Anderson, E L; McCartney, E S; Schreiber, J A; Thompson, E A
The clinical nurse specialists (CNSs) at an 814-bed tertiary care center have collaborated to develop a method for measuring and evaluating productivity of the CNS role. This method, which uses the CIPP Evaluation Model as a framework, parallels the nursing process and is outcome oriented. The applicability of this method to other fixed positions may be of interest to nursing managers and administrators.
... 42 Public Health 2 2010-10-01 2010-10-01 false Clinical nurse specialists' services. 410.76... § 410.76 Clinical nurse specialists' services. (a) Definition. As used in this section, the term...) Qualifications. For Medicare Part B coverage of his or her services, a clinical nurse specialist must— (1) Be...
... 42 Public Health 2 2012-10-01 2012-10-01 false Clinical nurse specialists' services. 410.76... § 410.76 Clinical nurse specialists' services. (a) Definition. As used in this section, the term...) Qualifications. For Medicare Part B coverage of his or her services, a clinical nurse specialist must— (1) Be...
... 42 Public Health 2 2011-10-01 2011-10-01 false Clinical nurse specialists' services. 410.76... § 410.76 Clinical nurse specialists' services. (a) Definition. As used in this section, the term...) Qualifications. For Medicare Part B coverage of his or her services, a clinical nurse specialist must— (1) Be...
... 42 Public Health 2 2013-10-01 2013-10-01 false Clinical nurse specialists' services. 410.76... § 410.76 Clinical nurse specialists' services. (a) Definition. As used in this section, the term...) Qualifications. For Medicare Part B coverage of his or her services, a clinical nurse specialist must— (1) Be...
With the introduction of nurse consultants, and regulation of the use of the designation 'specialist nurse', experienced practitioners such as clinical nurse specialists have seen their position eroded. Nurse consultants are a new NHS-employment category, and are expected to be at the top rank of the profession both in status and in salary. However, this article argues that nurses at various levels have the same core functions, and that these do not differ for nurse consultants. Distinguishing between practitioners that might have the same job description could be better done by measuring outcomes. More care needs to be taken over the use of words such as 'expert', which is used differently in different contexts, and it is suggested that competencies be developed by which to measure the effects of expertise. Although nurse consultant appointments are often driven by various political directives and they are employed to meet local and national priorities, difficult issues need to be faced. First, if nurse consultant jobs are the top of the clinical career ladder, will clinical nurse specialists (CNSs) need to accept a lower rung on it? Further, perhaps the title CNS should become obsolete or be regulated? Can CNSs claim parity of pay using the 'Agenda for Change' framework?
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specialist. Clinical Nurse Specialist. 1(Summer 1987) 81 - 84. 11. Hodson, D.M., The evolving role of advanced practice nurses in surgery AORN Journal 67...The evolving role of advanced practice nurses in surgery . AORN Journal, 67(5), 998-1009. Hulley, S. B., Cummings, S .R., Browner, W. S., Grady, D...Montana. State of Montana Laws, Statutes & Regulations 1996 Jul; 228 p. These nurses are trained to perform minor surgery . Same-Day Surgery 2004 Mar; 28
Vidall, Cheryl; Barlow, Helen; Crowe, Maggie; Harrison, Isabel; Young, Annie
Despite emerging evidence for the clinical and financial efficacy of the clinical nurse specialist (CNS), the provision of this role is patchy across the country. There is also a risk that incumbent CNS' may be redirected to less specialist work in trusts that do not appreciate the full value of the service that these nurses provide. Optimal and equitable patient access to CNS care will require the development of a strong evidence base showing that specialist nurses not only deliver patient-focused care, but that they can also help to meet healthcare managers' objectives of streamlined, cost-effective clinical services.
Bell, Sue Ellen; Hulbert, James R
Translating social justice into clinical nurse specialist (CNS) practice involves not only facilitating equitable access to healthcare resources but also changing the definition of health from individual centric to population based. Clinical nurse specialists working within hospitals or healthcare systems generally have not explored the ethical conflicts between demand and available healthcare resources. Application of social justice to CNS practice requires microallocation decisions in direct patient care and macroallocation decisions in the distribution of all societal goods that alleviate health disparities. This article reviews the meaning, history, and current basis for the application of the principle of social justice to CNS practice.
Fenton, Mary V.; Brykczynski, Karen A.
A comparison of results of two studies regarding the actual practice of clinical nurse specialists and nurse practitioners revealed a shared core of advanced practice competencies as well as distinct differences between practice roles. (JOW)
... 42 Public Health 3 2010-10-01 2010-10-01 false Payment for nurse practitioners' and clinical nurse... HEALTH SERVICES Physicians and Other Practitioners § 414.56 Payment for nurse practitioners' and clinical nurse specialists' services. (a) Rural areas. For services furnished beginning January 1, 1992...
... 42 Public Health 3 2014-10-01 2014-10-01 false Payment for nurse practitioners' and clinical nurse... AND OTHER HEALTH SERVICES Physicians and Other Practitioners § 414.56 Payment for nurse practitioners' and clinical nurse specialists' services. (a) Rural areas. For services furnished beginning January...
... 42 Public Health 3 2012-10-01 2012-10-01 false Payment for nurse practitioners' and clinical nurse... AND OTHER HEALTH SERVICES Physicians and Other Practitioners § 414.56 Payment for nurse practitioners' and clinical nurse specialists' services. (a) Rural areas. For services furnished beginning January...
... 42 Public Health 3 2011-10-01 2011-10-01 false Payment for nurse practitioners' and clinical nurse... HEALTH SERVICES Physicians and Other Practitioners § 414.56 Payment for nurse practitioners' and clinical nurse specialists' services. (a) Rural areas. For services furnished beginning January 1, 1992...
... 42 Public Health 3 2013-10-01 2013-10-01 false Payment for nurse practitioners' and clinical nurse... AND OTHER HEALTH SERVICES Physicians and Other Practitioners § 414.56 Payment for nurse practitioners' and clinical nurse specialists' services. (a) Rural areas. For services furnished beginning January...
... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse...
... 42 Public Health 2 2014-10-01 2014-10-01 false Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse...
... 42 Public Health 2 2011-10-01 2011-10-01 false Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse...
... 42 Public Health 2 2012-10-01 2012-10-01 false Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse...
... 42 Public Health 2 2013-10-01 2013-10-01 false Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse...
Becker, Dawn Marie
Night-shift nurses receive fewer educational opportunities and less administrative support than do day-shift staff, tend to be newer, with less experience and fewer resources, and experience greater turnover rates, stress, and procedural errors. In an attempt to bridge the gap between day- and night-shift nursing, a night-shift clinical nurse specialist (CNS) position was created in a midsized, community teaching hospital. The goal was to provide an advanced practice presence to improve patient outcomes, communication, education, and cost-effectiveness. The night-shift CNS participated in nursing education and skill certifications, communicated new procedures and information, and created a communication committee specifically for night-shift nurses. Through regular rounding and on-call notification, the CNS was available to every area of the hospital for consultation and clinical assistance and assisted with rapid responses, codes, and traumas. Providing education during night shift reduced overtime costs and increased morale, positively affecting turnover rates. The night-shift CNS position has improved morale and equalized support for night-shift nurses. More research, most notably in specific night-shift metrics, is necessary, and with the implementation of the role in additional facilities, more can be understood about improving patient care and nursing staff satisfaction during night shift.
Dias, Maria-Helena; Chambers-Evans, Jane; Reidy, Mary
The clinical nurse specialist (CNS) role in Canada has 5 key components: clinical practice, consultation, education, research, and leadership. This study focuses on the consultation component: how it is described by CNSs and the facilitators and barriers to its implementation. A qualitative descriptive design was used to interview 8 CNSs who worked with adult populations in a university hospital setting.The findings indicate that managing crisis situations, ensuring continuity of care, and supporting other health professionals and health-care teams are key areas of consultation. Role ambiguity perceived by other professionals and constant demands and expectations due to a changing environment constitute the major challenges of CNS practice, requiring CNSs to continuously clarify their role in accordance with changes in time and place.
As the advanced practice nursing initiative in Canada gains momentum, effort is being directed towards clarifying and defining advanced practice roles. A qualitative study was undertaken to increase understanding of the clinical nurse specialist role of advanced practice. Sixteen nurses who worked in advanced practice roles, organizing and providing healthcare for children with complex health needs and their families across the continuum of care, participated in in-depth conversations about the nature of their practice, the knowledge that informs it and the factors that influence it. Findings suggest that clinical nurse specialists have a unique role in the organization and delivery of healthcare for specialized populations with complex health needs in their dual focus on the system level of healthcare and on population health needs. Initiatives directed to children and families within the study participants' specialties included program development, consultation and educational outreach and the development of clinical guidelines and policies. Although the nurses described their practice as focusing both on individual children and families and on the population of children and families within their specialty, it is at the population level that they see their greatest potential for contributing to the delivery of high-quality, cost-effective healthcare.
Fitzgerald, Ruth P
Doctor flight from rural areas is an international phenomenon that places great pressure on primary health care delivery. In New Zealand, the response to these empty doctors' surgeries has been the introduction of nurse-led rural health clinics that have attracted controversy both in the media and from urban-based doctors over whether such nurse-led care is a direct substitution of medical care. This article analyzes the reflections of nurses working in some of these clinics who suggest that their situation is more complex than a direct substitution of labor. Although the nurses indicate some significant pressures moving them closer to the work of doctoring, they actively police this cross-boundary work and labor simultaneously to shore up their nursing identities. My own conclusions support their assertions. I argue that it is the maintenance of a holistic professional habitus that best secures their professional identity as nurses while they undertake the cross-boundary tasks of primary rural health care. There are clear professional benefits and disadvantages for the nurses in these situations, which make the positions highly politicized. These recurring divisions of labor within medical care giving and the elaboration of new types of care worker form an appropriate although neglected topic of study for anthropologists. The study of the social organization of clinical medicine is much enriched by paying closer attention to its interaction with allied health professions and their associated understandings of "good" care.
Stilos, Kalli; Daines, Pat
Demand for palliative care services in Canada will increase owing to an aging population and the evolving role of palliative care in non-malignant illness. Increasing healthcare demands continue to shape the clinical nurse specialist (CNS) role, especially in the area of palliative care. Clinical nurse specialists bring specialized knowledge, skills and leadership to the clinical setting to enhance patient and family care. This paper highlights the clinical leadership role of the CNS as triage leader for a hospital-based palliative care consulting team. Changes to the team's referral and triage processes are emphasized as key improvements to team efficiency and timely access to care for patients and families.
Roberts, Debbie; Hibberd, Pat; Lewis, Christopher Alan; Turley, Joanne
To date, quality indicators that have been developed for nursing tend to focus on acute, secondary care settings. It remains unclear whether such quality indicators are applicable to community settings, particularly in rural environments. This research aims to identify the consensus view among specialist nurses regarding their unique nursing contribution within their rural community. Identifying agreed aspects of the unique role within the rural community area will enable quality care metrics to be developed, allowing specialist nurses to measure their unique contribution to rural health care in the future. The research used the Delphi technique to identify a consensus view among a population of specialist community nurses working in a designated rural area in Wales. The strongest area of consensus related to clinical and teaching expertise, where participants perceive educational expertise as being at the forefront of their role. In terms of care for individuals, consensus was focused on four main areas: developing appropriate criteria for referral in to the service, collaborative working, education, and advocacy roles. The findings highlight similarities to models of care provision elsewhere. Specific quality indicators are required for clinical nurse specialists working in rural areas. Current quality indicators may not be applicable across all clinical settings. Further work is required to explore the nature of rural nursing practice.
Forging new frontiers is one description for the completion of the Human Genome Project (HGP) in 2003. This project produced a human DNA blueprint that is revolutionalizing society, changing healthcare, and producing new practice standards. With the genome map, scientists are identifying DNA variations that transform traditional models of health promotion, disease prevention, disease classification, treatment, and symptom management. The HGP is shifting emphasis from traditional genetics to an expanded genomic message. Nursing has responded to the HGP completion by establishing genomic nursing competencies. In 2005, the American Nurses Association (ANA), along with 48 nursing organizations, including the National Association of Clinical Nurse Specialists (NACNS), endorsed minimum essential genetic/genomic nursing competencies for all registered nurses, regardless of education or specialty area. How does the clinical nurse specialist (CNS) explore the HGP frontier and integrate essential genomic nursing competencies into practice? This article discusses the HGP, the development of essential genetic/genomic nursing competencies, and the genomic role of the advanced practice CNS. A 1-day genomics program is described as a pilot project for integrating competencies in practice and education.
Brandt, Patricia A.; Magyary, Diane L.
Nursing specialists are prepared at the master's level to function as members of interdisciplinary and family-centered early intervention teams for disabled children. A specialty program of study emphasizes advanced and specialized clinical practice; education of clients, families, staff, and professionals; consultation; research use; evaluation…
Good, Mary Ellen
This paper presents strategies for the clinical nurse specialist (CNS) in the school setting to use in case management of migrant children with dental disease. Although dental disease is the major health problem of all school-age children in the nation, the problem is even more severe for children of migrant farmworkers. Leininger's transcultural…
The role of the clinical nurse specialists (HIV/AIDS) who work in areas with a low known prevalence of HIV is considered and their contribution to patient care, either directly or indirectly through the education and support of other health care workers, is discussed. Attention is given to the implications for nursing practice and the role of the clinical nurse specialist associated with the relative infrequency of contact with patients who have HIV disease; and some of the issues for people living with HIV/AIDS in rural areas are alluded to. Finally, some of the limitations of the clinical nurse specialist role are delineated and some consideration is given to the future role of clinical nurse specialists for HIV and AIDS.
Kaasalainen, Sharon; Ploeg, Jenny; Donald, Faith; Coker, Esther; Brazil, Kevin; Martin-Misener, Ruth; Dicenso, Alba; Hadjistavropoulos, Thomas
Pain management for older adults in long-term care (LTC) has been recognized as a problem internationally. The purpose of this study was to explore the role of a clinical nurse specialist (CNS) and nurse practitioner (NP) as change champions during the implementation of an evidence-based pain protocol in LTC. In this exploratory, multiple-case design study, we collected data from two LTC homes in Ontario, Canada. Three data sources were used: participant observation of an NP and a CNS for 18 hours each over a 3-week period; CNS and NP diaries recording strategies, barriers, and facilitators to the implementation process; and interviews with members of the interdisciplinary team to explore perceptions about the NP and CNS role in implementing the pain protocol. Data were analyzed using thematic content analysis. The NP and CNS used a variety of effective strategies to promote pain management changes in practice including educational outreach with team members, reminders to nursing staff to highlight the pain protocol and educate about practice changes, chart audits and feedback to the nursing staff, interdisciplinary working group meetings, ad hoc meetings with nursing staff, and resident assessment using advanced skills. The CNS and NP are ideal champions to implement pain management protocols and likely other quality improvement initiatives.
Clark, David; Seymour, Jane; Douglas, Hannah-Rose; Bath, Peter; Beech, Nicola; Corner, Jessica; Halliday, Deborah; Hughes, Philippa; Haviland, Jo; Normand, Charles; Marples, Rachael; Skilbeck, Julie; Webb, Tom
In the UK, the work of Macmillan clinical nurse specialists in palliative care is now well established. There has been little research, however, into the organizational context in which these nurses operate and the implications for the services they deliver. We report on a major evaluation of the service delivery, costs, and outcomes of Macmillan nursing services in hospital and community settings. The study was based on eight weeks of fieldwork in each of 12 selected services. Data are presented from semi-structured interviews, clinical records, and cost analysis. We demonstrate wide variation across several dimensions: location and context of the services; activity levels; management patterns; work organization and content; links with other colleagues; and resource use. We suggest that such variation is likely to indicate the existence of both excellent practice and suboptimal practice. In particular, our study highlights problems in how teamwork is conceptualized and delivered. We draw on recent organizational theories to make sense of the heterogeneous nature of Macmillan nursing services.
Patterson, Amy E; Mason, Tina M; Duncan, Pamela
This article describes a Magnet®-designated, national cancer institute comprehensive cancer center's quest to restructure the organization's evidence-based practice (EBP)/performance improvement (PI) framework leveraging the role of the clinical nurse specialist (CNS) as a coach to support staff nurses in EBP/PI initiatives. The support of the CNS is essential in developing effective projects, minimizing barriers, and maintaining a level of engagement in the EBP process from problem identification through dissemination and sustainment of practice changes.
National Advisory Council on Nurse Education and Practice, Rockville, MD.
This document presents the findings of the National Advisory Council on Nurse Education and Practice regarding the role, education, and supply of clinical nurse specialists (CNSs). The first section of the report examines the following eight background issues: (1) early development of the CNS; (2) current CNS supply; (3) roles and impact of the…
appeared in the nursing literature in 1938 ( Peplau , 1973). In 1943 the National League for Nursing Education, a forerunner of today’s National League for...of nursing, including psychiatric nursing (Crabtree, 1979; Garrison, 1953; Peplau , 1982a). The 1946 National Mental Health Act defined psychiatric...health literatures reflecting current expectations for this role will be reviewed. Historical Overview Peplau (1982a) traced the evolution of education
Kwok, Wing-Yee; Kloppenburg, Margreet; Beaart-van de Voorde, Liesbeth JJ; Huizinga, Tom WJ; Vliet Vlieland, Thea PM
Background The purpose of this study was to describe the effectiveness of a single one-hour consultation by a clinical nurse specialist in patients with hand osteoarthritis during daily rheumatology practice in secondary care. Methods Consecutive patients diagnosed by rheumatologists to have primary hand osteoarthritis and referred to the clinical nurse specialist were eligible for entry into this study. The standardized 1-hour consultation consisted of assessments and education on hand osteoarthritis by a clinical nurse specialist. Before and 3 months after the consultation, assessments were done to evaluate treatment (use of assistive devices, acetaminophen), health-related quality of life (physical component summary [PCS] score of Short-Form 36), and hand pain/function (Australian/ Canadian Osteoarthritis Hand Index [AUSCAN]). Paired t-tests and McNemar tests were used to analyze differences between baseline and follow-up. Satisfaction was measured after consultation at follow-up using a multidimensional questionnaire comprising 13 items (rated on a four-point scale). Results A total of 439 patients were referred, with follow-up data available for 195 patients, comprising 177 (87%) females, and of mean age 59 ± 9.0 years. After consultation, the proportions of patients using assistive devices and/or acetaminophen increased significantly from 30% to 39% and from 35% to 49%, respectively. PCS improved significantly (P = 0.03) whereas AUSCAN hand pain/function showed no significant differences compared with baseline (P values 0.52 and 0.92, respectively). The proportions of patients reporting to be satisfied or fully satisfied ranged from 78% to 99% per item. Conclusion A single, comprehensive, standardized assessment and education by a clinical nurse specialist improved the physical dimension of health-related quality of life in hand osteoarthritis. Most patients were satisfied with the consultation. Further controlled trials are needed to determine the added
Palmer, Deborah; El Miedany, Yasser
The extensive use of biological agents in recent years for the treatment of rheumatological diseases has required a steep learning curve for the specialist nurses who manage and work in this specialty. Safe prescribing of biological therapies requires good infrastructure and specialist nursing personnel. With additional training, the specialist nurse may take responsibility for a number of tasks in the patient pathway including screening, treatment administration, patient education, prescription coordination for home drug delivery, patient support, monitoring and data collection. Biological treatment is becoming more widely used in several specialities, in particular gastroenterology, dermatology and ophthalmology. Since 2002, rheumatology specialist nurses have taken the lead in assessment and providing biologic therapy, not only for patients suffering from rheumatic diseases but also for those with immune-mediated inflammatory disorders. The unique nature and variable safety profiles of these agents led to the development of immune-mediated inflammatory disease infusion (IMID) centres and highlighted the importance of having biological specialist nurses. This article will discuss the evolution of the IMID/biologic specialist nurse role and how IMID services started with goodwill from the rheumatology nurse specialists to develop into a main component of the holistic approach to care.
Balzer, Katrin; Butz, Stefanie; Bentzel, Jenny; Boulkhemair, Dalila; Lühmann, Dagmar
The care in nursing homes was examined based on scientific studies. The analysis focuses on dementia and type II diabetes. There is evidence for deficits in the supply of medical specialist attendance to nursing home residents with these diseases in Germany. Compared with corresponding guidelines the medical care for nursing home residents may be too low or inadequate. PMID:23755088
Epilepsy in children is a complex disease with significant psychosocial consequences for the child and their family. The intervention of a multidisciplinary team enables the care to be adapted and provides support for the families. At Sainte-Justine Hospital in Montreal, Canada, the nurse clinician specialised in epilepsy plays a key role in this team.
Barrett, Anne; Latham, Dinah; Levermore, Joy
Due to the reorganization of primary care trusts across the country, certain trusts proposed a reduction in the specialist district nurse practitioner numbers in favour of less qualified community nurses and health care assistants. Such proposals in one PCT were blocked, partly in response to documentation compiled by practitioners at the sharp end of nursing practice. With the new agenda of practice based commissioning, it is imperative that commissioners and management alike are aware of the scope of specialist district nurse practitioners. This is the first of a series of articles looking at specific case histories where the role of the district nurse is highlighted. It is the intention to stress the importance of the clinical expertise and confidence required by the district nurse to care for patients with complex needs in the community.
Whitehead, Bill; Bailey, Elaine
Mentors play a pivotal role in assessing and supporting nursing students. This can be rewarding but stressful. With increasing numbers of students requiring clinical placements, ward mentors are becoming overloaded. This article examines a new method of supporting senior nursing students in placement while alleviating the pressures on overworked mentors. It recommends the use of specialist nurses to support pre-registration students through a structured learning pathway. The scheme also opens up new areas for clinical allocations. This is a summary: the full paper can be accessed at nursingtimes.net.
documentation (Coleman & Henneman , 1991). These rounds can be lead by the CNS who has knowledge of educational methods, clinical issues, and staff needs...Craig, J. P., Bibro, M. C ., O’Connell, K. J. (1982). Cysts containing renal VHL Disease 53 cell carcinoma in von Hippel-Lindau disease. The Journal...of Uroloqy, 128, 798-800. Coleman, S., & Henneman , E. A. (1991). Comprehensive patient care and documentation through unit-based nursing rounds
District nurse (DN) care delivery has undergone substantial change in recent years due to changing demographics and service delivery demands that have called for a move of care delivery from secondary to primary care. The title District Nurse is recorded with the Nursing and Midwifery Council (NMC) on completion of the Specialist Practice Qualification in District Nursing (SPQ DN), which purports to be a 'transformational' course that prepares future caseload holders to manage their team and prioritise care delivery effectively. This article explores the need for assertiveness skills in this role in response to Australian research, and outlines the pedagogic interventions implemented during the SPQ DN course to enhance this skill. Assertiveness scores were monitored for the duration of the course and demonstrated a significant increase-a topic that is now the subject of a future, funded study.
Reed, Suellen B.; Hoffman, Sharon E.
To pin down the appropriate parameters for graduate nursing education, the authors say we must explore the meanings of advanced generalist and specialist. They discuss the focus, scope, and depth of the community health major, psychiatric mental health nursing, nursing care of children, maternity nursing, medical-surgical nursing, and nursing…
Hanley, Judy; Adams, Jane
This article describes the initial development and subsequent evolution of a simple referral assessment tool for stoma care. The first author's personal experience identified that there was widespread inconsistency in perceptions of local multidisciplinary teams as to when it was appropriate to refer to specific specialist nursing teams. This resulted in both inappropriate and delayed referrals. A 'Think Specialist Nurse' initiative was developed across the author's trust, building on the traffic light template from the 'ThinkGlucose' tool, to facilitate referrals to clinical nurse specialists. The stoma-care specific tool, 'Think Stoma Nurse', has subsequently evolved beyond its initial audience, and has been adapted into materials aimed at patients and carers.
Södergren, Ulrika; Benjaminson, Carin; Mattsson, Janet
Background: Specialist nurse students are upon graduation certified to have increased their professional competence to an advanced level. But how do specialist nurse students themselves experience and understand their professional competence and its development upon graduation? This is what this study aims at describing. Method: This study has a…
Millberg, Lena German; Berg, Linda; Brämberg, Elisabeth Björk; Nordström, Gun; Ohlén, Joakim
The aim was to explore the major concerns of specialist nurses pertaining to academic learning during their education and initial professional career. Specialist nursing education changed in tandem with the European educational reform in 2007. At the same time, greater demands were made on the healthcare services to provide evidence-based and safe patient-care. These changes have influenced specialist nursing programmes and consequently the profession. Grounded Theory guided the study. Data were collected by means of a questionnaire with open-ended questions distributed at the end of specialist nursing programmes in 2009 and 2010. Five universities were included. Further, individual, pair and group interviews were used to collect data from 12 specialist nurses, 5-14 months after graduation. A major concern for specialist nurses was that academic learning should be "meaningful" for their professional future. The specialist nurses' "meaningful academic learning process" was characterised by an ambivalence of partly believing in and partly being hesitant about the significance of academic learning and partly receiving but also lacking support. Specialist nurses were influenced by factors in two areas: curriculum and healthcare context. They felt that the outcome of contribution to professional confidence was critical in making academic learning meaningful.
Forrest, Christopher B
High use of specialist physicians and specialized procedures coupled with low exposure to primary care are distinguishing traits of the US health care system. Although the tasks of the primary care medical home are well established, consensus on the normative clinical roles of specialist physicians has not been achieved, which makes it unlikely that the specialist workforce is being used most effectively and efficiently. This article describes a typology of specialists' clinical roles that is based on the conceptual basis for health care specialism and empirical evaluations of the specialty referral process. The report concludes with a discussion on the implications of the typology for improving the effectiveness and efficiency of the primary-specialty care interface.
Westmoreland, Donna; Hays, Bevely J.
The Health Systems Nurse specialist program is an innovative master's curriculum in community health nursing, nursing administration, and nursing informatics. Students learn to work collaboratively to determine health priorities, develop and implement interventions, and monitor and improve patient outcomes. (Contains 11 references.) (JOW)
The removal of district nurses from the Nursing and Midwifery Council's recognised specialist practitioner list has resulted in many employers not commissioning district nurse courses and a lack of clarity about the skills required to be a team leader. This article discusses a practice development initiative to support learning through a practice based competency programme, to develop skills of local staff members.
Rojas, Crystal L; Seckman, Charlotte A
Health information technology is revolutionizing the way we interact with health-related data. One example of this can be seen in the rising adoption rates of electronic health records by healthcare providers. Nursing plays a vital role in electronic health record adoption, not only because of their numbers but also their intimate understanding of workflow. The success of an electronic health record also relies on how usable the software is for clinicians, and a thorough usability evaluation is needed before implementing a system within an organization. Not all nurses have the knowledge and skills to perform extensive usability testing; therefore, the informatics nurse specialist plays a critical role in the process. This article will discuss core usability principles, provide a framework for applying these concepts, and explore the role of the informatics nurse specialist in electronic health record evaluation. Health information technology is fundamentally changing the clinical practice environment, and many nurses are seeking leadership positions in the field of informatics. As technology and software become more sophisticated, usability principles must be used under theguidance of the informatics nurse specialist to provide a relevant, robust, and well-designed electronic health record to address the needs of the busy clinician.
Admi, Hanna; Zohar, Hana; Rudner, Yael
This study gains insight into the role of the breast care nurse specialist through an analysis of thank you letters written by women with breast cancer in a tertiary hospital in Israel. Descriptive content analysis was used to analyze 125 thank you letters. The findings revealed three aspects of the role of the breast care nurse specialist: instrumental, cognitive, and emotional. The women described these aspects as "paving the way through bureaucracy" (instrumental), being a "traffic light at a crossroad in life" (cognitive), and treating each one of them "as if I am your only patient" (emotional). This analysis highlighted the significance of the breast care nurse specialist in a holistic and integrative role that fills a gap within the biomedical healthcare system. Transferability of the findings to other nurse specialist roles in different clinical settings should be investigated.
Crowe, M; Inder, M; Carlyle, D; Wilson, L; Whitehead, L; Panckhurst, A; O'Brien, T; Frampton, C; Joyce, P
The aim of the study is (1) to assess the feasibility of delivering nurse-led specialist supportive care as an adjunct to usual care in the clinical setting; (2) to examine the relationship between the delivery of specialist supportive care and improved self-efficacy and functioning and reduced depressive symptoms. A randomized controlled trial of the clinical effectiveness of specialist supportive care as an adjunct to usual care was conducted in community mental health services at one site. Participants were randomized to either usual care or usual care and the adjunctive intervention. Self-report measures of depression, general functioning and self-efficacy were completed by participants in both groups at baseline and 9 months. The intervention was delivered parallel to usual treatment arrangements. While recruitment numbers were sufficient, a low rate of engagement meant we were unable to show significant differences in depressive symptoms or self-efficacy between the usual care group and the specialist supportive care plus usual care group. This study demonstrated that it was difficult to engage patients with bipolar disorder in specialist supportive care when they were currently in a mood episode and under the care of community mental health services.
Jonker, J M; Smorenburg, C H; Schiphorst, A H; van Rixtel, B; Portielje, J E A; Hamaker, M E
To identify ways to improve cancer care for older patients, we set out to examine how older patients in the Netherlands are currently being evaluated prior to oncological treatment and to explore the potential obstacles in the incorporation of a geriatric evaluation, using a web-based survey sent to Dutch medical oncology specialists and oncology nursing specialists. The response rate was 34% (183 out of 544). Two-thirds of respondents reported that a geriatric evaluation was being used, although primarily on an ad hoc basis only. Most respondents expressed a desire for a routine evaluation or more intensive collaboration with the geriatrician and 86% of respondents who were not using a geriatric evaluation expressed their interest to do so. The most important obstacles were a lack of time or personnel and insufficient availability of a geriatrician to perform the assessment. Thus, over 30% of oncology professionals in the Netherlands express an interest in geriatric oncology. Important obstacles to a routine implementation of a geriatric evaluation are a lack of time, or insufficient availability of geriatricians; this could be overcome with policies that acknowledge that quality cancer care for older patients requires the investment of time and personnel.
Curran, Mary K
The American Nurses Association advocates for nursing professional development (NPD) specialists to have an earned graduate degree, as well as educational and clinical expertise. However, many NPD specialists have limited exposure to adult learning theory. Limited exposure to adult learning theory may affect NPD educational practices, learning outcomes, organizational knowledge transfer, and subsequently, the professional development of the nurses they serve and quality of nursing care. An examination of current teaching practices may reveal opportunities for NPD specialists to enhance educational methods to promote learning, learning transfer, and organizational knowledge and excellence. This article, the first in a two-part series, examines best practices of adult learning theories, nursing professional development, curriculum design, and knowledge transfer. Part II details the results of a correlational study that examined the effects of four variables on the use of adult learning theory to guide curriculum development for NPD specialists in hospitals.
Cornwall, Amanda; Moore, Sally; Plant, Hilary
This paper reports on a study exploring the usefulness of e-mail as a means of communication between nurse specialists and patients with lung cancer and their families. The study involved two lung cancer nurse specialists and 16 patients and family members who used e-mail with them during the 6-month study period. Data were collected from three sources: (1) e-mail contact between the nurse specialists and patients/family members, (2) patient/family member questionnaire and (3) a focus group/reflective session with the nurse specialists. Quantitative data collected from the e-mails and the questionnaires were analysed descriptively and are presented as summary statistics. Text data from the questionnaires and e-mails were analysed using content analysis. Findings suggest that e-mail can be an effective and convenient means of communication between nurse specialists, and patients and family members. Patients and family members reported high levels of satisfaction with this method of communication. It was found to be quick and easy, and patients and family members were satisfied with both the response and the speed of response from the nurse specialists. Nurse specialists were also positive about e-mail use and found that the benefits of using e-mail with patients/family members outweighed any disadvantages. Further investigation is recommended involving other health care professionals and different patient groups to ensure the safe and appropriate use of e-mail within health care.
