaureate nursing students.
Baldonado, A; Beymer, P L; Barnes, K; Starsiak, D; Nemivant, E B; Anonas-Ternate, A
1998-01-01
Using Leininger's Theory of Culture Care Diversity and Universality as a framework, this research examined transcultural practices of nurses and students. A survey was administered to a convenience sample of registered nurses and senior baccalaureate students with 767 usable questionnaires returned. Neither group expressed confidence in their ability to care for culturally-diverse patients. Registered nurses (RNs) reported assessing cultural factors and modifying practices more frequently than did students. Respondents reported their beliefs about transcultural nursing were influenced by being with people of other cultures, their own personal values, and education. Analysis of the open-ended questions revealed two major themes. First, both nurses and students perceive an overwhelming need for transcultural nursing. Second, nurses and students respond to cultural challenges by modifying their care. Modifications are based on language and communication, pain perception and relief, religious and spiritual dimensions, gender and family roles, and other values. Results suggest that nurses and students are aware of culture, recognize that culture influences the care they provide, and modify their health teaching and nursing care based on culture. The use of a conceptual framework to help make modifications in care was not mentioned.
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Registered nurses' clinical reasoning skills and reasoning process: A think-aloud study.
Lee, JuHee; Lee, Young Joo; Bae, JuYeon; Seo, Minjeong
2016-11-01
As complex chronic diseases are increasing, nurses' prompt and accurate clinical reasoning skills are essential. However, little is known about the reasoning skills of registered nurses. This study aimed to determine how registered nurses use their clinical reasoning skills and to identify how the reasoning process proceeds in the complex clinical situation of hospital setting. A qualitative exploratory design was used with a think-aloud method. A total of 13 registered nurses (mean years of experience=11.4) participated in the study, solving an ill-structured clinical problem based on complex chronic patients cases in a hospital setting. Data were analyzed using deductive content analysis. Findings showed that the registered nurses used a variety of clinical reasoning skills. The most commonly used skill was 'checking accuracy and reliability.' The reasoning process of registered nurses covered assessment, analysis, diagnosis, planning/implementation, and evaluation phase. It is critical that registered nurses apply appropriate clinical reasoning skills in complex clinical practice. The main focus of registered nurses' reasoning in this study was assessing a patient's health problem, and their reasoning process was cyclic, rather than linear. There is a need for educational strategy development to enhance registered nurses' competency in determining appropriate interventions in a timely and accurate fashion. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Lin, Hsien-Cheng
2017-02-01
Nursing information systems can enhance nursing practice and the efficiency and quality of administrative affairs within the nursing department and thus have been widely considered for implementation. Close alignment of human-computer interaction can advance optimal clinical performance with the use of information systems. However, a lack of introduction of the concept of alignment between users' perceptions and technological functionality has caused dissatisfaction, as shown in the existing literature. This study provides insight into the alignment between nurses' perceptions and how technological functionality affects their satisfaction with Nursing Information System use through a reductionist perspective of alignment. This cross-sectional study collected data from 531 registered nurses in Taiwan. The results indicated that "perceived usefulness in system quality alignment," "perceived usefulness in information quality alignment," "perceived ease of use in system quality alignment," "perceived ease of use in information quality alignment," and "perceived ease of use in service quality alignment" have significantly affected nurses' satisfaction with Nursing Information System use. However, "perceived usefulness in service quality alignment" had no significant effect on nurses' satisfaction. This study also provides some meaningful implications for theoretical and practical aspects of design.
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Design and methodology of the Geo-social Analysis of Physicians' settlement (GAP-Study) in Germany.
Groneberg, David A; Boll, Michael; Bauer, Jan
2016-01-01
Unequally distributed disease burdens within populations are well-known and occur worldwide. They are depending on residents' social status and/or ethnic background. Country-specific health care systems - especially the coverage and distribution of health care providers - are both a potential cause as well as an important solution for health inequalities. Registers are built of all accredited physicians and psychotherapists within the outpatient care system in German metropolises by utilizing the database of the Associations of Statutory Health Insurance Physicians. The physicians' practice neighborhood will be analyzed under socioeconomic and demographic perspectives. Therefore, official city districts' statistics will be assigned to the physicians and psychotherapists according to their practice location. Averages of neighborhood indicators will be calculated for each specialty. Moreover, advanced studies will inspect differences by physicians' gender or practice type. Geo-spatial analyses of the intra-city practices distribution will complete the settlement characteristics of physicians and psychotherapists within the outpatient care system in German metropolises. The project "Geo-social Analysis of Physicians' settlement" (GAP) is designed to elucidate gaps of physician coverage within the outpatient care system, dependent on neighborhood residents' social status or ethnics in German metropolises. The methodology of the GAP-Study enables the standardized investigation of physicians' settlement behavior in German metropolises and their inter-city comparisons. The identification of potential gaps within the physicians' coverage should facilitate the delineation of approaches for solving health care inequality problems.
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[Advance directives. Representatives' opinions].
Busquets I Font, J M; Hernando Robles, P; Font I Canals, R; Diestre Ortin, G; Quintana, S
The use and usefulness of Advance Directives has led to a lot of controversy about their validity and effectiveness. Those areas are unexplored in our country from the perspective of representatives. To determine the opinion of the representatives appointed in a registered Statement of Advance Directives (SAD) on the use of this document. Telephone survey of representatives of 146 already dead people and who, since February 2012, had registered a SAD document. More the two-thirds (98) of respondents recalled that the SAD was consulted, with 86 (58.9%) saying that their opinion as representative was consulted, and 120 (82.1%) believe that the patient's will was respected. Of those interviewed, 102 (69.9%) believe that patients who had previously planned their care using a SAD had a good death, with 33 (22.4%) saying it could have been better, and 10 (6.9%) believe they suffered greatly. The SAD were mostly respected and consulted, and possibly this is related to the fact that most of the representatives declare that the death of those they represented was perceived as comfortable. It would be desirable to conduct further studies addressed at health personnel in order to know their perceptions regarding the use of Advance Directives in the process of dying. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.
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Lee, Nam-Ju; Cho, Eunhee; Bakken, Suzanne
2010-03-01
The purposes of this study were to develop a taxonomy for detection of errors related to hypertension management and to apply the taxonomy to retrospectively analyze the documentation of nurses in Advanced Practice Nurse (APN) training. We developed the Hypertension Diagnosis and Management Error Taxonomy and applied it in a sample of adult patient encounters (N = 15,862) that were documented in a personal digital assistant-based clinical log by registered nurses in APN training. We used Standard Query Language queries to retrieve hypertension-related data from the central database. The data were summarized using descriptive statistics. Blood pressure was documented in 77.5% (n = 12,297) of encounters; 21% had high blood pressure values. Missed diagnosis, incomplete diagnosis and misdiagnosis rates were 63.7%, 6.8% and 7.5% respectively. In terms of treatment, the omission rates were 17.9% for essential medications and 69.9% for essential patient teaching. Contraindicated anti-hypertensive medications were documented in 12% of encounters with co-occurring diagnoses of hypertension and asthma. The Hypertension Diagnosis and Management Error Taxonomy was useful for identifying errors based on documentation in a clinical log. The results provide an initial understanding of the nature of errors associated with hypertension diagnosis and management of nurses in APN training. The information gained from this study can contribute to educational interventions that promote APN competencies in identification and management of hypertension as well as overall patient safety and informatics competencies. Copyright © 2010 Korean Society of Nursing Science. Published by . All rights reserved.
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Smith, Tony; Harris, Jillian; Woznitza, Nick; Maresse, Sharon; Sale, Charlotte
2015-01-01
Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as ‘a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care’. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiences in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities. PMID:26451243
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Smith, Tony; Harris, Jillian; Woznitza, Nick
Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as ‘a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care’. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiencesmore » in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities.« less
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Primary Nursing: A Call for Clarity, Empowerment, and Accountability.
Ruch, Shirley
2018-04-01
Registered nurses' (RNs') unique educational preparation, skills, scope of practice, and relationship with those we serve must be articulated and honored. The Primary Nursing care delivery model gives practical, functional life to the relationship of professional trust between RNs and their patients.
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Kobleder, Andrea; Mayer, Hanna; Senn, Beate
2017-02-01
To explore the experiences of women with vulvar neoplasia with care delivered by an Advanced Practice Nurse. Women with vulvar neoplasia suffer from a high number of symptoms and report a lack of information and support by health care professionals. Further, talking about their disease, which is still a social taboo, is difficult for them. From approaches for other patients, it can be suggested that support from an Advanced Practice Nurse can be helpful. For Advanced Practice Nurse development, implementation and evaluation, it is important to assess patients' perceptions. But so far, little is known about how patients with vulvar neoplasia experience support of an Advanced Practice Nurse. A qualitative interview study was chosen to gain understanding of the experience of women with vulvar neoplasia who received care delivered by an Advanced Practice Nurse. Narrative interviews were conducted with a purposive sample of 13 women with vulvar neoplasia after they received care from an Advanced Practice Nurse for six months. Thematic analysis was used to analyse the data from the interviews. Four main themes could be identified: a trusting relationship; accessibility; feeling safe and secure; and feeling someone is there for you. Women felt more secure and less alone in the experience of their illness through having the possibility of contacting an Advanced Practice Nurse and getting sufficient information and psychosocial support. Women with vulvar neoplasia experienced care delivered by an Advanced Practice Nurse as 'feeling someone is there for you'. Due to the localisation of the disease and the associated social taboo, psychosocial support from the Advanced Practice Nurse beyond months after surgery was very important for them. Addressing psychosocial needs in caring for women with vulvar neoplasia must be given greater attention in clinical practice. Further, continuous nursing support delivered by an Advanced Practice Nurse beyond the acute treatment phase can be recommended. © 2016 John Wiley & Sons Ltd.
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De Geest, Sabina; Moons, Philip; Callens, Betty; Gut, Chris; Lindpaintner, Lyn; Spirig, Rebecca
2008-11-01
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.
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da Costa Carbogim, Fábio; de Oliveira, Larissa Bertacchini; de Campos, Guilherme Gushiken; de Araújo Nunes, Esther Alves; Alves, Katiusse Rezende; de Araújo Püschel, Vilanice Alves
2017-06-01
The aim of this review is to identify and synthesize the best available evidence on the effectiveness of teaching strategies aimed at improving critical thinking (CT) in registered nurses who provide direct patient care. Specifically, the research question is: What are the best teaching strategies to improve CT skills in registered nurses who provide direct patient care?
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ERIC Educational Resources Information Center
Coffey, Sue; Lindsay, Gail M.; Cochrane, Marianne; Cummings, Katherine; Macdonald, Karen; Mairs, Sandra; Sproul, Susan; Bouchard, Shelley; Lulat, Zainab; Salamat, Nadia; Bell, Ronald
2016-01-01
Background: Education of nurses from a diploma to a degree is a global phenomenon. However, bridging is often seen as a "backdoor" route to becoming a Registered Nurse and very little evaluation data exists to challenge this notion. Objectives: This research project was undertaken to explore student characteristics, academic performance,…
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ERIC Educational Resources Information Center
Deveau, Roy; McGill, Peter
2016-01-01
Background: The front-line management role in services for people with intellectual disabilities remains rather under-researched. The aim of this study was to examine the experiences of registered managers in services for adults with intellectual disability who exhibit challenging behaviour. Method: Interviews, primarily focussed upon staff…
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ERIC Educational Resources Information Center
Smeyers, Paul
2012-01-01
This article presents the author's response to Paul Standish's "Registers of the Religious". Addressing what he calls the "global", Paul Standish starts from MacIntyre's observation that people live in a world characterized by a vocabulary of value whose purchase on life is no longer authentically experienced: "MacIntyre's diagnosis of the…
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A contemporary examination of workplace learning culture: an ethnomethodology study.
Newton, Jennifer M; Henderson, Amanda; Jolly, Brian; Greaves, Judith
2015-01-01
Creating and maintaining a sustainable workforce is currently an international concern. Extensive literature suggest that students and staff need to be 'engaged', that is they need to interact with the health team if they are to maximise learning opportunities. Despite many studies since the 1970s into what creates a 'good' learning environment, ongoing issues continue to challenge healthcare organisations and educators. A 'good' learning environment has been an intangible element for many professions as learning is hindered by the complexity of practice and by limitations on practitioners' time available to assist and guide novices. This study sought to explore the nature of the learning interactions and experiences in clinical nursing practice that enhance a 'good' workplace learning culture for both nursing students and qualified nurses. An ethnomethodology study. A range of clinical settings in Victoria and Queensland, Australia. Students and registered nurses (n=95). Fieldwork observations were carried out on student nurses and registered nurses, followed by an individual interview with each participant. An iterative approach to analysis was undertaken; field notes of observations were reviewed, interviews transcribed verbatim and entered into NVivo10. Major themes were then extracted. Three central themes: learning by doing, navigating through communication, and 'entrustability', emerged providing insights into common practices potentially enhancing or detracting from learning in the workplace. Students' and registered nurses' learning is constrained by a myriad of interactions and embedded workplace practices, which can either enhance the individual's opportunities for learning or detract from the richness of affordances that healthcare workplace settings have to offer. Until the culture/or routine practices of the healthcare workplace are challenged, the trust and meaningful communication essential to learning in practice, will be achievable only serendipitously. Copyright © 2014 Elsevier Ltd. All rights reserved.
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Microbial biopesticides for invertebrate pests and their markets in the United States.
Arthurs, Steven; Dara, Surendra K
2018-01-31
Microbial pesticides based on bacteria, fungi and viruses or their bioactive compounds have long been developed as alternatives for synthetic pesticides to control invertebrate pests. However, concern for environmental and human health from excessive reliance on chemical pesticides, changes in residue standards, and increased demand for organically grown produce has contributed to a considerable growth in their use in recent years. There are currently 356 registered biopesticide active ingredients in the U.S., including 57 species and/or strains of microbes or their derivatives, labelled for use against pestiferous insects, mites and nematodes. Strains of Bacillus thuringiensis for Lepidoptera remain the most popular products, but newer bacterial strains and their metabolites have been developed against a wider range of arthropods for use on fruit, vegetable and ornamental crops. Currently, ten fungal species/strains are registered against thrips, whiteflies, aphids, or other sucking pests and plant parasitic nematodes in greenhouse, nursery and field crops, while five nucleopolyhedroviruses and three granuloviruses are registered for Lepidoptera in field and greenhouse grown vegetables and ornamentals, tree fruit and nuts, forestry, and stored products. Many of these products are organic listed and most have 4 h or less reentry and no pre-harvest restrictions. Investment by multinational companies, advances in screening, industrial fermentation and storage of new microorganisms, are increasing the market share for microbials. Here, we summarize the market for microbial-based pesticides labelled for invertebrates in the U.S. We cover current uses and recent advances that further advance their use in additional markets in the coming decades. Copyright © 2018 Elsevier Inc. All rights reserved.
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Center of Excellence to build nursing scholarship and improve health care in Italy.
Rocco, Gennaro; Affonso, Dyanne; Mayberry, Linda; Sasso, Loredana; Stievano, Alessandro; Alvaro, Rosaria
2015-03-01
This article profiles the establishment and initial phase (2010-2014) of a Center of Excellence (CoE) as an instrument to strengthen nursing scholarship and improve health care in Italy. This CoE is unique as a non-university-based center. The National Regulatory Board of Registered Nurses, Health Visitors, and Pediatric Nurses (IPASVI) designated substantial administrative and funding support to the CoE for advancing nursing education, clinical practice, research development, and research training. Boyer's Model of Scholarship underpinned the CoE's conceptual framework, and its operational infrastructure was adapted from the U.S. National Institutes of Health P20 program award mechanism. Diverse methods included sponsoring research studies by nurse-led teams, research training courses, nursing education longitudinal studies, evidence-based practice training, and related pilot studies. Multiple collaborative projects were conducted via the CoE in conjunction with the successful launch of an expansive digital library and communication system accessible to nurses. The introduction of English proficiency courses was also a unique contribution. The CoE concept is a potential instrument to strengthen nursing scholarship in Italy with potential scalability considerations to other global settings. An overlapping focus on research, education, and practice under the umbrella of nursing scholarship within a CoE while engaging all levels of nursing is important to impact healthcare changes. © 2015 Sigma Theta Tau International.