Chappell, Kathy B; Richards, Kathy C
This systematic review evaluated the relationship between new graduate nurses and clinical leadership skill, and between new graduate nurse transition programs and clinical leadership skill. New graduate nurse transition programs have been cited as one strategy to improve clinical leadership skill, but to our knowledge, no one has synthesized the evidence on new graduate nurse transition programs and clinical leadership skill. Results of this review showed that new graduate nurse transition programs that were at least 24 weeks in length had a positive impact on clinical leadership skill. New graduate nurse transition programs using the University HealthSystem Consortium/American Association of Colleges of Nursing Nurse Residency curriculum had the greatest impact, followed by curriculum developed by the Versant New Graduate RN Residency, an important finding for nursing professional development specialists.
Soden, Katie; Ali, Simone; Alloway, Lara; Barclay, David; Perkins, Paul; Barker, Stephanie
The aim of this qualitative study was to gain a better understanding of how nurses working on inpatient specialist palliative care units assess and manage breakthrough pain. Thematic analysis of semi-structured interviews with fifteen nurses from five different specialist palliative care units in the UK was undertaken. Themes identified have been broadly categorized into four main areas: defining breakthrough pain, assessing breakthrough pain, managing breakthrough pain, and attitudes/teamwork. Nurses had difficulty defining breakthrough pain as a distinct pain subtype and were often unable to differentiate it from poorly controlled background pain. This study highlights significant training needs and suggests that the theoretical work and recently published consensus recommendations around breakthrough pain now need to be translated into day-to-day clinical practice.
Jacobi, Judith; Ray, Shaunta'; Danelich, Ilya; Dodds Ashley, Elizabeth; Eckel, Stephen; Guharoy, Roy; Militello, Michael; O'Donnell, Paul; Sam, Teena; Crist, Stephanie M; Smidt, Danielle
This paper describes the goals of the American Society of Health-System Pharmacists' Pharmacy Practice Model Initiative (PPMI) and its recommendations for health-system pharmacy practice transformation to meet future patient care needs and elevate the role of pharmacists as patient care providers. PPMI envisions a future in which pharmacists have greater responsibility for medication-related outcomes and technicians assume greater responsibility for product-related activities. Although the PPMI recommendations have elevated the level of practice in many settings, they also potentially affect existing clinical pharmacists, in general, and clinical pharmacy specialists, in particular. Moreover, although more consistent patient care can be achieved with an expanded team of pharmacist providers, the role of clinical pharmacy specialists must not be diminished, especially in the care of complex patients and populations. Specialist practitioners with advanced training and credentials must be available to model and train pharmacists in generalist positions, residents, and students. Indeed, specialist practitioners are often the innovators and practice leaders. Negotiation between hospitals and pharmacy schools is needed to ensure a continuing role for academic clinical pharmacists and their contributions as educators and researchers. Lessons can be applied from disciplines such as nursing and medicine, which have developed new models of care involving effective collaboration between generalists and specialists. Several different pharmacy practice models have been described to meet the PPMI goals, based on available personnel and local goals. Studies measuring the impact of these new practice models are needed.
German Millberg, Lena; Berg, Linda; Lindström, Irma; Petzäll, Kerstin; Öhlén, Joakim
In conjunction with the introduction of the Bologna process in Sweden, specialist nursing education programmes were moved up to the second cycle of higher education with the opportunity to take a one-year master's degree, which also meant that students would undertake a degree project carrying 15 ECTS. The purpose of this study was to examine the introduction of postgraduate degree projects on the second-cycle level into Swedish specialist nursing programmes in accordance with the Bologna process. Five universities were involved and the study design took the form of action research. Problem formulation, planning, evaluation and follow-up with reflection led to new actions over a period of 2 1/2 years. Through a review of local curriculum documents, the implementation of a postgraduate degree project was monitored and these reviews, together with field notes, were analysed by means of constant comparative analysis. The results revealed a variety of tensions that arose when postgraduate degree projects were introduced, taking the form of differing views on the relationship between research, clinical development, specific professional objectives and academic objectives. These tensions were reflected in six areas of change. In summary, it can be noted that implementation of the postgraduate degree projects highlighted tensions related to basic views of learning.
Godfrey, Athleen B.
This article relates experiences and insights gained by a nurse educator directing the University of Utah College of Nursing's Utah Early Intervention Personnel Preparation project, a graduate-level interdisciplinary program to prepare early intervention specialists. Recommendations are offered for development of preservice or inservice…
Fairweather, C; Gardner, G
Over the past decade the discipline of nursing has been reviewing its practice, especially in relation to specialty areas. There has been an appreciation by nursing leaders that specialisation brings with it concerns related to a disuniting effect on the discipline and a fragmentation of nursing's traditional generalist practice. Accompanying these concerns is a debate over what is a specialty and how to define a specialist. This qualitative study drew upon a constructivist methodology, to explore how nurses, working in specialty areas, define and give meaning to their practice. Three groups of nurses (n=20) from the specialty of critical care were interviewed using a focus group technique. The data were analysed to build constructions of specialty practice. A distinct and qualitative difference was recognised in the practice behaviours of nurses working in the specialty area. The qualitatively different practice behaviours have been identified as 'nursing-in-a-specialty' and 'specialist nurse'. Two constructions emerged to differentiate the skill behaviours, these were 'practice' and 'knowledge'. The specialist nurse practices were based on two distinct types of practice, that of 'discretion' and 'incorporation'. 'Knowledge' was constructed as a synthesis of propositional and practice knowledge. By Carrie Fairweather and Glenn Gardner.
Cleary, Michelle; Horsfall, Jan; Mannix, Judy; O'Hara-Aarons, Maureen; Jackson, Debra
In this qualitative study, the experiences of a small cohort of registered nurses (RN) during the first 2 years of mental health employment were documented. A total of 13 semistructured interviews were completed from within a specialist mental health setting. Eleven issues were identified: (i) teamwork; (ii) experiential learning; (iii) self-development; (iv) confidence; (v) listening; (vi) rapport; (vii) keen observation; (viii) patience; (ix) empathy; (x) learning from colleagues; and (xi) maintaining a positive approach towards patients. The nurses focused on the here-and-now circumstances, rather than on future plans, or past preparation, and were able to elucidate the qualities and skills that they brought to their clinical work. Participants were most proud of achievements that bridged the personal and professional, such as self-development, working closely with patients to develop rapport, experiential learning, and teamwork. Findings highlight the importance of teamwork to newly-graduated RN entering the mental health environment. It is known that teamwork can convey a sense of belonging and help create an environment in which applied experiential clinical learning can occur. Therefore, it is important that efforts are made to facilitate team building and opportunities for teamwork when new graduates are transitioning into the mental health clinical practice environment.
Bunn, Frances; Goodman, Claire; Pinkney, Emma; Drennan, Vari M
Specialist nurses are one way of providing support for family carers of people with dementia, but relatively little is known about what these roles achieve, or if they are more effective than roles that do not require a clinical qualification. The aim of this review was to synthesise the literature on the scope and effectiveness of specialist nurses, known as Admiral Nurses, and set this evidence in the context of other community-based initiatives to support family carers of people with dementia. We undertook a systematic review of the literature relating to the scope and effectiveness of Admiral Nurses and a review of reviews of interventions to support the family carers of people with dementia. To identify studies, we searched electronic databases, undertook lateral searches and contacted experts. Searches were undertaken in November 2012. Results are reported narratively with key themes relating to Admiral Nurses identified using thematic synthesis. We included 33 items relating to Admiral Nurses (10 classified as research) and 11 reviews evaluating community-based support for carers of people with dementia. There has been little work to evaluate specific interventions provided by Admiral Nurses, but three overarching thematic categories were identified: (i) relational support, (ii) co-ordinating and personalising support and (iii) challenges and threats to the provision of services by Admiral Nurses. There was an absence of clearly articulated goals and service delivery was subject to needs of the host organisation and the local area. The reviews of community-based support for carers of people with dementia included 155 studies but, in general, evidence that interventions reduced caregiver depression or burden was weak, although psychosocial and educational interventions may reduce depression in carers. Community support for carers of people with dementia, such as that provided by Admiral Nurses, is valued by family carers, but the impact of such initiatives is
General Accounting Office, Washington, DC. Div. of Human Resources.
Selected Department of Defense (DOD) policies were examined concerning nurse anesthetists, nurse midwives, and nurse practitioners, particularly in regard to the extent to which these nurse specialists are allowed an independent scope of practice in military hospitals and the degree of physician supervision they require. Discussions were held with…
Asheervath, J.; Blevins, D.R.
Written in outline format, this reference will help nurses further their understanding of advanced nursing procedures. Information is provided on the physiological, psychological, environmental, and safety considerations of nursing activities associated with diagnostic and therapeutic procedures. Special consideration is given to the areas of pediatric nursing, nursing assessment, and selected radiologic and nuclear medicine procedures for each system. Contents: Clinical Introduction. Clinical Nursing Practice: Focus on Basics. Focus on Cardiovascular Function. Focus on Respiratory Function. Focus on Gastrointestinal Function. Focus on Renal and Genito-Urological Function. Focus on Neuro-Skeletal and Muscular Function. Appendices.
Cui, Jing; Zhou, Lingjun; Zhang, Lingjuan; Li, Li; Zhao, Jijun
To train pain nursing specialists through a pain education program, 20 nurses from six hospitals in Shanghai Province and seven in six provinces of China received the training of 2-month pain education and 4-month clinical practice. This nonrandomized pilot study examined the results of tests before and after the program, case report evaluations, future plan evaluations, clinical practice, and satisfaction questionnaire. After the program, the score of the test increased significantly compared with that before the program (44.1 ± 3.19; paired-sample t = 10.363; p < .0001). All of the participants thought that the program had broadened their vision, 19 (95%) thought that the program had raised the level of their theoretical knowledge in pain management, 17 (85%) thought that the program had improved their skills in clinical practice, and 15 (75%) thought that the program had played a role in enhancing their research abilities. Considering the whole program, most students (n = 17; 85%) were quite satisfied, and 3 (15%) were simply satisfied. By content analysis of the opening questions, we found that the participants had deeper and broader ideas about nurses' role and pain nursing specialists' responsibilities in pain management. The program improved nurses' attitudes, knowledge, and skills in pain management. The participants recognized pain nursing specialists' responsibilities in pain management more clearly.
Mohan, S; Wilkes, L M; Ogunsiji, O; Walker, A
This study aims to describe the experiences of nurses caring for cancer patients in non-specialist wards. The study was conducted in a large (420 beds) and small (32 beds) hospital in an area health service with urban and rural populations in the west of Sydney. A qualitative descriptive approach was utilized to collect data from the nurses. Data were collected using a survey and in-depth interviews of nurses working in non-specialist cancer wards. Transcribed data were managed with Nudist Vivo software and analysed for common themes using process of constant comparison and contrast. Twenty-five surveys were returned and five nurses volunteered to be interviewed. The six major themes that emerged from analysis of data were: emotional nature of care, lack of time, lack of knowledge of cancer treatment, family support, environment not conducive to proper care and dealing with patient's non-acceptance of cancer diagnosis. The nurses in this study wished to provide quality supportive care for cancer patients and their families but the inconducive environment and inadequate relevant training hindered the nurses' efforts. This then presents further need of relevant training for nurses in cancer care and time management, to meet up with these challenges.
Elliot, R; Adams, J
Older people form the largest group occupying acute hospital beds and many of them will have undiagnosed mental health problems. The creation of a Dementia Nurse Specialist role in a district general hospital provided the opportunity to assess the extent of the previously unmet need among patients, carers and nursing staff. Over 30 patients were seen each month, while around 6 to 12 were diagnosed as having dementia. Other activities undertaken as part of the role included providing information and support for carers, and advice on management of behaviours and support for ward staff. The role also involved policy writing, pathway and local strategy planning, care plan development, and formal and informal teaching on dementia. It is argued that this fixed-term post demonstrated that a Dementia Nurse Specialist could provide significant input in an acute hospital setting, by improving the experience of hospitalization for vulnerable older people and their carers.
Guarini, Alessandra; Marinis, Francesca De; Kohn, Anna; Orzes, Nicoletta; D’Incà, Renata; Iannone, Teresa; Giaquinto, Antonella; Rivara, Cinzia; Ridola, Lorenzo; Lorenzetti, Roberto; Zullo, Angelo
Background Management of inflammatory bowel disease (IBD) patients requires a multidisciplinary approach. Among the working team, the role of IBD nurse is expected to be particularly relevant when managing patients receiving biological therapies. We performed a survey to assess the presence of IBD nurse in centers where patients were receiving biologics. Methods For this Italian nationwide survey a specific questionnaire was prepared. IBD nurse was defined as a nurse directly involved in all phases of biological therapy, from pre-therapy screening, administration and monitoring during therapy, to follow up performed by a dedicated helpline, completed a specific training on biological therapy therapy, and observed international guidelines. Results A total of 53 Italian IBD centers participated in the survey, and 91 valid questionnaires were collected. Overall, 34 (37.4%) nurses could be classified as IBD specialists. IBD nurses had a significantly higher educational level than other nurses, they were more frequently operating in Central or Southern than in Northern Italy, they were working in an Academic center rather than in a General hospital, and in IBD centers with >25 patients on biological therapy. On the contrary, mean age, gender distribution, years of nursing, and years working in the IBD unit did not significantly differ between IBD and other nurses. Conclusions Our nationwide survey showed that the presence of an IBD nurse is still lacking in the majority of Italian IBD centers where patients receive biological therapies, suggesting a prompt implementation. PMID:27708516
Healthcare organizations, consultant groups, vendor companies, and academic institutions feel the challenge to enhance user experiences with information systems. To meet this challenge, organizations and companies are looking to better understand and utilize a variety of informatics roles to further marketing, business, or healthcare goals. Nursing is one practice area that can support the successful integration of information systems development, implementation, support, and user experience. However, the definition and development of such a role or position has met with mixed success. This article explores some of the issues and influences related to the role's development. The issues, impacts, and influences have been identified based on healthcare business assessment, job description analysis, employment and project evaluations, and professional standards set by the American Nurses Association.
Ng, San; Kessler, Linda; Srivastava, Rani; Dusek, Janice; Duncan, Deborah; Tansey, Margaret; Jeffs, Lianne
Despite the growing prevalence and healthcare needs of people living with mental illness, the stigma associated with mental health nursing continues to present challenges to recruiting new nurses to this sector. As a key recruitment strategy, five mental health hospitals and three educational institutions collaborated to develop and pilot an innovative nursing residency program. The purpose of the Mental Health Nursing Residency Program was to dispel myths associated with practising in the sector by promoting mental health as a vibrant specialty and offering a unique opportunity to gain specialized competencies. The program curriculum combines protected clinical time, collaborative learning and mentored clinical practice. Evaluation results show significant benefits to clinical practice and an improved ability to recruit and retain nurses. Nursing leadership was crucial at multiple levels for success. In this paper, we describe our journey in designing and implementing a nursing residency program for other nurse leaders interested in providing a similar program to build on our experience.
This article builds on a previous one which discussed the use of de Bono's thinking tool, 'six thinking hats' in the clinical, managerial, educational and research areas of nursing (Lewis 1995). This article explores clinical supervision and describes how the six thinking hats may be used as a reflective tool in the supervision of nurse lecturers who teach counselling skills.
This paper examines the aids and barriers to implementing the psychosocial interventions (PSI) which trainees learned on two teaching modules. The main purpose of the modules is to teach trainees PSI to help them be more effective in their care of patients with severe mental illness. The trainees were qualified nurses working in acute mental health wards in various London hospitals. PSI has been found to be helpful for patients with psychotic symptoms in community contexts. In this study, the implementation of PSI specific to acute inpatient mental health settings is explored. This was achieved by conducting semi-structured audiotaped interviews with all 20 trainees from a single cohort. The data were analysed by categories and themes to elicit not only the problems but also helpful strategies which can be used when working with PSI in acute inpatient mental health settings. The paper concludes by offering recommendations for future good practice for this area of mental health service.
Lennon, Alan; Hu, Peter
Some clinical laboratories require workers who have basic knowledge in molecular techniques (such as fluorescent in situ hybridization and polymerase chain reaction). Exclusively molecular diagnostic laboratories need workers to be competent in a variety of cutting edge molecular technologies, such as DNA sequencing, array-based comparative genomic hybridization, quantitative polymerase chain reaction, and many other techniques. Having only one certification for molecular biology at the entry level, as newly prescribed by the Board of Certification, doesn't accurately define the two very differently trained types of people these differing types of laboratories require. Creating a second molecular certification, at the specialist level, would address this issue positively.
Redman, Judy; McDonnell, Ann; Borthwick, Diana; White, John
Objectives This qualitative study examines how the Lung Cancer Nurse Specialist (LCNS) role operates and why they may be able to increase access to treatment. Setting 4 Hospital NHS Foundation Trusts in England. Design A multiple case study design using semistructured interviews, observation and Framework Analysis techniques. Participants Four LCNSs, comprised the ‘cases’. Twenty four clinicians who worked with the LCNS participated in individual interviews. Six LCNSs took part in a group interview and 60 lung cancer multidisciplinary team (MDT) members and co-ordinators were observed in the MDT meeting. Results The LCNS is crucial within the MDT and can act as a catalyst to patient access to treatment. The study identified the clinical activity (assessment, managing symptoms, psychological support and information provision) and role characteristics that can facilitate treatment access. These characteristics are the LCNS's presence across the patient pathway, acting as the ‘hub’ of the MDT, maintaining a holistic patient focus and working to an advanced level of practice. The findings indicate how factors may have a cumulative impact on treatment access. Conclusions If UK patient with lung cancer survival rates are to improve in line with comparable countries, we need to employ every advantage. This study demonstrates how the LCNS role may open doors to positive patient outcomes, including treatment. Further research is required to explore patients’ experiences, decision-making and attitudes to treatment. PMID:26685023
Bland, Ann R; Rossen, Eileen K
Some nurses describe individuals diagnosed with borderline personality disorder (BPD) as among the most challenging and difficult patients encountered in their practice. As a result, the argument has been made for nursing staff to receive clinical supervision to enhance therapeutic effectiveness and treatment outcomes for individuals with BPD. Formal clinical supervision can focus on the stresses of working in a demanding environment within the work place and enable nurses to accept accountability for their own practice and development (Pesut & Herman, 1999). A psychiatric-mental health clinical nurse specialist can provide individual and/or group supervision for the nursing staff, including education about patient dynamics, staff responses, and treatment team decisions. A clinical nurse specialist also can provide emotional support to nursing staff, which enhances job satisfaction, as they struggle to maintain professional therapeutic behavior with these individuals.
The purpose of this research is to enlight the actual nursing act of the student in order to search for what makes sense in his (her) self nursing becoming and to reinterpret what is said regarding what is done. Up till, researchs were focused on declarative intentions; instead here, we go beyond using an innovative approach based on the clinical activity research method applied to the nursing education field.
Munari, Denize Bouttelet; Oliveira, Nunila Ferreira de; Saeki, Toyoko; Souza, Maria Conceição Bernardo Demello E
This literature review was organized on the basis of the Annals of Mental Health Researcher and Psychiatric Nursing Specialists Meetings promoted by the University of São Paulo at Ribeirão Preto College of Nursing. It aimed to describe the history of these events, investigating the scenario and trends through the reading of texts published in these documents. All annals available from 1990 to 2004 were analyzed and read, based on an analysis protocol. The results showed that the published texts reflect the historical momentum of each national mental health policy movement in Brazil, indicating contradictions and advances. The conclusion is that the events provided a privileged forum to discuss and exchange experiences about the future of psychiatric nursing and mental health care, teaching and research in Brazil.
Schrum, Ronna A.
The purpose of this study was to examine specific variables associated with nursing student retention in Associate Degree Nursing (ADN) Programs. Jeffreys (2004) Nursing Undergraduate Retention and Success (NURS) conceptual model provided the framework for this descriptive correlational study. One hundred sixty eight pre-licensure associate degree…
Pillemer, Karl; Meador, Rhoda; Henderson, Charles, Jr.; Robison, Julie; Hegeman, Carol; Graham, Edwin; Schultz, Leslie
Purpose: This article reports on a randomized, controlled intervention study designed to reduce employee turnover by creating a retention specialist position in nursing homes. Design and Methods: We collected data three times over a 1-year period in 30 nursing homes, sampled in stratified random manner from facilities in New York State and…
Clarke, Colette M; Kane, Deborah J; Rajacich, Dale L; Lafreniere, Kathryn D
Although a limited number of studies have focused on bullying in nursing education to date, all of those studies demonstrate the existence of bullying in clinical settings, where nursing students undertake a significant amount of their nursing education. The purpose of this study was to examine the state of bullying in clinical nursing education among Canadian undergraduate nursing students (N = 674) in all 4 years of their nursing program. Results suggest that nursing students experience and witness bullying behaviors at various frequencies, most notably by clinical instructors and staff nurses. Third-year and fourth-year students experience more bullying behaviors than first-year and second-year students. Implications for practice include ensuring that clinical instructors are well prepared for their role as educators. Policies must be developed that address the issue of bullying within nursing programs and within health care facilities where nursing students undertake their clinical nursing education.
Background A common feature of prehospital emergency care is the short and fragmentary patient encounters with increased demands for efficient and rapid treatment. Crucial decisions are often made and the premise is the specialist ambulance nurse’s ability to capture the situation instantaneously. The assessment is therefore a pre-requisite for decisions about appropriate actions. However, the low exposure to severe trauma cases in Sweden leads to vulnerability for the specialist ambulance nurse, which makes the assessment more difficult. Our objective was to describe specialist ambulance nurses’ perceptions of assessing patients exposed to severe trauma. Methods This study had a phenomenographic approach and was performed in 2011 as an interview study. 15 specialist ambulance nurses with a minimum of 2.5 years of experience from praxis were included. The analysis of data was performed using phenomenography according to Marton. Results The perceptions of assessing patients exposed to severe trauma were divided into: To be prepared for emergency situations, Confidence in one’s own leadership and Developing professional knowledge. Conclusions This study reveals that the specialist ambulance nurse, on the scene of accident, finds the task of assessment of severe trauma patients difficult and complicated. In some cases, even exceeding what they feel competent to accomplish. The specialist ambulance nurses feel that no trauma scenarios are alike and that more practical skills, more training, exercise and feedback are needed. PMID:22985478
Recently, there has been a significant increase in the number of nurse specialist posts working with patients with lung cancer in the UK. This has been in response to a recognized need to improve lung cancer services. However, there is concern that these posts have been developed quickly with little strategic planning or evaluation. This paper is a collaborative project by the members of The London and South East Lung Cancer Forum for Nurses and aims to offer guidelines to managers and practitioners on areas where improvements may be made in the care of patients with lung cancer. Recommendations are based on Government guidelines, evidence from recent research studies and the experience of the members of the Forum.
McCallum, Jacqueline; Lamont, David; Kerr, Emma-Louise
Specialist environments have traditionally not been considered as practice learning environments for year one nursing students. Through implementation of the hub and spoke model of practice learning this was implemented across one health board and Higher Education Institution in Scotland. Sixty nine students from specialist and 147 from general areas out of a total population of 467 students (46.2%) and thirteen mentors from specialist and 26 from general areas out of a total 577 mentors (6.7%) completed a questionnaire. The findings support this initiative and suggest in some cases student experiences are more positive in specialist environments.
Grant, J S; Davis, L L; Kinney, M R
The primary goal of nursing research is to develop a scientific knowledge base for practice. Postanesthesia nurses are expected to critique nursing research before applying findings to clinical practice. As consumers of research, postanesthesia nurses must be able to employ critical evaluation skills to judge the merit and relevance of research to their clinical practice. This article presents criteria for critiquing clinical nursing research reports to determine their relevance to practice.
Coetzee, Minette; Britton, Margretta; Clow, Sheila E
The voice of clinical nurses is important to find and hear in the design of curricula. A participative action research project proposed to add this voice to the design of a new Critical Care Child Nursing programme at the University of Cape Town (UCT). Nurses' experiences of nursing critically ill children and their perceived learning needs in this context, were the central focus of the study. Participants were registered nurses working in the paediatric intensive care unit at the Red Cross Children's Hospital (a specialist hospital), which offers secondary and tertiary care in the Cape Town region and beyond. Data were gathered in five focussed group discussions. Findings indicate that the Critical Care Child Nurse needs not only a specialised knowledge base and acutely developed assessment skills, but also astute interpersonal skills. The nurse's professional identity and integration into the multidisciplinary team need exploring. Together with the development of interpersonal skills, the nurse needs to engage the child and family.
The development of specialist nursing practice has blurred the boundaries between medicine and nursing. This mainly qualitative study compares the structure of epilepsy specialist nurse (ESN) and consultant neurologist (CN) clinical interviews at first seizure presentation and opinion on diagnosis. Twenty patients with a suspected first seizure were randomly allocated for clinical review with an ESN and then a CN, or vice versa. Clinical interviews were unstructured and audio-recorded. The ESN and CN reached an independent diagnosis for each patient. Audiotapes were transcribed verbatim. Emergent themes were identified, catalogued and grouped into major thematic areas. Annotated audio recordings, medical notes and dictated clinic letters were used to validate findings. Statistical analysis of inter-rater agreement of diagnosis was evaluated using Kappa. The clinical interviews of CN and ESN were similar in structure. Differences demonstrated CNs concentrated on the prodrome to events and expressed less diagnostic uncertainty. ESNs concentrated on post-ictal recovery and used more investigations. Complete disagreement on diagnosis occurred in 5 (25%) patients. Kappa score=0.510, demonstrating a moderate level of inter rater agreement on diagnosis between the CN and ESN.
Mátrai, Zoltán; Tóth, László; Sávolt, Akos; Péley, Gábor; Tínusz, Anikó; Palla, Eva; Bartal, Alexandra; Horti, Ildikó; Kásler, Miklós
The uniform European structure and professional standards for high quality breast cancer care were established in conjunction with the European Organisation for Research and Treatment, the European Society of Mastology and the European Breast Cancer Coalition with the support of the European Parliament. Well-prepared professional teams including a new member called the breast care nurse serve as ground for special breast cancer centers with international accreditation that provide modern, evidence based, patient centered multidisciplinary oncological care. The responsibilities of the new qualified professional staff member include the psycho-social support of the patient and carers from the moment of diagnosis throughout the whole oncological treatment, the fostering of delivering information and communication between patients and specialists. As a result of the curriculum founded by the European Oncology Nursing Society, breast care nurses have become key members of the practice of holistic breast cancer care in countries where the European recommendations have already been implemented. Considering the expected rearrangement of national oncological care, the new sub-specialty is outlined for the first time in the light of the experiences gained at the National Institute of Oncology, Budapest, a comprehensive cancer center.
Diekelmann, Nancy L.; And Others
A new way to view the nursing curriculum is presented based on Heideggerian phenomenology and clinical nursing knowledge research. A restructuring of the nursing curriculum based on this approach allows researchers to generate new research questions and has implications for alternative curricular and instructional practices. In addition, this…
Griffith, Richard; Tengnah, Cassam
The numbers of district nurse clinics are continuing to grow in primary care and they provide timely and more cost effective intervention for patients. The clinics provide exciting opportunities for district nurses but also carry an increased risk of exposure to liability. This article discusses some of the key areas of accountability underpinning the duty of care of district nurses working in nurse-led clinics.
Pearcey, Patricia; Draper, Peter
Student nurses spend one half of their educational programme in the clinical area. The success of an educationally sound clinical placement is crucial to forming a professional nursing identity that will encompass the seen and 'unseen' aspects of the nurses' role. The aim of this study was to explore the clinical nursing environment through the perceptions of first year student nurses. Semi-structured interviews were used to collect data from 12 student nurses who each had four weeks clinical experience, representing 21 wards and five hospitals. Results suggest that these student nurses were disillusioned with the reality of clinical nursing and that their expectations of nursing were not realised. They perceived that paperwork, completing tasks and meeting targets were dominant features of nursing work at the expense of patient contact and communication. A majority indicated that nursing was not as caring as they expected and vowed to hold on to their personal values of caring about patients and forming communicative, interpersonal relationships with them.
Berndt, Jodi L.
Clinical experiences are an integral component of nursing education. Because the amount of time that a student spends in clinical experiences can be as many as twelve to sixteen hours per week, the clinical instructor plays a significant role in the nursing student's development of nursing knowledge. Many nurse educators attempt to balance dual…
Nail, Lillian M.; Lange, Linda L.
Addresses the recognition of differences between clinical and research data in using computerized clinical nursing databases and the issues of privacy and confidentiality for patients whose records are involved. Describes procedures for assessing the quality and usability of these data for nursing research. (SK)
Veltri, Linda M
The clinical learning experience is used in nursing programs of study worldwide to prepare nurses for professional practice. This study's purpose was to use Naturalistic Inquiry to understand the experiences of staff nurses in an obstetrical unit with undergraduate nursing students present for clinical learning. A convenience sample of 12 staff nurses, employed on a Family Birth Center, participated in semi-structured interviews. The constant comparative method as modified by Lincoln and Guba was used to analyze data. Five themes related to staff nurses experiences of clinical learning were identified: Giving and Receiving; Advancing Professionally and Personally; Balancing Act; Getting to Know and Working with You; and Past and Present. This research highlights staff nurses' experiences of clinical learning in undergraduate nursing education. Staff nurses exert a powerful, long lasting influence on students. A need exists to prepare and judiciously select nurses to work with students. Clinical agencies and universities can take joint responsibility providing tangible incentives, financial compensation, and recognition to all nurses working with nursing students.
Brahm, Carl-Otto; Klingberg, Gunilla; Ekfeldt, Anders
In 1998 the Swedish Parliament decided about increased financing of dental support and service given to persons with disabilities who were dependent on nursing personnel or others in their activities of daily life including oral hygiene procedures. One part of the legislation called "Necessary dental care, group 3" (NDC3) includes persons with intellectual disabilities and disabilities due to brain damage, autism and autism-like disorders, and persons with lasting mental and physical disabilities not related to normal ageing. The objectives where to investigate persons affected by this legislation; how many and what patients covered by NDC3 in Västra Götaland County received prosthodontic therapy from 2001 through 2004, at hospital dental clinics or dental specialist clinics. Patients treated with prosthodontic restorations covered financially by the county council under the terms of NDC3 were identified through the county council's registers. The application forms for NDC3 were retrieved and information about patient characteristics and type of treatments were compiled. It was shown that 57 patients covered by NDC3 in Västra Götaland County received prosthodontic therapy at dental specialist clinics and 50 were treated at the hospital dental clinics for extensive prosthodontic treatment needs. The mean age for the patients rehabilitated with removable dentures was higher (56.2 years) compared with patients treated with single tooth implants (39.7 years). About 30 patients, representing 1 to 2% of the NDC3 population in Västra Götaland County were rehabilitated with more advanced prosthodontic restorations in hospital dental clinics or dental specialist clinics each year. In conclusion and with respect to the probably large need for prosthodontic therapy among persons with disabilities, the use of NDC3 has not been properly utilized.
An audit was undertaken of people with a diagnosis of breast cancer who were referred to a community palliative care specialist nursing team over a 12-month period, to explore the reasons for referral to the service and the duration of involvement with the service. Breast cancer patients accounted for 10% of the total referrals to the specialist service, with symptom management (including pain control) and emotional support being the main reasons for referral. The majority of people referred with breast cancer had metastatic breast cancer (87%); interestingly, 13% had primary breast cancer. The mean duration of intervention was 3 months and 1 week. Referrals seemed to occur late in patients' disease trajectories, and total numbers were lower than might be expected. It may be concluded that there is scope for the specialist palliative care team to be a more integral part of care for patients with metastatic breast cancer.
Lennon, Julie; Harper, Robert; Biswas, Sus; Lloyd, Chris
This article presents a survey of the demographical, educational and visual functional characteristics of children attending a specialist paediatric low-vision assessment clinic at Manchester Royal Eye Hospital. Comprehensive data were collected retrospectively from children attending the paediatric low-vision clinic between January 2003 and…
Romero, José Antonio Vinagre; Heredero, Carmen De Pablos
Clinical practice guidelines in nursing (CPG-N) are tools that allow the necessary knowledge that frequently remains specialist-internalised to be made explicit. These tools are a complement to risk adjustment systems (RAS), reinforcing their effectiveness and permitting a rationalisation of healthcare costs. This theoretical study defends the importance of building and using CPG-Ns as instruments to support the figure of the nursing supervisor in order to optimise the implementation of R&D and hospital quality strategies, enabling clinical excellence in nursing processes and cost-efficient reallocation of economic resources through their linear integration with SARs.
Hannigan, B; Burnard, P; Edwards, D; Turnbull, J
Surveys of the leaders of the UK's post-qualifying education courses for community mental health nurses have taken place, on an annual basis, for over 10 years. In this paper, findings from the survey undertaken in the 1998--99 academic year are reported. These findings include: that most course leaders do not personally engage in clinical practice; that interprofessional education takes place at a minority of course centres, and that course philosophies and aims are characterised by an emphasis on both outcomes (in terms of, for example, skills acquisition, knowledge development and the ability to engage in reflective practice), and process (adult learning).
Lovato, Sabrina; Lovato, Liliana; Cunico, Laura
Moral distress in nursing practice is described as a suffering situation that arises when the nurse is unable to act her/his ethical choices, when institutional constraints interfere with acting in the way she/he believes to be right. The aim is to describe nursing practice situations causing moral distress resulting from the recognition of the ethical appropriate actions combined with the impossibility to pursue it; to describe how nurses manage moral distress situations and the strategies to cope with them. A focus group was conducted in three wards of a large teaching-hospital in the north of Italy. In another ward the nurses were asked to write a moral distress experience. A total of 40 nurses were involved and 50 experiences collected. The experiences' analysis has shown 5 source areas of moral distress: 1) clinical decision; 2) nursing competences; 3) nurse-physician collaboration; 4) organization of care; 5) safe care. For each area the most frequent themes were highlighted.Areas of clinical decision, nursing competences, nurse-physician collaboration involve nurse leaders in identification and implementation of strategies for managing moral distress.
Lin, Chiou-Fen; Kao, Ching-Chiu
The significant changes in nursing manpower utilization in Taiwan over the past two decades are due in large part to the implementation of the National Health Insurance program and the rising need for long-term care. The changes have impacted clinical nursing manpower utilization in two important ways. Firstly, there has been a substantial increase in overall demand for nursing manpower. In particular, the need for clinical nurses has nearly quadrupled during this time period. Secondly, the level of difficulty involved in patient care has risen dramatically, with factors including increased disease severity and increased care quality expectations, among others. These changes, coupled with demands on nursing manpower imposed from other sectors, underpin and further exacerbate the problem of nursing manpower shortages throughout the healthcare system. To raise the quality of the nursing work environment, the Ministry of Health and Welfare (MOHW) brought together Taiwan's key professional nursing organizations to promote 10 care-reform strategies, establish the nursing-aid manpower system, and create the nursing classification system as an approach to effectively attract nurses to take positions in the medical system.
Purpose: This study aims to explore the lived experience of learning for a group of staff nurses in the Middle East, who undertook a post-registration nursing education programme in the speciality of nephrology nursing (the NNP) between 2001 and 2002. The broad-based curriculum seeks to develop the staff nurses into active learners, able to…
Robinson, Suzanne; Cote, Debra
NCATE's (2010) "Report of the Blue Ribbon Panel" calls for a shift toward clinical preparation and partnerships as a means of adequately preparing new teachers for the 21st century classroom. Looking at special education teacher preparation, there exist few model programs that have paved the road for others in implementing new clinical…
Fang, Zhuyuan; Fan, Xiaowei; Chen, Gong
Correlation analysis and processing of massive medical information can be implemented through big data technology to find the relevance of different factors in the life cycle of a disease and to provide the basis for scientific research and clinical practice. This paper explores the concept of constructing a big medical data platform and introduces the clinical model construction. Medical data can be collected and consolidated by distributed computing technology. Through analysis technology, such as artificial neural network and grey model, a medical model can be built. Big data analysis, such as Hadoop, can be used to construct early prediction and intervention models as well as clinical decision-making model for specialist and special disease clinics. It establishes a new model for common clinical research for specialist and special disease clinics.
Jacobson, Ann F; Warner, Andrea M; Fleming, Eileen; Schmidt, Bruce
Clinical research is necessary for developing nursing's body of knowledge and improving the quality of gastroenterology nursing care. The support and participation of nursing staff are crucial to conducting interventional research. Identification of characteristics of nurses and their work settings that facilitate or impede participation in research is needed. The purpose of this descriptive correlational study was to examine the effect of personal and professional characteristics and attitudes about nursing research on staff nurses' participation in a clinical nursing research project. A questionnaire measuring nurses' attitudes, perceptions of availability of support, and research use was distributed to staff nurses working on an endoscopy lab and two same-day surgery units where a nursing research study had recently been conducted. Investigator-developed items measured nurses' attitudes about the utility and feasibility of the interventions tested in the original study. A total of 36 usable questionnaires comprised the sample. Factor analysis of the two questionnaires resulted in three-factor (Importance of Research, Interest in Research, and Environment Support of Research) and two-factor (Value of Cognitive-Behavioral Interventions [CBIs] and Participation in Study) solutions, respectively. There were no statistically significant differences in mean scores for the five factors between nurses who did (n = 19) and those who did not (n = 17) participate in the original study. The Participation in Research Factor was significantly negatively correlated with years in nursing (r = -.336, p < .05) and positively correlated with the importance of research factor (r = .501, p < .01). Importance of research was negatively correlated with years in nursing (r = -.435, p < .01) and positively correlated with value of CBI (r = .439, p < .01) and participation in study (r = .501, p < .01). Findings from the study will contribute to the body of knowledge about factors that
Kirk, Timothy W
Understanding, shared meaning, and mutual trust lie at the heart of the therapeutic nurse-patient relationship. This article introduces the concept of clinical intimacy by applying the interpersonal process model of intimacy to the nurse-patient relationship. The distinction between complementary and reciprocal behaviours, and between intimate interactions and intimate relationships, addresses background concerns about the appropriateness of intimacy in nursing relationships. The mutual construction of meaning in the interactive process between nurses and patients is seen to lie at the heart of clinical intimacy as a hermeneutic enterprise. Intimacy is distinguished from empathy based on intentionality and the status and location of meaning. Reasons for continued investigation into clinical intimacy as an explanatory model for nursing as a hermeneutic practice are presented.
Ohio State Univ., Columbus. National Center for Research in Vocational Education.
These lesson plans and student materials--handouts and workbook--for a secondary-postsecondary-level course for clinical specialists are one of a number of military-developed curriculum packages selected for adaptation to vocational instruction and curriculum development in a civilian setting. Purpose stated for the 105-hour course is to provide…
Seright, Teresa J.
The purpose of this study was to develop substantive theory regarding decision making by the novice nurse in a rural hospital setting. Interviews were guided by the following research questions: What cues were used by novice rural registered nurses in order to make clinical decisions? What were the sources of feedback which influenced subsequent…
Evidence-based healthcare (EBHC) emphasizes the integration of the best research evidence with patient values, specialist suggestions, and clinical circumstances during the process of clinical decision-making. EBHC is a recognized core competency in modern healthcare. Nursing is a professional discipline of empirical science that thrives in an environment marked by advances in knowledge and technology in medicine as well as in nursing. Clinical nurses must elevate their skills and professional qualifications, provide efficient and quality health services, and promote their proficiency in EBHC. The Institute of Medicine in the United States indicates that evidence-based research results often fail to disseminate efficiently to clinical decision makers. This problem highlights the importance of better promoting the evidence-based healthcare fundamentals and competencies to frontline clinical nurses. This article describes the historical background and present development of evidence-based healthcare from the perspective of modern clinical nursing in light of the importance of evidence-based healthcare in clinical nursing; describes the factors associated with evidence-based healthcare promotion; and suggests strategies and policies that may improve the promotion and application of EBHC in clinical settings. The authors hope that this paper provides a reference for efforts to improve clinical nursing in the realms of EBHC training, promotion, and application.
Computer-assisted learning (CAL) may be defined as any learning that is mediated by a computer and which requires no direct interaction between the user and a human instructor in order to run. Instead, CAL presents the user with an interface (constructed by an educator skilled in the field of study) which allows the user to follow a lesson plan or may allow self-directed access to particular information of interest. CAL has been claimed to improve knowledge retention and achievement scores, enhance clinical judgement skills and reduce required instruction time; performing as well (if not better) when compared to other more traditional education techniques. The advantages of the utilisation of CAL in nursing education can be made clear by consideration of adult education theory and curriculum design, as well as the particular learning needs of nurses themselves. Research and development into a theoretical framework for CAL design and implementation has allowed the identification of beneficial aspects of CAL resources. Although the cost of commercial software may be prohibitive to some institutions, possibilities exist for educators to create their own CAL packages relatively simply.
Presents reasons for objecting to a clinical component in the graduate nursing administration curriculum and suggests some curriculum content, while stating that only a nurse with clinical experience should be a nursing administrator. Describes how a nurse manager administers the program while staff nurses provide the patient care. (MF)
Messinger-Rapport, Barbara J; Gammack, Julie K; Thomas, David R; Morley, John E
This is the seventh article in the series of Clinical Updates on Nursing Home Care. The topics covered are antiresorptive drugs, hip fracture, hypertension, orthostatic hypotension, depression, undernutrition, anorexia, cachexia, sarcopenia, exercise, pain, and behavioral and psychological symptoms of dementia.
McNee, Peter; Clarke, Dave; Davies, Jane
The teaching of clinical skills within nursing is currently enjoying a resurgence following the implementation of the 'Fitness for Practice Curriculum'. However, the teaching of clinical skills specifically within children's nursing has received little attention within the research arena. This article presents the data of a national postal survey sent to United Kingdom institutions providing pre-registration child branch studies, to ascertain the current provision of clinical skills teaching. The findings conclude that very few institutions have invested in specific skills laboratories to teach children's nursing students. It was also identified that a wide range of clinical skills are taught to child branch students; however, the resources and realism to clinical practice is limited by the lack of specialist children's skills laboratories or equipment. In conclusion the authors recommend the development of child specific skills laboratories, to augment child branch skills teaching, in order to enhance the realistic simulation of clinical practice.
Background The role of the clinical nurse/midwife specialist and advanced nurse/midwife practitioner is complex not least because of the diversity in how the roles are operationalised across health settings and within multidisciplinary teams. This aim of this paper is to use The SCAPE Study: Specialist Clinical and Advanced Practitioner Evaluation in Ireland to illustrate how case study was used to strengthen a Sequential Explanatory Design. Methods In Phase 1, clinicians identified indicators of specialist and advanced practice which were then used to guide the instrumental case study design which formed the second phase of the larger study. Phase 2 used matched case studies to evaluate the effectiveness of specialist and advanced practitioners on clinical outcomes for service users. Data were collected through observation, documentary analysis, and interviews. Observations were made of 23 Clinical Specialists or Advanced Practitioners, and 23 matched clinicians in similar matched non-postholding sites, while they delivered care. Forty-one service users, 41 clinicians, and 23 Directors of Nursing or Midwifery were interviewed, and 279 service users completed a survey based on the components of CS and AP practice identified in Phase 1. A coding framework, and the generation of cross tabulation matrices in NVivo, was used to make explicit how the outcome measures were confirmed and validated from multiple sources. This strengthened the potential to examine single cases that seemed ‘different’, and allowed for cases to be redefined. Phase 3 involved interviews with policy-makers to set the findings in context. Results Case study is a powerful research strategy to use within sequential explanatory mixed method designs, and adds completeness to the exploration of complex issues in clinical practice. The design is flexible, allowing the use of multiple data collection methods from both qualitative and quantitative paradigms. Conclusions Multiple approaches to data
Background In countries with scarce specialized Human resource for health, patients are usually referred. The other alternative has been mobilizing specialists, clinical specialist outreach. This study examines whether clinical specialist outreach is a cost effective way of using scarce health expertise to provide specialist care as compared to provision of such services through referral system in Ethiopia. Methods A cross-sectional study on four purposively selected regional hospitals and three central referral hospitals was conducted from Feb 4-24, 2009. The perspective of analysis was societal covering analytic horizon and time frame from 1 April 2007 to 31 Dec 2008. Data were collected using interview of specialists, project focal persons, patients and review of records. To ensure the propriety standards of evaluation, Ethical clearance was obtained from Jimma University. Results It was found that 532 patients were operated at outreach hospitals in 125 specialist days. The unit cost of surgical procedures was found to be ETB 4,499.43. On the other hand, if the 125 clinical specialist days were spent to serve patients referred from zonal and regional hospitals at central referral hospitals, 438 patients could have been served. And the unit cost of surgical procedures through referral would have been ETB 6,523.27 per patient. This makes clinical specialist outreach 1.45 times more cost effective way of using scarce clinical specialists' time as compared to referral system. Conclusion Clinical specialist outreach is a cost effective and cost saving way of spending clinical specialists' time as compared to provision of similar services through referral system. PMID:20540766
Gerard, Sally; Grossman, Sheila; Godfrey, Marjorie
The scope of the clinical nurse leader (CNL) is evolving in practice across the country. The preparation of this pivotal role in a complex healthcare environment has prompted the collaboration of nurse academics, nurse administrators, and clinicians to design unique educational experiences to maximize best practice. Knowledge attained regarding healthcare improvement and patient safety must not only be theoretical, but personal and application focused. Utilizing the American Association of Colleges of Nursing's CNL white paper and published resources faculty developed a clinical leadership course focused on active learning and reflection. Students explore concepts of improvement and quality related to business models of high functioning organizations including healthcare. Three key components of the course are described in detail; "quality is personal", executive interviews and the "5P" clinical microsystems assessment. Evaluation outcomes are discussed. Course content and innovative teaching/learning strategies for CNL are shared which may support the growth of CNL program development nationally.
Park, Eun-Jun; Park, Seungmi; Jang, In-Sun
This study examines the extent and predictors of unethical clinical behaviors among nursing students in South Korea. From survey data of 345 undergraduate nursing students, unethical clinical behaviors were examined with respect to 11 individual characteristics, frequency and perceived seriousness of classroom cheating, two factors of individual attitude, and four contextual factors. Qualitative data from two focus group interviews were analyzed to explore reasons for and contexts of unethical clinical behaviors. About sixty-six percent of the participants engaged in one or more unethical clinical behaviors over a one-semester period. The prevalence of such behaviors varied widely from 1.7% to 40.9% and was related to the type of nursing program, the number of clinical practicum semesters completed, ethical attitudes toward cheating behaviors, the frequency of cheating on assignments, the frequency of cheating on exams, the perceived prevalence of cheating by peers, and prior knowledge of academic integrity. According to the regression analysis, the last four variables explained 29.4% of the variance in the prevalence of unethical clinical behaviors. In addition, multiple reasons and possible interventions for clinical misconduct were reported during the focus group interviews. Unlike cheating in the classroom, clinical misconduct was strongly induced by clinical nurses and poor clinical practice environments. In sum, unethical clinical behaviors were widespread among the participants and need to be corrected.
Suplee, Patricia Dunphy; Gardner, Marcia; Jerome-D'Emilia, Bonnie
Nursing faculty who teach in clinical settings face complex situations requiring evidence-based educational and evaluative strategies, yet many have had limited preparation for these tasks. A convenience sample of 74 nursing faculty participated in a survey about clinical teaching in prelicensure nursing programs. Most faculty developed teaching skills through conferences (57%), orientation at their educational institution (53%), or exposure in graduate school (38%). Thirty-one percent reported having no preparation for clinical teaching. Faculty felt least prepared to manage students with learning, physical, or emotional disabilities and incivility. Twenty-six percent had no preparation for evaluating students in the clinical setting, and only 17% had worked with a faculty mentor. Few evidence-based teaching strategies were used by the faculty. These findings indicate gaps exist in the preparation of clinical faculty. Graduate education, comprehensive orientation programs, and continuing professional development may help to ensure faculty are effective in managing and evaluating student learning.
McKie, Andrew; Baguley, Fiona; Guthrie, Caitrian; Jackson, Carol; Kirkpatrick, Pamela; Laing, Adele; O'Brien, Stephen; Taylor, Ruth; Wimpenny, Peter
The recent interest in wisdom in professional health care practice is explored in this article. Key features of wisdom are identified via consideration of certain classical, ancient and modern sources. Common themes are discussed in terms of their contribution to 'clinical wisdom' itself and this is reviewed against the nature of contemporary nursing education. The distinctive features of wisdom (recognition of contextual factors, the place of the person and timeliness) may enable their significance for practice to be promoted in more coherent ways in nursing education. Wisdom as practical knowledge (phronesis) is offered as a complementary perspective within the educational preparation and practice of students of nursing. Certain limitations within contemporary UK nursing education are identified that may inhibit development of clinical wisdom. These are: the modularization of programmes in higher education institutions, the division of pastoral and academic support and the relationship between theory and practice.
Carcuac, Olivier; Jansson, Leif
Implant therapy has become a widely recognized treatment alternative for replacing missing teeth. Several long term follow-up studies have shown that the survival rate is high. However, complications may appear and risk indcators associated with early and late failures have been identified. The purpose of the present retrospective clinical study was to describe some clinical features of patients with clinical signs of peri-implantitis and to identify risk indicators of peri-implantitis in a population at a specialist clinic of Periodontology. In total,the material consisted of 377 implants in 111 patients with the diagnosis peri-implantitis. The mean age at the examination was found to be 56.3 years (range 22-83) for females and 64.1 years (range 27-85) for males. The mean number of remaining teeth was found to be 10.5 (S.D. 8.89) and the mean number of implants was 5.85 (S.D. 3.42). For a majority of the subjects, more than 50% of the remaining teeth had a marginal bone loss of more than 1/3 of the root length. Forty-sex percent of the patients visited regularly dental hygienists for supportive treatment. The percentage of implants with peri-implantitis was significantly increased for smokers compared to non-smokers (p = 0.04). In the group of non-smokers, 64% of the implants had the diagnosis peri-implantitis, while the corresponding relative frequency for smokers was 78%. A majority of the individuals had a Plaque index and Bleeding on probing index >50%. The median of the follow-up time after implant placement was 7.4 years and the observation period was not significantly correlated to the degree of bone loss around the implants. Among the subjects with a mean bone loss >6 mm at implants with peri-implantitis, more than 70% had a mean marginal bone loss > 1/3 of the root length of the remaining teeth. A positive and significant correlation was found between the degree of marginal bone loss in remaining teeth and the degree of bone loss around implants with peri
Parker, Pamela J
Nursing is a low-technology field moving into high technology. Understanding that technology of the future is a tool to improve patient care will help caregivers embrace this change. With nurse leaders at the table as systems are planned we can ensure that care survives.
Umar, Nisser Ali; Hajara, Moses John; Khalifa, Mohammed
Aiming to assess the impact of the intervention in reducing the patients' waiting time in the clinic, two surveys were conducted before and after task shifting intervention in an anti-retroviral (ARV) clinic at the Specialist Hospital, Bauchi, Nigeria in November 2008 and April 2009, respectively. Before the task shifting, six nurses from the clinic were trained on integrated management of adolescent and adult illness, as well as on the principle and guidelines for the anti-retroviral therapy, after which their schedule in the clinic was broadened to include seeing HIV patients presenting for routine refill and follow-up visits. In this study, fifty-six and sixty patients, respectively out of 186 and 202 who attended the clinic on the days of the pre- and post-intervention surveys, were randomly sampled. Data on patients' sex, age and marital status, whether patient a first timer or follow up visitor and the time spent in the clinic on that day as well as the number and composition of staff and equipment in the clinic was collected. The difference in waiting time spent between the first group before task shifting and second group after task shifting was statistically analyzed and significance tested using unpaired t-test. There was a reduction in the average waiting time for patients attending the clinic from 6.48 h before task shifting to 4.35 h after task shifting. The difference of mean was -2.13 h, with 95% CI: -2.44:-1.82 hours and the test of significance by unpaired t-test P<0.0001. PMID:28299042
Umar, Nisser Ali; Hajara, Moses John; Khalifa, Mohammed
Aiming to assess the impact of the intervention in reducing the patients' waiting time in the clinic, two surveys were conducted before and after task shifting intervention in an anti-retroviral (ARV) clinic at the Specialist Hospital, Bauchi, Nigeria in November 2008 and April 2009, respectively. Before the task shifting, six nurses from the clinic were trained on integrated management of adolescent and adult illness, as well as on the principle and guidelines for the anti-retroviral therapy, after which their schedule in the clinic was broadened to include seeing HIV patients presenting for routine refill and follow-up visits. In this study, fifty-six and sixty patients, respectively out of 186 and 202 who attended the clinic on the days of the pre- and post-intervention surveys, were randomly sampled. Data on patients' sex, age and marital status, whether patient a first timer or follow up visitor and the time spent in the clinic on that day as well as the number and composition of staff and equipment in the clinic was collected. The difference in waiting time spent between the first group before task shifting and second group after task shifting was statistically analyzed and significance tested using unpaired t-test. There was a reduction in the average waiting time for patients attending the clinic from 6.48 h before task shifting to 4.35 h after task shifting. The difference of mean was −2.13 h, with 95% CI: −2.44:−1.82 hours and the test of significance by unpaired t-test P<0.0001. PMID:28299044
... comprehensive plans of care, of all participants in the program. (a) There must be at least one registered nurse on duty each day of operation of the adult day health care program. This nurse must be currently... that this nurse be a geriatric nurse practitioner or a clinical nurse specialist. (b) The number...
Epstein, C; Bakanauskas, A
Achievement of successful patient outcomes depends on the availability of a primary nurse responsible for all aspects of nursing care. A consistent caregiver not only has a grasp of phenomena at hand but possesses an overall perspective of recovery. Care can be evaluated and readjusted on a timely basis. Identification of signs of progress as well as deterioration may be facilitated through continuity of care. The primary nurse can provide meaningful, ongoing information to the patient and significant others as a means of optimizing their coping behaviors. Effective nursing care of the patient with DIC is enhanced by a thorough understanding of its pathophysiology and its clinical manifestations. When the critical care nurse has a comprehensive knowledge base and uses purposeful assessment skills, potential complications become much clearer and are avoided. The primary nurse who knows how to prioritize care is capable of anticipating the patient's needs. By integrating theory with practice, the critical care nurse functions from a position of strength in promoting quality patient care.
Rahnavard, Zahra; Eybpoosh, Sana; Alianmoghaddam, Narges
Abstract Background and Objectives: The credit of the practice nurses in developing countries, due to gap between theory and practice in nursing education and health care delivery has been questioned by nursing professionals. Therefore, the aims of this study were to investigate the effectiveness of the application of the CTA model in nursing students' clinical skills and to assess the participants' (faculty members, staff nurses, and nursing students) level of satisfaction with the CTA model and with achieving the educational goals in Iran, as a developing country. Methods and Materials: In this experimental study, random sampling was used to assess 104 nursing students' clinical skills, and assess 6 faculty members and 6 staff nurses. After obtaining informed consent, the level of satisfaction was evaluated by a questionnaire and clinical skills were evaluated by standard checklists. Data were assessed and analyzed with SPSS version 15. Results: The results showed that the mean scores of all clinical skills of the students were significantly higher after intervention (p<0.01). Moreover, the mean scores of instructors' satisfaction with applying the CTA model was significantly higher (p = 0.004), but their satisfaction with achieving clinical education outcomes did not show a significant difference (p = 0.109). Similarly, students' satisfaction with achieving educational outcomes did not show any significant differences between the two groups (P = 0.058). Conclusion: According to this study, the CTA model is an effective method for developing clinical skills in nursing students in Iran as a developing country. Therefore, application of the method is recommended in clinical nursing education systems of such counties.
Dehghan Nayeri, Nahid; Hooshmand Bahabadi, Abbas; Kazemnejad, Anoshirvan
One of the main objectives of quantitative researches is assessment of models developed by qualitative studies. Models validation through their testing implies that the designed model is representative of the existed facts. Hence, this study was conducted to assess the clinical nurses' productivity model presented for Iranian nurses' productivity. The sample of the study consisted of 360 nurses of Tehran University of Medical Sciences. The research tool was a questionnaire for measuring the components of clinical nurses' productivity. After completing all steps of instrument psychometric and getting answers from the participants, the factors introduced in the questionnaire were named and then Lisrel Path Analysis tests were performed to analyze the components of the model. The results of the model test revealed there is an internal relationship among different components of the model. Regression Analysis showed that each increasing unit in components of the model was to be added to central variable of productivity model -human resource. Model components altogether explained 20 % of clinical nurses' productivity variance. This study found that the important component of productivity is human resources that are reciprocally related to other components of the model. Therefore, it can be stated that the managers can promote the productivity by using efficient strategies to correct human resource patterns.
Messinger-Rapport, Barbara J; Cruz-Oliver, Dulce M; Thomas, David R; Morley, John E
This article is the sixth in the series of clinical updates on nursing home care. The topics covered are management of hypertension, antidepressant medications in people with dementia, peripheral arterial disease, probiotics in prevention, and treatment of Clostridium difficile-associated diarrhea, frailty, and falls.
Moore, Susan; Stichler, Jaynelle F
Clinical nurses have the knowledge and expertise required to provide efficient and proficient patient care. Time and knowledge deficits can prevent nurses from developing and implementing quality improvement or evidence-based practice projects. This article reviews a process for professional development of clinical nurses that helped them to define, implement, and analyze quality improvement or evidence-based practice projects. The purpose of this project was to educate advanced clinical nurses to manage a change project from inception to completion, using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) Change Acceleration Process as a framework. One-to-one mentoring and didactic in-services advanced the knowledge, appreciation, and practice of advanced practice clinicians who completed multiple change projects. The projects facilitated clinical practice changes, with improved patient outcomes; a unit cultural shift, with appreciation of quality improvement and evidence-based projects; and engagement with colleagues. Project outcomes were displayed in poster presentations at a hospital exposition for knowledge dissemination.
Schuster, Pamela; And Others
A survey of 22 nurse education programs found that 70% allocate less than 1 teaching credit hour to 1 clinical contact hour; 50% of programs had 10 or more students in classes, despite the fact that faculty were concerned about learning and supervision in courses with more than 8 students. (SK)
Hanson, Karla J; Stenvig, Thomas E
Clinical education accounts for a significant portion of baccalaureate nursing (BSN) education. This study examined recent BSN program graduates' views about clinical nursing educator attributes that enhance the ability of the graduates to provide safe, effective patient care. In this descriptive study, 6 participants were interviewed using grounded theory techniques. The study framework blended the elements of cognitive field theory, the humanistic philosophy of teaching and learning, the gestalt theory of learning, and Hergenhahn's behavioral change model. Participants identified three attributes of a good clinical nursing educator: knowledge, interpersonal presentation, and teaching strategies. Analysis revealed that educator attributes and phases of the clinical experience process together form the foundation for clinical experience praxis. Educators can improve the clinical education experience by developing teaching strategies and evaluation tools that build on the positive attributes and phases of the clinical experience identified in this study.
Dee, Cheryl; Stanley, Ellen E.
Objectives: This research was conducted to provide new insights on clinical nurses' and nursing students' current use of health resources and libraries and deterrents to their retrieval of electronic clinical information, exploring implications from these findings for health sciences librarians. Methods: Questionnaires, interviews, and observations were used to collect data from twenty-five nursing students and twenty-five clinical nurses. Results: Nursing students and clinical nurses were most likely to rely on colleagues and books for medical information, while other resources they frequently cited included personal digital assistants, electronic journals and books, and drug representatives. Significantly more nursing students than clinical nurses used online databases, including CINAHL and PubMed, to locate health information, and nursing students were more likely than clinical nurses to report performing a database search at least one to five times a week. Conclusions and Recommendations: Nursing students made more use of all available resources and were better trained than clinical nurses, but both groups lacked database-searching skills. Participants were eager for more patient care information, more database training, and better computer skills; therefore, health sciences librarians have the opportunity to meet the nurses' information needs and improve nurses' clinical information-seeking behavior. PMID:15858624
Li, Min; Bai, Jie; Huang, Jie
To investigate the cause analysis of clinical medication nursing risks and propose relevant nursing measures, so as to control and reduce the clinical nursing risks and reach the physical and mental safety of patients and nurses. Clinical nursing risk events with 30 cases in TCM Hospital of Zhengzhou City from June 2010 to April 2012 were underwent statistical analyses. The risk of medication error ranked the first in the direct reasons of nursing risks, accounting for a higher ratio. Moreover, the reasons of nursing risks were also involved in nonstandard operation, disease observation and other relative factors. Nurses must fully understand the relative factors of medication nursing risks, regarding the patients as their own family and always permeating the consciousness of nursing risks into the working process.
Gale, C; Santhakumaran, S; Nagarajan, S; Statnikov, Y
Objective To assess the impact of reorganisation of neonatal specialist care services in England after a UK Department of Health report in 2003. Design A population-wide observational comparison of outcomes over two epochs, before and after the establishment of managed clinical neonatal networks. Setting Epoch one: 294 maternity and neonatal units in England, Wales, and Northern Ireland, 1 September 1998 to 31 August 2000, as reported by the Confidential Enquiry into Stillbirths and Sudden Deaths in Infancy Project 27/28. Epoch two: 146 neonatal units in England contributing data to the National Neonatal Research Database at the Neonatal Data Analysis Unit, 1 January 2009 to 31 December 2010. Participants Babies born at a gestational age of 27+0-28+6 (weeks+days): 3522 live births in epoch one; 2919 babies admitted to a neonatal unit within 28 days of birth in epoch two. Intervention The national reorganisation of neonatal services into managed clinical networks. Main outcome measures The proportion of babies born at hospitals providing the highest volume of neonatal specialist care (≥2000 neonatal intensive care days annually), having an acute transfer (within the first 24 hours after birth) and/or a late transfer (between 24 hours and 28 days after birth) to another hospital, assessed by change in distribution of transfer category (“none,” “acute,” “late”), and babies from multiple births separated by transfer. For acute transfers in epoch two, the level of specialist neonatal care provided at the destination hospital (British Association of Perinatal Medicine criteria). Results After reorganisation, there were increases in the proportions of babies born at 27-28 weeks’ gestation in hospitals providing the highest volume of neonatal specialist care (18% (631/3495) v 49% (1325/2724); odds ratio 4.30, 95% confidence interval 3.83 to 4.82; P<0.001) and in acute and late postnatal transfers (7% (235) v 12% (360) and 18% (579) v 22% (640), respectively
Tacconelli, Evelina; Poljak, Mario; Cacace, Marina; Caiati, Giovanni; Benzonana, Nur; Nagy, Elisabeth; Kortbeek, Titia
Objective In 2009, in a European survey, around a quarter of Europeans reported witnessing discrimination or harassment at their workplace. The parity committee from the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) designed a questionnaire survey to investigate forms of discrimination with respect to country, gender and ethnicity among medical professionals in hospitals and universities carrying out activities in the clinical microbiology (CM) and infectious diseases (ID) fields. Design The survey consisted of 61 questions divided into five areas (sociodemographic, professional census and environment, leadership and generic) and ran anonymously for nearly 3 months on the ESCMID website. Subjects European specialists in CM/ID. Results Overall, we included 1274 professionals. The majority of respondents (68%) stated that discrimination is present in medical science. A quarter of them reported personal experience with discrimination, mainly associated with gender and geographic region. Specialists from South-Western Europe experienced events at a much higher rate (37%) than other European regions. The proportion of women among full professor was on average 46% in CM and 26% in ID. Participation in high-level decision-making committees was significantly (>10 percentage points) different by gender and geographic origin. Yearly gross salary among CM/ID professionals was significantly different among European countries and by gender, within the same country. More than one-third of respondents (38%) stated that international societies in CM/ID have an imbalance as for committee member distribution and speakers at international conferences. Conclusions A quarter of CM/ID specialists experienced career and research discrimination in European hospitals and universities, mainly related to gender and geographic origin. Implementing proactive policies to tackle discrimination and improve representativeness and balance in career among CM
LaFauci, Frances F.