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An ethnographic study of nurses' experience with nursing research and its integration in practice.
Dupin, Cécile Marie; Borglin, Gunilla; Debout, Christophe; Rothan-Tondeur, Monique
2014-09-01
To report from a study aimed at illuminating how French Registered Nurses experience and engage in nursing research in clinical practice. Nursing research in France is mainly conducted by nurses working at clinical research units rather than by dedicated nurse researchers. Education, i.e. advanced degrees, in the field of nursing research is still in its infancy and not yet consistent with the international context. Outside France, the general perception is that nursing research is a unified part of professional nursing. Consequently, in-depth knowledge about how nurses in a French clinical context might experience and engage in nursing research is still lacking. The design of this study was influenced by an ethnographic approach as described by the French anthropologists Beaud and Weber. Data, participatory observations, field notes and interviews (n = 6) were collected in a teaching hospital between April-August 2012. The field consisted of a wound-care unit and clinical research units. Collected data were analysed based on Beaud and Weber's description of analysis. Three beliefs were identified: being a unified part of a research team, being an integral part of 'crosswise - across' activities and being part of research activities. Commitment to nursing research was strengthened by patient-related issues. Based on this context, nursing research would likely benefit from the support of a naturalized reciprocity between clinical practice and research. © 2014 John Wiley & Sons Ltd.
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Schwartz, Denise Baird; Posthauer, Mary Ellen; O'Sullivan Maillet, Julie
2013-07-01
It is the position of the Academy of Nutrition and Dietetics that individuals have the right to request or refuse nutrition and hydration as medical treatment. Registered dietitians should work collaboratively as part of an interprofessional team to make recommendations on providing, withdrawing, or withholding nutrition and hydration in individual cases and serve as active members of institutional ethics committees. This practice paper provides a proactive, integrated, systematic process to implement the Academy's position. The position and practice papers should be used together to address the history and supporting information of ethical and legal issues of feeding and hydration identified by the Academy. Elements of collaborative ethical deliberation are provided for pediatrics and adults and in different conditions. The process of ethical deliberation is presented with the roles and responsibilities of the registered dietitian and the dietetic technician, registered. Understanding the importance and applying concepts dealing with cultural values and religious diversity is necessary to integrate clinical ethics into nutrition care. Incorporating screening for quality-of-life goals is essential before implementing the Nutrition Care Process and improving health literacy with individual interactions. Developing institution-specific policies and procedures is necessary to accelerate the practice change with artificial nutrition, clinical ethics, and quality improvement projects to determine best practice. This paper supports the "Position of the Academy of Nutrition and Dietetics: Ethical and Legal Issues of Feeding and Hydration" published in the June 2013 issue of the Journal of the Academy of Nutrition and Dietetics. Copyright © 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
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Qualitative evaluation of a delirium prevention and management programme.
Kang, Yun; Moyle, Wendy; Cooke, Marie; O'Dwyer, Siobhan
2017-12-01
To evaluate the effect of an educational programme on registered nurses' knowledge and attitude in delirium care for hospitalised older adults with and without dementia, and to examine the strengths and weaknesses of the programme from the participants' perspectives. Providing care for patients with delirium or delirium superimposed on dementia often poses particular challenges such as distinguishing between delirium and dementia for nurses. A descriptive qualitative study was used. A delirium educational programme based on adult learning principles was provided to the participants. A purposive sample of 12 registered nurses who participated in the educational programme undertook individual interviews. Content analysis was conducted to identify unique and common themes indicative of registered nurse perceptions. Registered nurses reported improved knowledge and attitude towards the delirium care of hospitalised older adults with dementia and at risk of delirium. Active learning in the programme facilitated the participants' learning processes. This active learning included deep learning, collaborative learning and application of new concepts to practice. Most participants felt that they had inadequate management support to apply their new knowledge in practice, and this included staff resource and policies and protocols. The qualitative findings indicated that the delirium education had benefited the participants by improving their knowledge and attitude towards the delirium care of hospitalised older adults with dementia and at risk of delirium. This study provided an understanding of the strengths and limitations of the educational programme delivered to registered nurses in South Korea. Registered nurses in South Korea should need not only appropriate education, but also adequate resources, policies and guidelines as well as support from managers and from all other healthcare professionals. © 2017 John Wiley & Sons Ltd.
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Impact of ancestry categorisations on residential segregation measures using Swedish register data.
Jarvis, Benjamin; Kawalerowicz, Juta; Valdez, Sarah
2017-07-01
Country-of-birth data contained in registers are often aggregated to create broad ancestry group categories. We examine how measures of residential segregation vary according to levels of aggregation. We use Swedish register data to calculate pairwise dissimilarity indices from 1990 to 2012 for ancestry groups defined at four nested levels of aggregation: (1) micro-groups containing 50 categories, (2) meso-groups containing 16 categories, (3) macro-groups containing six categories and (4) a broad Western/non-Western binary. We find variation in segregation levels between ancestry groups that is obscured by data aggregation. This study demonstrates that the practice of aggregating country-of-birth statistics in register data can hinder the ability to identify highly segregated groups and therefore design effective policy to remedy both intergroup and intergenerational inequalities.
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Nursing practice environment and registered nurses' job satisfaction in nursing homes.
Choi, JiSun; Flynn, Linda; Aiken, Linda H
2012-08-01
Recruiting and retaining registered nurses (RNs) in nursing homes is problematic, and little research is available to guide efforts to make nursing homes a more attractive practice environment for RNs. The purpose of this study was to examine relationships between aspects of the nursing practice environment and job satisfaction among RNs in nursing homes. The sample included 863 RNs working as staff RNs in 282 skilled nursing facilities in New Jersey. Two-level hierarchical linear modeling was used to account for the RNs nested by nursing homes. Controlling for individual and nursing home characteristics, staff RNs' participation in facility affairs, supportive manager, and resource adequacy were positively associated with RNs' job satisfaction. Ownership status was significantly related to job satisfaction; RNs working in for-profit nursing homes were less satisfied. A supportive practice environment is significantly associated with higher job satisfaction among RNs working in nursing homes. Unlike other nursing home characteristics, specific dimensions of the nursing practice environment can be modified through administrative actions to enhance RN job satisfaction.
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van der Plas, Annicka Gm; Pasman, H Roeline W; Schweitzer, Bart; Onwuteaka-Philipsen, Bregje D
2018-05-01
In PaTz (PAlliatieve Thuis Zorg, palliative care at home), modelled after the Gold Standards Framework, GPs and community nurses meet on a regular basis to identify patients with palliative care needs (the PaTz register), and to discuss care for these patients. To study the effects of the implementation of PaTz, and provide additional analyses on two important elements: the PaTz register and patient discussions. A pre- and post-evaluation among Dutch GPs ( n = 195 before the start of PaTz; n = 166, 1 year after the start of PaTz). The GPs also provided data on recently deceased patients ( n = 460 before the start of PaTz; n = 305 14 months after the start of PaTz). GPs from all 37 PaTz groups filled in questionnaires. Pre- and post-test differences were analysed using multilevel analyses to adjust for PaTz group. Identification of patients with palliative care needs was done systematically for more patients after implementation of PaTz compared with before (54.3% versus 17.6%). After implementation, 64.8% of deceased patients had been included on the PaTz register. For these patients, when compared with patients not included on the PaTz register, preferred place of death was more likely to be known (88.1% of patients not on the register and 97.3% of deceased patients included on the register), GPs were more likely to have considered a possible death sooner (>1 month before death: 53.0% and 80.2%), and conversations on life expectancy, physical complaints, existential issues, and possibilities of care occurred more often (60.8% and 81.3%; 68.6% and 86.1%; 22.5% and 34.2%; 60.8% and 84.0%, respectively). Implementation of PaTz improved systematic identification of palliative care patients within the GP practice. Use of the PaTz register has added value. © British Journal of General Practice 2018.
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Goisis, Alice; Remes, Hanna; Barclay, Kieron; Martikainen, Pekka; Myrskylä, Mikko
2017-01-01
Abstract Advanced maternal age at birth is considered a major risk factor for birth outcomes. It is unclear to what extent this association is confounded by maternal characteristics. To test whether advanced maternal age at birth independently increases the risk of low birth weight (<2,500 g) and preterm birth (<37 weeks’ gestation), we compared between-family models (children born to different mothers at different ages) with within-family models (children born to the same mother at different ages). The latter procedure reduces confounding by unobserved parental characteristics that are shared by siblings. We used Finnish population registers, including 124,098 children born during 1987–2000. When compared with maternal ages 25–29 years in between-family models, maternal ages of 35–39 years and ≥40 years were associated with percentage increases of 1.1 points (95% confidence intervals: 0.8, 1.4) and 2.2 points (95% confidence intervals: 1.4, 2.9), respectively, in the probability of low birth weight. The associations are similar for the risk of preterm delivery. In within-family models, the relationship between advanced maternal age and low birth weight or preterm birth is statistically and substantively negligible. In Finland, advanced maternal age is not independently associated with the risk of low birth weight or preterm delivery among mothers who have had at least 2 live births. PMID:29206985
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"What Are All These Dogs Doing at School?" Using Therapy Dogs to Promote Children's Reading Practice
ERIC Educational Resources Information Center
Jalongo, Mary Renck
2005-01-01
This article discusses how registered therapy dogs can motivate and support children as they practice reading aloud in the company of the dog and with the support of the dog's handler. It also offers practical advice to educators, librarians, administrators, and community members seeking to implement such a program in their communities.
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ERIC Educational Resources Information Center
Bergen Community Coll., Paramus, NJ.
The Associate Degree Nursing Program at Bergen Community College developed and field tested competency-based instructional modules in a program designed to allow licensed practical nurses to qualify to take the certification examination for registered nurses after a year of study. Thirteen licensed practical nurses were enrolled in the first class…
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Shiu, Ann T Y; Lee, Diana T F; Chau, Janita P C
2012-08-01
This article is a report on a study to explore the development of expanding advanced nursing practice in nurse-led clinics in Hong Kong. Nurse-led clinics serviced by advanced practice nurses, a common international practice, have been adopted in Hong Kong since 1990s. Evaluations consistently show that this practice has good clinical outcomes and contributes to containing healthcare cost. However, similar to the international literature, it remains unclear as to what the elements of good advanced nursing practice are, and which directions Hong Kong should adopt for further development of such practice. A multiple-case study design was adopted with six nurse-led clinics representing three specialties as six case studies, and including two clinics each from continence, diabetes and wound care. Each case had four embedded units of analysis. They included non-participant observation of nursing activities (9 days), nurse interviews (N = 6), doctor interviews (N = 6) and client interviews (N = 12). The data were collected in 2009. Within- and cross-case analyses were conducted. The cross-case analysis demonstrated six elements of good advanced nursing practice in nurse-led clinics, and showed a great potential to expand the practice by reshaping four categories of current boundaries, including community-hospital, wellness-illness, public-private and professional-practice boundaries. From these findings, we suggest a model to advance the scope of advanced nursing practice in nurse-led clinics. The six elements may be applied as audit criteria for evaluation of advanced nursing practice in nurse-led clinics, and the proposed model provides directions for expanding such practice in Hong Kong and beyond. © 2011 Blackwell Publishing Ltd.
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Pryor, Julie; Smith, Clair
2002-08-01
This study sought to explore systematically the role of Registered Nurses working in rehabilitation in Australia. Rehabilitation has been identified as an important aspect of health care. However, evidence of a comprehensive investigation of the nurses' role in rehabilitation cannot be found. From Australia, in particular, no research has been published in this area. This study used a qualitative approach by engaging 13 nurses in one-to-one interviews and a further 21 in focus group discussions. Thematic analysis was conducted on the interview and focus group data. Seven domains of practice were identified and are suggested as a framework for the specialty practice of rehabilitation nursing. They capture the 'how' and 'what' of rehabilitation nursing practice. Central to this practice is a rehabilitative approach to patient care, teaching and coaching, and continual assessment. The nurses explained in detail how these aspects of rehabilitation nursing differentiate their practice from that of their acute care colleagues. The rehabilitative approach is one of a variety of approaches to nursing care, but should not be seen as the exclusive domain of rehabilitation nurses. Rehabilitation belongs in every nurse's toolkit.
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Factors associated with personal protection equipment use and hand hygiene among hemodialysis staff.
Shimokura, Gayle; Weber, David J; Miller, William C; Wurtzel, Heather; Alter, Miriam J
2006-04-01
Because exposure to blood by health care workers is frequent during hemodialysis, gloves are required for all contact with patients and their equipment, followed by hand hygiene. In this study, we investigated factors associated with performing these practices as recommended. Staff members from a sample of 45 US hemodialysis facilities were surveyed using an anonymous self-administered questionnaire. Factors independently associated with reporting increased compliance with recommended hand hygiene and glove use practices during patient care were identified with multivariate modeling. Of 605 eligible staff members, 420 (69%) responded: registered nurses, 41%; dialysis technicians, 51%; and licensed practical nurses, 8%. Only 35% reported that dialysis patients were at risk for bloodborne virus infections, and only 36% reported always following recommended hand hygiene and glove use practices. Independent factors associated with more frequent compliance were being a technician (versus a registered nurse) and reporting always doing what was needed to protect themselves from infection. Compliance with recommended hand hygiene and glove use practices by hemodialysis staff was low. The rationale for infection control practices specific to the hemodialysis setting was poorly understood by all staff. Infection control training should be tailored to this setting and should address misconceptions.
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Mock Code: A Code Blue Scenario Requested by and Developed for Registered Nurses
Rideout, Janice; Pritchett-Kelly, Sherry; McDonald, Melissa; Mullins-Richards, Paula; Dubrowski, Adam
2016-01-01
The use of simulation in medical training is quickly becoming more common, with applications in emergency, surgical, and nursing education. Recently, registered nurses working in surgical inpatient units requested a mock code simulation to practice skills, improve knowledge, and build self-confidence in a safe and controlled environment. A simulation scenario using a high-fidelity mannequin was developed and will be discussed herein. PMID:28123919
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The examination of nursing work through a role accountability framework.
White, Deborah E; Jackson, Karen; Besner, Jeanne; Norris, Jill M
2015-07-01
To use work analysis data to describe the amount of time registered nurses (RNs) and health care aides (HCA) spent on key clinical role accountabilities and other work activities. Health care providers are not effectively utilized. To improve their efficiency and effectiveness, it is necessary to understand how nursing providers enact their role accountabilities. Using palm pilot Function Analysis technology, observers recorded the activities of 35 registered nurse and 17 health care aides shifts on a second-by-second basis over 5 days. Work activities were classified using the Nursing Role Effectiveness Model, which conceptualizes nursing practice in terms of clinical role accountabilities. The registered nurses spent a considerable amount of time on bio-medical assessment/surveillance, relatively little time was spent on patient and family psycho-social-cultural-spiritual assessment/surveillance and support. Unlike other work sampling studies, this research project examined nursing work within a role accountability framework; an important first step in the call for the measurement of the impact of nursing care. Changes to how registered nurses and health care aides enact their role will require a clear vision by unit managers and their staff of their role accountabilities, and the gap between ideal and actual practice. © 2013 John Wiley & Sons Ltd.
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-07-08
...)-- Effective Vocational Rehabilitation (VR) Service Delivery Practices; Notice Inviting Applications for New... in the Federal Register on February 1, 2008 (73 FR 6132). The Effective Vocational Rehabilitation (VR... Centers (RRTC) Requirements and Effective Vocational Rehabilitation (VR) Service Delivery Practices. Note...