Professional registered nursing is an essential part of the health care system and student nurses need experimental learning with actual patients to learn to practice as a nurse. The health care system has changed dramatically and nursing schools have decreasing access to the health care agencies. The clinical educational experience develops…
Mental illness is a huge problem many people face in the U.S. and around the world. The American Psychiatric Nurses Association indicates there is a shortage of nurses in every level and role in psychiatric-mental health nursing. Raising up a generation of nurses who want to work with the mentally ill is a challenge for nurse educators. The use of role playing and simulation in the learning lab prior to entering the clinical setting and reflective journaling in the clinical rotation can improve undergraduate nursing students' mental health clinical experience.
assessments received praise for those records completed during testing, issues surrounding identification and prioritizing nursing care problems and...of inpatient treatment and the patient’s responses. Nursing documentation reflects nursing practice patterns based on planned nursing care , which, in...Nursing History/Nursing Assessment/ Nursing Care Plans); the necessity of transcribing all orders appearing on physician order sheets to allow for
Feucht, Ute Dagmar; van Rooyen, Elise; Skhosana, Rinah; Bergh, Anne-Marie
The global agenda for improved neonatal care includes the scale-up of kangaroo mother care (KMC) services. The establishment of district clinical specialist teams (DCSTs) in South Africa (SA) provides an excellent opportunity to enhance neonatal care at district level and ensure translation of policies, including the requirement for KMC implementation, into everyday clinical practice. Tshwane District in Gauteng Province, SA, has been experiencing an increasing strain on obstetric and neonatal services at central, tertiary and regional hospitals in recent years as a result of growing population numbers and rapid up-referral of patients, with limited down-referral of low-risk patients to district-level services. We describe a successful multidisciplinary quality improvement initiative under the leadership of the Tshwane DCST, in conjunction with experienced local KMC implementers, aimed at expanding the district's KMC services. The project subsequently served as a platform for improvement of other areas of neonatal care by means of a systematic approach.
Gunn, Bridget; Shenoy, Anant M.; Blanchard, Rebecca
Objective With the myriad of cases presented to clinicians every day at our integrated academic health system, clinical questions are bound to arise. Clinicians need to recognize these knowledge gaps and act on them. However, for many reasons, clinicians might not seek answers to these questions. Our goal was to investigate the rationale and process behind these unanswered clinical questions. Subsequently, we explored the use of biomedical information resources among specialists and primary care providers and identified ways to promote more informed clinical decision making. Methods We conducted a survey to assess how practitioners identify and respond to information gaps, their background knowledge of search tools and strategies, and their usage of and comfort level with technology. Results Most of the 292 respondents encountered clinical questions at least a few times per week. While the vast majority often or always pursued answers, time was the biggest barrier for not following through on questions. Most respondents did not have any formal training in searching databases, were unaware of many digital resources, and indicated a need for resources and services that could be provided at the point of care. Conclusions While the reasons for unanswered clinical questions varied, thoughtful review of the responses suggested that a combination of educational strategies, embedded librarian services, and technology applications could help providers pursue answers to their clinical questions, enhance patient safety, and contribute to patient-based, self-directed learning. PMID:28096740
Kim, Hyungyung; Kim, Insook; Chae, Yougmoon
This study a methodological study; to acquire knowledge on the nursing process by steps of knowledge definition, collection, and representation; then, to design a data warehouse and nursing process clinical decision support system.
Voorn, Veronique M A; Vermeulen, Henricus M; Nelissen, Rob G H H; Kloppenburg, Margreet; Huizinga, Tom W J; Leijerzapf, Nicolette A C; Kroon, Herman M; Vliet Vlieland, Thea P M; van der Linden, Henrica M J
The subject of the study is to investigate whether health-related quality of life (HRQoL), pain and function of patients with hip or knee osteoarthritis (OA) improves after a specialist care intervention coordinated by a physical therapist and a nurse practitioner (NP) and to assess satisfaction with this care at 12 weeks. This observational study included all consecutive patients with hip or knee OA referred to an outpatient orthopaedics clinic. The intervention consisted of a single, standardized visit (assessment and individually tailored management advice, to be executed in primary care) and a telephone follow-up, coordinated by a physical therapist and a NP, in cooperation with an orthopaedic surgeon. Assessments at baseline and 10 weeks thereafter included the short form-36 (SF-36), EuroQol 5D (EQ-5D), hip or knee disability and osteoarthritis outcome score (HOOS or KOOS), the intermittent and constant osteoarthritis pain questionnaire (ICOAP) for hip or knee and a multidimensional satisfaction questionnaire (23 items; 4 point scale). Eighty-seven patients (57 female), mean age 68 years (SD 10.9) were included, with follow-up data available in 63 patients (72 %). Statistically significant improvements were seen regarding the SF-36 physical summary component score, the EQ-5D, the ICOAP scores for hip and knee, the HOOS subscale sports and the KOOS subscales pain, symptoms and activities of daily living. The proportions of patients reporting to be satisfied ranged from 79 to 98 % per item. In patients with hip and knee OA pain, function and HRQoL improved significantly after a single-visit multidisciplinary OA management intervention in specialist care, with high patient satisfaction.
Clarke, Sonya; McDonald, Sinead; Rainey, Debbie
The aim of this article is to explore the views of registered nurses undertaking the new Objective Structured Clinical Examination (OSCE), incorporating an integrated preparatory skills workshop. The workshop and the OSCE were audited with particular regard to the student experience. This article describes the audit process and the results of three questionnaires: one carried out before the OSCE assessment, a second immediately after the workshop and a third four days after the assessment. The results provide an insight into the student experience.
Carney, Diane M; Bistline, Betty
Across the healthcare system, staff development specialists and nurse leaders have been challenged with the development, implementation, and evaluation of processes by which clinical nursing staff demonstrate competence in an efficient and effective manner. The purpose of this article is to describe one approach used in an acute care setting. Staff development specialists and nurse leaders played key roles in assessing, developing, and evaluating a nursing competency validation fair.
A surgical care practitioner (SCP) is a registered nurse or allied health professional who, following specific education and competency training, carries out pre- and post-operative treatment and some surgical interventions under the supervision of a consultant surgeon, contributing to the maintenance of surgical services and the enhancement of patient care. With a cohesive approach, the SCP can do much to ensure continuity of care and mutual understanding and concordance between staff, child and family. Costs can be reduced and the surgical training of junior doctors supported. The results of this audit show that, with the inclusion of an SCP, higher quality general children's surgery can be provided at a medium-sized district general hospital, so that patients can be seen locally.
Sherrod, Roy Ann; Morrison, Ruby Shaw
Nurse educators need practical, effective methods to help nursing students understand the importance of quality improvement activities and their relationship to the financial viability of organizations. This article describes a project designed to provide students with an opportunity to apply quality improvement principles in a rural, nurse-managed clinic with the ultimate goal of improving potential reimbursement for services through improved documentation. Implications for students, nurse educators, and rural clinics are provided.
Röhricht, Frank; Elanjithara, Thomas
Aims and method Service utilisation and clinical outcomes of a newly developed specialist primary-secondary care liaison clinic for patients with medically unexplained symptoms (MUS) were evaluated in a cross-sectional and feasibility pilot study. The impact of body-oriented psychological therapy (BOPT) was explored in a small cohort of patients with an identified somatoform disorder. Results Of 147 consecutive referrals, 113 patients engaged with the assessment process. Of patients with MUS, 42% (n = 45) had a primary diagnosis of somatoform disorder, 36% (n = 38) depressive disorder, and depressive symptoms (even subsyndromal) mediated the effect of somatic symptoms. A marked variation of presenting complaints and service utilisation across ethnic groups was noted. A significant reduction in somatic symptom levels and service utilisation was achieved for patients undergoing BOPT. Clinical implications A high proportion of patients with MUS have undiagnosed and therefore untreated mental disorders. New and locally derived collaborative care models of active engagement in primary care settings are required. Patients with somatoform disorder may benefit from BOPT; this requires further evaluation in adequately powered clinical trials.
Cioffi, Jane Marie
There is evidence to suggest that there is a general decline in clinical expertise in nursing as a result of experienced clinicians leaving the profession. The expertise of clinical nursing practice is an important resource and needs to be captured and made available to others as loss of this knowledge and expertise has implications for clinical outcomes. This paper aims to discuss the current nursing workforce, loss of clinical expertise, the nature of expertise and the way it can be captured. Clarification and articulation of clinical knowledge of nursing experts provides the means for knowledge to be transferred to a less experienced workforce and be available in an accessible form in the workplace. Leverage of nursing expertise in this manner has the potential to benefit less experienced staff, hold clinical nursing expertise in the workplace and improve clinical outcomes and satisfaction with performance.
Hunter, Sharyn; Arthur, Carol
Graduate nurses may have knowledge and adequate clinical psychomotor skills however they have been identified as lacking the clinical reasoning skills to deliver safe, effective care suggesting contemporary educational approaches do not always facilitate the development of nursing students' clinical reasoning. While nursing literature explicates the concept of clinical reasoning and develops models that demonstrate clinical reasoning, there is very little published about nursing students and clinical reasoning during clinical placements. Semi-structured interviews were conducted with ten clinical educators to gain an understanding of how they recognised, developed and appraised nursing students' clinical reasoning while on clinical placement. This study found variability in the clinical educators' conceptualisation, recognition, and facilitation of students' clinical reasoning. Although most of the clinical educators conceptualised clinical reasoning as a process those who did not demonstrated the greatest variability in the recognition and facilitation of students' clinical reasoning. The clinical educators in this study also described being unable to adequately appraise a student's clinical reasoning during clinical placement with the use of the current performance assessment tool.
Egan, Brent M
The ASH hypertension specialists and ASH clinical and comprehensive hypertension centers represent a continuum of expertise and capacity positioned to play a major role in advancing the Triple Aim, which includes improving the patient care experience, population health, and value in cardiovascular health promotion and disease prevention. The ASH hypertension specialists board is dedicated to testing and designating a broad range of qualified health care professionals as clinical hypertension specialists. A continuing partnership with ASH, recognizing the need for an appropriate firewall between education and testing, is essential in providing the education and training programs required to grow and sustain the specialized workforce required to translate current evidence and future advances in personalized medicine into better care for individuals, better health for populations, and better value for payers. Moreover, growth of the ASH hypertension registry has the potential to accelerate advances in education and patient care as noted previously. The ASH hypertension specialists board is excited about the opportunities available to a well-trained and collaborative multidisciplinary group of clinical hypertension specialists in an era of ACOs pursuing the Triple Aim.
Choi, Jeeyae; Choi, Jeungok E
To enhance patient safety from falls, many hospital information systems have been implemented to collect clinical data from the bedside and have used the information to improve fall prevention care. However, most of them use administrative data not clinical nursing data. This necessitated the development of a web-based Nursing Practice and Research Information Management System (NPRIMS) that processes clinical nursing data to measure nurses' delivery of fall prevention care and its impact on patient outcomes. This pilot study developed computer algorithms based on a falls prevention protocol and programmed the prototype NPRIMS. It successfully measured the performance of nursing care delivered and its impact on patient outcomes using clinical nursing data from the study site. Results of the study revealed that NPRIMS has the potential to pinpoint components of nursing processes that are in need of improvement for preventing patient from falls.
Forbes, Thomas A; McMinn, Alissa; Crawford, Nigel; Leask, Julie; Danchin, Margie
Vaccine hesitancy (VH) is an issue of global concern. The quality of communication between healthcare providers and parents can influence parental immunization acceptance. We aimed to describe immunization uptake following specialist immunization clinic (SIC) consultation for Australian children of VH parents as a cohort, and according to pre-clinic parental position on immunization. At a single tertiary pediatric SIC (RCH, Melbourne) a retrospective descriptive study classified VH families according to 3 proposed parental positions on immunization at initial clinic attendance. Immunization status at follow up was ascertained via the Australian Children's Immunization Register and National HPV Program Register and compared between groups. Of the VH cohort, 13/38 (34%) families were classified as hesitant, 21 (55%) as late/selective vaccinators and 4 (11%) as vaccine refusers. Mean follow up post-SIC attendance was 14.5 months. For the overall VH cohort, the majority chose selective immunization (42%) following SIC consultation. When analyzed by pre-clinic parental position on immunization, there was a trend for hesitant families to proceed with full immunization, selective families to continue selective immunization and refusing families to remain unimmunised (p < 0.0001). The most commonly omitted vaccines were hepatitis B (66%) and Haemophilus influenzae type B (55%), followed by the meningococcal C conjugate vaccine (53%) and measles, mumps and rubella vaccine (53%). Immunization outcome appears to correlate with pre-clinic parental position on immunization for the majority of families attending a SIC in Australia, with selective immunization the most common outcome. Tailored communication approaches based on parental position on immunization may optimise clinic resources and engagement of families, but require prospective research evaluation. PMID:26366978
Forbes, Thomas A; McMinn, Alissa; Crawford, Nigel; Leask, Julie; Danchin, Margie
Vaccine hesitancy (VH) is an issue of global concern. The quality of communication between healthcare providers and parents can influence parental immunization acceptance. We aimed to describe immunization uptake following specialist immunization clinic (SIC) consultation for Australian children of VH parents as a cohort, and according to pre-clinic parental position on immunization. At a single tertiary pediatric SIC (RCH, Melbourne) a retrospective descriptive study classified VH families according to 3 proposed parental positions on immunization at initial clinic attendance. Immunization status at follow up was ascertained via the Australian Children's Immunization Register and National HPV Program Register and compared between groups. Of the VH cohort, 13/38 (34%) families were classified as hesitant, 21 (55%) as late/selective vaccinators and 4 (11%) as vaccine refusers. Mean follow up post-SIC attendance was 14.5 months. For the overall VH cohort, the majority chose selective immunization (42%) following SIC consultation. When analyzed by pre-clinic parental position on immunization, there was a trend for hesitant families to proceed with full immunization, selective families to continue selective immunization and refusing families to remain unimmunised (p < 0.0001). The most commonly omitted vaccines were hepatitis B (66%) and Haemophilus influenzae type B (55%), followed by the meningococcal C conjugate vaccine (53%) and measles, mumps and rubella vaccine (53%). Immunization outcome appears to correlate with pre-clinic parental position on immunization for the majority of families attending a SIC in Australia, with selective immunization the most common outcome. Tailored communication approaches based on parental position on immunization may optimise clinic resources and engagement of families, but require prospective research evaluation.
Ghetti, Claire M
The discipline of child life enjoys a strong presence in many medical settings within the current pediatric healthcare environment. Due to the widespread establishment of child life programs, music therapists often find themselves negotiating their role and contributions to pediatric healthcare in relation to the field of child life. There is increasing interest among music therapy interns and clinicians in pursuing certification in child life to increase clinical knowledge and enhance marketability. A small, but strong, cohort of dual-certified music therapists/child life specialists is currently practicing in the field, but the nuances of their clinical practice have not been systematically examined. The current study used an interpretative phenomenological approach to explore the lived experiences of eight dual-certified clinicians, and to interpret how clinicians make sense of those lived experiences. Two overarching themes of identity and flexibility arose from the analysis: issues relating to establishing, challenging, and modifying professional identity; and flexibility manifested within areas of theoretical orientation, professional role, and clinical approach. Dual-certified clinicians vary in the degree to which they integrate the fields of music therapy and child life in practice, from complete and seamless integration of the two, to exclusive practice of only one field, depending upon the bounds of their positions. Participants reported that child life training is beneficial, but not necessary for achieving advanced practice in pediatric medical music therapy. Implications for the continuing advancement of music therapy in pediatric healthcare are discussed.
Scott, Kathleen; White, Kathryn; Roydhouse, Jessica K
Clinical trials nurses play a pivotal role in the conduct of clinical research, but the educational and career pathway for these nurses remains unclear. This article reports findings from a survey of nurses working in cancer clinical trials research in Australia. Most participants held postgraduate qualifications (42 of 61); however, clinical trials education was primarily attained through short professional development courses. Interest in pursuing trial-specific postgraduate education was high, but barriers were identified, including cost, time, and unclear benefit for career advancement. Job titles varied substantially, which is indicative of an unclear employment pathway. These findings suggest that initiatives to improve the educational and career pathway for clinical trials nurses are needed and should include the following: formal educational preparation, greater consistency in employment status, and clearer career progression. These strategies should be underpinned by broad professional recognition of the clinical trials nurse as a specialized nursing role.
Xu, Richard H; Wong, Eliza LY
Objective This study is a preliminary exploration of the association between patient involvement in decision-making and patient socioeconomic characteristics and experience in specialist outpatient clinics (SOPCs) in Hong Kong. Methods Cross-sectional telephone interviews were conducted using the Specialist Outpatient Experience Questionnaire (SOPEQ) in 26 Hospital Authority public SOPCs in Hong Kong. The SOPEQ was designed by The School of Public Health and Primary Care at The Chinese University of Hong Kong, fully taking into account both literature review and the local context of the public specialist outpatient system in Hong Kong. A total of 22,525 eligible participants were recruited for the study. Results There were 13,966 valid responses. The results indicated that the patients who had more involvement in decision-making were younger (odds ratio [OR] =2.10; 95% CI 1.75, 2.53), more highly educated (OR =1.67; 95% CI 1.45, 1.93), less likely to be receiving a government allowance (OR =0.61; 95% CI 0.57, 0.65), and less likely to be in the new case group (OR =0.84; 95% CI 0.78, 0.92). Participants living with their families (OR =3.38; 95% CI 2.03, 5.63) or who were unemployed (OR =1.10; 95% CI 1.01, 1.21) had a more decisive role in the decision- making process. Those participants who had been more involved in decision-making and wanted to continue being more involved had greater levels of satisfaction (mean =7.94; P<0.001) and a better health status (OR =0.49; 95% CI 0.41, 0.58). Conclusion Engaging patients in their health care management remains a challenge in improving patient-centered care. Our results suggest that patient engagement is associated with perceived health status and the experience of using a health service. Understanding patients’ characteristics and roles facilitates the development of preferred styles in the decision-making model. PMID:28331297
Vernon, Howard; McDermaid, Cameron
Tension-type headache (TTH) is a highly prevalent condition experienced annually by 30-70% of the population. As a chief complaint, it occupies 5-8% of chiropractors’ caseloads, but is probably more prevalent in multiple complaint cases. While numerous clinical descriptions exist in the literature of the management of TTH by chiropractors, and while there is a small body of clinical trials of the treatment of non-migrainous headache by spinal manipulation, there is no systematic survey of the approaches to its treatment by chiropractors. The goals of this study were to determine the test-retest reliability of a questionnaire designed to identify the most commonly used treatments for TTH and to report on any consistent findings as a potential profile of typical practice approach. The respondents consisted of a group of Canadian chiropractic clinical specialists. Respondents were asked to complete a survey which consisted of a comprehensive list of chiropractic treatment procedures including standard manual manipulations and mobilisations, soft tissue therapies, modalities, exercises, behavioral therapies, acupuncture, nutrition and four “systems” techniques. The respondents were asked to rate their frequency of use of these procedures on a 4-point scale ranging from “always” to “never”. The surveys were completed twice within a two day interval. The response rate was 18/25 (72%). Eighty-seven percent (87%) of the items were rated identically on both surveys. All but one of the items achieved a statistically significant reliability coefficient. The highest rated items were “upper cervical manipulations”, “upper cervical soft tissue therapy” and “neck stretching exercises”. The items which received the lowest endorsement were: chiropractic procedures to the dorso-lumbo-pelvic spine, most therapy modalities and the “systems” techniques which were included in the survey. Years in practice appeared to have very little effect on the use of
Preheim, Gayle; Casey, Kathy; Krugman, Mary
The Clinical Scholar Model (CSM) is a practice-education partnership focused on improving the outcomes of clinical nursing education by bridging the academic and service settings. An expert clinical nurse serves as a clinical scholar (CS) to coordinate, supervise, and evaluate the clinical education of nursing students in collaboration with school of nursing faculty. This article describes the model's evolution, how the model is differentiated from traditional clinical instruction roles and responsibilities, and the benefits to the collaborating clinical agency and school of nursing.
Livsey, Kae R
This study examines the associations between professional behaviors of baccalaureate nursing students and student perceptions of select factors within the clinical learning environment, including the role of clinical faculty leadership. Participants (n=243) were recruited from a randomly selected list of 1000 members of the National Student Nurses Association (NSNA) among sixteen states within the Southern region of the United States. Results revealed a direct relationship exists between student perceptions of structural empowerment in their clinical learning environment and professional nursing practice behaviors among students. Also found was that relationships between variables in the model are significantly strengthened by student perceptions of strong leadership behaviors of clinical faculty. Findings from this study may assist nurse educators by contributing knowledge relevant to support/facilitate the transition of individuals from student nurses to professional registered nurses and, thus enhance the impact of professional nurses' contributions in healthcare delivery.
The anticipated nursing shortage in the United States is well documented and continues to be a topic of discussion. A nationwide solution has been for nursing programs to increase their enrollment of nursing students. This could be difficult for many nursing schools; as many have a shortage of qualified nursing faculty with which to instruct…
Mingpun, Renu; Srisa-ard, Boonchom; Jumpamool, Apinya
The problem of lack of nurses can be solved by employing student nurses. Obviously, nurse instructors and preceptors have to work extremely hard to train student nurses to meet the standard of nursing. The preceptorship model is yet to be explored as to what it means to have an effective program or the requisite skills to be an effective…
Bartz, Claudia; Dean-Baar, Susan
A nursing school-clinic partnership was designed to teach nursing students community health practice skills. A longitudinal evaluation is being conducted to ensure that it meets the goals of baccalaureate education and urban health nursing and that it follows a multilevel process model of organizational socialization. (Contains 37 references.) (SK)
Wallace, Robyn A.
Background: Adults with Down syndrome (DS) are predisposed to syndromic and environmental gastrointestinal conditions. Method: In a hospital-based clinic for adults with DS, a chart audit was conducted to assess the range and frequency of gastrointestinal conditions. Results: From January 2003 to March 2005, 57 patients attended the clinic,…
Gruen, Russell; Bailie, Ross
People in remote Aboriginal communities in the Northern Territory have greater morbidity and mortality than other Australians, but face considerable barriers when accessing hospital-based specialist services. The Specialist Outreach Service, which began in 1997, was a novel policy initiative to improve access by providing a regular multidisciplinary visiting specialist services to remote communities. It led to two interesting juxtapositions: that of 'state of the art' specialist services alongside under-resourced primary care in remote and relatively traditional Aboriginal communities; and that of attempts to develop an evidence base for the effectiveness of outreach, while meeting the short-term evaluative requirements of policy-makers. In this essay, first we describe the development of the service in the Northern Territory and its initial process evaluation. Through a Cochrane systematic review we then summarise the published research on the effectiveness of specialist outreach in improving access to tertiary and hospital-based care. Finally we describe the findings of an observational population-based study of the use of specialist services and the impact of outreach to three remote communities over 11 years. Specialist outreach improves access to specialist care and may lessen the demand for both outpatient and inpatient hospital care. Specialist outreach is, however, dependent on well-functioning primary care. According to the way in which outreach is conducted and the service is organised, it can either support primary care or it can hinder primary care and, as a result, reduce its own effectiveness.
Holder, Elizabeth; Mark, Tony
A study was conducted at Humber College to investigate the attitudes of college-prepared diploma nursing students towards psychiatric nursing. Specifically, the study sought to determine the effect of psychiatric nursing role models on student attitudes, and whether a relationship existed between clinical placement and student attitudes. The study…
Ioannides, A P
The role of the nurse teacher in relation to the clinical setting has been debated for 20 years, yet it has been the subject of relatively few large studies. Recent studies led to inconclusive results, hence the nurse lecturer's clinical role remains an area of long-standing dispute. Changes in nurse education United Kingdom Central Council (UKCC) and the amalgamation of nurse education into higher education as part of the Strategy for Nursing, as well as the expansion of supernumerary status for student nurses, gave impetus to the search for a new clinical role for nurse lecturers. Research suggests that nurse teachers wish to maintain clinical contact, but the nature of this contact is vigorously debated at present. Lee, in reviewing the literature, concluded that this topic is highly contentious in terms of its nature, extent and purpose. She goes as far as to suggest that there is a need for empirical research to address the question as to whether there is a role for nurse lecturers in the clinical area. This paper examines some of the factors which influence the development of the clinical aspect of the role of nurse lecturers, explains how the author performed this role and the perceived benefits to students, mentors and the lecturer. It proposes a clinical role model based on the literature and the author's own personal experience as a 'clinical liaison lecturer' since the integration of nursing education into higher education. Key points The clinical role of the nurse teacher remains an area of long standing dispute Nurse lecturers wish to maintain clinical contact and maintain clinical competence, but in reality no consensus exists as to its meaning The mentor's role can be complemented by a clinically competent nurse lecturer who arguably should be able to teach in the classroom and the practice settings Using a triangular approach to reviewing student's experience, lecturers can update their clinical knowledge, demonstrate credibility, promote education
Rodriguez, P; Goorapah, D
The emergence of clinical supervision in nursing is viewed with both enthusiasm and reservation. Professional growth of the nurse practitioner is envisaged through adopting this support framework, although concerns exist particularly in relation to the role of management in monitoring performance and standards. Most authors have attempted to reassure nurses by stressing the positive elements. Potential benefits include the development of self-learning and clinical skills through reflection using a supervisor. It is anticipated that the supervisee will retain ultimate control of the process. Implementation of clinical supervision in nurse education is being considered. The need for a formal method of support has not been identified by teachers. It is debatable whether a format similar to that for clinical practice would be appropriate when the role of the nurse teacher focuses mainly on academic rather than clinical issues. Supervision in nurse education may be accepted or rejected, but a decision cannot be reached until role and cost issues have been adequately addressed.
Anthony, Maureen; Yastik, Joanne
This qualitative study aimed to explore the experiences of nursing students as targets of incivility in clinical settings, to describe their perceptions of specific uncivil and favorable behaviors by nurses, and to examine how nursing students think schools of nursing should address incivility in clinical settings. Four focus groups were conducted comprising 21 prelicensure nursing students. Data were collected with semi-structured interviews. Uncivil behaviors fell into three themes: exclusionary, hostile or rude, and dismissive. Positive experiences occurred when students felt included by the staff nurses in patient care. Schools of nursing should prepare students through discussion. Our research suggests that incivility occurs in clinical education. Further research on a larger scale is needed to provide qualitative and generalizable findings. All health care team members, including students, should be educated about the organization's code of conduct.
Davoodvand, Shirmohammad; Abbaszadeh, Abbas; Ahmadi, Fazlollah
One of the advanced nursing care procedures emphasized by nursing organizations around the world is patient or nursing advocacy. In addition to illustrating the professional power of nursing, it helps to provide effective nursing care. The aim of the present study was to explain the concept of patient advocacy from the perspective of Iranian clinical nurses. This was a qualitative study that examined the viewpoint and experiences of 15 clinical nurses regarding patient advocacy in nursing. The nurses worked in intensive care units (ICUs), coronary care units (CCUs), and emergency units. The study participants were selected via purposeful sampling. The data was collected through semi-structured interviews and analyzed using content analysis. Data analysis showed that patient advocacy consisted of the two themes of empathy with the patient (including understanding, being sympathetic with, and feeling close to the patient) and protecting the patients (including patient care, prioritization of patients’ health, commitment to the completion of the care process, and protection of patients' rights). The results of this study suggest that nurses must be empathetic toward and protective of their patients. The results of the present study can be used in health care delivery, nursing education, and nursing management and planning systems to help nurses accomplish their important role as patient advocates. It is necessary to further study the connections between patient advocacy and empathy. PMID:27471588
Davoodvand, Shirmohammad; Abbaszadeh, Abbas; Ahmadi, Fazlollah
One of the advanced nursing care procedures emphasized by nursing organizations around the world is patient or nursing advocacy. In addition to illustrating the professional power of nursing, it helps to provide effective nursing care. The aim of the present study was to explain the concept of patient advocacy from the perspective of Iranian clinical nurses. This was a qualitative study that examined the viewpoint and experiences of 15 clinical nurses regarding patient advocacy in nursing. The nurses worked in intensive care units (ICUs), coronary care units (CCUs), and emergency units. The study participants were selected via purposeful sampling. The data was collected through semi-structured interviews and analyzed using content analysis. Data analysis showed that patient advocacy consisted of the two themes of empathy with the patient (including understanding, being sympathetic with, and feeling close to the patient) and protecting the patients (including patient care, prioritization of patients' health, commitment to the completion of the care process, and protection of patients' rights). The results of this study suggest that nurses must be empathetic toward and protective of their patients. The results of the present study can be used in health care delivery, nursing education, and nursing management and planning systems to help nurses accomplish their important role as patient advocates. It is necessary to further study the connections between patient advocacy and empathy.
McMurray, Janet; Zerah, Simone; Hallworth, Michael; Koeller, Ursula; Blaton, Victor; Tzatchev, Kamen; Charilaou, Charis; Racek, Jaroslav; Johnsen, Anders; Tomberg, Karel; Harmoinen, Aimo; Baum, Hannsjörg; Rizos, Demetrios; Kappelmayer, Janos; O'Mullane, John; Nubile, Giuseppe; Pupure, Silvija; Kucinskiene, Zita; Opp, Matthias; Huisman, Wim; Solnica, Bogdan; Reguengo, Henrique; Grigore, Camelia; Spanár, Július; Strakl, Greta; Queralto, Josep; Wallinder, Hans; Schuff-Werner, Peter
In 1997, the European Communities Confederation of Clinical Chemistry and Laboratory Medicine (EC4) set up a Register for European Specialists in Clinical Chemistry and Laboratory Medicine. The operation of the Register is undertaken by a Register Commission (EC4RC). During the last 10 years, more than 2000 specialists in Clinical Chemistry and Laboratory Medicine have joined the Register. In 2007, EC4 merged with the Federation of European Societies of Clinical Chemistry and Laboratory Medicine (FESCC) to form the European Federation of Clinical Chemistry and Laboratory Medicine (EFCC). A Code of Conduct was adopted in 2003 and a revised and updated version, taking account particularly of the guidelines of the Conseil Européen des Professions Libérales (CEPLIS) of which EFCC is a member, is presented in this article. The revised version was approved by the EC4 Register Commission and by the EFCC Executive Board in Paris on 6 November, 2008.
McMurray, Janet; Zérah, Simone; Hallworth, Michael; Schuff-Werner, Peter; Haushofer, Alexander; Szekeres, Thomas; Wallemacq, Pierre; Tzatchev, Kamen; Charilaou, Charis; Racek, Jaroslav; Johnsen, Anders; Tomberg, Karel; Harmoinen, Aimo; Baum, Hannsjörg; Rizos, Demetrios; Kappelmayer, Janos; O'Mullane, John; Nubile, Giuseppe; Pupure, Silvija; Kucinskiene, Zita; Opp, Matthias; Jansen, Rob; Solnica, Bogdan; Reguengo, Henrique; Grigore, Camelia; Spanár, Július; Strakl, Greta; Queralto, Josep; Wallinder, Hans; Wieringa, Gijsbert
In 1997, the European Communities Confederation of Clinical Chemistry and Laboratory Medicine (EC4) set up a Register for European Specialists in Clinical Chemistry and Laboratory Medicine. The operation of the Register is undertaken by a Register Commission (EC4RC). During the last 12 years, more than 2200 specialists in Clinical Chemistry and Laboratory Medicine have joined the Register. In 2007, EC4 merged with the Forum of European Societies of Clinical Chemistry and Laboratory Medicine (FESCC) to form the European Federation of Clinical Chemistry and Laboratory Medicine (EFCC). Two previous Guides to the Register have been published, one in 1997 and another in 2003. The third version of the Guide is presented in this article and is based on the experience gained and development of the profession since the last revision. Registration is valid for 5 years and the procedure and criteria for re-registration are presented as an Appendix at the end of the article.