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Health Professionals' Perceptions of Sexual Assault Management: A Delphi Study
ERIC Educational Resources Information Center
Jancey, Jonine; Meuleners, Lynn; Phillips, Maureen
2011-01-01
Objective: To explore health professionals' perceptions of sexual assault management practices and identify issues related to these practices across Western Australia (WA). Design: A two-round electronic Delphi study was undertaken with health professionals (medical doctors, registered nurses, social workers and managers). Setting: Healthcare…
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Education of advanced practice nurses in Canada.
Martin-Misener, Ruth; Bryant-Lukosius, Denise; Harbman, Patricia; Donald, Faith; Kaasalainen, Sharon; Carter, Nancy; Kilpatrick, Kelley; DiCenso, Alba
2010-12-01
In Canada, education programs for the clinical nurse specialist (CNS) and nurse practitioner (NP) roles began 40 years ago. NP programs are offered in almost all provinces. Education for the CNS role has occurred through graduate nursing programs generically defined as providing preparation for advanced nursing practice. For this paper, we drew on pertinent sections of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing to describe the following: (1) history of advanced practice nursing education in Canada, (2) current status of advanced practice nursing education in Canada, (3) curriculum issues, (4) interprofessional education, (5) resources for education and (6) continuing education. Although national frameworks defining advanced nursing practice and NP competencies provide some direction for education programs, Canada does not have countrywide standards of education for either the NP or CNS role. Inconsistency in the educational requirements for primary healthcare NPs continues to cause significant problems and interferes with inter-jurisdictional licensing portability. For both CNSs and NPs, there can be a mismatch between a generalized education and specialized practice. The value of interprofessional education in facilitating effective teamwork is emphasized. Recommendations for future directions for advanced practice nursing education are offered.
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Choi, Sandy Pin-Pin; Cheung, Kin; Pang, Samantha Mei-Che
2013-04-01
To examine how front-line registered nurses' perception of their work environment associates with and predicts nurse outcomes in terms of job satisfaction and turnover intention. Mounting evidence has pointed to an inseparable link between attributes of the nursing work environment and nurse outcomes. However, there is a paucity of research examining nurses' perception of their work environment beyond the Western context. This cross-sectional survey involved 1271 registered nurses working in 135 inpatient units in 10 public hospitals in Hong Kong. The instrument comprised items developed from in-depth interviews with front-line nurses that explored nurses' perception of their work environment. Factor analysis identified five dimensions (professionalism, co-worker relationship, management, staffing and resources, and ward practice) of the nursing work environment. Logistic regression analysis further identified professionalism, management and ward practice as significant factors in predicting nurses' turnover intention, and staffing and resources as an additional factor in predicting their job satisfaction. Attributes of the nursing work environment have a significant bearing on nurses' job satisfaction and intention to leave. Managerial effort should focus on improving nurses' work conditions through detailed resource planning, effective management and removal of work constraints that affect nursing practice. © 2012 Blackwell Publishing Ltd.
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Advanced Technology Training System on Motor-Operated Valves
NASA Technical Reports Server (NTRS)
Wiederholt, Bradley J.; Widjaja, T. Kiki; Yasutake, Joseph Y.; Isoda, Hachiro
1993-01-01
This paper describes how features from the field of Intelligent Tutoring Systems are applied to the Motor-Operated Valve (MOV) Advanced Technology Training System (ATTS). The MOV ATTS is a training system developed at Galaxy Scientific Corporation for the Central Research Institute of Electric Power Industry in Japan and the Electric Power Research Institute in the United States. The MOV ATTS combines traditional computer-based training approaches with system simulation, integrated expert systems, and student and expert modeling. The primary goal of the MOV ATTS is to reduce human errors that occur during MOV overhaul and repair. The MOV ATTS addresses this goal by providing basic operational information of the MOV, simulating MOV operation, providing troubleshooting practice of MOV failures, and tailoring this training to the needs of each individual student. The MOV ATTS integrates multiple expert models (functional and procedural) to provide advice and feedback to students. The integration also provides expert model validation support to developers. Student modeling is supported by two separate student models: one model registers and updates the student's current knowledge of basic MOV information, while another model logs the student's actions and errors during troubleshooting exercises. These two models are used to provide tailored feedback to the student during the MOV course.
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Nurse Knowledge, Work Environment, and Turnover in Highly Specialized Pediatric End-of-Life Care.
Lindley, Lisa C; Cozad, Melanie J
2017-07-01
To examine the relationship between nurse knowledge, work environment, and registered nurse (RN) turnover in perinatal hospice and palliative care organizations. Using nurse intellectual capital theory, a multivariate analysis was conducted with 2007 National Home and Hospice Care Survey data. Perinatal hospice and palliative care organizations experienced a 5% turnover rate. The professional experience of advanced practice nurses (APNs) was significantly related to turnover among RNs (β = -.032, P < .05). Compared to organizations with no APNs professional experience, clinical nurse specialists and nurse practitioners significantly reduced RN turnover by 3 percentage points. No other nurse knowledge or work environment variables were associated with RN turnover. Several of the control variables were also associated with RN turnover in the study; Organizations serving micropolitan (β = -.041, P < .05) and rural areas (β = -.037, P < .05) had lower RN turnover compared to urban areas. Organizations with a technology climate where nurses used electronic medical records had a higher turnover rate than those without (β = .036, P < .05). The findings revealed that advanced professional experience in the form of APNs was associated with reductions in RN turnover. This suggests that having a clinical nurse specialist or nurse practitioner on staff may provide knowledge and experience to other RNs, creating stability within the organization.
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[Tissue engineering of urinary bladder using acellular matrix].
Glybochko, P V; Olefir, Yu V; Alyaev, Yu G; Butnaru, D V; Bezrukov, E A; Chaplenko, A A; Zharikova, T M
2017-04-01
Tissue engineering has become a new promising strategy for repairing damaged organs of the urinary system, including the bladder. The basic idea of tissue engineering is to integrate cellular technology and advanced bio-compatible materials to replace or repair tissues and organs. of the study is the objective reflection of the current trends and advances in tissue engineering of the bladder using acellular matrix through a systematic search of preclinical and clinical studies of interest. Relevant studies, including those on methods of tissue engineering of urinary bladder, was retrieved from multiple databases, including Scopus, Web of Science, PubMed, Embase. The reference lists of the retrieved review articles were analyzed for the presence of the missing relevant publications. In addition, a manual search for registered clinical trials was conducted in clinicaltrials.gov. Following the above search strategy, a total of 77 eligible studies were selected for further analysis. Studies differed in the types of animal models, supporting structures, cells and growth factors. Among those, studies using cell-free matrix were selected for a more detailed analysis. Partial restoration of urothelium layer was observed in most studies where acellular grafts were used for cystoplasty, but no the growth of the muscle layer was observed. This is the main reason why cellular structures are more commonly used in clinical practice.
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Application of Guided Imagery to Facilitate the Transition of New Graduate Registered Nurses
Boehm, Laura B.; Tse, Alice M.
2016-01-01
Traditionally, the new graduate registered nurse (RN) transition has included a didactic and skills-based orientation accompanied by a period of preceptored practice. However, these methods do not ensure that new RNs are in a state of reduced anxiety to fully interact with their new environment. Transition to practice may cause anxiety, and the new graduate RN may perceive moderate to severe stress. One method of stress reduction is the use of guided imagery, which has shown strong potential with a variety of populations undergoing stressful events. Today, new graduate RNs expect institutions to facilitate orientation to their new employment settings and assist in the transition to their role as a professional nurse. This article proposes a model that incorporates guided imagery for refining the new graduate RN transition process. The model can be adapted for use in the context of orienting other adult learners to unfamiliar practice situations. PMID:23330588
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Administrator Leadership Styles and Their Impact on School Nursing.
Davis, Charles R
2018-01-01
In comparison to other professional staff in an educational based setting, the registered professional school nurse has unique roles, responsibilities, education, training, and scope of practice. In carrying out this unique and specialized role, school nurses operate under a building administrator, the leader of the building and often the immediate supervisor of the school nurse. In addition, many school nurses in small districts are the only registered professional nurse employed by the school. The building administrator's leadership style not only sets the tone for the day-to-day operations in the school but also impacts the school nurse functioning and program implementation. This article reviews the three most common types of leadership styles as defined by Kurt Lewin-laissez-faire, democratic, and coercive/authoritarian-and their potential impact on school nursing practice. In addition, the article provides recommendations for school nurses for successful practice with regard to supervisor leadership styles.
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A survey-based exploration of the impact of dyslexia on career progression of UK registered nurses.
Morris, David; Turnbull, Patricia
2007-01-01
To explore the effects of dyslexia on the practice and career progression of UK registered nurses (RN). Literature suggests dyslexia can have a negative impact in the workplace and may pose particular difficulties for nurses, where accuracy in information processing activities is essential for practice. A questionnaire was used to survey RNs with dyslexia (n = 116) and results analysed using content analysis. Dyslexia provided a challenge to the everyday work of RNs, which was often met successfully using a range of individualized strategies. Career progression was achievable but compared with peers, was perceived to take longer. Disclosure of dyslexia to work-colleagues was selective and dependent on the perceived benefits. Informal support mechanisms were commonly utilized with formal management support less well defined. Dyslexia appears to have a negative impact on working practices and career progression, but remains a poorly understood and often hidden disability.
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Stratton, T D; Dunkin, J W; Juhl, N; Geller, J M
1995-05-01
Researchers have demonstrated repeatedly the importance of the relationship linking job satisfaction to employee retention. In rural areas of the country, where a persistent maldistribution of nurses continues to hamper health care delivery, the potential benefits of bolstering retention via enhancements in job satisfaction are of utmost utility to administrators and providers alike. Data were gathered from a multistate survey of registered nurses (RNs) practicing in rural hospitals, skilled nursing facilities, and community/public health settings (N = 1,647; response rate = 40.3%). The investigators found that the use of tuition reimbursement corresponded significantly with increased levels of job satisfaction among nurses in all three practice environments, as did day care services for nurses in acute care settings. Also, among hospital-based RNs, level of nursing education was found to be a significant factor in the relationship between tuition reimbursement and job satisfaction, with the highest level occurring among diploma-prepared nurses.
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Spirit at work and hope among the ruins: registered nurses' covenant of care.
Wagner, Joan I J; Gregory, David M
2015-09-01
To explore registered nurses' (RNs) perspectives about the health care system, management/leadership, patients and spirit at work (SAW). Researchers investigating RNs experiences of reduced job satisfaction and diminishing organisational commitment are looking carefully at spirit at work as a means to foster healthier workplaces. A descriptive, cross-sectional mixed methods design was used to measure and explore the relationships between spirit at work, job satisfaction and organisational commitment. A 2012 postal survey sent by the provincial licensing body to a random sample of 217 surgical and 158 home care registered nurses' in western Canada returned 179 surveys. Seventy-five respondents answered the open-ended survey question. Their responses warrant further content analysis and serve as the foundation of this article. Participants noted that organisational structures and policies, combined with unsupportive leadership, were associated with a reduced sense of community, lack of trust and diminished accountability. Spirit at work was described as sustaining registered nurses' and providing them with hope as they fulfilled their covenant of care with patients. Leadership attention to the advancement of SAW may support the covenant of care between the registered nurses and patient while fostering healthier workplaces. © 2014 John Wiley & Sons Ltd.
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Unattended Multiplicity Shift Register
DOE Office of Scientific and Technical Information (OSTI.GOV)
Newell, Matt; Jones, David C.
2017-01-16
The Unattended Multiplicity Shift Register (UMSR) is a specialized pulse counter used primarily to count neutron events originating in neutron detection instruments. While the counter can be used to count any TTL input pulses, its unique ability to record time correlated events and the multiplicity distributions of these events makes it an ideal instrument for counting neutron events in the nuclear fields of material safeguards, waste assay and process monitoring and control. The UMSR combines the Los Alamos National Laboratory (LANL) simple and robust shift register design with a Commercial-Off-The-Shelf (COTS) processor and Ethernet communications. The UMSR is fully compatiblemore » with existing International Atomic Energy Agency (IAEA) neutron data acquisition instruments such as the Advance Multiplicity Shift Register (AMSR) and JSR-15. The UMSR has three input channels: a multiplicity shift register input and two auxiliary inputs. The UMSR provides 0V to 2kV of programmable High Voltage (HV) bias and both a 12V and a 5V detector power supply output. A serial over USB communication line to the UMSR allows the use of existing versions of INCC or MIC software while the Ethernet port is compatible with the new IAEA RAINSTORM communication protocol.« less
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Pharmacy in transition: A work sampling study of community pharmacists using smartphone technology.
van de Pol, Jeroen M; Geljon, Jurjen G; Belitser, Svetlana V; Frederix, Geert W J; Hövels, Anke M; Bouvy, Marcel L
2018-03-09
The nature of community pharmacy is changing, shifting from the preparation and distribution of medicines to the provision of cognitive pharmaceutical services (CPS); however, often the provision of traditional services leaves little time for innovative services. This study investigated the time community pharmacists spend on the tasks and activities of daily practice and to what extent they are able to implement CPS-related services in daily practice. Self-reporting work sampling was used to register the activities of community pharmacists. A smartphone application, designed specifically for this purpose, alerted participants to register their current activity five times per working day for 6 weeks. Participants also completed an online survey about baseline characteristics. Ninety-one Dutch community pharmacists provided work-sampling data (7848 registered activities). Overall, 51.5% of their time was spent on professional activities, 35.4% on semi-professional activities, and 13.1% on non-professional activities. The proportion of time devoted to CPS decreased during the workweek, whereas the time spent on traditional task increased. This study shows it is feasible to collect work-sampling data using smartphone technology. Community pharmacists spent almost half of their time on semi-professional and non-professional activities, activities that could be delegated to other staff members. In practice, the transition to CPS is hampered by competing traditional tasks, which prevents community pharmacists from profiling themselves as pharmaceutical experts in daily practice. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.
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O'Connor, Laserina; Casey, Mary; Smith, Rita; Fealy, Gerard M; Brien, Denise O'; O'Leary, Denise; Stokes, Diarmuid; McNamara, Martin S; Glasgow, Mary Ellen; Cashin, Andrew
2018-03-01
To inform and guide the development of a future model of specialist and advanced nursing and midwifery practice. There is a sizable body of empirical literature supporting the unique contributions of specialist and advanced practice roles to health care. However, there is very little international evidence to inform the integration of a future model for advanced or specialist practice in the Irish healthcare system. A qualitative study was conducted to initiate this important area of inquiry. Purposive sampling was used to generate a sample of informants (n = 15) for the interviews. Nurses and midwives working in specialist and advanced practice and participants from other areas such as legislative, regulatory, policy, medicine and education were included in the sampling frame. Arguments for a new model of specialist and advanced practice were voiced. A number of participants proposed that flexibility within specialist and advanced practitioner career pathways was essential. Otherwise, there existed the possibility of being directed into specialised "silos," precluding movement to another area of integrated practice. Future specialist and advanced practice education programmes need to include topics such as the development of emotional and political intelligence. The contribution of specialist and advanced practice roles to the health service includes providing rapid access to care, seamless patient flow across services, early discharge and lead coordinator of the patient's care trajectory. There was a recommendation of moving towards a universal model to cultivate specialist and advanced nurse and midwife practitioners. The model design has Universal application in a range of contexts "U." It is Collaborative in its inclusivity of all key stakeholders "C." The model is Dynamic pertinent to accommodating movement of nurses and midwives across health continua rather than plateauing in very specialised "silos" "D." © 2017 John Wiley & Sons Ltd.