Berntsen, Karin; Bjørk, Ida Torunn
Clinical placements are important in the learning processes of nursing students. In Norway, clinical placement in nursing homes is obligatory for nursing students, and this is a demanding and complex setting for learning. This study aimed to assess how first-year nursing students perceived their learning environment in nursing homes and to explore which factors in the clinical learning environment had the greatest influence on students' overall satisfaction with their clinical placement. Students rated their perceptions of the psychosocial learning environment using the Clinical Learning Environment Inventory. Students perceived the learning environment as moderately positive. Mean scores were the highest on the Personalization subscale and the lowest on the Innovation subscale. Students who highly valued Innovation, Involvement, and Personalization had higher scores on the Satisfaction sub-scale. The results of this study indicate that major work is needed to develop the learning context for students in nursing homes.
Background There is a scarcity of research published on clinical scholarship. Much of the conceptualisation has been conducted in the academy. Nurse academics espouse that the practice of nursing must be built within a framework of clinical scholarship. A key concept of clinical scholarship emerging from discussions in the literature is that it is an essential component of enabling evidence–based nursing and the development of best practice standards to provide for the needs of patients/clients. However, there is no comprehensive definition of clinical scholarship from the practicing nurses. The aim of this study was to contribute to this definitional discussion on the nature of clinical scholarship in nursing. Methods Naturalistic inquiry informed the method. Using an interpretative approach 18 practicing nurses from Australia, Canada and England were interviewed using a semi-structured format. The audio-taped interviews were transcribed and the text coded for emerging themes. The themes were sorted into categories and the components of clinical scholarship described by the participants compared to the scholarship framework of Boyer [JHEOE 7:5-18, 2010]. Results Clinical scholarship is difficult to conceptualise. Two of the essential elements of clinical scholarship are vision and passion. The other components of clinical scholarship were building and disseminating nursing knowledge, sharing knowledge, linking academic research to practice and doing practice-based research. Conclusion Academic scholarship dominated the discourse in nursing. However, in order for nursing to develop and to impact on health care, clinical scholarship needs to be explored and theorised. Nurse educators, hospital-based researchers and health organisations need to work together with academics to achieve this goal. Frameworks of scholarship conceptualised by nurse academics are reflected in the findings of this study with their emphasis on reading and doing research and translating it
Mannix, Judy; Wilkes, Lesley; Daly, John
Clinical leadership has been identified as crucial to positive patient/client outcomes, across all clinical settings. In the new millennium, transformational leadership has been the dominant leadership style and in more recent times, congruent leadership theory has emerged to explain clinical leadership in nursing. This article discusses these two leadership models and identifies some of the shortcomings of them as models for clinical leadership in nursing. As a way of overcoming some of these limitations, aesthetic leadership is proposed as a style of leadership that is not antithetical to either model and reflects nursing's recognition of the validity of art and aesthetics to nursing generally. Aesthetic leadership is also proposed as a way to identify an expert clinical leader from a less experienced clinical leader, taking a similar approach to the way Benner (1984) has theorised in her staging of novice to expert clinical nurse.
Richardson, Hila; Gilmartin, Mattia J; Fulmer, Terry
To address the faculty shortage problem, schools of nursing are reexamining how they provide clinical education to undergraduate students to find ways to use faculty resources more efficiently and to maintain student enrollment. We describe a unique clinical teaching model implemented at the New York University College of Nursing. The new model currently being evaluated shifts from the traditional clinical education model, in which all clinical education is in a hospital or agency setting, to a model that substitutes high-fidelity human patient simulation for up to half of the clinical education experience. This article describes the clinical teaching model and its effects on nurse faculty capacity.
Milner, F Margaret; Estabrooks, C A; Humphrey, C
The purpose of this study was to examine the determinants of research utilization among clinical nurse educators. The primary goal for clinical nurse educators is the facilitation of professional development of practicing nurses. Responsibilities include promoting best practice by mentoring others, acting as an information source, and assisting in the development of policies and procedures based on available research evidence. Using Rogers' (Diffusion of Innovations, 4th edn., The Free Press, New York) diffusion of innovations theory as a theoretical foundation, we conducted a secondary analysis to test a predictive model of research utilization using linear regression. Results show that educators report significantly higher research use than staff nurses and managers. Predictors of research utilization include attitude toward research, awareness of information based on research, and involvement in research activities. Localite communication predicted conceptual research use and mass media predicted symbolic use, lending support to the idea that overall, instrumental, conceptual, and symbolic research utilization are conceptually different from one another. Our findings show that the research utilization behaviors of clinical nurse educators position them to facilitate evidence-based nursing practice in organizations. We discuss the theoretical, conceptual, and nursing role implications of our findings for nursing practice, education, and research. Suggestions for future research includes studying actual use of research findings of clinical nurse educators and designing intervention studies that assesses the effectiveness of clinical nurse educators as facilitators of research utilization in organizations.
Heise, Barbara A; Gilpin, Laura C
Although debriefing in simulation settings is routine in nursing education, debriefing does not routinely take place in clinical settings with nursing students after a patient has died. This pilot study sought to explore nursing students' perceptions of their first experience with the death of a patient. Students reported emotional distress and feelings of inadequacy with regard to communicating with and supporting the family of the dying patient. Only half the students sampled reported debriefing by their clinical instructor or staff. Nurse educators must include debriefing and student support following a patient death in the clinical setting.
Gore, Teresa N; Johnson, Tanya Looney; Wang, Chih-hsuan
Nurse educators claim accountability to ensure their students are prepared to assume leadership responsibilities upon graduation. Although front-line nurse leaders and nurse executives feel new graduates are not adequately prepared to take on basic leadership roles, professional nursing organizations such as the American Nurses Association (ANA) and the Association of Colleges of Nursing (AACN) deem leadership skills are core competencies of new graduate nurses. This study includes comparison of a leadership-focused multi-patient simulation and the traditional leadership clinical experiences in a baccalaureate nursing leadership course. The results of this research show both environments contribute to student learning. There was no statistical difference in the overall score. Students perceived a statistically significant difference in communication with patients in the traditional inpatient environment. However, the students perceived a statistical significant difference in teaching-learning dyad toward simulation.
Crumbley, D R; Ice, R C; Cassidy, R
The wound Care Clinic at Naval Hospital Charleston is a nurse-managed ambulatory clinic that has demonstrated the successful application of nursing case management in caring for patients with chronic and complex wounds. Nursing case management is an outcomes-based system of assessment, planning, provision of nursing services, coordination of interdisciplinary efforts, education, and referral. Nursing case management has been shown, in the literature and at Naval Hospital Charleston, to be an extension of role of professional nursing practice and results in decreased costs, improved quality of care, faster wound healing times, decreased complications, and greater coordination of care between specialty disciplines. These positive results are illustrated in several case studies. Nursing case management has many implications for the successful implementation of any healthcare delivery system where decreased costs and improved quality of care are valued, and it has special benefit in the complex management of chronically ill patients.
Jenkins-Cameron, Stella L.
The purpose of the study was to examine nurse educators' (NEs) perceptions of their level of preparedness to guide learning in clinical rotations of associate degree pre-licensure nursing programs of a South Atlantic state. The study also sought to determine the relationship between clinical experience, formal education, and teaching experience to…
Shinnick, Mary Ann
Public health relies on well trained nurses and clinical experience is an important component of that training. However, clinical experience training for student nurses also has significant challenges, as it can place patients at risk. Also it is difficult to schedule/predict patient conditions and procedures. Human patient simulation (HPS) can…
Haggerty, Lois A; Grace, Pamela
Clinical wisdom, an essential foundation of nursing care that provides for the "good" of individual patients while taking into account the common good, is a concept that is difficult to define and comprehend. However, understanding what constitutes clinical wisdom is essential for the education of the types of nurses who are most likely to provide leadership that is consistent with the goals of nursing as outlined in the 2005 Code of Ethics for Nurses of the International Council of Nurses and the 2001 Code of Ethics for Nurses With Interpretive Statements of the American Nurses Association. The three key elements of wisdom, derived from the psychology and philosophy literature, are (1) balancing and providing for the good of another and the common good, (2) the use of intellect and affect in problem solving, and (3) the demonstration of experience-based tacit knowing in problematic situations. We conceptualized clinical wisdom as a more specific variant of general wisdom by examining how the core elements described can be linked to wisdom for nursing practice. In doing so, the nature of clinical wisdom is clarified and strategies are suggested to assist nurse educators in developing wise nurses.
Tolhurst, B G; Bonner, A
This paper explores the development and implementation of specific criteria to determine the level of clinical performance of postgraduate nursing students during the first year of a Master of Nursing course. The authors describe two commonly used clinical skill assessment tools and identify limitations of these tools for postgraduate nursing students. As a result of these limitations, Clinical Assessment Criteria (CAC) utilising the framework of Benner (1984) was developed. Inherent within the CAC is four levels of clinical nursing performance, which enable the nurse teacher and student to monitor the progression from novice to proficient levels of practice within a specialty area. Following a successful pilot study, the CAC was incorporated into clinical assessments in nine specialty postgraduate courses. Furthermore, the framework developed for the CAC can also be integrated into a variety of professional development domains.
Evers, G C
Nursing as a health-service has a long tradition, nursing research however, a relatively short history. Florence Nightingale was the first to publish about nursing research in the year 1858. Since Nightingale, the need to study and improve the efficacy and efficiency of nursing has steadily increased. More than ever before, society needs nursing based on scientific knowledge and not just on unchallenged rituals and traditions. This scientific knowledge base can be acquired by clinical research. Within multidisciplinary clinical research it is necessary to focus on nursing's unique function. Virginia Henderson (1955) and Dorothea Orem (1959) have clearly explicated this function. Designs for clinical nursing research can be (quasi-) experimental, correlational or descriptive. Descriptive research can be qualitative or quantitative. Effects of nursing interventions on decrease of self-care problems and improvement of self-care capability and behaviors, should be investigated by experimental or quasi-experimental studies. Some examples of clinical nursing research are given. The first example demonstrates the effect of quantity and quality of nursing staff on patient's capabilities for hygiene self-care. The second example explicates the relation between self-care and quality of life with breast-cancer patients under chemotherapy treatment. The last example shows the effect of diabetes education on self-care behaviour and metabolic control. The examples given demonstrate the importance of clinical research focused on nursing's unique function. In order to accomplish this, programs of research are needed as well as close co-operation with nursing services, physicians and hospitals. Only when research findings are discussed and implemented in multidisciplinary teams, nursing will become more evidence-based.
Manning, Liz; Neville, Stephen
This article presents the findings of a study describing Clinical Nurse Educators' experiences, as they recall their transition from staff nurse to the Clinical Nurse Educator role, within a New Zealand District Health Board. Nurse Educator roles influence clinical practice and professional development of nurses, and although designated as a senior role nationally, the complexities and size of the role are poorly understood. A qualitative descriptive methodology utilising transition theory as a conceptual framework underpinned the study. A sample of eight Clinical Nurse Educators from a New Zealand District Health Board were interviewed about their transition from experienced staff nurse to inexperienced senior nurse. Data were analysed using a general inductive approach. Participants found the Clinical Nurse Educator role was more complex than anticipated, with no preparation for the role and sub-optimal orientation periods being provided by the District Health Board. As a result, signs of stress were evident as the enormity of the role became apparent. Consequently, employers need to ensure that appropriate orientation programmes and mentorship are inherent in health care organisations.
Clinical nurse educators are advanced practice nurses with preparation at the master's level or higher. Such nurses play an important role in organ procurement organizations. As leaders and members of the team, they provide structure and design to the training process. These educators oversee orientation of new employees, serve as mentors to preceptors, assess the learning needs of the organization, and provide ongoing training to veteran staff. Clinical nurse educators also contribute to continuous quality improvement for the organization and help to comply with regulatory standards.
Kaiser, Katherine Laux; Carter, Kimberly Ferren; O'Hare, Patricia A.; Callister, Lynn Clark
Describes the work of a task force to revise public health nursing curriculum that combined the expertise of the American Association of Colleges of Nursing and specialty organizations. Discusses the current state of community/public health nursing and the model used to identify core professional knowledge and values underpinning the curriculum.…
Ganley, Barbara J; Sheets, Ingrid
This article describes one university's experience in creating a master's geriatric clinical nurse specialist-nurse educator program to address the nursing faculty shortage and the need for geriatric clinical nurse specialists. The successes and challenges are outlined, and curricular ideas that may be beneficial to other nursing programs also are presented. This program has enhanced the university's pool of clinical instructors, increased its ability to provide services to older adults, and allowed faculty to instruct and focus undergraduates in the distinctions of geriatric nursing care. The biggest challenges faced were marketing and recruitment of nurses; these challenges were addressed, and possible solutions are offered. The most immediate benefit of this program was the generation of geriatric clinical nurse specialists.
deForest, Erin Kate; Thompson, Graham Cameron
In an effort to improve the quality and flow of care provided to children presenting to the emergency department the implementation of nurse-initiated protocols is on the rise. We review the current literature on nurse-initiated protocols, validated emergency department clinical scoring systems, and the merging of the two to create Advanced Nursing Directives (ANDs). The process of developing a clinical pathway for children presenting to our pediatric emergency department (PED) with suspected appendicitis will be used to demonstrate the successful integration of validated clinical scoring systems into practice through the use of Advanced Nursing Directives. Finally, examples of 2 other Advanced Nursing Directives for common clinical PED presentations will be provided. PMID:22778944
Steyer, Nathalia Helene; Oliveira, Magáli Costa; Gouvêa, Mara Regina Ferreira; Echer, Isabel Cristina; Lucena, Amália de Fátima
Objective To analyze the clinical profile, nursing diagnoses, and nursing care established for postoperative bariatric surgery patients. Method Cross-sectional study carried out in a hospital in southern Brazil with a sample of 143 patients. Data were collected retrospectively from electronic medical records between 2011 and 2012 and analyzed statistically. Results We found a predominance of adult female patients (84%) with class III obesity (59.4%) and hypertension (72%). Thirty-five nursing diagnoses were reported, among which the most frequent were: Acute Pain (99.3%), Risk for perioperative positioning injury (98.6%), and Impaired tissue integrity (93%). The most frequently prescribed nursing care were: to use protection mechanisms in the surgical patient positioning, to record pain as 5th vital sign, and to take vital signs. There was an association between age and comorbidities. Conclusion The nursing diagnoses supported the nursing care prescription, which enables the qualification of nursing assistance.
Franzen, Elenara; Scain, Suzana Fiore; Záchia, Suzana A; Schmidt, Maria Luiza; Rabin, Eliane G; da Rosa, Ninon Girardon; Menegon, Dóris B; dos Santos, Luciana Batista dos; Heldt, Elizeth
This study was aimed at verifyjing the relationship between demographic and clinicalfeatures and nursing diagnoses established during a nurse consultation in a general hospital. This is a cross-sectional study that assessed 237 nursing consultations of patients in two different programs Women's Health (46 in obstetrical nursing and 24 in mastology nursing) and 167 in diabetes mellitus education. A total of 49 nursing diagnoses were identified. The most frequent in the women's health program were: knowledge deficit, impaired comfort, impaired tissue, integrity and anxiety; in the program of diabetes education were: ineffective therapeutic regimen management, and imbalanced nutrition: more than body requirements. There was a significant association between the most common diagnoses with certain demographic and clinical features. The results confirmed that the identification of the nursing diagnoses during the consultation may provide accuracy in the focus of outpatient care.
Moore, Linda Weaver; Leahy, Cathy
This qualitative study explored the experiences of clinical nurse leaders (CNLs) as they implemented this new role. Twenty-four CNLs participated. Data were collected via an e-mail-distributed questionnaire. Data from open-ended questions were used to conduct a qualitative content analysis. Data were categorized according to question, key thoughts and phrases were established, and themes were determined. Findings revealed that nonsystematic role introduction was common. Two challenges to role implementation included role confusion and being overworked. The most positive aspect of the role was remaining close to the point of care. Participants noted that the overall response of the health care team to the role was positive despite participants' belief that the greatest roadblock to role success was the lack of support by nurse administrators. The support of nurse administrators and clear role expectations were viewed as essential for role sustain-ability. Understanding the experiences of CNLs as they launch this new role can provide insights for educators, administrators, CNLs, and other health care providers regarding the success and sustainability of the role. In addition, understanding the similarities between the clinical nurse specialist (CNS) role initiation in the past and the CNL role initiation today can foster the development of strategies for confronting the challenges of new role implementation.
Voltelen, Barbara; Konradsen, Hanne; Østergaard, Birte
As part of the Heart Failure Family Trial presently being conducted in Denmark, this qualitative process evaluation explored the perceptions of seven practicing cardiac nurses who offered family nursing therapeutic conversations (FNTC) to families in three heart failure outpatient clinics. FNTC were guided by the Calgary Family Assessment and Intervention Models. Data consisted of 34 case reports written by the nurses which documented the use of FNTC, including family responses to the FNTC. A focus group interview with the six of the nurses about their experience of offering FNTC was also conducted. Content analysis was performed using a combined deductive and inductive process. Nurses reported developing a distinct, closer, and more constructive relationship with the patients and their families and reported FNTC increased family bonding and strengthened family relationships. The nurses considered FNTC to be feasible interventions in the routine care provided in heart failure outpatient clinics.
Spicer, Sherri; Heller, Rebecca; Troth, Sarah
Preparing future nurses to provide appropriate care for patients and their families at the end of life can be a formidable challenge for nurse educators. Most nursing schools thread end-of-life concepts throughout the curriculum. Grand Canyon University includes a 40-hour hospice clinical as a component of a home healthcare practicum. Students' weekly written reflections reveal the depth of affective learning that occurs during this experience. Article includes hospice materials and resources.
The clinical role of nurse lecturers has been the subject of much debate since the transfer of nurse education into Higher Education Institutions within the United Kingdom. This article provides a critical evaluation of the clinical role of nurse lecturers in terms of policy drivers and strategies for implementing national guidelines. Policies from the initiation of Project 2000, through to recent consultation documents on the support of students in practice, are evaluated. Formal aspects of the nurse lecturer remit, such as link tutor and personal supervisor roles, are discussed in terms of their impact on clinical practice. There is also a brief review of the development of the lecturer practitioner role as a bridge between education and practice. The fundamental arguments in support of nurse lecturers maintaining a clinical role in practice are analysed. This analysis includes consideration of the concept of 'clinical credibility' in terms of the impact on teaching and the closure of the theory-practice gap. The article concludes with suggestions for strategies to resolve the ongoing debate surrounding the clinical role of nurse lecturers. These recommendations include a review of staff:student ratios in nurse education, re-evaluation of the need for a clinical role, and the use of innovative recruitment and development strategies by higher education institutions.
Sjölin, Helena; Lindström, Veronica; Hult, Håkan; Ringsted, Charlotte; Kurland, Lisa
In Sweden, ambulances must be staffed by at least one registered nurse. Twelve universities offer education in ambulance nursing. There is no national curriculum for detailed course content and there is a lack of knowledge about the educational content that deals with the ambulance nurse practical professional work. The aim of this study was to describe the content in course curricula for ambulance nurses. A descriptive qualitative research design with summative content analysis was used. Data were generated from 49 courses in nursing and medical science. The result shows that the course content can be described as medical, nursing and contextual knowledge with a certain imbalance with largest focus on medical knowledge. There is least focus on nursing, the registered nurses' main profession. This study clarifies how the content in the education for ambulance nurses in Sweden looks today but there are reasons to discuss the content distribution.
Di Giulio, P; Arrigo, C; Gall, H; Molin, C; Nieweg, R; Strohbucker, B
In order to improve the overall quality of clinical trials, the role of the nurse should be expanded. The minimum requirement to facilitate nurses' participation and the optimal implementation of a clinical research protocol is to provide access to the clinical protocol document itself. However, given the high workload in an oncology unit, there is often little time for the staff to read the entire document. In addition, clinical protocols do not often provide detailed practical instructions for delivering treatment, observing patients, managing toxicities, and treating complications. A nursing summary of the medical protocol is a document that provides a short and easy-to-read selection of protocol-relevant information. It enables nurses to safely and more easily implement the research protocol and improve the care of patients in clinical trials. Master nursing summaries can be prepared centrally by the group responsible for the research protocol, while the unit/wards involved in the research can customize or adapt it to local needs. The potential benefit of implementing nursing summaries is overall improvement of the quality of the study by (a) increasing the reliability of nursing care regarding patients' safety, (b) standardizing monitoring and care of patients, (c) standardizing preventive measures, (d) proposing similar management of complications related to experimental treatments. Moreover, discussing nursing summaries may help evaluate workload related to research, allowing for better planning and allocation of resources.
Park, Hyeoun-Ae; Kim, Younglan; Lee, Myung Kyung; Lee, Youngji
Objectives The aim of this study was to develop and validate Detailed Clinical Models (DCMs) for nursing assessments and interventions. Methods First, we identified the nursing assessment and nursing intervention entities. Second, we identified the attributes and the attribute values in order to describe the entities in more detail. The data type and optionality of the attributes were then defined. Third, the entities, attributes and value sets in the DCMs were mapped to the International Classification for Nursing Practice Version 2 concepts. Finally, the DCMs were validated by domain experts and applied to case reports. Results In total 481 DCMs, 429 DCMs for nursing assessments and 52 DCMs for nursing interventions, were developed and validated. The DCMs developed in this study were found to be sufficiently comprehensive in representing the clinical concepts of nursing assessments and interventions. Conclusions The DCMs developed in this study can be used in electronic nursing records. These DCMs can be used to ensure the semantic interoperability of the nursing information documented in electronic nursing records. PMID:22259726
Islam, Shofiq; Taylor, Christopher; Ahmed, Siddiq; Walton, Gary M
We explored how oral and maxillofacial (OMF) consultants describe themselves in their correspondence. We did a telephone survey of OMF surgeons' secretaries and compiled data on the specialist titles used. Data were available for 290 consultants and 19 different titles were identified. A total of 190 (66%) consultants used the title OMF surgeon alone and a further 22 (8%) combined it with the name of a subspecialty. The remaining 78 (27%) used 11 alternative titles. Of those surveyed, 212 (73%) continue to use the specialty title of OMF surgeon with or without the name of a subspecialty comprising a readily identifiable group of specialists.
Zieber, Mark Pijl; Williams, Beverley
The experience of nursing students who make mistakes during clinical practice is poorly understood. The literature identifies clinical practice mistakes as a significant issue in nursing practice and education but there is very little research on the topic. This study used a grounded theory approach to explore the experience of undergraduate nursing students who had made at least one mistake in their clinical practice. What emerged is a theory that illuminates the process of how students move through the positive and negative elements of the mistake experience the core variable that emerged from the study was "living through the mistake experience." The mistake experience was clearly a traumatic process for nursing students and students reported feeling unprepared and lacking the capability to manage the mistake experience. A number of recommendations for nursing education are proposed.
Oman, Kathleen S; Mancuso, Mary P; Ceballos, Kirtley; Makic, MaryBeth Flynn; Fink, Regina M
: Clinical nurses often find writing a challenge, but it's important to disseminate clinical practice initiatives that result in notable patient outcomes. Nurses have a responsibility to share what they do to improve patient care. The increased emphasis on the development and evaluation of evidence-based practice has made it necessary for nurses to share best practices that are associated with improved patient outcomes. We developed a six-month Writing for Publication workshop series designed to teach clinical nurses about the writing process and mentor them through the stages of preparing a manuscript to submit for publication. This successful program helped novice nurse authors become published professionals and had a great impact on our organization.
Masterson, Abigail; Robb, Liz
Clinical academics make a unique contribution to health research and scholarship by undertaking practice-focused research that offers direct benefits to patient care. The Florence Nightingale Foundation supports the development of research skills in nursing and midwifery through its scholarships and by establishing a network of chairs in clinical nursing practice research. The Florence Nightingale Foundation also provides leadership scholarships to deans and aspiring deans of university faculties of health. It is from these perspectives that the case is made for investment in clinical academic roles and the development of career pathways that embrace the art and science of nursing.
Background Clinical scholarship has been conceptualised and theorised in the nursing literature for over 30 years but no research has captured nurses’ clinicians’ views on how it differs or is the same as clinical expertise and clinical leadership. The aim of this study was to determine clinical nurses’ understanding of the differences and similarities between the clinical expert, clinical leader and clinical scholar. Methods A descriptive interpretative qualitative approach using semi-structured interviews with 18 practising nurses from Australia, Canada and England. The audio-taped interviews were transcribed and the text coded for emerging themes. The themes were sorted into categories of clinical expert, clinical leader and clinical scholarship as described by the participants. These themes were then compared and contrasted and the essential elements that characterise the nursing roles of the clinical expert, clinical leader and clinical scholar were identified. Results Clinical experts were seen as linking knowledge to practice with some displaying clinical leadership and scholarship. Clinical leadership is seen as a positional construct with a management emphasis. For the clinical scholar they linked theory and practice and encouraged research and dissemination of knowledge. Conclusion There are distinct markers for the roles of clinical expert, clinical leader and clinical scholar. Nurses working in one or more of these roles need to work together to improve patient care. An ‘ideal nurse’ may be a blending of all three constructs. As nursing is a practice discipline its scholarship should be predominantly based on clinical scholarship. Nurses need to be encouraged to go beyond their roles as clinical leaders and experts to use their position to challenge and change through the propagation of knowledge to their community. PMID:23587282
Marvos, Chelsea; Hale, Frankie B.
Objective: This exploratory, quantitative, descriptive study was undertaken to explore the relationship between clinical performance and anticipated retention in nursing students. Methods: After approval by the university's Human Subjects Committee, a sample of 104 nursing students were recruited for this study, which involved testing with a valid and reliable emotional intelligence (EI) instrument and a self-report survey of clinical competencies. Results: Statistical analysis revealed that although the group average for total EI score and the 6 score subsets were in the average range, approximately 30% of the individual total EI scores and 30% of two branch scores, identifying emotions correctly and understanding emotions, fell in the less than average range. This data, as well as the analysis of correlation with clinical self-report scores, suggest recommendations applicable to educators of clinical nursing students. Conclusions: Registered nurses make-up the largest segment of the ever-growing healthcare workforce. Yet, retention of new graduates has historically been a challenge for the profession. Given the projected employment growth in nursing, it is important to identify factors which correlate with high levels of performance and job retention among nurses. There is preliminary evidence that EI a nontraditional intelligence measure relates positively not only with retention of clinical staff nurses, but with overall clinical performance as well. PMID:27981096
Beattie, Bev; Koroll, Donna; Price, Susan
The use of high fidelity simulation (HFS) learning opportunities in nursing education has received increased attention in the literature. This article describes the design of a systematic framework used to promote critical inquiry and provide meaningful simulation clinical experiences for second year nursing students. Critical inquiry, as defined…
McKenna, Lisa; McCall, Louise; Wray, Natalie
Many nursing students enter undergraduate programmes with preconceived ideas about their future nursing careers, and intend to practice in particular areas such as midwifery or paediatrics. Through clinical placements, students are exposed to different clinical areas and professional socialization is facilitated. However, little is known about the influence of clinical placements on students' career intentions. This paper reports nursing findings drawn from a large qualitative study conducted in Victoria, Australia that sought to explore the influence of health professional students' clinical placements on their future career intentions. Participants were invited to be involved in either face-to-face or focus group interviews depending upon their own preference. Thematic data analysis revealed three main themes: 're-affirming career choice', 'working in a particular area' and 'work location'. Findings from the study add to our understanding of factors influencing nursing students' planning for their future careers including the impact of clinical placements.
Matumoto, Silvia; Fortuna, Cinira Magali; Kawata, Lauren Suemi; Mishima, Silvana Martins; Pereira, Maria José Bistafa
This study aims to present the re-signification process of the meanings of nurses' clinical practice in primary care from the perspective of extended clinic and permanent education. An intervention research was carried out with the approval of an ethics committee. Nine nurses participated in reflection groups from September to December 2008 in Ribeirão Preto-SP-Brazil. The redefinition process of the meanings proposed by the institutional analysis was mapped. The results point out that the nurses perceive differences in clinical work, by acknowledging the sense of user-centered clinical practice; daily limits and tensions and the need for support from managers and the team to deal with users' problems and situations. They identify the necessity to open space in the schedule to do that. It was concluded that nurses' clinical practice is being consolidated, and that collective analysis processes permit learning and the reconstruction of practices.
This series of articles explores various ways of supporting staff who work in the fast-moving and ever-changing health service. In previous articles, John Fowler an experienced nursing lecturer, author and consultant examined the importance of developing a supportive working culture and the role of preceptorship and mentoring. This article examines the use of clinical supervision within nursing.
Spurr, Shelley; Bally, Jill; Ogenchuk, Marcella; Peternelj-Taylor, Cindy
This article presents a proposed holistic Framework for Exploring Adolescent Wellness specific to the discipline of nursing. Conceptualized as a practical adolescent wellness assessment tool, the framework attends to the physical, spiritual, psychological and social dimensions of adolescent health. Through the discussion of a reconstructed case study the framework's application to nursing practice is illustrated. Nurses are distinctly positioned to promote adolescent wellness. This approach facilitates the exploration of the multiple influences on the health of adolescents, across a variety of clinical practice specialties and settings, by nurses of varying experiences.
Williams, Ann K; Parker, Vicki T; Milson-Hawke, Sally; Cairney, Karen; Peek, Carmel
The need to develop nurses as managers and leaders is crucial to the retention of registered nurses at a time of work force shortages and an increasingly aging work force in most Western industrialized countries. This article describes a creative and collaborative educational initiative developed at a large regional teaching hospital in New South Wales, Australia, designed to address this need. Based on a competency assessment process designed around face-to-face education, resource materials, and individualized mentoring from nurse unit managers, the aim of this multifaceted educational program is to develop effective team leaders in the clinical setting as well as a new generation of nursing leaders.
Manoochehri, H; Imani, E; Atashzadeh-Shoorideh, F; Alavi-Majd, A
Aim: Clinical competence is to carry out the tasks with excellent results in a different of adjustments. According to various studies, one of the factors influencing clinical competence is work experience. This experience affects the integrity of students' learning experience and their practical skills. Many nursing students practice clinical work during their full-time studying. The aim of this qualitative research was to clarify the role of clinical work during studying in novice nurses' clinical competence. Methods: This qualitative content analysis performed with the conventional approach. All teaching hospitals of Hormozgan University of Medical Sciences selected as the research environment. To collect data, deep and semi-structured interviews, presence in the scene and manuscripts used. To provide feedback for the next release and the capacity of the data, interviews were transcribed verbatim immediately. Results: 45 newly-graduated nurses and head nurses between 23 and 40 with 1 to 18 years of experience participated in the study. After coding all interviews, 1250 original codes were derived. The themes extracted included: task rearing, personality rearing, knowledge rearing, and profession rearing roles of clinical work during studying. Conclusion: Working during studying can affect performance, personality, knowledge, and professional perspectives of novice nurses. Given the differences that may exist in clinical competencies of novice nurses with and without clinical work experience, it is important to pay more attention to this issue and emphasize on their learning in this period. PMID:28316703
Manoochehri, H; Imani, E; Atashzadeh-Shoorideh, F; Alavi-Majd, A
Aim: Clinical competence is to carry out the tasks with excellent results in a different of adjustments. According to various studies, one of the factors influencing clinical competence is work experience. This experience affects the integrity of students' learning experience and their practical skills. Many nursing students practice clinical work during their full-time studying. The aim of this qualitative research was to clarify the role of clinical work during studying in novice nurses' clinical competence. Methods: This qualitative content analysis performed with the conventional approach. All teaching hospitals of Hormozgan University of Medical Sciences selected as the research environment. To collect data, deep and semi-structured interviews, presence in the scene and manuscripts used. To provide feedback for the next release and the capacity of the data, interviews were transcribed verbatim immediately. Results: 45 newly-graduated nurses and head nurses between 23 and 40 with 1 to 18 years of experience participated in the study. After coding all interviews, 1250 original codes were derived. The themes extracted included: task rearing, personality rearing, knowledge rearing, and profession rearing roles of clinical work during studying. Conclusion: Working during studying can affect performance, personality, knowledge, and professional perspectives of novice nurses. Given the differences that may exist in clinical competencies of novice nurses with and without clinical work experience, it is important to pay more attention to this issue and emphasize on their learning in this period.
Lovecchio, Catherine P; DiMattio, Mary Jane K; Hudacek, Sharon
The necessity to help baccalaureate nursing students transition to clinical practice in a health care environment governed by change has compelled nurse educators to investigate alternative clinical instruction models that nurture academic-practice partnerships and facilitate student clinical learning. This article describes an academic-practice partnership in a community hospital using the Clinical Liaison Nurse (CLN) model as a link between students and clinical faculty and reports results of a quasi-experimental study that compared perceptions of the clinical learning environment between students participating in the CLN model (experimental group) and those in a traditional, instructor-led clinical model (control group). Students assigned to the CLN model had statistically significantly higher individualization, satisfaction, and task orientation scores on the Clinical Learning Environment Inventory. The findings provide evidence that academic-practice partnerships can be successful in community hospital settings and enhance students' perceptions in the clinical learning environment.
Valizadeh, Leila; Zamanzadeh, Vahid; Habibzadeh, Hosein; Alilu, Leyla; Gillespie, Mark; Shakibi, Ali
Introduction: Despite the current shortage of nurses, it is important to know the reasons nurses want to leave the clinical setting. The purpose of this study was to explore the experiences of nurses who intend to leave clinical nursing. Methods: In a qualitative content analysis study, data obtained from 13 in-depth face-to-face semi-structured interviews with nurses working in hospitals affiliated to the Tabriz and Urmia University of Medical Sciences in Iran, selected through purposive sampling. A conventional content analysis was used for data analysis. Results: Four categories and eleven subcategories emerged during data analysis. The extracted categories and sub categories consisted of (I) Entry routes into nursing (implicitly entry, targeted entry), (II) Defects in dignity (lack of professional vision toward the nurses, social status of nurses), (III) Work in non-ideal working environment (lack of support, discrimination, conflict, lack of opportunities for advancement), and (IV) Dissatisfaction with working conditions (heavy workload, lack of power, unusual working hours). Conclusion: The findings of this qualitative study reflect professional turnover as a complex, ongoing, multidimensional process. By identifying the factors responsible, it could be possible to retain nurses in the field. PMID:27354981
Santullo, Antonella; Calabrese, Enzo; Canova, Giuliana; Curzi, Giovanni
In the USL Rimini was set up in 2007 a nursing service for the cerumen removal and it was implemented during time. To demonstrate through recorded activities data that this service managed by nurses is able to provide a timely and appropriate response to the users. Activities data were analyzed using descriptive statistics. The implementation of the nursing service in 2010 led to an increase (= 682) in performance compared to 2009, activities data of 2011 and 2012 show a more consistent pattern and consolidation of open days and in the number of services performed per session, all issues reported by users have been properly recognized by specialist nurse. All positive insights in terms of improved job satisfaction, high quality standards, minimum requirement of financial resources indicate that this service, may be replicated in other health care facilities. Future developments of the service should be aimed at the development of an informative brochure for users, an evaluation of users' satisfaction and an improvement of nursing notes.
Hilbert, Gail A.
A study to determine the incidence of unethical classroom and clinical behaviors among nursing students, to find out their opinions, and to investigate the relationships among demographic data, unethical behaviors and opinions about the behaviors is discussed. (Author/MLW)
McWilliam, Paula; Botwinski, Carol
The evaluation of nursing students' clinical competencies is essential to the educational process. The Objective Structured Clinical Examination (OSCE) program was designed to assess students in a variety of health topics that may not be experienced during the assigned clinical rotation. Building on prior work, the purpose of this study was to examine specific aspects of the nursing OSCE toward developing a reliable and valid tool for evaluating selected students' clinical competencies.The following areas were investigated using an assessment design: the development of case scenarios and updates, the role and training of the standardized patient, and students' perceptions of the nursing OSCE experience. Recommendations are made for the variety of case scenarios, frequency of updates, methods by which standardized patients should be trained, remediation, and program requirements. Students were overwhelmingly favorable to perceived benefits of participation in OSCEs during their nursing education.
Bettancourt, Lorena; Muñoz, Luz Angelica; Merighi, Miriam Aparecida Barbosa; dos Santos, Marcia Fernandes
During theoretical and practical activities in clinical training areas, nursing teachers provide the bases needed for the development of future professionals. The goal is to understand the experience of nursing teachers with nursing students in clinical training areas. Therefore, a phenomenological qualitative method was chosen, and Martin Heidegger's philosophical framework was used to support data analysis. Five faculty from a Chilean university participated in the study. The analysis permitted discovering the following themes: being a faculty at the hospital, contact with nurse practitioners and being a faculty in care teaching. The study demonstrated that teaching/care integration is a constructive element that facilitates the teaching and learning process, aiming to prepare nursing professionals who incorporate the bases of authentic care into their activities.
Grady, Christine; Edgerly, Maureen
Clinical research is a systematic investigation of human biology, health, or illness involving human beings. It builds on laboratory and animal studies and often involves clinical trials, which are specifically designed to test the safety and efficacy of interventions in humans. Nurses are critical to the conduct of ethical clinical research and face clinical, ethical, and regulatory challenges in research in many diverse roles. Understanding and addressing the ethical challenges that complicate clinical research is integral to upholding the moral commitment that nurses make to patients, including protecting their rights and ensuring their safety as patients and as research participants.
Mackenzie, Katherine M
Nurse education has traditionally relied on clinical placements to provide nursing students with the 'hands-on' experience that is not possible to teach in a classroom setting. However, with changes to the NHS this is becoming increasingly difficult, with fewer resources available and issues of patient safety to consider. Hennman and Cunningham (2005) recognize there is a significant gulf between the theoretical component taught in the classroom and the complex realities of clinical practice. Cave (2005) has suggested the move into higher education has hindered rather than helped the linking of theory and practice in nurse education, because many nurse teachers are far removed from clinical practice and therefore no longer competent or clinically credible to be able to teach up-to-date clinical skills. In Scotland the Practice Education Facilitators role in integrating theory with practice is essential for both the NHS Trusts and higher education institutes. It would appear that these clinicians are the lynchpin between linking university work with the harsh realities of daily practice. If nurse education is to provide effective clinical skill simulation then it must also provide effective teachers who are up to date with current practice. In many cases this will not be the nurse teacher.
Fumimori, Takeaki; Tsuruta, Daisuke; Kawakami, Tamihiro; Ohata, Chika; Furumura, Minao; Hashimoto, Takashi
Palmoplantar pustulosis (PPP) is currently treated with various modalities, including excimer light, a form of ultraviolet lamp. This study reports effect of excimer light treatment in 34 Japanese PPP patients treated at a private clinic by one doctor, who was certified as a dermatological specialist by the Japanese Dermatological Association. The statistical analyses were performed upon a collaborative basis with faculties in universities. Disease response scores were determined by response to excimer light treatment. Scores of 1, 2, 3 or 4 were assigned to patients whose palmoplantar pustular psoriasis area and severity index (PPPASI) decreased to 25% or less, 25.1-50%, 50.1-75% or more than 75.1% of pretreatment PPPASI, respectively. In this study, 44.1% PPP cases had scores of 1 or 2, and considered good responders to excimer light treatment. There were no statistical differences between males and females, and between older (≥40 years) and younger groups (≤39 years) in terms of disease response score. Disease duration did not show any significant difference among these scores. Treatment times, total amount of ultraviolet and total treatment duration showed significant differences between score 1 and score 4 groups (P = 0.0164, =0.0137 and =0.0267, respectively). Particular interest was paid to smoking habits. Smoking in male patients was significantly higher than that in female patients (P = 0.0169). There was no statistical difference between smokers and non-smokers in terms of response to excimer light. In conclusion, this study suggested that excimer light is useful for both initial regimen and suppression of exacerbation in treatments of PPP.
Freed, Patricia E; McLaughlin, Dorcas E; SmithBattle, Lee; Leander, Sheila; Westhus, Nina
Therapeutic letter writing (TLW) is a well-known intervention in family nursing practice but it has been overlooked as a strategy in nursing education to promote relationship-building. This article reviews what is known about TLW and presents what was learned by adding a TLW assignment to undergraduate clinical nursing courses. This paper adds to the evidence supporting TLW as an effective clinical teaching strategy to promote students relational skills and to recognize patients' strengths. TLW has benefits for students, patients and faculty.
Felton, Anne; Royal, Jan
Rapid changes during the past two decades have seen a growing challenge to prepare newly qualified nurses who are clinically competent and confident to meet the demands of contemporary healthcare. Recent publications emphasise the need to prioritise clinical skills in nurse education (DH 2012a, Francis, 2012). This discussion reports on a project scoping the clinical skills required within pre-registration nursing curricula and considers how this has influenced curriculum development at one Higher Education Institution in the UK. This paper reports on the project analysis of nursing and healthcare policy, identifying six core themes of skills relevant for nursing practice. Furthermore it explores the findings of a series of focus groups with nursing practitioners and managers identifying priorities for clinical skills in the pre-registration curriculum. These highlighted a broad range of skills required of newly qualified practitioners, which pose a challenge for integration within nurse education. How this challenge has been addressed through the incorporation of these skills themes throughout a new pre-registration curriculum is also examined.
Schafer, P J
Knowledge in nursing requires development of theories that address both the science and art of the professional practice discipline. "A Theory of Clinical Nursing" was analyzed to explicate the epistemologic dimensions within an historic perspective. Epistemologic dimensions defined by the philosophy of science--approaches to theory development, sources of knowledge, and methodology--were characterized from two perspectives, scientific inquiry and historicism. The major perspectives in the scientific mode, namely, mechanism, empiricism, logical positivism, and logical empiricism, were analyzed along the three dimensions of theory development, sources of knowledge, and methodology. Trends in theoretical developments in nursing were related to the scientific and historic perspectives and to the epistemologic dimensions. Juxtaposing the diversity of knowledge required for nursing science and practice, and the values systems of the practitioners, revealed the inadequacy of the scientific model. Nursing knowledge explication required several modes of inquiry to articulate the scientific basis of the discipline and the art of delivery of the practice. The historicist approach framed scientific work with the prevailing World View. The Rubin theory was located within the matrix of approaches to inquiry and perspectives in nursing science. Labeled by the theorist as both a nursing research and a nursing care model, "A Theory of Clinical Nursing" represented a transition model of nursing, undergirded by the major conceptualizations and methodologies of field, psychoanalytic, and social behaviorist traditions, but implicitly coalescing the art with the science of nursing. The theory addressed core concepts of person, situation, and nursing care, as well as major process themes of change and interaction. Nursing theories of a more narrow range, such as maternal role attainment and maternal identity, nested within the theory, while subsequent theoretical clarifications and
Lee, Geraldine A; Fitzgerald, Les
Nurse practitioners in Victoria, Australia must be prepared to Masters level before seeking nurse practitioner (NP) endorsement. The challenge from a university curriculum development perspective was to develop a programme that prepares the NP theoretically and clinically for their advanced practice role. The aim of this discussion paper is to outline how the internship model was developed and report the students' opinions on the model. The NP students complete the internship with a suitably qualified mentor which requires them to work together to develop and maintain a clinical learning plan, keep a log of the weekly meetings that shows how the objectives have been achieved. The internship includes advanced clinical assessment, prescribing, diagnostic and treatment skills and knowledge related to the nurse's specialty. The clinical assessment tool incorporates the National Competency Standards for the Nurse Practitioner and allows students and mentors to identify the level of practice and set clinical objectives. Students were asked to give feedback on the clinical internship and overall their comments were favourable, reporting benefits of a clinical mentor in their work and the clinical case presentations. The clinical internship allows the acquisition of knowledge and clinical skills in the clinical specialty with an expert clinical mentor in this innovative programme.
Kodama, Hiromi; Tsuntematsu, Kayoko; Yanai, Keiko
Forensic nursing scientifically obtains and preserves the criminal damage from victims of domestic violence, child abuse, elder abuse, sexual violence and other related forms of violence. This was developed in North America in the 1980s, and has carried out appropriate nursing care while protecting the human rights of victims. Serious crime in Japan has been increasing, and it would seem that forensic nursing opportunities should expand as well. However, in Japan, there hasn't been much discussion about forensic nursing. Theorizing that support for clinical forensic nursing should be recognized and relevant, we carried out a survey of 581 clinical nurses to investigate the development of forensic nursing in Japan. 93 clinical nurses (16.0%) had a low level of familiarity with forensic nursing; however, 324 nurses (56.3%) had encountered patients who had suffered violence. 264 nurses (45.4%) had a feeling of wanting to be involved in forensic nursing, but were not confident with the knowledge and technology, while 144 nurses (24.8%) were concerned about the larger responsibility they would have. 400 nurses (68.8%) hoped to receive specialized knowledge and technical education. It is necessary to establish an education system for forensic nursing in accordance with the educational status-quo while considering the present state of forensic nursing education.
Larsson, Inga E; Sahlsten, Monika J M
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.
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. PMID:28044103
Manuel, Jenni; Crowe, Marie
A number of recent, highly-publicized, perceived health-care service failures have raised concerns about health professionals' accountabilities. Relevant to these concerns, the present study sought to examine how mental health nurses understood clinical responsibility and its impact on their practice. A descriptive, qualitative design was used, and a convenience sample of 10 mental health nurses was recruited from specialist inpatient and outpatient mental health settings in Canterbury, New Zealand. Data were collected using semistructured interviews, and the transcriptions were analysed using an inductive, descriptive approach. Three major themes were identified: being accountable, fostering patient responsibility, and shifting responsibility. Being accountable involved weighing up patients' therapeutic needs against the potential for blame in an organizational culture of risk management. Fostering patient responsibility described the process of deciding in what situations patients could take responsibility for their behaviour. Shifting responsibility described the culture of defensive practice fostered by the organizational culture of risk aversion. The present study highlighted the challenges mental health nurses experience in relation to clinical responsibility in practice, including the balancing required between the needs of patients, the needs of the organization, and the perceived need for self-protection.
34 burnout " syndrome . 4. Reports indicate clinical nurses are providing effective, quality nursing care to patients in Air Force medical treatment facilities...clinical nurses are falling victim to " burnout " syndrome , which in turn is affecting their job satisfaction. Air Force clinical inpatient nurses are managing
McGregor, Alison H
Objectives Despite lumbar degenerative disc disease (LDDD) being significantly associated with non-specific low back pain and effective treatment remaining elusive, specialist multidisciplinary clinical stakeholder opinion remains unexplored. The present study examines the views of such experts. Design A reliable and valid electronic survey was designed to establish trends using theoretical constructs relating to current assessment and management practices. Clinicians from the Society of Back Pain Research (SBPR) UK were invited to take part. Quantitative data were collated and coded using Bristol Online Surveys (BOS) software, and content analysis was used to systematically code and categorise qualitative data. Setting Specialist multidisciplinary spinal interest group in the UK. Participants 38/141 clinically active, multidisciplinary SBPR members with specialist spinal interest participated. Among them, 84% had >9 years postgraduate clinical experience. Interventions None. Outcome measures Frequency distributions were used to establish general trends in quantitative data. Qualitative responses were coded and categorised in relation to each theme and percentage responses were calculated. Results LDDD symptom recurrence, in the absence of psychosocial influence, was associated with physical signs of joint stiffness (26%), weakness (17%) and joint hypermobility (6%), while physical factors (21%) and the ability to adapt (11%) were postulated as reasons why some experience pain and others do not. No one management strategy was supported exclusively or with consensus. Regarding effective modalities, there was no significant difference between allied health professional and medic responses (p=0.1–0.8). The future of LDDD care was expressed in terms of improvements in patient communication (35%), patient education (38%) and treatment stratification (24%). Conclusions Results suggest that multidisciplinary expert spinal clinicians appear to follow UK
Thomas, Sandra P; Burk, Renee
Horizontal violence is a form of workplace violence, a phenomenon that is prevalent in the nursing profession. Research has revealed a variety of negative peer-to-peer behaviors that lower morale and lead to turnover. However, little research has been conducted on "eating our young" (violence occurring between individuals with unequal power, such as staff nurse and student). We propose "vertical violence" as the appropriate term when abusive registered nurse (RN) behavior is directed towards students. We report a content analysis of stories written by junior nursing students about incidents of injustice perpetrated by staff RNs during their clinical experiences. Four levels of injustice were described. Nursing leadership, both in hospitals and educational institutions, must become engaged in efforts to eradicate vertical violence towards students.
Jahanpour, Faezeh; Sharif, Farkhondeh; Salsali, Mahvash; Kaveh, Mohammad H; Williams, Leonie M
Clinical decision-making is the basis for professional nursing practice. This can be taught and learned through appropriate teaching and clinical experiences. Unfortunately, it has been observed that many graduates are unable to demonstrate suitable clinical decision-making skills. Research and study on the process of decision-making and factors influencing it assists educators to find the appropriate educational and clinical strategies to teach nursing students. To explore the experience of nursing students and their view points regarding the factors influencing their development of clinical decision-making skills. An exploratory qualitative approach utilizing grounded theory methods was used; focus group interviews were undertaken with 32 fourth year nursing students and data were analysed using constant comparative analysis. Four main themes emerged from the data: clinical instructor incompetency, low self-efficacy, unconducive clinical learning climate and experiencing stress. The data indicated that students could not make clinical decisions independently. The findings of this study support the need to reform aspects of the curriculum in Iran in order to increase theory-practice integration and prepare a conductive clinical learning climate that enhances learning clinical decision-making with less stress.
Ó Lúanaigh, Padraig
This research was undertaken to understand the influence of registered nurses on nursing students' learning in the clinical environment to inform strategies to enable registered nurses to provide effective support to learners while also assisting nursing students to adopt approaches to maximise their learning in the clinical environment. A case study approach was applied in this research to explore descriptions of clinical experience of five final year nursing students. The student participants identified the importance of the clinical environment to their learning and wanted to and had actively managed their learning in the clinical environment. The students did not passively acquire knowledge or simply replicate what they observed from others. There was evidence that the students had strong and established perceptions of what constituted 'good' nursing and described an ability to discriminate between differing levels of nursing practice. Nursing knowledge was gained from respected registered nurses who were best able to describe and demonstrate the 'tricks of the trade' and 'little things that matter' when providing 'good' nursing. The outcomes from this research indicate an important role for registered nurses in both shaping nursing students' professional nursing identity and access to clinical learning.
Background Improving provider performance is central to strengthening health services in developing countries. Because of critical shortages of physicians, many clinics in sub-Saharan Africa are led by nurses. In addition to clinical skills, nurse managers need practical managerial skills and adequate resources to ensure procurement of essential supplies, quality assurance implementation, and productive work environment. Giving nurses more autonomy in their work empowers them in the workplace and has shown to create positive influence on work attitudes and behaviors. The Infectious Disease Institute, an affiliate of Makerere University College of Health Science, in an effort to expand the needed HIV services in the Ugandan capital, established a community-university partnership with the Ministry of Health to implement an innovative model to build capacity in HIV service delivery. This paper evaluates the impact on the nurses from this innovative program to provide more health care in six nurse managed Kampala City Council (KCC) Clinics. Methods A mixed method approach was used. The descriptive study collected key informant interviews from the six nurse managers, and administered a questionnaire to 20 staff nurses between September and December 2009. Key themes were manually identified from the interviews, and the questionnaire data were analyzed using SPSS. Results Introducing new HIV services into six KCC clinics was positive for the nurses. They identified the project as successful because of perceived improved environment, increase in useful in-service training, new competence to manage patients and staff, improved physical infrastructure, provision of more direct patient care, motivation to improve the clinic because the project acted on their suggestions, and involvement in role expansion. All of these helped empower the nurses, improving quality of care and increasing job satisfaction. Conclusions This community-university HIV innovative model was successful
Martínez Lara, Concepción; Praena Fernández, Juan Manuel; Gil García, Eugenia
Clinical Management Unit (CMU) is currently set in the Andalusian health institutions as the model reference management. This management model aims to make all healthcare professionals a powerful idea: the best performance of health resources is performed to drive clinical practice using the least number of diagnostic and therapeutic resources. The CMU not only aims at saving money, in the Clinical Management Agreement  are measured all the dimensions that make up the UGC: research, training, clinical process, the portfolio of services, objectives, financial management and indicators to control and security. The CMU is to transfer more responsibilities to Health Care Professionals, involving them in the management of the Unit. The CMU sets new approaches that directly affect health professionals and presents advantages and disadvantages for the Doctors and the Nurses, involved in achieving excellence in care work. Nurse Practitioners shows expectant before the changes are generated in health institutions and appears a discussion of skills derived from the CMU. Some Nurses believe that the bur, den of care to which they are subjected in public institutions has increased since the onset of the CMU and yet others believe that they are motivated and rewarded for the results obtained with this model of management. In health institutions, some professionals are more motivated than others and this is found in the outcome of health care activity . Given the positive and negative perceptions that arise in the CMU Professional Nurses, it is considered appropriate to focus the objective of this work in the search for factors that influence job satisfaction of nurses in the CMU. There are few studies about the CMU  but are absent when linked with nursing, so the pursuit of scientific knowledge related to nursing management model based on Clinical and Quality Care can lead to establish new concepts around the nursing profession, a profession in which major changes are
Najafi Doulatabad, Shahla; Mohamadhosaini, Sima; Ghafarian Shirazi, Hamid Reza; Mohebbi, Zinat
Stress at clinical environment is one of the cases that could affect the education quality among nursing students. The study aims to investigate Iranian nursing students' perceptions on the stressors in clinical environment in the South Western part of Iran. A cross-sectional descriptive study was conducted in 2010 to include 300 nursing students after their completion of second clinical nursing course in a hospital environment. Data were collected using a researcher-made questionnaire, with focus on the clinical environment stressors from personal, educational and training viewpoints. Data analysis was performed using SPSS software (IBM Corporation, Armonk, NY, USA) and descriptive statistics tests. Among the various stressors, the highest scores were given to the faculty (71 ± 19.77), followed by the students' personal characteristics (43.15 ± 21.79). Given that faculty-related factors provoked more stress in nursing students, nursing administration should diligently evaluate and improve communication skills among faculty to reduce student stress and enhance learning.
Ghamari Zare, Zohre; Adib-Hajbaghery, Mohsen
Background Pharmacological knowledge and medication management skills of student nurses greatly depend on the clinical nurse educators’ performance in this critical issue. However, the Iranian nurse educators’ performance in teaching pharmacology and medication management are not adequately studied. Objectives The current study aimed to investigate the nursing students’ perceptions on the status of clinical pharmaceutical and medication management education. Materials and Methods A cross-sectional study was conducted on all 152 nursing students registered in the seventh and eighth semesters at the Qom and Naragh branches of Islamic Azad University, and Kashan University of Medical Sciences in 2013 - 2014 academic year. The students’ perceptions on the performance of clinical nurse educators in teaching pharmacology and medication management were assessed using a researcher made questionnaire. The questionnaire consisted of 31 items regarding clinical educators’ performance in teaching pharmacology and medication management and two questions about students’ satisfaction with their level of knowledge and skills in pharmacology and medication management. Descriptive statistics was employed and analysis of variance was performed to compare the mean of scores of teaching pharmacology and medication management in the three universities. Results Among a total of 152 subjects, 82.9% were female and their mean age was 22.57 ± 1.55 years. According to the students, instructors had the weakest performance in the three items of teaching pharmacology and medication management based on the students’ learning needs, teaching medication management through a patient-centered method and teaching pharmacology and medication management based on the course plan. The students’ satisfaction regarding their own knowledge and skill of pharmacology and medication management was at medium level. Conclusions Nursing students gave a relatively low score in several aspects of
Coombs, Maureen A; Moorse, Sue E
This paper proposes that the current use of physical assessment skills within critical care nursing practice is part of a on-going nursing role development process. A review of the critical care nursing role highlights how nurses in this setting have always been responsive to patient management needs. In exploring one recent nursing role development, the critical care outreach nurse, it is suggested that enhanced assessment skills enable these practitioners to safely and competently assess critically ill patients out of the intensive care environment. The use of patient case studies in this paper, demonstrate how the theory of a more intensive physical assessment knowledge base can be applied in the everyday practice of an critical care outreach nurse. Through such systematic patient review, patient management plans can be agreed and ward based practitioners can be supported in the on-going treatment of sick ward patients. The use of the cases presented also highlights the complexity of the outreach nurse's practice in addressing clinical management and team management issues.
Introduction Different problems might lead to reduction in the efficiency of nursing students’ apprenticeship education and solving those problems. Aim This study was conducted to determine nursing internship problems from the perspective of trainers and students. Materials and Methods In this descriptive cross-sectional study, 20 trainers and 43 senior students of nursing were selected using census method. A researcher-made questionnaire was used to collect data. Total internal consistency (α) of the questionnaire was 0.88 and had proper convergent validity. SPSS was used to analyse data with applying descriptive and inferential statistics. Results More than 50% considered their course relatively weak or weak in helping intern nurses to acquire comprehensive view of the nursing profession that takes a social perspective into account, skills required for the processes of nursing and instructing patients. Problems such as insufficient access to welfare and educational facilities, lack of co-operation among clinical team and scattering of internship sessions during a course were mentioned by nurses and their trainers. They believed that changes must take place in the way internship courses are carried out. Conclusion Although the internship courses seem to achieve their aim of improving students’ skills and independence in providing different nursing services to students and their trainers generally have a positive attitude towards such courses, there are still problems in effective exercise of the training. PMID:27790467
Bartz, Claudia; Dean-Baar, Susan
This article describes the conceptualization and implementation of an academic-service partnership for a baccalaureate nursing program. The partnership began its fifth year in the fall of 2002; 107 students have entered the partnership since its inception. The partnership goals were to develop and implement clinical training experiences that teach students key skills for community-based practice settings, and to develop and evaluate an innovative and collaborative model for community-based clinical education. Students in the partnership have a unique opportunity for learning the art and science of nursing in a complex, integrated health care system with a strong emphasis on quality of environment, providers, and care delivery. A longitudinal program evaluation is underway, based on an American Association of Colleges of Nursing publication, the vision and goals of the School of Nursing, and the construct of organizational socialization.
Dickson, Geri L; Flynn, Linda
In this article, we describe the depth of knowledge and skill nurses used in making decisions regarding the safe processes and practices of medication administration. Using grounded theory, we identified the essence of medication safety by nurses as the theme of clinical reasoning. Nurses used two medication safety processes within the clinical reasoning theme-maintaining medication safety and managing the environment-together with six categories of patient-focused medication safety practices in the first process and four categories of environmental-focused safety practices within the second process. These processes and practices present an emerging model of safe medication administration developed from the narratives of 50 medical-surgical nurses. This model provides researchers with the basis for the development of systemic policies for safer medication administration for patients. Health care professional educators might also find the results useful in developing curricula focused on patient safety as the foundation of quality care.
Merighi, Miriam Aparecida Barbosa; de Jesus, Maria Cristina Pinto; Domingos, Selisvane Ribeiro da Fonseca; de Oliveira, Deíse Moura; Ito, Thaís Norika
This is a qualitative research, which used the social phenomenology of Alfred Schütz approach. Its purpose was meeting and discussing the expectations of teachers, nurses and students about teaching in the clinical field. Nine teachers, eleven nurses and eleven students of the Nursing Graduation grade from a public university of São Paulo were included in this study. Data were collected in 2012. As the results showed, there are expectations about the link between theory and practice that clinical teaching can offer and also the desire that such instruction enable the learners to develop a pro-active and participatory attitude. The reciprocity of perspectives was evident and should be considered when academic projects focused on nursing education are developed.
Strong, Margaret; Kane, Irene; Petras, Denise; Johnson-Joy, Cheryl; Weingarten, Joseph
Direct care nurses and nurse leaders were surveyed on their perceptions of the appropriateness, importance, and use in daily practice of 10 clinical nursing competencies needed for nurses to be successful in the future. Competencies needed in the 21st century are not based entirely on task-driven motor skills because comprehensive knowledge is essential to care for complex patients. Differences identified between direct care nurses, leaders, and educational levels provide educational opportunities for both groups.
Seed, Mary S; Torkelson, Diane J; Karshmer, Judith F
The national movement to transform the health care delivery systems must include a focus on mental health treatment. To address similar deficits across other practice domains, the Clinical Nurse Leader (CNL) role has been created. The CNL is a master's degree that prepares a nurse to use a systems perspective to improve outcomes for a cohort of patient, deliver care based on best practices, and coordinate care in a multidisciplinary team. Applying the CNL role to mental health care could help psychiatric mental health nursing be at the forefront in the transformation of mental health care delivery.
Green, A H; Conway-Welch, C
Successful negotiation of capitated rates will dictate whether nurse-managed clinics will survive the financial restructuring of the health care industry. It requires a clear understanding of what the clinic is contracted to do and an ability to teach a managed-care company what the services are worth.
Winch, Sarah; Henderson, Amanda Jane; Kay, Margaret; Burridge, Letitia Helen; Livesay, Georgia Jane; Sinnott, Michael John
This article presents a method of reconnecting and reaffirming with nurses the importance of compassion in health care by using a clinical compassion cafe, which describes nine steps that provide a forum to reaffirm clinicians' core values. This process has the potential to engage clinical staff in a different modality removed from the usual didactic approaches.
Ness, Elizabeth A; Royce, Cheryl
Clinical trials are paramount to improving human health. New trial designs and informed consent issues are emerging as a result of genomic profiling and the development of molecularly targeted agents. Many groups and individuals are responsible for ensuring the protection of research participants and the quality of the data produced. The specialty role of the clinical trials nurse (CTN) is critical to clinical trials. Oncology CTNs have competencies that can help guide their practice; however, not all oncology clinical trials are supervised by a nurse. Using the process of engagement, one organization has restructured oncology CTNs under a nurse-supervised model.
Chabeli, M; Muller, M
Over decades nursing had an interest in clarifying and developing its knowledge base and its conceptual foundation. Reflective thinking has become a popular word in nursing education world wide, but its meaning and effective use remains debatable because of lack of clarity in its meaning (Mackintosh, 1998:553). The researcher engaged in the concept analysis of reflective thinking so as to fully understand its meaning and interpretation, hence the research question to be addressed by this article is: "What is the meaning of reflective thinking in clinical nursing education?" This article seeks to explore and describe the conceptual meaning of reflective thinking in clinical nursing education using the method of concept analysis as outlined by Wilson (1963:23-39) and Gift (1997:75,76). Concept analysis of reflective thinking constitutes the first phase of a study to develop a model to facilitate reflective thinking in clinical nursing education, thus ensuring theoretical validity of the model. An extensive examination of domain specific and various disciplines' literature was explored as part of the concept analysis. A selection of information regarding variations and similarities in the use and interpretation of reflective thinking across clinical nursing education was drawn from computerised data bases. This increased the rigor and the findings of the analysis. Through deductive reasoning and drawing of inferences, attributes were clustered in an attempt to identify the apparent essence of the concept. Three categories and the related connotations emerged as follows: Antecedents (Cognitive and affective thinking skills). Process (The three phases of reflective thinking). Outcome ( New insight and changed perspective). Reflective thinking was considered from the result of concept analysis as a cyclic, interactive constructing mental process to improve practice in a specific context. It is recommended that a model to facilitate reflective thinking in clinical nursing
Nurses' clinical decision-making is a complex process that holds potential to influence the quality of care provided and patient outcomes. The evolution of nurses' decision-making that occurs with experience has been well documented. In addition, literature includes numerous strategies and approaches purported to support development of nurses' clinical decision-making. There has been, however, significantly less attention given to the process of assessing nurses' clinical decision-making and novice clinical educators are often challenged with knowing how to best support nurses and nursing students in developing their clinical decision-making capacity. The Situated Clinical Decision-Making framework is presented for use by clinical educators: it provides a structured approach to analyzing nursing students' and novice nurses' decision-making in clinical nursing practice, assists educators in identifying specific issues within nurses' clinical decision-making, and guides selection of relevant strategies to support development of clinical decision-making. A series of questions is offered as a guide for clinical educators when assessing nurses' clinical decision-making. The discussion presents key considerations related to analysis of various decision-making components, including common sources of challenge and errors that may occur within nurses' clinical decision-making. An exemplar illustrates use of the framework and guiding questions. Implications of this approach for selection of strategies that support development of clinical decision-making are highlighted.