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Tax, Casper; Abbink, Karin; Rovers, Maroeska M; Bekkers, Ruud L M; Zusterzeel, Petra L M
2018-01-01
Currently, a PET-CT is used to assess the need for extended field radiotherapy of para-aortic lymph nodes (PALN) in International Federation of Gynaecology and Obstetrics (FIGO) stage IB2, IIA2-IVA (locally advanced stage) cervical cancer. A small study established a sensitivity and specificity estimate for PALN metastases of 50% (95% CI; 7-93%) and 83% (95% CI; 52-98%), respectively. Surgical staging of PALN may lead to a higher diagnostic accuracy. However, surgical staging of para-aortic lymph nodes in locally advanced stage cervical cancer is not common practice. Therefore, a phase 2 randomised controlled trial is needed to assess its safety and feasibility. In addition to standard imaging (MRI or CT scan) with PET-CT, 30 adult women with FIGO stage IB2, IIA2-IVA cervical cancer will be randomised to receive either surgical staging or usual PET-CT staging. Administering extended field radiotherapy will be based on lymphadenectomy results for the intervention group and on the PET-CT results for the control group. Follow-up visits at 0, 3, 6, 9 and 12 months will assess health-related quality of life and progression-free survival.Primary safety and feasibility outcomes of surgical staging will be assessed by calculating means with 95% confidence intervals for duration of surgery, number of complications, blood loss, nodal yield after para-aortic lymphadenectomy and treatment delay due to surgical staging. Secondary patient-centred outcomes on quality of life and first year survival will be documented and compared between the two groups. Estimates of sensitivity, specificity and negative and positive predictive values of MRI, PET-CT and surgical staging will be presented with 95% CI.. All analysis will be performed according to the intention to treat principle. This study will assess safety and feasibility, expressed as the number and severity of complications, effect on quality of life and the treatment delay due to surgically staging para-aortic lymph nodes in locally advanced cervical cancer. It will provide insight in the diagnostic accuracy of the PET-CT and detection rate of missed (micro)metastases due to surgical staging. This information will be used to assess the necessity for a phase 3 study on the diagnostic accuracy of the PET-CT and surgical staging. If a phase 3 study is deemed necessary, current data can be used for sample size calculation of such a phase 3 study. Nederlands Trial Register/Dutch Trial Registry (www.trialregister.nl), NTR4922. Registered on 24 November 2014.
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Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal
2017-01-01
(1) To pilot 'we DECide' in terms of influence on advance care planning policy and practice in nursing home dementia care units. (2) To investigate barriers and facilitators for implementing 'we DECide'. This was a pre-test-post-test study in 18 nursing homes. Measurements included: compliance with best practice of advance care planning policy (ACP-audit); advance care planning practice (ACP criteria: degree to which advance care planning was discussed, and OPTION scale: degree of involvement of residents and families in conversations). Advance care planning policy was significantly more compliant with best practice after 'we DECide'; policy in the control group was not. Advance care planning was not discussed more frequently, nor were residents and families involved to a higher degree in conversations after 'we DECide'. Barriers to realizing advance care planning included staff's limited responsibilities; facilitators included support by management staff, and involvement of the whole organization. 'We DECide' had a positive influence on advance care planning policy. Daily practice, however, did not change. Future studies should pay more attention to long-term implementation strategies. Long-term implementation of advance care planning requires involvement of the whole organization and a continuing support system for health care professionals. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
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Eloranta, Katariina; Auvinen, Anssi
2015-07-17
Register-based research can provide important and valuable contributions to public health research, but involves ethical issues concerning the balance of public health benefits and individual autonomy. This study aimed to describe the opinions of the Finnish public about these issues. Mail survey questionnaire sent to a random sample of 1000 Finns. Participation proportion was 42%, with 258 women and 160 men. The majority of the participants (61%) were willing to provide their identifiable health information for research. Almost half of the participants (48%) would, nevertheless, like to be informed when their information is used. A third (30%) indicated no need for informed consent in register-based research, a similar proportion felt it should be obtained for every study, and 40% thought it necessary in some situations, such as studies addressing a sensitive study topic. As for the best policy for obtaining consent, the majority (86%) favoured broader consent methods: one consent covering a certain register or a research topic. Half of the participants (55%) desired a required ethical evaluation from register-based research addressing a sensitive issue. Privacy protection was the most common concern for register-based research. More than half of the participants were either content with the current Finnish laws concerning register-based research or wanted to liberalize them to advance research. The Finnish public is supportive of register-based research, but the requirement for informed consent divides opinions and many would at least like to be informed of the research use of their information.
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Clinical Experience in Advanced Practice Nursing: A Canadian Perspective.
ERIC Educational Resources Information Center
Donnelly, Glenn
2003-01-01
The role of advanced practice (AP) nurses must be clearly articulated and defined and not overshadowed by medical functions. Consensus on their educational preparation and explication of the nature of expertise in advanced practice are needed if AP nurses are to realize the full scope of their practice. (Contains 35 references.) (SK)
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Interferon after surgery for women with advanced (Stage II-IV) epithelial ovarian cancer.
Lawal, Aramide O; Musekiwa, Alfred; Grobler, Liesl
2013-06-06
Epithelial ovarian cancer (EOC) is a life-threatening disease. Most often women become symptomatic only in the advanced stages of the disease, increasing the difficulty of treatment. Whilst the disease responds well to surgery and chemotherapy, the relapse rate is high. New treatments to prevent disease recurrence or progression, prolong survival, and increase the quality of life are needed. To assess the effectiveness and safety of interferon after surgery in the treatment of advanced (stage II-IV) EOC. The Cochrane Gynaecological Cancer Review Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL) Issue 1, 2012, MEDLINE and EMBASE were searched to January 2012. Handsearching of conference proceedings was also undertaken. Reference lists of reviews and included trials were screened and experts in the field were contacted for additional trials. Clinical trials registers were searched for ongoing trials. Randomised controlled trials (RCTs) involving participants with advanced EOC that compared post-operative chemotherapy alone with post-operative interferon therapy in combination with chemotherapy or post-operative chemotherapy followed by interferon or observation alone Two review authors (AL and AM) independently screened the search results for relevant trials and extracted pre-specified information from each included trial. Data were managed using Review Manager 5.1. Hazard ratios (HR) were calculated for time-to-event outcomes and risk ratios (RR) for dichotomous outcomes, with corresponding 95% confidence intervals (CI). Five trials, including 1476 participants, were included in the review. Two trials compared interferon with observation alone and three trials compared interferon plus chemotherapy with chemotherapy alone. A meta-analysis of two trials involving 370 participants found no significant difference in both overall survival (HR 1.14, 95% CI 0.84 to 1.55) and progression free survival (HR 0.99, 95% CI 0.79 to 1.24) between the interferon and observation alone groups in post-surgical women who had undergone first-line chemotherapy for advanced EOC. One trial with 293 participants found that while no significant difference was observed in incidence of nausea or vomiting between the two treatment groups, significantly more flu-like symptoms (RR 2.25, 95% CI 1.73 to 2.91) and fatigue (RR 1.54, 95% CI 1.27 to 1.88) were reported in the interferon group. For the second comparison, a meta-analysis of two trials comprising 244 participants found that although there was no significant difference in overall survival between the interferon plus chemotherapy and the chemotherapy alone group (HR 1.14, 95% CI 0.74 to 1.76), women in the interferon plus chemotherapy group had worse progression free survival than those in the chemotherapy alone group (HR 1.43, 95% CI 1.02 to 2.00). Compared to chemotherapy alone, adding interferon to chemotherapy did not alter the incidence of adverse events in post-surgical women with advanced EOC. Implications for practice Based on low quality evidence, the addition of interferon to first-line chemotherapy did not alter the overall survival in post-surgical women with advanced EOC compared with chemotherapy alone. There is low quality evidence to suggest that interferon in combination with chemotherapy worsened the progression free survival in post-surgical women with advanced EOC compared with chemotherapy alone. There is not enough evidence that interferon therapy alone alters overall survival or progression free survival compared to observation alone in post-surgical women who have undergone first-line chemotherapy. Three of the five trials included in this review were stopped early and were, therefore, underpowered to detect any true effect of the intervention. The trials did not report the results of important outcomes in a uniform manner, preventing statistical aggregation of the results. Trial methodology was poorly reported resulting in unclear risk of bias. For clear recommendations to be made regarding the effectiveness of interferon in the treatment of advanced EOC, long-term, well conducted and adequately powered RCTs would be needed. However, the available data do not suggest that interferon has an adequately advantageous effect to warrant further investigation.
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Targeting Family Risk Factors in the Context of Treating Youth Depression: A Survey of Psychologists
ERIC Educational Resources Information Center
Parra, Gilbert R.; Buckholdt, Kelly E.; Olsen, James P.; Jobe-Shields, Lisa; Davis, Genevieve L.; Gamble, Heather L.
2011-01-01
This study investigated the practices and perceptions of psychologists related to targeting family risk factors when treating youth depression. Participants were practicing psychologists recruited through the National Register of Health Service Providers in Psychology (N = 279). Psychologists completed a brief anonymous survey about addressing…
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VET Providers Planning to Deliver Degrees: Good Practice Guide
ERIC Educational Resources Information Center
National Centre for Vocational Education Research (NCVER), 2015
2015-01-01
This good practice guide is intended to assist public and private registered training organisations (RTOs) planning to commence higher education (HE) delivery. The guide is based on research undertaken by Victor Callan and Kaye Bowman, who completed case studies with six providers currently delivering higher education qualifications in addition to…
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A Statewide Analysis of RNs' Intention To Leave Their Position.
ERIC Educational Resources Information Center
Rambur, Betty; Palumbo, Mary Val; McIntosh, Barbara; Mongeon, Joan
2003-01-01
Secondary analysis of registered nurse work force data from Vermont (n=4,418, 85% response) identified predictors of intention to leave current position. Differences in intention vary by educational attainment, hours worked, gender, practice role, and practice activity. Improving retention will require increased attention to compensation,…
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75 FR 68941 - Organization and Purpose
Federal Register 2010, 2011, 2012, 2013, 2014
2010-11-10
...;Prices of new books are listed in the first FEDERAL REGISTER issue of each #0;week. #0; #0; #0; #0;#0... U.S.C. 553 exempts ``rules of agency organization, procedure, or practice'' from rulemaking notice... Chairman with the approval of the Council (lawyers in private practice, scholars in the field of...
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Magnet status and registered nurse views of the work environment and nursing as a career.
Ulrich, Beth T; Buerhaus, Peter I; Donelan, Karen; Norman, Linda; Dittus, Robert
2007-05-01
To compare how registered nurses view the work environment and the nursing shortage based on the Magnet status of their organizations. The upsurge in organizations pursuing and obtaining Magnet recognition provides increased opportunities to investigate whether and how registered nurses who are employed in Magnet organizations and organizations pursuing Magnet status perceive differences in the nursing shortage, hospitals' responses to the shortage, characteristics of the work environment, and professional relationships. A nationally representative sample of registered nurses licensed to practice in the United States was surveyed. The views of registered nurses who worked in Magnet organizations, organizations in the process of applying for Magnet status, and non-Magnet organizations were analyzed as independent groups. Significant differences were found. Although there is a clear Magnet difference, there are also identifiable differences that occur during the pursuit of Magnet recognition. Many organizations in the process of applying for Magnet status rated higher than Magnet organizations, indicating that there is much to do to maintain the comparative advantages for Magnet hospitals.
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Magnet status and registered nurse views of the work environment and nursing as a career.
Ulrich, Beth T; Buerhaus, Peter I; Donelan, Karen; Norman, Linda; Dittus, Robert
2009-01-01
To compare how registered nurses view the work environment and the nursing shortage based on the Magnet status of their organizations. The upsurge in organizations pursuing and obtaining Magnet recognition provides increased opportunities to investigate whether and how registered nurses who are employed in Magnet organizations and organizations pursuing Magnet status perceive differences in the nursing shortage, hospitals' responses to the shortage, characteristics of the work environment, and professional relationships. A nationally representative sample of registered nurses licensed to practice in the United States was surveyed. The views of registered nurses who worked in Magnet organizations, organizations in the process of applying for Magnet status, and non-Magnet organizations were analyzed as independent groups. Significant differences were found. Although there is a clear Magnet difference, there are also identifiable differences that occur during the pursuit of Magnet recognition. Many organizations in the process of applying for Magnet status rated higher than Magnet organizations, indicating that there is much to do to maintain the comparative advantages for Magnet hospitals.
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O'Connell, Jane; Gardner, Glenn; Coyer, Fiona
2014-12-01
This paper presents a discussion on the application of a capability framework for advanced practice nursing standards/competencies. There is acceptance that competencies are useful and necessary for definition and education of practice-based professions. Competencies have been described as appropriate for practice in stable environments with familiar problems. Increasingly competencies are being designed for use in the health sector for advanced practice such as the nurse practitioner role. Nurse practitioners work in environments and roles that are dynamic and unpredictable necessitating attributes and skills to practice at advanced and extended levels in both familiar and unfamiliar clinical situations. Capability has been described as the combination of skills, knowledge, values and self-esteem which enables individuals to manage change, be flexible and move beyond competency. A discussion paper exploring 'capability' as a framework for advanced nursing practice standards. Data were sourced from electronic databases as described in the background section. As advanced practice nursing becomes more established and formalized, novel ways of teaching and assessing the practice of experienced clinicians beyond competency are imperative for the changing context of health services. Leading researchers into capability in health care state that traditional education and training in health disciplines concentrates mainly on developing competence. To ensure that healthcare delivery keeps pace with increasing demand and a continuously changing context there is a need to embrace capability as a framework for advanced practice and education. © 2014 John Wiley & Sons Ltd.
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Development of a conceptual policy framework for advanced practice nursing: an ethnographic study.
Schober, Madrean M; Gerrish, Kate; McDonnell, Ann
2016-06-01
To report on a study examining policy development for advanced practice nursing from intent of policy to realization in practice. Inclusion of advanced practice nursing roles in the healthcare workforce is a worldwide trend. Optimal advanced nursing practice requires supportive policies. Little is known about how policy is developed and implemented. Ethnography using an instrumental case study approach was selected to give an in-depth understanding of the experiences of one country (Singapore) to contribute to insight into development elsewhere. The four-phase study was conducted from 2008-2012 and included document analysis (n = 47), interviews with key policy decision makers (n = 12), interviews with nursing managers and medical directors (n = 11), interviews and participant observation with advanced practice nurses (n = 15). Key policymakers in positions of authority were able to promote policy development. However, this was characterized by lack of strategic planning for implementation. A vague understanding by nursing managers and medical directors of policies, the role and its position in the healthcare workforce led to indecision and uncertainty in execution. Advanced practice nurses developed their role based on theory acquired in their academic programme but were unsure what role to assume in practice. Lack of clear guidelines led to unanticipated difficulties for institutions and healthcare systems. Strategic planning could facilitate integration of advanced practice nurses into the healthcare workforce. A Conceptual Policy Framework is proposed as a guide for a coordinated approach to policy development and implementation for advanced practice nursing. © 2016 John Wiley & Sons Ltd.
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Procedure competencies and job functions of the urologic advanced practice nurse.
Kleier, Jo Ann
2009-01-01
A 2-round modified Delphi study recruited a panel urologic advanced practice nurse experts to identify the procedure competencies and job functions unique to the role of the advanced practice nurse specializing in the care of urology patients.
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Northway, Ruth; Parker, Michelle; James, Neil; Davies, Lynsey; Johnson, Kaye; Wilson, Sally
2015-12-01
Whilst there is a need to develop the research base within learning disability nursing it is also significant that currently there is little published data as to how research is taught to this group of nurses. To increase understanding of how research is currently taught to learning disability nurses within the UK. A survey design was used. The research was undertaken at a conference held in the UK in March 2014. 310 learning disability nurses attending the conference of which 212 completed the free text question. This comprised student nurses (n=158), registered nurses working in practice settings (n=25) and registered nurses working in educational institutions (n=24). Five participants did not specify their background. Participants were invited to complete a questionnaire that included a free text question regarding the teaching of research to learning disability nurses: it is the responses to this question that are reported in this paper. Responses were transcribed and thematically analysed. Eight themes emerged: Teaching approach--the good and the bad; finding the right level; right from the start; we need more time; generic versus specialist; there's not enough; getting research into practice; and what should we focus on? Variations exist in terms of the timing of research education, the teaching approaches used, and hence the quality of student experience. Of particular concern is the apparent gap between research teaching and the use of research in practice, and the reported lack of support for research within practice settings. However, enthusiasm for research is evident and hence recommendations are made both to enhance teaching and to strengthen links with practice. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Nooney, Jennifer G; Unruh, Lynn; Yore, Michelle M
2010-06-01
Efforts to retain nurses within the profession are critical for resolving the global nursing shortage, but very little research explores the phenomenon of nursing workforce attrition in the U.S. This study is the first to simultaneously investigate the timing of attrition through survival analysis, the exit path taken (career change vs. labor force separation), and the major socioeconomic, family structure, and demographic variables predicting attrition in this country. Using nationally representative U.S. data from the 2004 National Sample Survey of Registered Nurses (N=29,472), we find that the rate of labor force separation is highest after the age of 60, a typical pattern for retirement. However, a non-trivial proportion of career change also occurs at older ages (50+ years old), and the rate of labor force separation begins to climb at relatively young ages (30-40 years old). Particularly strong predictors of early labor force separation include being married and providing care to dependents in the home (young children or elderly parents). Career change is predicted strongly by higher levels of education, male gender, and current enrollment in a non-nursing degree program. Having an Advanced Practice credential reduced the hazards of attrition for both exit paths. The results suggest a fruitful path for future research and a number of policy approaches to curbing nurse workforce attrition. Copyright 2010 Elsevier Ltd. All rights reserved.
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Registered nurse retention strategies in nursing homes: a two-factor perspective.
Hunt, Selina R; Probst, Janice C; Haddock, Kathlyn S; Moran, Robert; Baker, Samuel L; Anderson, Ruth A; Corazzini, Kirsten
2012-01-01
As the American population ages and the proportion of individuals over the age of 65 expands, the demand for high-quality nursing home care will increase. However, nursing workforce instability threatens care quality and sustainability in this sector. Despite increasing attention to nursing home staff turnover, far less is known about registered nurse (RN) retention. In this study, the relationships between retention strategies, employee benefits, features of the practice environment, and RN retention were explored. Further, the utility of Herzberg's two-factor theory of motivation as a framework for nursing home retention studies was evaluated. This study was a secondary analysis of the nationally representative 2004 National Nursing Home Survey. The final sample of 1,174 participating nursing homes were either certified by Medicare or Medicaid or licensed by state agencies. We used a weighted multinomial logistic regression using an incremental approach to model the relationships. Although most nursing homes offered some combination of retention programs, the majority of strategies did not have a significant association with the level of RN retention reported by facilities. Director of nursing tenure and other extrinsic factors had the strongest association with RN retention in adjusted analyses. To improve RN retention, organizations may benefit greatly from stabilizing nursing home leadership, especially the director of nursing position. Second, managers of facilities with poor retention may consider adding career ladders for advancement, awarding attendance, and improving employee benefits. As a behavioral outcome of motivation and satisfaction, retention was not explained as expected using Herzberg's two-factor theory.
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Preparing nurses for practice: a phenomenological study of the new graduate in Australia.
Kelly, Jennifer; Ahern, Kathy
2009-03-01
To explore the expectations of final year nursing students before they start employment and to describe the experiences of newly graduated nurses during their first six months of employment as registered nurses. Nursing shortages are at crisis point world wide with registered nurses leaving the profession at a high rate and changing occupations. Thus, there is a need to reflect on new graduate nurses experiences in relation to retention and support. Husserl's phenomenological approach was used to gain insight and understanding into the lived experiences of new graduate nurses. Students enrolled in a Bachelor of Nursing programme at an Australian University were interviewed in their final semester and during employment in the hospital setting. Semi-structured interviews were used to gather data from 13 participants. Data were collected at three intervals: prior to commencing employment, one month and six months postemployment and the results were analysed thematically. As students, the participants held positive perceptions surrounding their impending role as a registered nurse and what it would encompass. However, after one month of employment, it became apparent that nursing comprised of a culture that embraced cliques which excluded them. The graduates were unprepared for 'bitchiness' and the limited amount of assistance with unfamiliar tasks they received from registered nurses. Participants also found rotating to different wards recreated the feelings they experienced on commencing employment. Nursing curricula should prepare new graduates for foreseeable stressors and oppressive practices so that graduates can become proactive in preventing and responding to factors such as silence and aggression. Moreover, nursing courses need to ensure that socialisation issues are addressed to assist in the eradication of oppressive practices. Finally, organisations need to address socialisation issues such as hostility within the workplace to address the attrition of new graduates from the profession. Individuals in clinical practice settings need to be cognisant of the significant role that experienced registered nurses and nurse unit managers occupy in the socialisation of new graduate nurses. Additionally, there needs to be increased awareness that nursing culture can influence recruitment and retention of new graduates. Further, health care organisations need to evaluate the benefits of new graduates rotating through clinical areas in the first 12 months of employment.
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42 CFR 483.75 - Administration.
Code of Federal Regulations, 2010 CFR
2010-10-01
... occupational therapy assistant; registered professional nurse; licensed practical nurse; or licensed or... by the facility staff; and (iii) For nurse aides providing services to individuals with cognitive...
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Busch, Deborah W; Logan, Kathleen; Wilkinson, Ashley
2014-01-01
Promotional practice efforts are needed in primary care to support and foster breastfeeding as the first and natural choice of nutrition for all infants regardless of race, ethnicity, educational, or income demographics in the United States. Societal awareness is increasing with regard to the significant protective qualities that human milk bestows upon public health. An estimated 75% of American mothers attempt to breastfeed, but according to the Centers for Disease Control and Prevention, just 13% are able to exclusively breastfeed by 6 months. Early identification of lactation issues is crucial to establishing and sustaining breastfeeding for the first 6 to 12 months of the child's life and beyond. We propose a set of primary care guidelines, applying a Tri-Core Model approach, to promote and foster breastfeeding efforts in the postpartum period. Breastfeeding promotion is a fundamental public health endeavor, and pediatric nurse practitioners and other advanced practice registered nurses (APRNs) are uniquely qualified to become specialists and experts in lactation care and management. Lactation support, which should be an integral facet of an APRN's practice and education, will aid in improving national breastfeeding rates and patient care outcomes. Application of the Tri-Core Model approach will help APRNs develop and implement evidence-based practice efforts that incorporate the mother-baby dyad and other multiprofessionals who are vested in successful breastfeeding outcomes. The goal of pediatric health care is provide safe and effective health care to all infants, children, and adolescents, and lactation care is an integral and crucial component of this effort. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
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El Hussein, Mohamed; Hirst, Sandra
2016-02-01
To construct a grounded theory that explains the clinical reasoning processes that registered nurses use to recognise delirium while caring for older adults in acute care settings. Delirium is often under-recognised in acute care settings; this may stem from underdeveloped clinical reasoning processes. Little is known about registered nurses' clinical reasoning processes in complex situations such as delirium recognition. Seventeen registered nurses working in acute care settings were interviewed. Concurrent data collection and analysis, constant comparative analysis and theoretical sampling were conducted in 2013-2014. A grounded theory approach was used to analyse interview data about the clinical reasoning processes of registered nurse in acute hospital settings. The core category that emerged from data was 'Tracking the footsteps'. This refers to the common clinical reasoning processes that registered nurses in this study used to recognise delirium in older adults in acute care settings. It depicted the process of continuously trying to catch the state of delirium in older adults. Understanding the clinical reasoning processes that contribute to delirium under-recognition provides a strategy by which this problem can be brought to the forefront of awareness and intervention by registered nurses. Registered nurses could draw from the various processes identified in this research to develop their clinical reasoning practice to enhance their effective assessment strategies. Delirium recognition by registered nurses will contribute to quality care to older adults. © 2016 John Wiley & Sons Ltd.
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Shigeta, Shogo; Nagase, Satoru; Mikami, Mikio; Ikeda, Masae; Shida, Masako; Sakaguchi, Isao; Ushioda, Norichika; Takahashi, Fumiaki; Yamagami, Wataru; Yaegashi, Nobuo; Udagawa, Yasuhiro; Katabuchi, Hidetaka
2017-11-01
The Japan Society of Gynecologic Oncology (JSGO) published the first practice guideline for endometrial cancer in 2006. The JSGO guideline evaluation committee assessed the effect of this guideline introduction on clinical practice and patient outcome using data provided by the Japan Society of Obstetrics and Gynecology (JSOG) cancer registration system. Data of patients with endometrial cancer registered between 2000 and 2012 were analyzed, and epidemiological and clinical trends were assessed. The influence of guideline introduction on survival was determined by analyzing data of patients registered between 2004 and 2009 using competing risk model. In total, 65,241 cases of endometrial cancer were registered. Total number of patients registered each year increased about 3 times in the analyzed period, and the proportion of older patients with type II endometrial cancer rapidly increased. The frequency of lymphadenectomy had decreased not only among the low-recurrence risk group but also among the intermediate- or high-recurrence risk group. Adjuvant therapy was integrated into chemotherapy (p<0.001). Overall survival did not significantly differ before and after the guideline introduction (hazard ratio [HR]=0.891; p=0.160). Additional analyses revealed patients receiving adjuvant chemotherapy showed better prognosis than those receiving adjuvant radiation therapy when limited to stage I or II (HR= 0.598; p=0.003). It was suggested that guideline introduction influenced the management of endometrial cancer at several aspects. Better organized information and continuous evaluation are necessary to understand the causal relationship between the guideline and patient outcome. Copyright © 2017. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology
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van Dam, Joris; Musuku, John; Zühlke, Liesl J; Engel, Mark E; Nestle, Nick; Tadmor, Brigitta; Spector, Jonathan; Mayosi, Bongani M
2015-01-01
Rheumatic heart disease (RHD) remains a major disease burden in low-resource settings globally. Patient registers have long been recognised to be an essential instrument in RHD control and elimination programmes, yet to date rely heavily on paper-based data collection and non-networked data-management systems, which limit their functionality. To assess the feasibility and potential benefits of producing an electronic RHD patient register. We developed an eRegister based on the World Heart Federation's framework for RHD patient registers using CommCare, an open-source, cloud-based software for health programmes that supports the development of customised data capture using mobile devices. The resulting eRegistry application allows for simultaneous data collection and entry by field workers using mobile devices, and by providers using computer terminals in clinics and hospitals. Data are extracted from CommCare and are securely uploaded into a cloud-based database that matches the criteria established by the WHF framework. The application can easily be tailored to local needs by modifying existing variables or adding new ones. Compared with traditional paper-based data-collection systems, the eRegister reduces the risk of data error, synchronises in real-time, improves clinical operations and supports management of field team operations. The user-friendly eRegister is a low-cost, mobile, compatible platform for RHD treatment and prevention programmes based on materials sanctioned by the World Heart Federation. Readily adaptable to local needs, this paperless RHD patient register program presents many practical benefits.
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Whelan, Kevin; Copeland, Emma; Oladitan, Leah; Murrells, Trevor; Gandy, Joan
2013-04-01
Research involvement among registered dietitians (RDs) is important in advancing dietetics practice and ensuring high-quality and cost-effective health care. There are no standardized approaches to measuring levels of research involvement. The aim of the study was to develop a standardized measure of research involvement and test its validity and reliability among RDs. The Research Involvement Questionnaire (RIQ) was developed and underwent content validation, resulting in a content validity index of 0.92. A postal questionnaire survey of RDs was undertaken at two time points. RDs were purposively selected and, based on their number of publications and grants, were assigned by the authors to one of four levels of research involvement: evidence-based practice, collaborating on research, leading research, and leadership in research. Of 192 questionnaires mailed, 111 RDs (58%) returned the first RIQ, of whom 82 (74%) also returned the second RIQ. Total scores and scores for each level were higher for RDs with higher levels of research involvement (P<0.001). RDs assigned by the RIQ to higher levels of research involvement had higher qualifications; were qualified for longer; and had greater evidence of research output, including journal publications and grants (P<0.001). There was excellent internal consistency as measured using Cronbach's coefficient (α=.98). The level of research involvement assigned by the RIQ and by the purposive selection process agreed on 76% of occasions, indicating substantial agreement beyond chance (κ=0.67; P<0.001). The level of research involvement assigned by the RIQ at two time points agreed on 86% of occasions, indicating almost perfect agreement beyond chance (κ=0.81; P<0.001). A valid and reliable questionnaire has been developed to measure research involvement among RDs, providing a useful tool for evaluating and supporting members of the profession to become more involved in research. Copyright © 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
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Akre, Olof; Garmo, Hans; Adolfsson, Jan; Lambe, Mats; Bratt, Ola; Stattin, Pär
2011-09-01
There are limited prognostic data for locally advanced prostate cancer PCa to guide in the choice of treatment. To assess mortality in different prognostic categories among men with locally advanced PCa managed with noncurative intent. We conducted a register-based nationwide cohort study within the Prostate Cancer DataBase Sweden. The entire cohort of locally advanced PCa included 14 908 men. After the exclusion of 2724 (18%) men treated with curative intent, 12 184 men with locally advanced PCa either with local clinical stage T3 or T4 or with T2 with serum levels of prostate-specific antigen (PSA) between 50 and 99 ng/ml and without signs of metastases remained for analysis. We followed up the patient cohort in the Cause of Death Register for ≤ 11 yr and assessed cumulative incidence of PCa -specific death stratified by age and clinical characteristics. The PCa -specific mortality at 8 yr of follow-up was 28% (95% confidence interval [CI], 25-32%) for Gleason score (GS) 2-6, 41% (95% CI, 38-44%) for GS 7, 52% (95% CI, 47-57%) for GS 8, and 64% (95% CI, 59-69%) for GS 9-10. Even for men aged >85 yr at diagnosis with GS 8-10, PCa was a major cause of death: 42% (95% CI, 37-47%). Men with locally advanced disease and a PSA<4 ng/ml at diagnosis were at particularly increased risk of dying from PCa. One important limitation is the lack of bone scans in 42% of the patient cohort, but results remained after exclusion of patients with unknown metastasis status. The PCa-specific mortality within 8 yr of diagnosis is high in locally advanced PCa, suggesting undertreatment, particularly among men in older age groups. Our results underscore the need for more studies of treatment with curative intent for locally advanced tumors. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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Kao, Chi-Yin; Huang, Guey-Shiun; Dai, Yu-Tzu; Pai, Ya-Ying; Hu, Wen-Yu
2015-06-01
Clinical research nurses (CRNs) play an important role in improving the quality of clinical trials. In Taiwan, the increasing number of clinical trials has increased the number of practicing CRNs. Understanding the role responsibilities of CRNs is necessary to promote professionalism in this nursing category. This study investigates the role responsibilities of CRNs in conducting clinical trials / research. A questionnaire survey was conducted in a medical center in Taipei City, Taiwan. Eighty CRNs that were registered to facilitate and conduct clinical trials at this research site completed the survey. "Subject protection" was the CRN role responsibility most recognized by participants, followed by "research coordination and management", "subject clinical care", and "advanced professional nursing". Higher recognition scores were associated with higher importance scores and lower difficulty scores. Participants with trial training had significantly higher difficulty scores for "subject clinical care" and "research coordination and management" than their peers without this training (p < .05). Participants who had participated in a long-term trial-training course earned higher importance scores for "CRN four-subthemes role responsibilities" (p <.05) and lower difficulty scores for "subject protection", "research coordination and management" (p <.005) than their short-term course peers. "Recognition of overall responsibilities" and "receiving trial training" were the significant predictors of difficulty in performing CRN role responsibilities, explaining 21.9% of the total variance. To further promote CRN as a professional career in Taiwan, the findings of this study recommend identifying the core competences of CRNs and adding CRN-related study materials into the advanced nursing curriculum. Long-term and systematic educational training may help CRNs understand the importance of their role responsibilities, better recognize their professional role, and reflect these responsibilities in clinical practice.