Nursing and other health professionals are increasingly using simulation as a strategy and a tool for teaching and learning at all levels that need clinical training. Nursing education for decades used simulation as an integral part of nursing education. Recent studies indicated that simulation improves nursing knowledge, clinical practice,…
Baker, C M; Boyd, N J; Stasiowski, S A; Simons, B J
Two unrelated public institutions formed a partnership to foster excellence in professional nursing. The organizational structure was described in Part 1 (February 1989). This second article reports a 15-week pilot study conducted on seven hospital units to determine the degree to which the clinical nurse specialist can merge the multiple functions of professional nursing: practice, education, and research.
Rahimaghaee, Flora; Nayeri, Nahid Dehghan; Mohammadi, Eesa
Any progressive organization should consider investing in its clinical nurses' professional growth if it desires to survive and succeed in offering care. Managers play a significant role in facilitating clinical nurses' professional growth. A content analysis study was conducted with 20 clinical nurses and managers in Iran in order to describe how they experienced managers' roles in relation to their professional growth. They believed that managers played two major roles in their professional growth process: motivating and inhibiting. From the participants' point of view, managers, through supporting, encouraging, and valuing staff and creating opportunities for learning, played a facilitating role in their professional growth. But, whenever the staff did not receive this support, they became discouraged and did not make any progress. The results can be used to improve management and, consequently, to enhance the professional growth of staff.
Wallace, Linda; Bourke, Mary P; Tormoehlen, Lucy J; Poe-Greskamp, Marlene V
The Nursing Students' Clinical Stress Scale, a Likert-type survey by Whang (2002), translated from Korean into English, was used to identify perceptions of stress in baccalaureate nursing students. Data was collected from a convenience sample of baccalaureate nursing students at a Midwestern university. Students ranked their perceived stress level from clinical situations. One open-ended item asked students to describe their most stressful clinical experience. Rasch Model analysis/diagnostics were used to check the instrument for validity and reliability. Quantitative data were analyzed for descriptive statistics (means). Information from open-ended question was analyzed for themes. Qualitative themes were consistent with results from quantitative analysis and well-aligned with the literature. Students were stressed by incivility by healthcare staff and instructors, inconsistencies and time constraints. Research shows that stress can interfere with learning. It is imperative to determine causes of stress so educators can help decrease stress and improve student learning.
Kreitzer, Mary Jo
While the essence of nursing has long been whole person (body, mind, and spirit) and whole system-focused, in reality the contemporary practice of nursing in many settings around the globe has become increasingly fragmented and de-stabilized. Nursing shortages in many parts of the world are significant, and hierarchies and bureaucracies often remove nurses from the point of care, be that the bedside, home, or clinic, replacing them with less skilled workers and filling their time with documentation and other administrative tasks. Integrative nursing is a framework for providing whole person/whole system care that is relationship-based and person-centered and focuses on improving the health and wellbeing of caregivers as well as those they serve. It is aligned with what is being called the “triple aim” in the United States—an effort focused on improving the patient experience (quality and satisfaction), improving the health of populations, and reducing the cost of care. The principles of integrative nursing offer clear and specific guidance that can shape and impact patient care in all clinical settings. PMID:25973268
Mohite, Abhijit A; Johnson, Andria; Rathore, Deepa S; Bhandari, Kamal; Crossman, Richard; Mehta, Purnima; Ahluwalia, Harpreet S
This article compares an independent nurse-led benign lesion service with a doctor-led one, and assesses the impact of clinician seniority on diagnostic accuracy rates. Retrospective review of benign lesions referred to a teaching hospital and managed in either a doctor- or nurse-led lid service. All lesions were diagnosed clinically, excised and then sent for histological diagnosis. Lesions were categorized into subtypes. Pre-excision clinical diagnoses were compared with histological diagnoses. Sensitivity, specificity and missed malignancy rates were calculated for each subtype. Accuracy was compared between different grades of doctors and a specialist nurse. 264 and 332 lesions were managed in a doctor-led and nurse-led service, respectively. Rates of accurate sub-typing were 79.6% and 80.4% in the doctor- and nurse-led services, respectively (p > 0.05). Clinician seniority had no bearing. Missed malignancies or pre-malignancies accounted for 1.1% and 1.5% of lesions in the doctor and nurse-led services, respectively (p > 0.05). Overall, the remaining misdiagnoses were benign lesions of another subtype (13.6%) or non-specific histological findings (5.0%) and 98.6% of lesions were confirmed as benign on histology. Overall sensitivity and specificity values were: benign epithelial proliferations 95.6% and 92.2%, epidermal inclusion cysts 92.2% and 88.0%, xanthelasma 97.5% and 100.0%, cysts of Moll 66.7% and 96.6%, naevi 39.4% and 99.8% and molluscum 20.0% and 99.8%, respectively. A dedicated nurse-led service is as effective in managing a range of clinically benign lid lesions as a doctor-led one, and clinician seniority has little impact on the diagnostic accuracy of these lesions.
Romero Ruiz, Adolfo; Parrado Borrego, Gema; Rodríguez González, José; Caparrós Miranda, Isabel S; Vargas Lirio, M Isabel; Ortiz Fernández, Primitiva
There is currently around one million people receiving oral anticoagulants in Spain. The drug most used is acenocoumarol, which requires coagulation monitoring to ensure that the patient is within its normal therapeutic range. Patients usually start this treatment in a hospital clinic and, when they are stabilised, they are referred to primary care, where they are followed-up by their community nurses. The usual practice is that nurses are responsible for changes in the dose when the patients are outside the range. This practice is not performed by hospital nurses, despite having sufficient experience and knowledge to adequately manage these types of patients. An Advanced Nursing Practice model has been introduced into the Haematology management unit of the Hospital Universitario Virgen de la Victoria, Málaga. This involves various aspects of attention and care of patients on anticoagulant therapy, and includes adjusting the doses of their treatment following a catalogue of therapeutic and diagnostic ranges.
Gousy, Mamood; Green, Kim
Nurses are at the forefront of implementing and managing change, given constantly changing healthcare services and the increase in demand for health care. Therefore, it is important to identify the best style of leadership to engage nurses in implementing service-led improvements. This article explores the effects of transformational leadership in bringing about service-led improvements in health care, using the example of setting up a nurse-led acupuncture clinic to optimise the care of patients with chronic pain. Transformational leadership was used throughout the project - from the initial local planning, training and development, through to liaising with the appropriate staff and deciding on an evaluation strategy. Transformational leadership proved to be an effective way to engage and empower nurses and other members of the chronic pain team to enable them to achieve the project aims.
Obizoba, Cordelia O.
The purpose of this phenomenological study was to gain an understanding of nursing faculty members' lived experiences of Objective Structured Clinical Examination (OSCE) in undergraduate nursing education. As owners of their programs' curriculum, nursing faculties are charged with the responsibility of providing needed knowledge, skills, and…
Rosenstein, Alan H; O'Daniel, Michelle
Providing safe, error-free care is the number-one priority of all health care professionals. Excellent outcomes have been associated with procedural efficiency, the implementation of evidence-based standards, and the use of tools designed to reduce the likelihood of medical error (such as computerized medication orders and bar-coded patient identification). But the impact of work relationships on clinical outcomes isn't as well documented. The current survey was designed as a follow-up to a previous VHA West Coast survey that examined the prevalence and impact of physicians' disruptive behavior on the job satisfaction and retention of nurses (see "Nurse-Physician Relationships: Impact on Nurse Satisfaction and Retention," June 2002). Based on the findings of that survey and subsequent comments on it, the follow-up survey examined the disruptive behavior of both physicians and nurses, as well as both groups' and administrators' perceptions of its effects on providers and its impact on clinical outcomes. Surveys were distributed to 50 VHA hospitals across the country, and results from more than 1,500 survey participants were evaluated. Nurses were reported to have behaved disruptively almost as frequently as physicians. Most respondents perceived disruptive behavior as having negative or worsening effects, in both nurses and physicians, on stress, frustration, concentration, communication, collaboration, information transfer, and workplace relationships. Even more disturbing was the respondents' perceptions of negative or worsening effects of disruptive behavior on adverse events, medical errors, patient safety, patient mortality, the quality of care, and patient satisfaction. These findings suggest that the consequences of disruptive behavior go far beyond nurses' job satisfaction and morale, affecting communication and collaboration among clinicians, which may well, in turn, have a negative impact on clinical outcomes. Strategies aimed at reducing the incidence and
Ebersole-Berkstresser, Kristie Anne
Nurse educators, at every level of pre-licensure nursing education, are charged with developing critical thinking skills within their students. Post-clinical conference is one teaching strategy that nurse educators can employ to help promote the development of critical thinking skills in pre-licensure nursing students. However, traditional…
Ewing, Gail; Farquhar, Morag; Booth, Sara
There has been a steady expansion of hospital-based palliative care in the United Kingdom but limited published research on health professionals' views of hospital multidisciplinary specialist palliative care services (SPCS). The aim of the study was to describe referrer (SPCS user) and provider (SPCS staff) perspectives on delivery of specialist palliative care in hospital. Interviews were conducted with referrers, including five junior doctors, 13 consultants, and six clinical nurse specialists, to investigate the reasons for referral, beneficial aspects, and barriers to use. Focus groups were conducted with providers, six medical and five nursing, to identify their perspective on delivering the specialist service in hospital. Discussions were tape recorded and transcribed verbatim. Data were analyzed thematically using a framework analysis approach. The study found large areas of agreement between referrers and providers on what hospital palliative care teams should be providing for patients, that is, expertise in managing difficult symptoms and complex psychosocial problems, and this was being achieved locally. Access to the specialist team was also important: visibility on the wards, informal routes of access to advice and a timely response by specialists. However, discordance in views of providing palliative care was also identified; in particular, whether specialists should be providing generalist palliative care (such as basic psychological support) neglected by ward teams and implementation of specialist advice by referrers. Such perspectives on the interface of generalist and specialist provision provide insights into improving care for palliative patients in the acute hospital setting.
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Sharples, L; Edmunds, J; Bilton, D; Hollingworth, W; Caine, N; Keogan, M; Exley, A
Background: With the decrease in junior doctor hours, the advent of specialist registrars, and the availability of highly trained and experienced nursing personnel, the service needs of patients with chronic respiratory diseases attending routine outpatient clinics may be better provided by appropriately trained nurse practitioners. Methods: A randomised controlled crossover trial was used to compare nurse practitioner led care with doctor led care in a bronchiectasis outpatient clinic. Eighty patients were recruited and randomised to receive 1 year of nurse led care and 1 year of doctor led care in random order. Patients were followed up for 2 years to ensure patient safety and acceptability and to assess differences in lung function. Outcome measures were forced expiratory volume in 1 second (FEV1), 12 minute walk test, health related quality of life, and resource use. Results: The mean difference in FEV1 was 0.2% predicted (95% confidence interval –1.6 to 2.0%, p=0.83). There were no significant differences in the other clinical or health related quality of life measures. Nurse led care resulted in significantly increased resource use compared with doctor led care (mean difference £1497, 95% confidence interval £688 to £2674, p<0.001), a large part of which resulted from the number and duration of hospital admissions. The mean difference in resource use was greater in the first year (£2625) than in the second year (£411). Conclusions: Nurse practitioner led care for stable patients within a chronic chest clinic is safe and is as effective as doctor led care, but may use more resources. PMID:12149523
Lancaster, Rachelle J; Westphal, Judith; Jambunathan, Jayalakshmi
The purpose of this study was to describe how students identify and interpret multiple embedded clinical cues in a case study, and then reflect these using SBAR (Situation, Background, Assessment, and Recommendation). Using Tanner's model of clinical judgment, a descriptive design was used to examine SBAR assignments completed by second-semester nursing students (n = 80). The majority of students (n = 62, 77.5%) in the study were unable to successfully follow all of the clinical judgment phases of the model: noticing, interpreting, responding, and reflecting. Although SBAR is an important tool for communicating clinical information, gaps exist between noticing and interpreting clinical cues, and forming an appropriate course of action.
Pan, Chong; Zhang, Dali; Kon, Audrey Wan Mei; Wai, Charity Sue Lea; Ang, Woo Boon
Continuous improvement in process efficiency for specialist outpatient clinic (SOC) systems is increasingly being demanded due to the growth of the patient population in Singapore. In this paper, we propose a discrete event simulation (DES) model to represent the patient and information flow in an ophthalmic SOC system in the Singapore National Eye Centre (SNEC). Different improvement strategies to reduce the turnaround time for patients in the SOC were proposed and evaluated with the aid of the DES model and the Design of Experiment (DOE). Two strategies for better patient appointment scheduling and one strategy for dilation-free examination are estimated to have a significant impact on turnaround time for patients. One of the improvement strategies has been implemented in the actual SOC system in the SNEC with promising improvement reported.
Shiboski, Caroline H.; Chen, Huichao; Secours, Rode; Lee, Anthony; Webster-Cyriaque, Jennifer; Ghannoum, Mahmoud; Evans, Scott; Bernard, Daphné; Reznik, David; Dittmer, Dirk P.; Hosey, Lara; Sévère, Patrice; Aberg, Judith A.
Objective Many studies include oral HIV-related endpoints that may be diagnosed by non-oral-health specialists (non-OHS) like nurses or physicians. Our objective was to assess the accuracy of clinical diagnoses of HIV-related oral lesions made by non-OHS compared to diagnoses made by OHS. Methods A5254, a cross-sectional study conducted by the Oral HIV/AIDS Research Alliance within the AIDS Clinical Trial Group, enrolled HIV-1-infected adults participants from six clinical trial units (CTU) in the US (San Francisco, New York, Chapel Hill, Cleveland, Atlanta) and Haiti. CTU examiners (non-OHS) received standardized training on how to perform an oral examination and make clinical diagnoses of specific oral disease endpoints. Diagnoses by calibrated non-OHS were compared to those made by calibrated OHS, and sensitivity and specificity computed. Results Among 324 participants, the majority were black (73%), men (66%), and the median CD4+ cell count 138 cells/mm3. The overall frequency of oral mucosal disease diagnosed by OHS was 43% in US sites, and 90% in Haiti. Oral candidiasis (OC) was detected in 153 (47%) by OHS, with erythematous candidiasis (EC) the most common type (39%) followed by pseudomembranous candidiasis (PC; 26%). The highest prevalence of OC (79%) was among participants in Haiti, and among those with CD4+ cell count ≤ 200 cells/mm3 and HIV-1 RNA > 1000 copies/mL (71%). The sensitivity and specificity of OC diagnoses by non-OHS were 90% and 92% (for EC: 81% and 94%; PC: 82% and 95%). Sensitivity and specificity were also high for KS (87% and 94%, respectively), but sensitivity was < 60% for HL and oral warts in all sites combined. The Candida culture confirmation of OC clinical diagnoses (as defined by ≥ 1 colony forming unit per mL of oral/throat rinse) was ≥ 93% for both PC and EC. Conclusion Trained non-OHS showed high accuracy of clinical diagnoses of OC in comparison with OHS, suggesting their usefulness in studies in resource-poor settings
Williams, Marjory; Avolio, Alice E; Ott, Karen M; Miltner, Rebecca S
The Office of Nursing Services of the Department of Veterans Affairs (VA) piloted implementation of the clinical nurse leader (CNL) into the care delivery model and established a strategic goal in 2011 to implement the CNL role across the VA health care system. The VA Office of Nursing Services CNL Implementation and Evaluation (CNL I&E) Service was created as one mechanism to facilitate that goal in response to a need identified by facility nurse executives for consultative support for CNL practice integration. This article discusses strategies employed by the CNL I&E consultative team to help facility-level nursing leadership integrate CNLs into practice. Measures of success include steady growth in CNL practice capacity as well as positive feedback from nurse executives about the value of consultative engagement. Future steps to better integrate CNL practice into the VA include consolidation of lessons learned, collaboration to strengthen the evidence base for CNL practice, and further exploration of the transformational potential of CNL practice across the care continuum.
Kohlenberg, Eileen; Kennedy-Malone, Laurie; Crane, Patricia; Letvak, Susan
The inclusion of gerontology content in the nursing curriculum is paramount as our population of older adults grows. As one of 10 recipients of the John A. Hartford Foundation/AACN awards for Enhancing Gerontological and Geriatric Nursing Education for Advanced Practice Nursing Programs, we successfully integrated gerontological/ geriatric content throughout core courses for all concentrations taught at the master's level. The Nurse Practitioner and Clinical Nurse Specialist Competencies for Older Adult Care were used as a guide to integrate gerontological nursing content across the core courses. We present examples of content, strategies, and evaluation methods that demonstrate infusion of gerontology in a nursing theory course, research course, and healthcare law and policy course. Twenty-two of the competencies are addressed in these core courses and provide a foundation for further development in the support and specialty courses for the nurse practitioner, clinical nurse specialist, nursing administrator, nurse educator, and nurse anesthetist. We also present helpful Web-based resources for older adult care.
High Blood Pressure , p.17). CP Hypertension Diuretics The mechanism of the antihypertensive...of High Blood Pressure stated that a regular Liz.- ".’-.. IO Hypertension 45 isotonic exercise program (i.e., walking, jogging, swimming, etc.) is an...epidemiological study that has been examining hypertension since 1948 has shown both systolic and diastolic blood pressure (SBP and DBP) to be of equal
McCormick, K A; Lang, N; Zielstorff, R; Milholland, D K; Saba, V; Jacox, A
The American Nurses Association (ANA) Cabinet on Nursing Practice mandated the formation of the Steering Committee on Databases to Support Clinical Nursing Practice. The Committee has established the process and the criteria by which to review and recommend nursing classification schemes based on the ANA Nursing Process Standards and elements contained in the Nursing Minimum Data Set (NMDS) for inclusion of nursing data elements in national databases. Four classification schemes have been recognized by the Committee for use in national databases. These classification schemes have been forwarded to the National Library of Medicine (NLM) for inclusion in the Unified Medical Language System (UMLS) and to the International Council of Nurses for the development of a proposed International Classification of Nursing Practice. PMID:7850567
Higuchi, Kathryn A. Smith; Donald, Janet G.
Interviews with eight medical and surgical nurses and audits of patient charts investigated clinical decision-making processes. Predominant thinking processes were description of facts, selection of information, inference, syntheses, and verification, with differences between medical and surgical specialties. Exemplars of thinking processes…
Wei, Chun-Wang; Lin, Yi-Chun; Lin, Yen-Ting
Clinical resources in nursing schools are always insufficient for satisfying the practice requirements of each student at the same time during a formal course session. Although several studies have applied information and communication technology to develop computer-based learning tools for addressing this problem, most of these developments lack…
Elisha, Sass; Rutledge, Dana N
The purpose of this study was to describe the experiences and attitudes of student registered nurse anesthetists (SRNAs) related to clinical instruction. This descriptive study used a cross-sectional survey method with a regionally stratified randomly selected sample of SRNA members from the American Association of Nurse Anesthetists data bank. A total of 2,673 SRNAs were invited by email to respond to an online, 54-item questionnaire; 696 SRNAs participated. Verbal abuse was reported by almost 70% of SRNA participants, but fewer experienced sexual harassment (13%), physical abuse (14%), or racial discrimination (72%). However, SRNAs reported that their Certified Registered Nurse Anesthetist (CRNA) preceptors most often served as positive role models. These SRNAs found CRNA preceptors, unique cases, reading, and clinical lectures more helpful to their clinical learning compared with grand rounds, surgeons, and anesthesiology residents. The SRNAs' perceptions of the ideal behavioral characteristics for CRNA preceptors included calmness during stressful events, use of nonthreatening communication, clear communication, and encouraging independent decision making. The educational process for nurse anesthetists is continually evolving and improving. Study findings offer insights that may assist in improvements in the clinical component of SRNA education.
Ewertsson, Mona; Allvin, Renée; Holmström, Inger K; Blomberg, Karin
Despite an increasing focus on simulation as a learning strategy in nursing education, there is limited evidence on the transfer of simulated skills into clinical practice. Therefore it's important to increase knowledge of how clinical skills laboratories (CSL) can optimize students' learning for development of professional knowledge and skills, necessary for quality nursing practice and for patient safety. Thus, the aim was to describe nursing students' experiences of learning in the CSL as a preparation for their clinical practice. Interviews with 16 students were analysed with content analysis. An overall theme was identified - walking the bridge - in which the CSL formed a bridge between the university and clinical settings, allowing students to integrate theory and practice and develop a reflective stance. The theme was based on categories: conditions for learning, strategies for learning, tension between learning in the skills laboratory and clinical settings, and development of professional and personal competence. The CSL prepared the students for clinical practice, but a negative tension between learning in CSL and clinical settings was experienced. However, this tension may create reflection. This provides a new perspective that can be used as a pedagogical approach to create opportunities for students to develop their critical thinking.
Rashotte, Judy; Carnevale, F A
The aim of this article is to explore the complex forms of knowledge involved in diagnostic and interventional decision making by comparing the processes in medicine and nursing, including nurse practitioners. Many authors assert that the practice of clinical decision making involves the application of theoretical knowledge (acquired in the classroom and textbooks) as well as research evidence, upon concrete particular cases. This approach draws on various universal principles and algorithms to facilitate the task. On the other hand, others argue that this involves an intuitive form of judgement that is difficult to teach, one that is acquired principally through experience. In an exploration of these issues, this article consists of three sections. A clarification of terms commonly used when discussing decision making is provided in the first section. In the second section, an epistemological analysis of decision making is presented by examining several perspectives and comparing them for their use in the nursing and medical literature. Bunge's epistemological framework for decision making (based on scientific realism) is explored for its fit with the aims of medicine and nursing. The final section presents a discussion of knowledge utilization and decision making as it relates to the implications for the education and ongoing development of nurse practitioners. It is concluded that Donald Schön's conception of reflective practice best characterizes the skillful conduct of clinical decision making.
Lim, Ji Young; Noh, Wonjung
In this study, we identified key components of financial-analysis education for clinical nurses. We used a literature review, focus group discussions, and a content validity index survey to develop key components of financial-analysis education. First, a wide range of references were reviewed, and 55 financial-analysis education components were gathered. Second, two focus group discussions were performed; the participants were 11 nurses who had worked for more than 3 years in a hospital, and nine components were agreed upon. Third, 12 professionals, including professors, nurse executive, nurse managers, and an accountant, participated in the content validity index. Finally, six key components of financial-analysis education were selected. These key components were as follows: understanding the need for financial analysis, introduction to financial analysis, reading and implementing balance sheets, reading and implementing income statements, understanding the concepts of financial ratios, and interpretation and practice of financial ratio analysis. The results of this study will be used to develop an education program to increase financial-management competency among clinical nurses.
Managed Diabetes Foot Clinic 5b. GRANT NUMBER HU0001-04-1-TS10 5c. PROGRAM ELEMENT NUMBER N/A 6. AUTHOR(S) 5d. PROJECT NUMBER N04-017...measured outcomes of a nurse-managed diabetes foot clinic on foot wound rates, health care costs, and changes in health status in adults with... diabetes . Design: This study reflects results of a two-group randomized, controlled trial. Sample: Participants were 126 adults with diabetes for more
Park, Hyeoun-Ae; Jeon, Eunjoo; Chung, Eunja
Objectives The purpose of this study was to test the feasibility of an electronic nursing record system for perinatal care that is based on detailed clinical models and clinical practice guidelines in perinatal care. Methods This study was carried out in five phases: 1) generating nursing statements using detailed clinical models; 2) identifying the relevant evidence; 3) linking nursing statements with the evidence; 4) developing a prototype electronic nursing record system based on detailed clinical models and clinical practice guidelines; and 5) evaluating the prototype system. Results We first generated 799 nursing statements describing nursing assessments, diagnoses, interventions, and outcomes using entities, attributes, and value sets of detailed clinical models for perinatal care which we developed in a previous study. We then extracted 506 recommendations from nine clinical practice guidelines and created sets of nursing statements to be used for nursing documentation by grouping nursing statements according to these recommendations. Finally, we developed and evaluated a prototype electronic nursing record system that can provide nurses with recommendations for nursing practice and sets of nursing statements based on the recommendations for guiding nursing documentation. Conclusions The prototype system was found to be sufficiently complete, relevant, useful, and applicable in terms of content, and easy to use and useful in terms of system user interface. This study has revealed the feasibility of developing such an ENR system. PMID:22844649
Grady, Janet L
The Virtual Clinical Practicum (VCP) involves a clinical nursing education delivery strategy that uses video teleconferencing technology to address time, distance, and resource barriers. Technology-delivered education can augment the existing curriculum by increasing student access to clinical experts in specialty areas, thus supporting efficient use of faculty resources. This article describes the implementation of the VCP process and student perceptions of its effectiveness and usefulness. The VCP was shown to be a successful method of clinical nursing education, offering students exposure to clinical situations not available by other means. Opportunities for dialogue, critical reflection, and synthesis allowed students to experience the benefits of a traditional experience, enhanced through technology and tailored to the specific needs of the students. Respondents overwhelmingly recommended further use of the VCP to augment existing clinical nursing education methods.
The discipline of pediatric nephrology addresses a wide range of conditions of varying severity. The most benign conditions include orthostatic proteinuria, and thin basement nephropathy. The most challenging diagnosis in the field is chronic renal failure, particularly if the patient is an infant. Nurses trained in pediatric nephrology provide care to this entire spectrum of patients within the context of their family. The varied responsibilities and specialized training of the pediatric nephrology nurse as described in this article can serve as a prototype for the independent role of clinical care coordinator.
How Do Dyslexic Nursing Students Cope with Clinical Practice Placements? The Impact of the Dyslexic Profile on the Clinical Practice of Dyslexic Nursing Students: Pedagogical Issues and Considerations
Price, Geraldine A.; Gale, Anne
The safety of dyslexic nurses, and whether they are a danger to their patients, has been widely discussed. This empirical study sought to discover the impact of the dyslexic profile on clinical practice for nursing students. Two focus groups of third-year nursing students in higher education were set up: a control group and a dyslexic group. The…
Coombs, Maureen; Latter, Sue; Richardson, Alison
Since the publication of the UK Clinical Research Collaboration's (UKRC, 2007) recommendations on careers in clinical research, interest has grown in the concept of clinical academic nursing careers, with increased debate on how such roles might be developed and sustained (Department of Health, 2012). To embed clinical academic nursing roles in the NHS and universities, a clear understanding and appreciation of the contribution that such posts might make to organisational objectives and outcomes must be developed. This paper outlines an initiative to define the potential practice and research contribution of clinical academic roles through setting out role descriptors. This exercise was based on our experience of a clinical academic career initiative at the University of Southampton run in partnership with NHS organisations. Role descriptors were developed by a group of service providers, academics and two clinical academic award-holders from the local programme. This paper outlines clinical academic roles from novice to professor and describes examples of role descriptors at the different levels of a career pathway. These descriptors are informed by clinical academic posts in place at Southampton as well as others at the planning stage. Understanding the nature of clinical academic posts and the contribution that these roles can make to healthcare will enable them to become embedded into organisational structures and career pathways.
Anderson, Jan; Hurst, Margaret; Marques, Ana; Millar, David; Moya, Sue; Pover, Lesley; Stewart, Sue
A qualitative psychoanalytic clinical research project using a post-Kleinian contemporary approach was undertaken by a team of seven qualified and experienced child psychotherapists working in community Tier 3 Child and Adolescent Mental Health Services (CAMHS). A number of referred young people who deliberately harmed themselves or attempted…
The purpose of this transcultural qualitative study was to discover, describe and explain the meaning of a caring student-teacher encounter within the context of clinical education. Clinical teachers are registered nurses who have completed a university undergraduate nursing degree program and at least 1 year of post-registration clinical experience. They are employed as full-time staff of the faculty of nursing. Among the 19 Jordanian undergraduate nursing students interviewed, "clinical nurse teachers as caring mothers," emerged as an important theme. This paper describes the clinical teachers in their mothering roles, such as supporting, negotiating, reinforcing, transforming and releasing nursing students throughout their clinical practice. Understanding students' cultural beliefs and values provides possible predictors that could facilitate positive student-teacher relationships that could be used to plan the clinical education for nursing students. There is also a need to develop workshops in clinical teaching that would incorporate cultural awareness, especially in a multicultural student-teacher groups.
Diefenbeck, Cynthia A; Plowfield, Lisa Ann; Herrman, Judith W
The education of future generations of nurses is in need of philosophic and programmatic transformation in keeping with the rapidly changing health care delivery system. The Nurse Residency Model is one baccalaureate nursing program's response to calls for reform. Rooted in a spirit of collegiality and lifelong learning, the three facets of its philosophy include enhanced socialization, improved transition to practice, and increased student accountability. Students gain increased competency and demonstrate increased accountability with each progressive semester in the program, which culminates in clinical immersion in the senior year. Unique programmatic features of this model include field experiences, the simulation lab, and a work requirement. Additional benefits include resource efficiency and patient safety. Implementation remains an ongoing process. Outcome indicators are expected to yield valuable data on which to develop an evidence base in support of the model.
Milani, Alessandra; Mazzocco, Ketti; Stucchi, Sara; Magon, Giorgio; Pravettoni, Gabriella; Passoni, Claudia; Ciccarelli, Chiara; Tonali, Alessandra; Profeta, Teresa; Saiani, Luisa
Few resources are available to quantify clinical trial-associated workload, needed to guide staffing and budgetary planning. The aim of the study is to describe a tool to measure clinical trials nurses' workload expressed in time spent to complete core activities. Clinical trials nurses drew up a list of nursing core activities, integrating results from literature searches with personal experience. The final 30 core activities were timed for each research nurse by an outside observer during daily practice in May and June 2014. Average times spent by nurses for each activity were calculated. The "Nursing Time Required by Clinical Trial-Assessment Tool" was created as an electronic sheet that combines the average times per specified activities and mathematic functions to return the total estimated time required by a research nurse for each specific trial. The tool was tested retrospectively on 141 clinical trials. The increasing complexity of clinical research requires structured approaches to determine workforce requirements. This study provides a tool to describe the activities of a clinical trials nurse and to estimate the associated time required to deliver individual trials. The application of the proposed tool in clinical research practice could provide a consistent structure for clinical trials nursing workload estimation internationally.
Gayle, Krystal A.T.; Tulloch Reid, Marshall K.; Younger, Novie O.; Francis, Damian K.; McFarlane, Shelly R.; Wright-Pascoe, Rosemarie A.; Boyne, Michael S.; Wilks, Rainford J.; Ferguson, Trevor S.