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Evaluation of an academic service partnership using a strategic alliance framework.
Murray, Teri A; James, Dorothy C
2012-01-01
Strategic alliances involve the sharing of resources to achieve mutually relevant benefits and they are flexible ways to access resources outside of one's own institution. The recent landmark report from the Institute of Medicine, The Future of Nursing: Leading Change, Advancing Health, called for academic and health care organizations to strategically align around the future registered nurse workforce to improve the quality and safety of patient care. The dedicated education unit (DEU) is one practical way for 2 entities to align so that students can learn to administer safe, quality care. Because DEUs have great potential, it is critical to evaluate the alignment between the academic and service partner for appropriate fit, mutual benefit, and long-term success. In this article, we analyze the effectiveness of the Saint Louis University School of Nursing (SLUSON) and Mercy Hospital, St. Louis (MHSL) DEU project, an alliance between a medical center and school of nursing, using the Single Alliance Key Success Model. Copyright © 2012 Elsevier Inc. All rights reserved.
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The shortages of nurses in NSW: a motivation hygiene approach to identifying problems and solutions.
Carroll, E; Dwyer, L
1988-01-01
For a number of years public hospitals in NSW have experienced high turnover figures for nursing staff and have been unable to recruit sufficient numbers of registered nurses back into hospital employment. This paper outlines factors on both the demand and the supply side which contribute to the present shortage. It then goes on to argue that a greater appreciation of the causes of the shortage, and strategies for its resolution, can be gained by presenting the issues from the perspective of Herzberg's Motivation--Hygiene Theory. 'Motivation' factors, providing satisfaction to nurses, include achievement and recognition, the work itself, responsibility, advancement and potential for personal growth. 'Hygiene' factors, producing dissatisfaction, include physical working conditions, employer policies and administrative practices, interpersonal relations, salary. Discussion of the issues from this perspective indicates that strategies to resolve the crisis must proceed on two fronts. Continuing efforts must be made to promote job satisfaction among nurses while at the same time reducing the incidence of factors promoting job dissatisfaction.
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Successful design and delivery of a professional poster.
Berg, Judith; Hicks, Rod
2017-08-01
Poster presentations are increasingly popular for dissemination of scientific and clinical knowledge at professional meetings; however, this professional skill is generally absent from advanced practice registered nurse (APRN) curricula and acquisition of the skill must occur in other arenas. The purpose of this article is to promote professional development by educating APRNs, students, and faculty on the essentials of poster development and presentation. To aid in poster presentation skill development, types of posters, advantages and disadvantages, content and design, and tips to enhance these presentations are discussed. What is known on these topics is summarized and emphasis on professional appearance and conduct is highlighted. Content and layout, use of color, imagery, and positive and negative space are crucial design elements. Poster presentation essentials include being prepared, professional appearance, and professional behavior. Designing and presenting a professional poster is an essential skill for all APRNs as the ability to communicate knowledge is central to the role. ©2017 American Association of Nurse Practitioners.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Clark, M. A.; Strelchenko, Alexei; Vaquero, Alejandro
Lattice quantum chromodynamics simulations in nuclear physics have benefited from a tremendous number of algorithmic advances such as multigrid and eigenvector deflation. These improve the time to solution but do not alleviate the intrinsic memory-bandwidth constraints of the matrix-vector operation dominating iterative solvers. Batching this operation for multiple vectors and exploiting cache and register blocking can yield a super-linear speed up. Block-Krylov solvers can naturally take advantage of such batched matrix-vector operations, further reducing the iterations to solution by sharing the Krylov space between solves. However, practical implementations typically suffer from the quadratic scaling in the number of vector-vector operations.more » Using the QUDA library, we present an implementation of a block-CG solver on NVIDIA GPUs which reduces the memory-bandwidth complexity of vector-vector operations from quadratic to linear. We present results for the HISQ discretization, showing a 5x speedup compared to highly-optimized independent Krylov solves on NVIDIA's SaturnV cluster.« less
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Nursing Home Stakeholder Views of Resident Involvement in Medical Care Decisions
Garcia, Theresa J.; Harrison, Tracie C.; Goodwin, James S.
2017-01-01
Demand by nursing home residents for involvement in their medical care, or, patient-centered care, is expected to increase as baby boomers begin seeking long-term care for their chronic illnesses. To explore the needs in meeting this proposed demand, we used a qualitative descriptive method with content analysis to obtain the joint perspective of key stakeholders on the current state of person-centered medical care in the nursing home. We interviewed 31 nursing home stakeholders: 5 residents, 7 family members, 8 advanced practice registered nurses, 5 physicians, and 6 administrators. Our findings revealed constraints placed by the long-term care system limited medical involvement opportunities and created conflicting goals for patient-centered medical care. Resident participation in medical care was perceived as low, but important. The creation of supportive educational programs for all stakeholders to facilitate a common goal for nursing home admission and to provide assistance through the long-term care system was encouraged. PMID:25721717
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Attitudes of Dental Hygienists towards Independent Practice and Professional Autonomy.
Catlett, April
2016-08-01
The purpose of this cross-sectional, quantitative research was to examine if registered dental hygienists feel competent to work independently based on regulations of dental supervision. A stratified sample of 360 dental hygienists from 8 states completed the Dempster Practice Behaviors Scale survey. ANOVA and MANOVA analyses revealed how state dentist supervision level, age, degree of education, employment status, gender and years of clinical experience affect the perceived autonomy of professional dental hygienists. The response rate included 360 dental hygienists from 8 states. According to the findings age, education level and gender affected the hygienist's level of autonomy. In all 8 states, the registered dental hygienists have a high level of autonomy and feel competent to work independently. The DPBS scores of the sample registered dental hygienists suggest that they feel prepared and competent to perform preventive dental hygiene services without dentist supervision. The attitudes of the dental hygienist sample from each of the 4 state dentist supervision levels supports a move toward achieving professional jurisdiction of preventive dental care within the U.S. Copyright © 2016 The American Dental Hygienists’ Association.
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Analysis instruments for the performance of Advanced Practice Nursing.
Sevilla-Guerra, Sonia; Zabalegui, Adelaida
2017-11-29
Advanced Practice Nursing has been a reality in the international context for several decades and recently new nursing profiles have been developed in Spain as well that follow this model. The consolidation of these advanced practice roles has also led to of the creation of tools that attempt to define and evaluate their functions. This study aims to identify and explore the existing instruments that enable the domains of Advanced Practice Nursing to be defined. A review of existing international questionnaires and instruments was undertaken, including an analysis of the design process, the domains/dimensions defined, the main results and an exploration of clinimetric properties. Seven studies were analysed but not all proved to be valid, stable or reliable tools. One included tool was able to differentiate between the functions of the general nurse and the advanced practice nurse by the level of activities undertaken within the five domains described. These tools are necessary to evaluate the scope of advanced practice in new nursing roles that correspond to other international models of competencies and practice domains. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
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10 CFR 903.11 - Advance announcement of rate adjustment.
Code of Federal Regulations, 2012 CFR
2012-01-01
... 903.11 Energy DEPARTMENT OF ENERGY POWER AND TRANSMISSION RATES Procedures for Public Participation in Power and Transmission Rate Adjustments and Extensions for the Alaska, Southeastern, Southwestern, and... advertisement, and/or by Federal Register publication. Written comments relevant to rate policy and design and...
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10 CFR 903.11 - Advance announcement of rate adjustment.
Code of Federal Regulations, 2011 CFR
2011-01-01
... 903.11 Energy DEPARTMENT OF ENERGY POWER AND TRANSMISSION RATES Procedures for Public Participation in Power and Transmission Rate Adjustments and Extensions for the Alaska, Southeastern, Southwestern, and... advertisement, and/or by Federal Register publication. Written comments relevant to rate policy and design and...
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10 CFR 903.11 - Advance announcement of rate adjustment.
Code of Federal Regulations, 2013 CFR
2013-01-01
... 903.11 Energy DEPARTMENT OF ENERGY POWER AND TRANSMISSION RATES Procedures for Public Participation in Power and Transmission Rate Adjustments and Extensions for the Alaska, Southeastern, Southwestern, and... advertisement, and/or by Federal Register publication. Written comments relevant to rate policy and design and...
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10 CFR 903.11 - Advance announcement of rate adjustment.
Code of Federal Regulations, 2014 CFR
2014-01-01
... 903.11 Energy DEPARTMENT OF ENERGY POWER AND TRANSMISSION RATES Procedures for Public Participation in Power and Transmission Rate Adjustments and Extensions for the Alaska, Southeastern, Southwestern, and... advertisement, and/or by Federal Register publication. Written comments relevant to rate policy and design and...
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Goisis, Alice; Remes, Hanna; Barclay, Kieron; Martikainen, Pekka; Myrskylä, Mikko
2017-12-01
Advanced maternal age at birth is considered a major risk factor for birth outcomes. It is unclear to what extent this association is confounded by maternal characteristics. To test whether advanced maternal age at birth independently increases the risk of low birth weight (<2,500 g) and preterm birth (<37 weeks' gestation), we compared between-family models (children born to different mothers at different ages) with within-family models (children born to the same mother at different ages). The latter procedure reduces confounding by unobserved parental characteristics that are shared by siblings. We used Finnish population registers, including 124,098 children born during 1987-2000. When compared with maternal ages 25-29 years in between-family models, maternal ages of 35-39 years and ≥40 years were associated with percentage increases of 1.1 points (95% confidence intervals: 0.8, 1.4) and 2.2 points (95% confidence intervals: 1.4, 2.9), respectively, in the probability of low birth weight. The associations are similar for the risk of preterm delivery. In within-family models, the relationship between advanced maternal age and low birth weight or preterm birth is statistically and substantively negligible. In Finland, advanced maternal age is not independently associated with the risk of low birth weight or preterm delivery among mothers who have had at least 2 live births. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.
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Hardy, Maryann; Johnson, Louise; Sharples, Rachael; Boynes, Stephen; Irving, Donna
2016-06-01
To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. Using the World Health Organization definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs, and data were systematically extracted using electronic data extraction pro forma. 407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n = 7) focusing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The articles were generally considered to be of low-to-moderate quality, with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, the included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No articles reported data relating to time to diagnosis, time to recovery or patient mortality. Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited. This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality.
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Juul, Lise; Maindal, Helle T; Zoffmann, Vibeke; Frydenberg, Morten; Sandbaek, Annelli
2014-01-01
Type 2 diabetes is a common metabolic disease with the potential for prevention of complications. The prevention requires a high level of lasting actions from the patients, which may be burdensome. The aim of this trial was to evaluate the effectiveness of a training course for general practice nurses in motivation support at 18 months follow-up in the affiliated type 2 diabetes population. Forty general practices with nurse-led diabetes consultations from the area of Aarhus, Denmark were randomised 1∶1 to either intervention or usual practice. Intervention practices were offered a 16-hour Self-determination theory-based course including communication training for general practice nurses delivered over 10 months. The affiliated diabetes populations (aged 40-74 years) were identified from registers (intervention n = 2,005; usual n = 2,029). Primary outcomes were register-based glycated haemoglobin (HbA1c) -, total cholesterol levels, and well-being measured by the Problem Areas In Diabetes scale (PAID) and the mental component summary score, SF12 (SF12, mcs). Intention-to-treat analyses were performed. Predefined subgroups analyses were performed. The differences between the intervention- and the control practices' mean HbA1c and total cholesterol at follow-up adjusted for baseline values and clustering were respectively: -0.02%-points (95% CI: -0.11 to 0.07; p: 0.67); 0.08 mmol/l (95% CI: 0.01 to 0.15; p: 0.02). Differences in median scores adjusted for clustering were for PAID: 1.25; p = 0.31 and SF12, mcs: 0.99; p = 0.15. Women in intervention practices differed from women in usual practices on mean HbA1c: -0.12%-points (-0.23 to -0.02; p = 0.02) and SF12, mcs: 2.6; p = 0.01. Offering a training course for general practice nurses in applying the Self-determination theory in current type 2 diabetes care had no effect compared with usual practice measured by HbA1c and total cholesterol levels and the well-being at 18 months of follow-up in a comprehensive register-based diabetes population. Subgroup analyses suggested a possible effect in women, which deserves further attention. ClinicalTrials.gov (Identifier NCT01187069).
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Perkins, Danielle E K
2010-01-01
Newly graduated registered nurses face a barrage of physical and mental challenges in their first few years of practice, especially in the hospital setting. This article explores discrepancies between student nurse practice and professional nursing practice and the challenges that new nurses face in bridging the gap between idealistic theory and realistic practice. The author's subsequent graduate nursing education and continued practice in the field resulted in a personal evolution of practice that elicited a profound sense of appreciation for the field and a desire to share these experiences with other practicing nurses and students.
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Getting to Outcomes: A Best Practice Process to Help Schools Achieve Desired Outcomes
ERIC Educational Resources Information Center
Maras, Melissa A.; Wandersman, Abe; Splett, Joni Williams; Flaspohler, Paul; Weist, Mark
2012-01-01
This article describes Getting to Outcomes (GTO), a 10-step framework for accountability designed to facilitate effective implementation of evidence-based programs and improvement of home-grown practices (Getting to Outcomes and GTO are trademarks registered by the University of South Carolina and RAND; Wandersman, Imm, Chinman, & Kaftarian,…
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Report on Legal Protection for Databases. A Report of the Register of Copyrights. August, 1997.
ERIC Educational Resources Information Center
Library of Congress, Washington, DC. Copyright Office.
This report gives an overview of the past and present domestic and international legal framework for database protection. It describes database industry practices in securing protection against unauthorized use and Copyright Office registration practices relating to databases. Finally, it discusses issues raised and concerns expressed in a series…
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Federal Register 2010, 2011, 2012, 2013, 2014
2013-07-05
... Relay Service (IP Relay) providers; Adopts rules to protect the privacy of customer information relating... Structure and Practices of the Video Relay Service Program; Telecommunications Relay Services and Speech-to-Speech Services for Individuals With Hearing and Speech Disabilities; Final Rule #0;#0;Federal Register...
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Confirmatory Factor Analysis on the Professional Suitability Scale for Social Work Practice
ERIC Educational Resources Information Center
Tam, Dora M. Y.; Twigg, Robert C.; Boey, Kam-Wing; Kwok, Siu-Ming
2013-01-01
Objective: This article presents a validation study to examine the factor structure of an instrument designed to measure professional suitability for social work practice. Method: Data were collected from registered social workers in a provincial mailed survey. The response rate was 23.2%. After eliminating five cases with multivariate outliers,…
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ERIC Educational Resources Information Center
Meekins, Eva M.
2016-01-01
Teamwork and communication are essential concepts for new graduate registered nurses working as members of the interprofessional team. Studies have shown the efficacy of applying these interprofessional education concepts by allowing student nurses to round with health teams before graduation. The innovative practice of rounding significantly…
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Gregory A. Guisti
2012-01-01
A standardized, interactive, interview process was used with practicing Registered Professional Foresters asking a suite of questions to ascertain their management approaches to coast redwood (Sequoia sempervirens [D. Don] Endl.) stands that could best be transferred to other projects and lands interested in recruiting older forest...
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Dellefield, Mary Ellen; Corazzini, Kirsten
2015-01-01
Development of the comprehensive care plan (CCP) is a requirement for nursing homes participating in the federal Medicare and Medicaid programs, referred to as skilled nursing facilities. The plan must be developed within the context of the comprehensive interdisciplinary assessment framework—the Resident Assessment Instrument (RAI). Consistent compliance with this requirement has been difficult to achieve. To improve the quality of CCP development within this framework, an increased understanding of complex factors contributing to inconsistent compliance is required. In this commentary, we examine the history of the comprehensive care plan; its development within the RAI framework; linkages between the RAI and registered nurse staffing; empirical evidence of the CCP’s efficacy; and the limitations of extant standards of practices in CCP development. Because of the registered nurse’s educational preparation, professional practice standards, and licensure obligations, the essential contributions of professional nurses in CCP development are emphasized. Recommendations for evidence-based micro and macro level practice changes with the potential to improve the quality of CCP development and regulatory compliance are presented. Suggestions for future research are given. PMID:27417811
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Advance care planning for nursing home residents with dementia: policy vs. practice.
Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal
2016-03-01
The aims of this study were: to evaluate the advance care planning policy for people with dementia in nursing homes; to gain insight in the involvement of residents with dementia and their families in advance care planning, and in the relationship between the policy and the actual practice of advance care planning. Through advance care planning, nursing home residents with dementia are involved in care decisions, anticipating their reduced decision-making capacity. However, advance care planning is rarely realized for this group. Prevalence and outcomes have been researched, but hardly any research has focused on the involvement of residents/families in advance care planning. Observational cross-sectional study in 20 nursing homes. The ACP audit assessed the views of the nursing homes' staff on the advance care planning policy. In addition, individual conversations were analysed with 'ACP criteria' (realization of advance care planning) and the 'OPTION' instrument (involvement of residents/families). June 2013-September 2013. Nursing homes generally met three quarters of the pre-defined criteria for advance care planning policy. In almost half of the conversations, advance care planning was explained and discussed substantively. Generally, healthcare professionals only managed to involve residents/families on a baseline skill level. There were no statistically significant correlations between policy and practice. The evaluations of the policy were promising, but the actual practice needs improvement. Future assessment of both policy and practice is recommended. Further research should focus on communication interventions for implementing advance care planning in the daily practice. © 2015 John Wiley & Sons Ltd.
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Teo, Irene; Singh, Ratna; Malhotra, Chetna; Ozdemir, Semra; Dent, Rebecca A; Kumarakulasinghe, Nesaretnam Barr; Yeo, Wee Lee; Cheung, Yin Bun; Malhotra, Rahul; Kanesvaran, Ravindran; Yee, Alethea Chung Pheng; Chan, Noreen; Wu, Huei Yaw; Chin, Soh Mun; Allyn, Hum Yin Mei; Yang, Grace Meijuan; Neo, Patricia Soek Hui; Nadkarni, Nivedita V; Harding, Richard; Finkelstein, Eric A
2018-04-23
Advanced cancer significantly impacts quality of life of patients and families as they cope with symptom burden, treatment decision-making, uncertainty and costs of treatment. In Singapore, information about the experiences of advanced cancer patients and families and the financial cost they incur for end-of-life care is lacking. Understanding of this information is needed to inform practice and policy to ensure continuity and affordability of care at the end of life. The primary objectives of the Cost of Medical Care of Patients with Advanced Serious Illness in Singapore (COMPASS) cohort study are to describe changes in quality of life and to quantify healthcare utilization and costs of patients with advanced cancer at the end of life. Secondary objectives are to investigate patient and caregiver preferences for diagnostic and prognostic information, preferences for end-of-life care, caregiver burden and perceived quality of care and to explore how these change as illness progresses and finally to measure bereavement adjustment. The purpose of this paper is to present the COMPASS protocol in order to promote scientific transparency. This cohort study recruits advanced cancer patients (n = 600) from outpatient medical oncology clinics at two public tertiary healthcare institutions in Singapore. Patients and their primary informal caregiver are surveyed every 3 months until patients' death; caregivers are followed until 6 months post patient death. Patient medical and billing records are obtained and merged with patient survey data. The treating medical oncologists of participating patients are surveyed to obtain their beliefs regarding care delivery for the patient. The study will allow combination of self-report, medical, and cost data from various sources to present a comprehensive picture of the end-of-life experience of advanced cancer patients in a unique Asian setting. This study is responsive to Singapore's National Strategy for Palliative Care which aims to identify opportunities to meet the growing need for high quality care for Singapore's aging population. Results will also be of interest to policy makers and researchers beyond Singapore who are interested to understand and improve the end-of-life experience of cancer patients. NCT02850640 (Prospectively registered on June 9, 2016).
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Tennessee advanced practice nurse compensation survey results 2006-2007.
Arnold, Kimberly
2007-01-01
In 2006, representatives from Middle Tennessee Advanced Practice Nurses (MTAPN), Greater Memphis Area Advanced Practice Nurses (GMAAPN), and Northeast Tennessee Nurse Practitioners Association (NETNPA) decided to poll APNs in Tennessee to compare data with the most recent results from the Advance for Nurse Practitioners national NP survey. Every other year, Advance for Nurse Practitioners publishes salary survey results from their survey. Most recently, in January 2006, an average nationwide salary for all APNs was reported at $74,812, with Tennessee's average at $71,068.
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Kennerly, Susan; Heggestad, Eric D; Myers, Haley; Yap, Tracey L
2015-07-29
An effective workforce performing within the context of a positive cultural environment is central to a healthcare organization's ability to achieve quality outcomes. The Nursing Culture Assessment Tool (NCAT) provides nurses with a valid and reliable tool that captures the general aspects of nursing culture. This study extends earlier work confirming the tool's construct validity and dimensionality by standardizing the scoring approach and establishing norm-referenced scoring. Scoring standardization provides a reliable point of comparison for NCAT users. NCAT assessments support nursing's ability to evaluate nursing culture, use results to shape the culture into one that supports change, and advance nursing's best practices and care outcomes. Registered nurses, licensed practical nurses, and certified nursing assistants from 54 long-term care facilities in Kentucky, Nevada, North Carolina, and Oregon were surveyed. Confirmatory factor analysis yielded six first order factors forming the NCAT's subscales (Expectations, Behaviors, Teamwork, Communication, Satisfaction, Commitment) (Comparative Fit Index 0.93) and a second order factor-The Total Culture Score. Aggregated facility level comparisons of observed group variance with expected random variance using rwg(J) statistics is presented. Normative scores and cumulative rank percentages and how the NCAT can be used in implementing planned change are provided.
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Jangland, Eva; Yngman Uhlin, Pia; Arakelian, Erebouni
2016-11-01
The position of Nurse Practitioner is a new role in Nordic countries. The transition from a registered nurse to the Nurse Practitioner role has been reported to be a personal challenge. This study, guided by the Nordic theoretical model for use in the education of advanced practice nurses, represents a unique opportunity to describe this transition for newly graduated Nurse Practitioners in an interprofessional surgical care team in Sweden. The aim was to explore how the first Nurse Practitioners in surgical care experienced the transition into a new role and what competences they used in the team. Eight new Nurse Practitioners with parallel work in clinical practice were interviewed twice around the time of their graduation. The qualitative analyses show that the participants integrated several central competences, but the focus in this early stage in their new role was on direct clinical praxis, consultation, cooperation, case management, and coaching. Transition from the role of clinical nurse specialist to nurse practitioner was a challenging process in which the positive response from patients was a driving force for the new Nurse Practitioners. The participants felt prepared for and determined to solve the challenging situations they approached working in the interprofessional team. Copyright © 2016 Elsevier Ltd. All rights reserved.
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[Manpower of rheumatology in catalonia (Spain)].
Ortiz-Santamaría, V; Olivé, A
2005-12-01
To determine the changes in Rheumatology provision and working practice that have occurred on the basis of the 1990, 1996 surveys carried out to update the Catalan Society for Rheumatology register The register includes all rheumatologists in Catalonia (Spain) who are registered and who do clinical work. Questionnaires were sent to all rheumatologists on the register. The questionnaires asked about location and clinical commitments. One hundred twenty-four rheumatologists work at the public system in Catalonia, 80 (65%) work at hospitals. The majority of rheumatologists (105; 84,6%) are located in the province of Barcelona. One fith of the rheumatologists have a temporal work. Ten general hospitals are still lacking of rheumatologists. Although the number of rheumatologists in Catalonia has increased there are ongoing inequalities in the provision of Rheumatology, especially between Barcelona and the rest of provinces. Copyright © 2005 Elsevier España S.L. Barcelona. Published by Elsevier Espana. All rights reserved.
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Laverty, Anthony A; Harris, Matthew J; Watt, Hilary C; Greaves, Felix; Majeed, Azeem
2017-01-01
Objective To examine associations between the contract and ownership type of general practices and patient experience in England. Design Multilevel linear regression analysis of a national cross-sectional patient survey (General Practice Patient Survey). Setting All general practices in England in 2013–2014 (n = 8017). Participants 903,357 survey respondents aged 18 years or over and registered with a general practice for six months or more (34.3% of 2,631,209 questionnaires sent). Main outcome measures Patient reports of experience across five measures: frequency of consulting a preferred doctor; ability to get a convenient appointment; rating of doctor communication skills; ease of contacting the practice by telephone; and overall experience (measured on four- or five-level interval scales from 0 to 100). Models adjusted for demographic and socioeconomic characteristics of respondents and general practice populations and a random intercept for each general practice. Results Most practices had a centrally negotiated contract with the UK government (‘General Medical Services’ 54.6%; 4337/7949). Few practices were limited companies with locally negotiated ‘Alternative Provider Medical Services’ contracts (1.2%; 98/7949); these practices provided worse overall experiences than General Medical Services practices (adjusted mean difference −3.04, 95% CI −4.15 to −1.94). Associations were consistent in direction across outcomes and largest in magnitude for frequency of consulting a preferred doctor (−12.78, 95% CI −15.17 to −10.39). Results were similar for practices owned by large organisations (defined as having ≥20 practices) which were uncommon (2.2%; 176/7949). Conclusions Patients registered to general practices owned by limited companies, including large organisations, reported worse experiences of their care than other patients in 2013–2014. PMID:29096580
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Cowling, Thomas E; Laverty, Anthony A; Harris, Matthew J; Watt, Hilary C; Greaves, Felix; Majeed, Azeem
2017-11-01
Objective To examine associations between the contract and ownership type of general practices and patient experience in England. Design Multilevel linear regression analysis of a national cross-sectional patient survey (General Practice Patient Survey). Setting All general practices in England in 2013-2014 ( n = 8017). Participants 903,357 survey respondents aged 18 years or over and registered with a general practice for six months or more (34.3% of 2,631,209 questionnaires sent). Main outcome measures Patient reports of experience across five measures: frequency of consulting a preferred doctor; ability to get a convenient appointment; rating of doctor communication skills; ease of contacting the practice by telephone; and overall experience (measured on four- or five-level interval scales from 0 to 100). Models adjusted for demographic and socioeconomic characteristics of respondents and general practice populations and a random intercept for each general practice. Results Most practices had a centrally negotiated contract with the UK government ('General Medical Services' 54.6%; 4337/7949). Few practices were limited companies with locally negotiated 'Alternative Provider Medical Services' contracts (1.2%; 98/7949); these practices provided worse overall experiences than General Medical Services practices (adjusted mean difference -3.04, 95% CI -4.15 to -1.94). Associations were consistent in direction across outcomes and largest in magnitude for frequency of consulting a preferred doctor (-12.78, 95% CI -15.17 to -10.39). Results were similar for practices owned by large organisations (defined as having ≥20 practices) which were uncommon (2.2%; 176/7949). Conclusions Patients registered to general practices owned by limited companies, including large organisations, reported worse experiences of their care than other patients in 2013-2014.
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Epigenetics: An Emerging Framework for Advanced Practice Psychiatric Nursing.
DeSocio, Janiece E
2016-07-01
The aims of this paper are to synthesize and report research findings from neuroscience and epigenetics that contribute to an emerging explanatory framework for advanced practice psychiatric nursing. Discoveries in neuroscience and epigenetics reveal synergistic mechanisms that support the integration of psychotherapy, psychopharmacology, and psychoeducation in practice. Advanced practice psychiatric nurses will benefit from an expanded knowledge base in neuroscience and epigenetics that informs and explains the scientific rationale for our integrated practice. © 2015 Wiley Periodicals, Inc.
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Medical engagement and organizational characteristics in general practice.
Ahnfeldt-Mollerup, Peder; dePont Christensen, René; Halling, Anders; Kristensen, Troels; Lykkegaard, Jesper; Nexøe, Jørgen; Barwell, Fred; Spurgeon, Peter; Søndergaard, Jens
2016-02-01
Medical engagement is a mutual concept of the active and positive contribution of doctors to maintaining and enhancing the performance of their health care organization, which itself recognizes this commitment in supporting and encouraging high quality care. A Medical Engagement Scale (MES) was developed by Applied Research Ltd (2008) on the basis of emerging evidence that medical engagement is critical for implementing radical improvements. To study the importance of medical engagement in general practice and to analyse patterns of association with individual and organizational characteristics. A cross-sectional study using a sampled survey questionnaire and the official register from the Danish General Practitioners' Organization comprising all registered Danish GPs. The Danish version of the MES Questionnaire was distributed and the survey results were analysed in conjunction with the GP register data. Statistically adjusted analyses revealed that the GPs' medical engagement varied substantially. GPs working in collaboration with colleagues were more engaged than GPs from single-handed practices, older GPs were less engaged than younger GPs and female GPs had higher medical engagement than their male colleagues. Furthermore, GPs participating in vocational training of junior doctors were more engaged than GPs not participating in vocational training. Medical engagement in general practice varies a great deal and this is determined by a complex interaction between both individual and organizational characteristics. Working in collaboration, having staff and being engaged in vocational training of junior doctors are all associated with enhanced levels of medical engagement among GPs. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Registered nurse job satisfaction and satisfaction with the professional practice model.
McGlynn, Karen; Griffin, Mary Quinn; Donahue, Moreen; Fitzpatrick, Joyce J
2012-03-01
This paper describes the initial assessment of job satisfaction and satisfaction with the professional practice environment of registered nurses working on units where a professional practice model was implemented and the relationship between these two variables. The nursing shortage has been linked to overall job satisfaction and specifically to nurses' satisfaction with the professional practice environment. Initiatives to increase retention and recruitment and decrease turnover have been linked to work satisfaction among nurses. A descriptive, cross-sectional design was used with participants (N = 101) from four patient care units; this represented a 55% response rate. The nurses were moderately satisfied with the professional practice environment but had overall low job satisfaction. There was a significant negative relationship between overall work satisfaction and satisfaction with the professional practice environment (P < 0.0001). The introduction of the professional practice model may have raised awareness of the components of job satisfaction that were not being met. Thus, the nurses may have become more knowledgeable about the potential needs in these areas. Nurse managers and leaders must recognize that job satisfaction consists of many dimensions, and each of these dimensions is important to nurse retention. Implementation of a professional practice model may heighten awareness of the missing components within a practice environment and lead to decreased overall satisfaction. A broader understanding of characteristics associated with increased satisfaction may aid in development of organizational change necessary to retain and attract nurses. © 2012 Blackwell Publishing Ltd.
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Job satisfaction of registered dental practitioners.
Luzzi, L; Spencer, A J; Jones, K; Teusner, D
2005-09-01
This study was designed to measure job satisfaction among registered clinical dentists so as to identify issues which may influence recruitment and retention of dentists in active clinical practice. A questionnaire measuring dimensions of job satisfaction was mailed to a stratified random sample of 80 private and 80 public sector dentists selected from the 1999 Victorian Dental Register. An adjusted response rate of 60 per cent was achieved (n = 87). Analyses showed significant differences (ANOVA; p < 0.05) in levels of satisfaction for various dimensions of job satisfaction by gender, age group and practice type. Differences in job satisfaction between male and female dentists related to the personal time dimension. Differences in satisfaction between dentists of different age groups were attributable to six dimensions: relationships with colleagues, relationships with patients, relationships with staff, personal time, community and administrative responsibilities. Differences between levels of satisfaction among private and public dentists related to the autonomy, relationships with patients, pay and resources dimensions. There are various dimensions of job satisfaction that may be pertinent to issues influencing recruitment and retention of dentists. Differences that exist between levels of job satisfaction among private and public sector dentists, between male and female dentists and dentists of different age groups need to be addressed in order to improve recruitment and retention rates of dentists in active clinical practice in different sectors of the dental care system.
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Wilde, Ruth; McTavish, Alison; Crawshaw, Marilyn
2014-03-01
The UK Department of Health's consultation on the future of the Human Fertilisation and Embryology Authority (HFEA) presented an opportunity to review current practice in relation to donor conception (DC) and make recommendations for improving services to those seeking fertility treatment, to families with donor conceived children and those of donors, and to those seeking later information. The year 2023 marks the start of post-2005 donor conceived adults having statutory access to identifying information about their donor(s); some adults with pre-2005 donors will have access sooner if the donor(s) re-registers as 'willing to be identified'. This paper examines current practice in UK licensed treatment centres in collecting and disseminating donor information and in supporting donors and prospective parents. Further, it considers current HFEA functions concerning DC including its responsibilities for the Register of Information and Donor Sibling Link and its approach to policy making, regulation and the release of information from these Registers to applicants. Proposals for how these functions could be carried out in the future are set out together with recommendations for national support and intermediary services. The key evidence available to support these recommendations is outlined.
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An Advanced Pharmacy Practice Framework for Australia
Jackson, Shane; Martin, Grant; Bergin, Jennifer; Clark, Bronwyn; Stupans, Ieva; Yeates, Gilbert; Nissen, Lisa; Marty, Stephen; Gysslink, Paul; Matthews, Andrew; Kirsa, Sue; Deans, Kerry; Sorimachi, Kay
2015-01-01
The need to develop An Advanced Pharmacy Practice Framework for Australia (the “APPF”) was identified during the 2010 review of the competency standards for Australian pharmacists. The Advanced Pharmacy Practice Framework Steering Committee, a collaborative profession-wide committee comprised of representatives of ten pharmacy organisations, examined and adapted existing advanced practice frameworks, all of which were found to have been based on the Competency Development and Evaluation Group (CoDEG) Advanced and Consultant Level Framework (the “CoDEG Framework”) from the United Kingdom. Its competency standards were also found to align well with the Domains of the National Competency Standards Framework for Pharmacists in Australia (the “National Framework”). Adaptation of the CoDEG Framework created an APPF that is complementary to the National Framework, sufficiently flexible to customise for recognising advanced practice in any area of professional practice and has been approved by the boards/councils of all participating organisations. The primary purpose of the APPF is to assist the development of the profession to meet the changing health care needs of the community. However, it is also a valuable tool for assuring members of the public of the competence of an advanced practice pharmacist and the quality and safety of the services they deliver. PMID:28975900
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Currie, Kay; Grundy, Maggie
2011-10-01
To highlight implications for managers from the implementation of a national advanced practice succession planning development pathway within Scotland. Internationally, advanced practice posts have often developed in an ad-hoc manner, with little organizational attention to succession planning. Evaluation of a pilot national succession planning development pathway identified mechanisms which facilitate or hamper effective planning for advanced practice roles. A responsive evaluation design incorporating semi-structured questionnaires to pathway participants (n = 15) and semi-structured telephone interviews with case-site pathway participants (n = 7) and their line managers. Managers believed the development pathway was worthwhile; however, there was limited strategic planning to match individuals' development to service need. Practitioners generally perceived managers as interested in their development, although levels of practical support varied. There is concern from both managers and practitioners regarding ongoing funding for advanced practice development. The present evaluation study reiterates the need for organizational commitment to succession planning including robust service needs analysis mechanisms and adequate funding for development processes. Nurse managers are viewed as the 'gatekeepers' to opportunities for developing advanced nurse practitioners; scare resources must be targeted effectively to support succession planning through the development of selected individuals for future advanced practice posts, justified by service need. © 2011 Blackwell Publishing Ltd.
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Year-End Clinic Handoffs: A National Survey of Academic Internal Medicine Programs.
Phillips, Erica; Harris, Christina; Lee, Wei Wei; Pincavage, Amber T; Ouchida, Karin; Miller, Rachel K; Chaudhry, Saima; Arora, Vineet M
2017-06-01
While there has been increasing emphasis and innovation nationwide in training residents in inpatient handoffs, very little is known about the practice and preparation for year-end clinic handoffs of residency outpatient continuity practices. Thus, the latter remains an identified, yet nationally unaddressed, patient safety concern. The 2014 annual Association of Program Directors in Internal Medicine (APDIM) survey included seven items for assessing the current year-end clinic handoff practices of internal medicine residency programs throughout the country. Nationwide survey. All internal medicine program directors registered with APDIM. Descriptive statistics of programs and tools used to formulate a year-end handoff in the ambulatory setting, methods for evaluating the process, patient safety and quality measures incorporated within the process, and barriers to conducting year-end handoffs. Of the 361 APDIM member programs, 214 (59%) completed the Transitions of Care Year-End Clinic Handoffs section of the survey. Only 34% of respondent programs reported having a year-end ambulatory handoff system, and 4% reported assessing residents for competency in this area. The top three barriers to developing a year-end handoff system were insufficient overlap between graduating and incoming residents, inability to schedule patients with new residents in advance, and time constraints for residents, attendings, and support staff. Most internal medicine programs do not have a year-end clinic handoff system in place. Greater attention to clinic handoffs and resident assessment of this care transition is needed.
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The Implications of Parental Consanguinity on the Care of Neonates.
Ng, Diana
2016-08-01
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.
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-11-02
... and filed with Congress and the Library of Congress. The General Advisory Committee to the U.S... published in the Federal Register in advance as required by FACA and meetings are open to the public unless...
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School Violence, Role of the School Nurse in Prevention. Issue Brief
ERIC Educational Resources Information Center
Blout, JoAnn D.; Rose, Kathleen C.; Suessmann, Mary; Coleman, Kara; Selekman, Janice
2012-01-01
Registered professional school nurses (hereinafter referred to as school nurses) advance safe school environments by promoting the prevention and reduction of school violence. School nurses collaborate with school personnel, healthcare providers, parents, and community members to identify and implement evidence-based educational programs. The…
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ERIC Educational Resources Information Center
McVeigh, Diane; And Others
1991-01-01
The articulated Bachelor of Science/Master of Science nursing program at the University of California-San Francisco School of Nursing is designed to alleviate nurses' fears about their professional futures by giving nonbaccalaureate registered nurses an opportunity to earn bachelor's and advanced degrees while they continue to work. (Author/JOW)
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Identifying emotional intelligence in professional nursing practice.
Kooker, Barbara Molina; Shoultz, Jan; Codier, Estelle E
2007-01-01
The National Center for Health Workforce Analysis projects that the shortage of registered nurses in the United States will double by 2010 and will nearly quadruple to 20% by 2015 (Bureau of Health Professionals Health Resources and Services Administration. [2002]. Projected supply, demand, and shortages of registered nurses, 2000-2020 [On-line]. Available: http:bhpr.hrsa.gov/healthworkforce/reports/rnprojects/report.htm). The purpose of this study was to use the conceptual framework of emotional intelligence to analyze nurses' stories about their practice to identify factors that could be related to improved nurse retention and patient/client outcomes. The stories reflected evidence of the competencies and domains of emotional intelligence and were related to nurse retention and improved outcomes. Nurses recognized their own strengths and limitations, displayed empathy and recognized client needs, nurtured relationships, used personal influence, and acted as change agents. Nurses were frustrated when organizational barriers conflicted with their knowledge/intuition about nursing practice, their communications were disregarded, or their attempts to create a shared vision and teamwork were ignored. Elements of professional nursing practice, such as autonomy, nurse satisfaction, respect, and the professional practice environment, were identified in the excerpts of the stories. The shortage of practicing nurses continues to be a national issue. The use of emotional intelligence concepts may provide fresh insights into ways to keep nurses engaged in practice and to improve nurse retention and patient/client outcomes.
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Registered nurses' use of research findings in the care of older people.
Boström, Anne-Marie; Kajermo, Kerstin Nilsson; Nordström, Gun; Wallin, Lars
2009-05-01
To describe registered nurses' reported use of research in the care of older people and to examine associations between research use and factors related to the elements: the communication channels, the adopter and the social system. Research use among registered nurses working in hospital settings has been reported in many studies. Few studies, however, have explored the use of research among registered nurses working in the care of older people. A cross-sectional survey. In eight municipalities, all registered nurses (n = 210) working in older people care were invited to participate (response rate 67%). The Research Utilisation Questionnaire was adopted. Questions concerning the work organisation and research-related resources were sent to the Community Chief Nurse at each municipality. Descriptive statistics and logistic regression were applied. The registered nurses reported a relatively low use of research findings in daily practice, despite reporting a positive attitude to research. The registered nurses reported lack of access to research reports at the work place and that they had little support from unit managers and colleagues. Registered nurses working in municipalities with access to research-related resources reported more use of research than registered nurses without resources. The factors 'Access to research findings at work place', 'Positive attitudes to research' and 'Nursing programme at university level' were significantly associated with research use. There is a great potential to increase registered nurses' use of research findings in the care of older people. Factors which were linked to the communication channels and the adopter were associated with research use. Strategies to enhance research use should focus on access to and adequate training in using information sources, increased knowledge on research methodology and nursing science and a supportive organisation.
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Rebeiro, Geraldine; Edward, Karen-leigh; Chapman, Rose; Evans, Alicia
2015-12-01
A significant proportion of undergraduate nursing education occurs in the clinical setting in the form of practising skills and competencies, and is a requirement of all nursing curriculum for registration to practice. Education in the clinical setting is facilitated by registered nurses, yet this interpersonal relationship has not been examined well. To investigate the experience of interpersonal relationships between registered nurses and student nurses in the clinical setting from the point of view of the registered nurse. Integrative review Review methods: The databases of MEDLINE, CINAHL and OVID were searched. Key words used included: Registered Nurse, Preceptor, Buddy Nurse, Clinical Teacher, Mentor, Student Nurse, Nursing Student, Interpersonal Relationships, Attitudes and Perceptions. Additional review of the literature was manually undertaken through university library textbooks. 632 abstracts were returned after duplicates were removed. Twenty one articles were identified for full text read (quantitative n=2, mixed n=6, qualitative n=14); of these, seven articles addressed the experience of interpersonal relationships between registered nurses and student nurses in the clinical setting from the point of view of the registered nurse and these were reviewed. Providing education for registered nurses to enable them to lead student education in the clinical setting communicates the organizational value of the role. Registered nurses identified being supported in having the time-to-teach were considered important in facilitation of the clinical teaching role. The integrative review did not provide evidence related to the impact diverse clinical settings can have on the relationships between registered nurses and student nurses revealing an area for further examination. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.
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Are reporting radiographers fulfilling the role of advanced practitioner?
Milner, R C; Snaith, B
2017-02-01
Advanced practice roles are emerging in all disciplines at a rapid pace and reporting radiographers are ideally placed to work at such level. Advanced practitioners should demonstrate expert practice and show progression into three other areas of higher level practice. Most existing literature has focussed on the image interpretation aspect of the role, however there is little evidence that plain film reporting radiographers are undertaking activities beyond image interpretation and fulfilling the role of advanced practitioner. Letters were posted to every acute NHS trust in the UK, inviting reporting radiographers to complete an online survey. Both quantitative and qualitative information was sought regarding demographics and roles supplementary to reporting. A total of 205 responses were analysed; 83.3% of reporting radiographers describe themselves as advanced practitioner, however significantly less are showing progression into the four core functions of higher level practice. A total of 97.0% undertake expert practice, 54.7% have a leadership role, 19.8% provide expert lectures and 71.1% have roles encompassing service development or research, though most of these fall into the service development category. 34.5% felt that they were aware of the differences between extended and advanced practice though much less (9.3%) could correctly articulate the difference. Few individuals are aware of the difference between extended and advanced practice. Though the majority of plain film reporting radiographers identify themselves as advanced practitioners, significantly less evidence all four core functions of higher level practice. The number of individuals undertaking research and providing expert-level education is low. Copyright © 2016 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
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Wanyonyi, Kristina L; Radford, David R; Harper, Paul R; Gallagher, Jennifer E
2015-09-15
In primary care dentistry, strategies to reconfigure the traditional boundaries of various dental professional groups by task sharing and role substitution have been encouraged in order to meet changing oral health needs. The aim of this research was to investigate the potential for skill mix use in primary dental care in England based on the undergraduate training experience in a primary care team training centre for dentists and mid-level dental providers. An operational research model and four alternative scenarios to test the potential for skill mix use in primary care in England were developed, informed by the model of care at a primary dental care training centre in the south of England, professional policy including scope of practice and contemporary evidence-based preventative practice. The model was developed in Excel and drew on published national timings and salary costs. The scenarios included the following: "No Skill Mix", "Minimal Direct Access", "More Prevention" and "Maximum Delegation". The scenario outputs comprised clinical time, workforce numbers and salary costs required for state-funded primary dental care in England. The operational research model suggested that 73% of clinical time in England's state-funded primary dental care in 2011/12 was spent on tasks that may be delegated to dental care professionals (DCPs), and 45- to 54-year-old patients received the most clinical time overall. Using estimated National Health Service (NHS) clinical working patterns, the model suggested alternative NHS workforce numbers and salary costs to meet the dental demand based on each developed scenario. For scenario 1:"No Skill Mix", the dentist-only scenario, 81% of the dentists currently registered in England would be required to participate. In scenario 2: "Minimal Direct Access", where 70% of examinations were delegated and the primary care training centre delegation patterns for other treatments were practised, 40% of registered dentists and eight times the number of dental therapists currently registered would be required; this would save 38% of current salary costs cf. "No Skill Mix". Scenario 3: "More Prevention", that is, the current model with no direct access and increasing fluoride varnish from 13.1% to 50% and maintaining the same model of delegation as scenario 2 for other care, would require 57% of registered dentists and 4.7 times the number of dental therapists. It would achieve a 1% salary cost saving cf. "No Skill Mix". Scenario 4 "Maximum Delegation" where all care within dental therapists' jurisdiction is delegated at 100%, together with 50% of restorations and radiographs, suggested that only 30% of registered dentists would be required and 10 times the number of dental therapists registered; this scenario would achieve a 52% salary cost saving cf. "No Skill Mix". Alternative scenarios based on wider expressed treatment need in national primary dental care in England, changing regulations on the scope of practice and increased evidence-based preventive practice suggest that the majority of care in primary dental practice may be delegated to dental therapists, and there is potential time and salary cost saving if the majority of diagnostic tasks and prevention are delegated. However, this would require an increase in trained DCPs, including role enhancement, as part of rebalancing the dental workforce.
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Wang, Xiaohui; Chontawan, Ratanawadee; Nantsupawat, Raymoul
2012-02-01
The aim of this study was to describe the relationship between the transformational leadership of nurse managers and job satisfaction among clinical Registered Nurses at a tertiary care hospital in China. The healthcare system is changing rapidly. Research in Western countries has shown that transformational leadership affects job satisfaction. However, very little research related to this subject has been conducted in healthcare settings in China. The sample consisted of 238 nurses who work at a tertiary care hospital in China. Data were collected from April to August 2006. Research instruments included a demographic data form, a Leadership Practice Inventory and a Job Satisfaction Scale for clinical registered nurses. Both the transformational leadership of nurse managers and job satisfaction among clinical Registered Nurses were at a moderate level. There was a statistically significant positive correlation between the transformational leadership of nurse managers and job satisfaction (r = 0·556, P < 0·001). The findings indicate that the transformational leadership of nurse managers could have an effect on the job satisfaction of clinical Registered Nurses. © 2011 Blackwell Publishing Ltd.