This study aimed to estimate the proportion of patients at the University Hospital of the West Indies (UHWI) Diabetes Clinic who engage in recommended foot care and footwear practices. Seventy-two participants from the UHWI Diabetes Clinic completed an interviewer-administered questionnaire on foot care practices and types of footwear worn. Participants were a subset of a sex-stratified random sample of clinic attendees and were interviewed in 2010. Data analysis included frequency estimates of the various foot care practices and types of footwear worn. Participants had a mean age of 57.0±14.3 years and mean duration of diabetes of 17.0±10.3 years. Fifty-three percent of participants reported being taught how to care for their feet, while daily foot inspection was performed by approximately 60% of participants. Most participants (90%) reported daily use of moisturizing lotion on the feet but almost 50% used lotion between the toes. Approximately 85% of participants reported wearing shoes or slippers both indoors and outdoors but over 40% reported walking barefoot at some time. Thirteen percent wore special shoes for diabetes while over 80% wore shoes without socks at some time. Although much larger proportions reported wearing broad round toe shoes (82%) or leather shoes (64%), fairly high proportions reported wearing pointed toe shoes (39%), and 43% of women wore high heel shoes. In conclusion, approximately 60% of patients at the UHWI diabetic clinic engage in daily foot inspection and other recommended practices, but fairly high proportions reported foot care or footwear choices that should be avoided. PMID:24765484
Al-Qaaydeh, Sharifa; Lassche, Madeline; Macintosh, Christopher I
Pediatric nursing clinical often causes feelings of fear, thus hindering students' performance. This sparked the creation of the "pediatric nursing student clinical comfort and worry assessment tool," which can be utilized to identify worry-provoking elements before and after pediatric clinical rotations. The purpose of this study is to describe the development and psychometric testing of this tool. Psychometric tests used to assess data quality, reliability, and construct validity demonstrated that the pediatric nursing student clinical comfort and worry assessment tool can be used to evaluate nursing students' comfort and worry in pediatric nursing clinical rotations.
Talashek, M L; Gerace, L M; Miller, A G; Lindsey, M
The prevalence of substance use among patients presenting to primary health care settings mandates clinical competency in the area for nurse practitioners (NPs). An educational intervention with an evaluation component is described. The effect of incorporating substance use content into a Family Nurse Practitioner (FNP) curriculum was tested with a convenience sample of 16 FNP students and 8 practicing NPs. Students' knowledge increased significantly; however, differences in students' and practicing NPs' knowledge did not reach significance. Students' clinical competency increased significantly, as demonstrated by standardized patient clinical evaluations, and was significantly better than the practicing NPs in the skill domains of evaluation and record keeping. Educational intervention can improve NP identification of substance-abusing patients in primary health care settings.
Serçekuş, Pınar; Başkale, Hatice
Clinical education has a vital role in nursing curriculum. Clinical education environment can be enhanced by feedbacks provided by students. The purpose of this research was to search factors that affect the clinical learning environment. A qualitative approach was used. 36 nursing students were recruited from school of nursing in Turkey. It was found that students are negatively affected by communication errors and feedbacks given in the presence of patients by instructors. The constant presence of instructors may be the source of stress for some students. Besides peer support and favourable communication with peers have a positive impact on student learning. Communication with hospital staff and instructors are important. The study revealed that student learning is affected by the level of confidence and support displayed by patients. In order to ensure the most favourable learning environment for students, it is essential that cooperation should be increased between school staff and clinical staff, instructor skills should be developed, and students should be supported in the clinical environment.
Farrell, Maureen J; Rose, Louise
Personal digital assistants (PDAs) are increasingly in use in both clinical practice and nursing education as a method of providing timely access to resources at the point of care. This article describes the use of PDAs during the medical-surgical clinical component of a Bachelor of Nursing program in Australia. The aim of the study was to investigate whether PDAs would enhance students' pharmacological and clinical contextual knowledge and to identify issues associated with the use of PDAs in students' clinical experience. A mixed-method approach was used incorporating a quasi-experimental design with pretest and posttest of pharmacological knowledge and focus group discussions. Students using the PDAs demonstrated a moderate increase in their mean score, which was double the increase in the control group. Findings from the focus group discussions indicated that students found the PDAs easy to use and perceived their use as beneficial to their learning in the clinical area. This study provides support for the ongoing implementation of PDAs into nursing education.
Beal, Judy A; Riley, Joan M
The purpose of this national study was to explore the vision of chief academic officers for baccalaureate nursing education. We invited chief academic nursing officers, randomly selected from a representative sample of accredited baccalaureate nursing programs to participate in the study. Audiotaped interviews were conducted in focus groups at professional meetings or by telephone and were transcribed verbatim. Data collection continued until thematic saturation was reached (N = 29). Analysis of the findings revealed themes that described future vision for baccalaureate education that provides guidance to faculty as they develop curriculum. An overarching theme "We are all Stewards of the Profession" and three supporting themes emerged: "Learning Pathways are Varied," "Faculty Need to Grow," and "New Pedagogies Need to Focus on the Development of 'Who I Am' as a Clinical Scholar." Findings point to a future where diverse learning pathways are integrated throughout the curriculum. The curriculum of tomorrow will place greater emphasis on the development of professional identity as a nurse and calls for expanded stewardship for nursing education. Deans recommended that investing time and resources into well-designed faculty development programs will help all faculty, regardless of appointment, to adapt to changing student needs and rapidly evolving practice environments.
DeMarco, Rosanna F; Pulcini, Joyce; Haggerty, Lois A; Tang, Trinh
Recently, the American Association of Colleges of Nursing (AACN) resolved that a new practice degree, the doctorate in nursing practice (DNP), is to become the terminal practice degree and minimum education standard for advanced practice nurses by the year 2015(American Association of Colleges of Nursing. (2004). AACN position statement on the practice doctorate in nursing. Retrieved July 1, 2007, from http://www.aacn.nche.edu.html). The DNP will have a clinical-intensive focus. Advanced practice nurses potentially impacted by this resolution will include nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists. A task force at the William F. Connell School of Nursing at Boston College conducted an electronic survey in 2006 in an attempt to understand nurses' thoughts about doctoral preparation and the interest of nurses in Massachusetts in pursuing doctoral study. A self-selected group of 376 nurses participated in the study. Nurses identified both positive and negative perceptions related to the degree's viability and practicality, with a majority (55%) preferring the DNP as an educational option.
Carver, Neil; Ashmore, Russell; Clibbens, Nicola
In 1994 the Department of Health recommended that nurses be introduced to the process of clinical supervision during pre-registration training. In response to this recommendation, the now defunct English National Board (ENB) stated that: "It will be a requirement that all students of pre-registration nursing programmes receive preparation in what to expect from clinical supervision" (ENB, 1995, p. 4). Despite the fact that no further guidance was issued there is an emerging body of literature exploring this area. This paper reports findings from the initial phase of a three-year prospective longitudinal study examining students' experiences of group clinical supervision undertaken as part of their pre-registration training. In this part of the study 32 mental health nursing students participated in focus groups in which they discussed their expectations of clinical supervision. Content analysis of the data produced five major categories: 'the nature of clinical supervision'; 'roles and responsibilities'; 'staying safe and doing no harm'; 'being in a group'; and 'being a student'. The findings suggest that the idea of supervision is attractive to students, although there are significant anxieties both about supervision in general and of group supervision in particular.
Beglinger, Joan Ellis; Hauge, Barbara; Krause, Sheryl; Ziebarth, Laura
The progression of five professional nurses from shared governance council chairs to unit director positions and the progression of three nurses from shared governance council chairs to clinical nurse specialist roles in an 18-year period provide compelling evidence of the impact shared governance has provided in the development of future nurse leaders in our organization. The collective wisdom of those who have lived this experience suggests that the opportunities inherent in these clinical nurse leadership roles make this a logical progression, including getting noticed and nudged, developing an understanding of the big picture, developing a results orientation, and substantial skill acquisition.
In the treatment of cancer in children, treatment procedures have been reported to be one of the most feared elements, as more painful than the illness as such. This study draws on a video ethnography of routine needle procedure events, as part of fieldwork at a paediatric oncology clinic documenting everyday treatment negotiations between nurses and young children. On the basis of detailed transcriptions of verbal and nonverbal staff-child interaction, the analyses focus on ways in which pain and anxiety can be seen as phenomena that are partly contingent on nurses' emotion work. The school-age children did not display fear. In the preschool group, though, pain and fear seemed to be phenomena that were greatly reduced through nurses' emotion work. This study focuses on three preschoolers facing potentially painful treatment, showing how the nurses engaged in massive emotion work with the children, through online commentaries, interactive formats (delegation of tasks, consent sequences, collaborative 'we'-formats), as well as solidarity-oriented moves (such as praise and endearment terms). Even a young toddler would handle the distress of needle procedures, when interacting with an inventive nurse who mobilized child participation through skilful emotion work.
Rashid, Zahra Aly; Millodot, Michel; Evans, Katharine S. E.
PURPOSE: To describe the characteristics of keratoconus (KC) patients seen in a contact lens clinic of a children's hospital in Kenya. RESULTS: A total of 254 patients’ records were analyzed. Mean age at presentation to the clinic was 20.97 ± 11.13 year (range, 6–84 years) with 75% between the ages of 6 and 25 years. There was a preponderance of males (59.8%). Most patients were referred by an ophthalmologist. All patients were Africans. The most common complaints were blurred vision (50%), poor visual acuity with spectacles (33.5%), contact lens intolerance (11.8%), and other (unspecified). Most cases were severe (71%) followed by moderate (22.9%) and mild (6.2%). Mean BCVA was 0.24 ± 0.23 (6/11). An optical correction was provided in 98% of cases; 34.6% with spectacles, 31.1% with gas permeable lenses and the remaining with both. Referral for keratoplasty was warranted in 16.5%. CONCLUSION: This is the first study of KC conducted in Kenya. KC presented at a very early age and tended to be severe. Ophthalmologists were the main source of referral. The main presenting symptom was reduced vision. Optical correction was the most common management and the percentage of patients referred for surgery concurred with other studies. PMID:27994389
Fuqua, Lou; Fuqua, Debbie
Designed to address the skills that an auto parts specialist must master in order to be effective in the market place, this manual consists of 13 units of instruction. Covered in the units are orientation; human relations; communications; safety; parts and systems identification; stocking, shipping, and receiving; inventory control; cataloging and…
Ohio State Univ., Columbus. Center on Education and Training for Employment.
This publication contains 17 subjects appropriate for use in a competency list for the occupation of telecommunications specialist, 1 of 12 occupations within the business/computer technologies cluster. Each unit consists of a number of competencies; a list of competency builders is provided for each competency. Titles of the 17 units are as…
Ohio State Univ., Columbus. Center on Education and Training for Employment.
This publication identifies 20 subjects appropriate for use in a competency list for the occupation of accounting specialist, 1 of 12 occupations within the business/computer technologies cluster. Each unit consists of a number of competencies; a list of competency builders is provided for each competency. Titles of the 20 units are as follows:…
Air Force School of Health Care Sciences, Sheppard AFB, TX.
This course is designed to help military personnel to attain the rating of optometry specialist in the Air Force. The packet includes both a teacher's plan of instruction and five student study guides/workbooks. The teacher's plan of instruction contains lesson plans, lists of student instructional materials and audiovisual aids, and suggested…
Ravanipour, Maryam; Bahreini, Masoud; Ravanipour, Masoumeh
Background: Peer learning is an educational process wherein someone of the same age or level of experience level interacts with other students interested in the same topic. There is limited evidence specifically focusing on the practical use of peer learning in Iran. The aim of this study was to explore nursing students’ experiences of peer learning in clinical practice. Materials and Methods: A qualitative content analysis was conducted. Focus groups were used to find the students’ experiences about peerlearning. Twenty-eight baccalaureate nursing students at Bushehr University of Medical Sciences were selected purposively, and were arranged in four groups of seven students each. The focus group interviews were conducted using a semi-structured interview schedule. All interviews were tape-recorded, transcribed verbatim, and analyzed using conventional content analysis method. Results: The analysis identified four themes: Paradoxical dualism, peer exploitation, first learning efficacy, and socialization practice. Gained advantages and perceived disadvantages created paradoxical dualism, and peer exploitation resulted from peer selection and peer training. Conclusion: Nursing students reported general satisfaction concerning peer learning due to much more in-depth learning with little stress than conventional learning methods. Peer learning is a useful method for nursing students for practicing educational leadership and learning the clinical skills before they get a job. PMID:26097860
Gifford, Clive; Evers, Catherine; Walden, Sarah
Clinical psychologists are well placed to work with people with learning disabilities given the high prevalence of psychiatric disorders in this population and the specialist training undertaken by psychologists. The evidence for psychological interventions in learning disabilities is scarce compared to the evidence for mainstream psychological…
Bifarin, Oladayo; Stonehouse, David
Clinical supervision involves a supportive relationship between supervisor and supervisee that facilitates reflective learning and is part of professional socialisation. Clinical supervision can take many different forms and may be adapted to suit local circumstances. A working agreement is required between the parties to the supervision and issues surrounding confidentiality must be understood. High-quality clinical supervision leads to greater job satisfaction and less stress. When it is absent or inadequate, however, the results can be serious and it is particularly important that student nurses are well supported in this way. Further research in this area is necessary.
Grindel, Cecelia Gatson; Bateman, Anne L.; Patsdaughter, Carol A.; Babington, Lynn M.; Medici, Geraldine
Adult health/medical-surgical nurses (n=54) and mental health/psychiatric nurses (n=54) were surveyed about contributions of nursing students in clinical placements. Students provided clinical staff with opportunities for mentoring, reciprocal learning, and professional development and made direct contributions to patient care. (SK)
Juthani-Mehta, Manisha; Tinetti, Mary; Perrelli, Eleanor; Towle, Virginia; Van Ness, Peter H.; Quagliarello, Vincent
We determined the inter-observer variability of clinical criteria for urinary tract infection (UTI) in nursing home residents. Pairs of nursing home staff caring for thirty residents were interviewed at times of suspected UTI. At least one measure from each clinical criteria category was reliably observed by nursing home staff members. PMID:18419369
The purpose of clinical practicums is to help nursing students learn from real clinical experiences. In clinical settings, nursing instructors set-aside time at the end of each clinical day for reflective, debriefing discussions that are designed to draw the students' attention to relevant information and help them understand their beliefs and experiences. The students' competence and decision-making skills are enhanced when they are able to reflect on critical incidents or everyday practice events. It is sometimes difficult, however, for instructors to engage students meaningfully in discussions and promote reflection when students are fatigued. In this article, I argue that it is possible to refresh, support, and inspire undergraduate nursing students by engaging them in an activity designed to distract them and occupy their conscious attention, so that their more divergent and less accessible ideas are allowed to surface. Less accessible ideas are associated with the default network; regions in the brain that are most active when the brain is allowed to rest and wander. Congruent with the middle range theory of comfort, a distracting activity will provide comfort to students who are fatigued and/or distressed, and at the same time, will enhance their reflective capacities. A distracting activity that is enjoyable, not too demanding, and can be sustained for more than just a few minutes works best for idea generation and reflection.
Sedlak, C A
The development of critical thinking is an essential component of baccalaureate nursing education and yet little is known about beginning nursing students' critical thinking abilities in making clinical decisions. The purpose of this study was to describe the critical thinking of seven beginning baccalaureate nursing students during their first clinical nursing course. Qualitative methodology using the case study approach was used to describe students' critical thinking from their perspectives. Sources of data for describing students' critical thinking included reflective journal writing, interviews, and the researcher's nonparticipatory lab observations. Paul's (1993) dimensions of reasoning were used as a framework to describe students' critical thinking. Four major themes revealed through the data analysis were: development of the professional self-perspective, development of a perfectionist perspective, development of a caring perspective, and development of a self-directed learning perspective. The descriptive nature of the study indicated that beginning students do indeed think critically. Opportunities for dialogue in a supportive environment are instrumental in facilitating students' critical thinking and growth as reflective practitioners.
Haugan, Grethe; Hanssen, Ingrid
In this article based on a literary study, the form of knowledge named familiarity knowledge is examined. Although rooted in the philosophical tradition of Wittgenstein and Polanyi, the development of familiarity knowledge is tied in with clinical practice and particular patients and contexts while paying attention to the framework factors influencing the setting as a whole as well as with theoretical knowledge relevant to the situation at hand. Palliative care makes a backdrop for some of the discussion. Familiarity knowledge can never be context free and attends to that which is unique in every nurse-patient relationship. Both assertive and familiarity knowledge are needed to care for dying patients in a competent, sensitive, and truly caring manner. Mentors need to help students synthesize assertive knowledge and familiarity knowledge during their clinical studies to enrich both kinds of knowledge and deepen their understanding. Student nurses expertly mentored and tutored while caring for dying patients living at home become, for instance, less apprehensive about facing dying patients than students not so mentored. Nurses need to understand the complexity of nursing care to be able to see the uniqueness of the situation and approach the individual patient on the bases of experience and insight.
Freeman, B A; Coronado, J R
In a large VA teaching hospital, the primary nursing care delivery model is established with an all-RN staff. Several new initiatives and incentives have been implemented to maintain nurse satisfaction during this period of nurse shortage, but the primary nurse's relationship with her or his patient is the most satisfying and rewarding opportunity in this setting. The professional profile of the nurse staff reflects high academic preparation, certification in clinical area of practice, and involvement in nursing organizations. Primary nursing is successful because of the availability of support services, which enable the nurse to remain with the patient on the nursing unit. The primary nursing care delivery model and staffing were evaluated and revised to include licensed vocational (practical) nurses as associate nurses. Nurses on staff affirm their authority and autonomy to make and carry out clinical decisions about the nursing care of their primary patients. Physicians recognize nurses as the co-primary care provider in a clinical practice atmosphere of mutual respect and collaboration. New opportunities for professional growth and self-actualization enrich the work environment.
The orientation process assists the graduate nurse (GN) to make the transition from nursing student to professional nurse. The collegial clinical model is an orientation strategy that was designed, developed, and implemented to assist GNs with this transition. GNs are familiar with the composition of a clinical group as this is the manner in which the hospital experiences are designed in nursing school. With the nurse educator effectively functioning as a clinical instructor during 3 days of the clinical orientation, the GNs ease into the transition to the unit on which they will be working. Four GNs hired to work on the postpartum unit during June 2006 participated in the pilot test of the collegial clinical model. Quotations from the reflective journal exercise that the GNs completed clearly show the benefit of this type of orientation. Preorientation and postorientation meetings with preceptors also highlight the benefits of this model as an orientation strategy.
Dell'Acqua, Magda Cristina Queiroz; Miyadahira, Ana Maria Kazue; Ide, Cilene Aparecida Costardi
Thinking about nursing education implies articulating this issue with the expressions of theoretical frameworks, from the perspective of a pedagogical aspect that includes both constructivism and competencies. The objective was to characterize, from a longitudinal view, the construction of care competencies that exist in the teaching plans of nursing undergraduate programs. This exploratory-descriptive study used a qualitative approach. Documentary analysis was performed on the nine teaching plans of undergraduate care subjects. The ethical-legal aspects were guaranteed, so that data was collected only after the study had been approved by the Research Ethics Committee. The data evidenced a curriculum organization centered on subjects, maintaining internal rationales that seem to resist summative organizations. Signs emerge of hardly substantial links between any previous knowledge and the strengthening of critical judgment and clinical reasoning. As proposed, the study contributed with reconsiderations for the teaching-learning process and showed the influence of constructivism on the proposal of clinical competencies.
Dennis, Karen E.
Increasing numbers of hospitals and medical centers employ clinical nurse researchers. Nursing doctoral programs can prepare graduates for this role with courses in philosophy and ethics; research methods, statistics, and measurement; grantsmanship; and information dissemination. (SK)
Ihlenfeld, J T
A meta-analysis of 125 nurses in three types of nursing roles investigated whether these nurses received social support from their administrators, the types of social support received, and whether more or less social support from these managers was desired. The Arizona Social Support Interview Schedule (ASSIS) was used to assess these questions. Results showed that home health nurses received social participation and physical assistance, whereas staff nurses received positive feedback and physical assistance. Nursing faculty received little support from their managers. Social exchange theory predicts that intangibles such as social support should exist in equitable relationships. It is possible that the difference in the nurses' and administrators' statuses and power levels affected staff nurses' results. Mental health clinical nurse specialists can use these results to help nurses understand their work relationships.
Supamanee, Treeyaphan; Krairiksh, Marisa; Singhakhumfu, Laddawan; Turale, Sue
This qualitative study explored the clinical nursing leadership competency perspectives of Thai nurses working in a university hospital. To collect data, in-depth interviews were undertaken with 23 nurse administrators, and focus groups were used with 31 registered nurses. Data were analyzed using content analysis, and theory development was guided by the Iceberg model. Nurses' clinical leadership competencies emerged, comprising hidden characteristics and surface characteristics. The hidden characteristics composed three elements: motive (respect from the nursing and healthcare team and being secure in life), self-concept (representing positive attitudes and values), and traits (personal qualities necessary for leadership). The surface characteristics comprised specific knowledge of nurse leaders about clinical leadership, management and nursing informatics, and clinical skills, such as coordination, effective communication, problem solving, and clinical decision-making. The study findings help nursing to gain greater knowledge of the essence of clinical nursing leadership competencies, a matter critical for theory development in leadership. This study's results later led to the instigation of a training program for registered nurse leaders at the study site, and the formation of a preliminary clinical nursing leadership competency model.
Michelson, Daniel; Sclare, Irene
This study addressed psychological needs, patterns of service utilization and provision of care in a specialist mental health service for young refugees and asylum seekers in London. Comparisons were made between two groups with different levels of postulated mental health need: unaccompanied minors (UAMs; n = 49) and children accompanied to the UK by one or more primary caregivers (n = 29). Significant differences were observed in referral pathways, with UAMs more likely to be referred by social services and less likely to be referred from medical agencies. UAMs also attended fewer sessions during treatment, and missed a greater proportion of scheduled appointments. Contrary to prediction, group comparisons revealed similar levels of post-migration stress and overall psychological morbidity. However, UAMs experienced significantly more traumatic events prior to resettlement, and were more likely to exhibit symptoms of post-traumatic stress disorder (PTSD) than their accompanied peers. Despite their elevated risk of PTSD, UAMs were less likely than accompanied children to have received trauma-focused interventions. UAMs were also significantly less likely to have been treated using cognitive therapy, anxiety management and parent/carer training, as well as receiving fewer types of practical assistance with basic social needs. The clinical and service implications of these findings are discussed.
Hathorn, Donna; Machtmes, Krisanna; Tillman, Ken
One response to the nursing shortage is to increase promotion and retention in nursing programs: However, negative attitudes of nurses threaten student progression and retention. A phenomenological study explored the lived experience of nurses who worked with student nurses to discover "what" attitudes nurses had toward student nurses…
Rock, Samuel K., Jr.; Chagalis, George P.
The Basic Medical Specialist course has one of the largest enrollments of the U.S. Army's Academy of Health Sciences; 11,000 soldiers were trained in this course in 1977 and 1978. Training encompasses both emergency first aid (for field medics) and basic nursing skills. A task force working to improve Army training developed this course, in…
Kille, Michael O.
This four-volume student text is designed for use by Air Force personnel enrolled in a self-study extension course for optometry specialists. Covered in the individual volumes are optometry clinic administration (optometry career and field training, ethical relationships and professionalism, eligibility for optometric care and appointment…
Oltra-Rodríguez, Enrique; Rich-Ruiz, Manuel; Orts-Cortés, María Isabel; Sánchez-López, Dolores; González-Carrión, Pilar
Since nursing became an university degree in 1977, there have been several regulations to develop specialties, all of them agreeing on the need to include skills in research. Indeed, the relevance of acquiring these skills in all current disciplines has led to Royal Decree 99/2011, which regulates the official PhD courses, and recognises specialist nurses as qualified to access PhD studies. Nowadays, students from six of the seven specialties included in the Royal Decree 450/2005 on nursing specialties, are performing their training. The acquisition of research skills is seen as an opportunity and a challenge. However, the organizational structure of training facilities (multiprofessional teaching units) and the incorporation of nurses as clinical tutors, who initiated this teaching activity, deserve special attention to ensure the correct acquisition of research skills in the training of specialist nurses.
Kim, Y.; Park, H.-A.
Objectives The aims of this study were to develop detailed clinical models (DCMs) for nursing problems related to perinatal care and to test the applicability of these detailed clinical models. Methods First, we extracted entities of nursing problems by analyzing nursing-problem statements from nursing records, reviewing the literature, and interviewing nurse experts. Second, we extracted attributes and possible values needed to describe the entities in more detail by again analyzing nursing statements, reviewing the literature, and consulting nurse experts. Third, DCMs were modeled by linking each entity with possible attributes with value sets and optionalities. Fourth, entities, attributes and value sets in the DCMs were mapped to the International Classification for Nursing Practice (ICNP) version 2. Finally, DCMs were validated by consulting a group of experts and by applying them to real clinical data and nursing care scenarios published in the literature. The adequacy of the entities, attributes, value sets, and optionalities of the attributes were validated. Results Fifty-eight entities were identified, 41 entities from nursing records, 12 entities from literature review and 5 entities from nurse experts. Sixty-five attributes with values were identified, 25 attributes from nursing records, 34 attributes from literature review, and 6 attributes from nurse experts. In total 58 DCMs were developed and validated. Conclusions The DCMs developed in this study can ensure that electronic health records contain meaningful and valid information, and support the semantic interoperability of nursing information. PMID:23616872
Chabeli, M; Muller, M
A qualitative, contextual, exploratory and descriptive design for theory generation was used to develop a model to facilitate reflective thinking in clinical nursing education (Mouton & Marais, 1990:43; Mouton, 1996: 103-109; Chinn & Kramer 1991:79-120). A model was developed within the existing frameworks of theory generation. Wilson (1963:23-39) and Gift (1997:75,76) provided a theoretical framework for a concept analysis of reflective thinking in phase one of the study. Further conceptual meaning was attained through a perceptual survey where twelve nurse educators participated in a focus group interview with regard to how reflective thinking can be facilitated in clinical nursing education. Classification of the main concepts and sub-concepts was made through a conceptualisation process within Dickoff, James and Wiedenbach's (1968:415-435) theoretical framework using the six elements of practice theory. Concluding relation statements were inferred through deductive analysis and synthesis after conceptualisation of each main concept. The relation statements provided the basis for model description (Chinn & Kramer, 1991:107-125). Definitions of the main concepts and sub-concepts were described using the basic rules by (Rossouw, 2001:10-11; Cohen & Copi, 1994:192-195). The adapted educational process from five learning theories provided a framework through which the procedure to facilitate reflective thinking in clinical nursing education was described. Lastly, the model was evaluated using the pre-determined criteria by Chinn and Kramer (1991:128-137) and refined by experts in qualitative research and theory generation. Guidelines were developed which do not form part of this article. Theoretical validity was ensured. Recommendations, limitations, challenging hypothesis and a conclusion were made.
Ennis, Gary; Happell, Brenda; Broadbent, Marc; Reid-Searl, Kerry
Communication has been identified as an important attribute of clinical leadership in nursing. However, there is a paucity of research on its relevance in mental health nursing. This article presents the findings of a grounded theory informed study exploring the attributes and characteristics required for effective clinical leadership in mental health nursing, specifically the views of nurses working in mental health about the importance of effective communication in day to day clinical leadership. In-depth interviews were conducted to gain insight into the participants' experiences and views on clinical leadership in mental health nursing. The data that emerged from these interviews were constantly compared and reviewed, ensuring that any themes that emerged were based on the participants' own experiences and views. Participants recognized that effective communication was one of the attributes of effective clinical leadership and they considered communication as essential for successful working relationships and improved learning experiences for junior staff and students in mental health nursing. Four main themes emerged: choice of language; relationships; nonverbal communication, and listening and relevance. Participants identified that clinical leadership in mental health nursing requires effective communication skills, which enables the development of effective working relationships with others that allows them to contribute to the retention of staff, improved outcomes for clients, and the development of the profession.
Babenko-Mould, Yolanda; Iwasiw, Carroll L; Andrusyszyn, Mary-Anne; Laschinger, Heather K S; Weston, Wayne
The purpose of this study was to use a cross-sectional survey design, with an integrated theoretical perspective, to examine clinical teachers' (n = 64) and nursing students' (n = 352) empowerment, teachers' and students' perceptions of teachers' use of empowering teaching behaviors, students' perceptions of nurses' practice behaviors, and students' confidence for practice in acute care settings. In this study, teachers and students were moderately empowered. Teachers reported using a high level of empowering teaching behaviors, which corresponded with students' perceptions of teachers' use of such behaviors. Teachers' empowerment predicted 21% of their use of empowering teaching behaviors. Students reported nurses as using a high level of professional practice behaviors. Students felt confident for professional nursing practice. The findings have implications for practice contexts related to empowering teaching-learning environments and self-efficacy.
Callister, Lynn Clark; Cox, Amy Harmer
Although international opportunities are the hallmark of nursing education at a large private university, the meaning of participating in such clinical nursing electives has not been described. The purpose of this phenomenological study of nurses was to examine the personal and professional meaning of participating in international clinical nursing electives during their undergraduate nursing studies. Audiotaped interviews were conducted with 20 former nursing students who had had this opportunity. "Opening our hearts and minds" was described by the study's participants, with the following themes: increasing understanding of other cultures and peoples, increasing understanding of global sociopolitical and health issues, increasing the commitment to make a difference, experiencing personal and professional growth, contributing to professional development in the host country, making interpersonal connexions, and developing cultural competence. This study makes an important contribution to the documentation of the meaning of participating in international nursing clinical experiences. Data are being used for long-term curricular planning in the development and refinement of future international clinical nursing electives and to provide outcomes data for professional accreditation. There are broader implications for the movement beyond individual cultural competence to increasing global consciousness and the improvement of global health care.
O'Mara, Linda; McDonald, Jane; Gillespie, Mary; Brown, Helen; Miles, Lynn
Clinical learning is an essential component of becoming a nurse. However at times, students report experiencing challenging clinical learning environments (CCLE), raising questions regarding the nature of a challenging clinical learning environment, its impact on students' learning and how students might respond within a CCLE. Using an Interpretive Descriptive study design, researchers held focus groups with 54 students from two Canadian sites, who self-identified as having experienced a CCLE. Students defined a CCLE as affected by relationships in the clinical area and by the context of their learning experiences. CCLE decreased students' learning opportunities and impacted on them as persons. As students determined which relationships were challenging, they tapped other resources and they used strategies to rebuilt, reframe, redirect and/or retreat relative to the specific challenge. Relationships also acted as buffers to unsupportive practice cultures. Implications for practice and research are addressed.
McInnes, Susan; Peters, Kath; Hardy, Jennifer; Halcomb, Elizabeth
An increased burden of chronic and complex conditions treated in the community and an aging population have exacerbated the primary care workload. Predicted nursing shortages will place further stressors on this workforce. High quality clinical placements may provide a strategic pathway to introduce and recruit new nurses to this speciality. This paper is Part 2 of a two part series reporting the findings of a mixed methods project. Part 1 reported on the qualitative study and Part 2 reports on the quantitative study. Forty-five pre-registration nursing students from a single Australian tertiary institution and 22 primary care Registered Nurse (RN) mentors who supervised student learning completed an online survey. Students largely regarded their primary care placement positively and felt this to be an appropriate learning opportunity. Most RNs were satisfied with mentoring pre-registration nursing students in their setting. Furthermore, the RNs desire to mentor students and the support of general practitioners (GPs) and consumers were seen as key enablers of pre-registration nursing placements. Findings from this study provide a preliminary impression of primary care clinical placements from the perspective of pre-registration nursing students and registered nurse mentors. Further research should examine whether a broader scope of non-traditional health settings such as non-government organisations, charities, pharmacies, welfare and social services can also provide appropriate learning environments for pre-registration nursing students.
The purpose of this study is the development of effective clinical teaching methods of nursing education using touching in hospital nursing care. The clinical teaching-learning process was designed based on the Steinaker, N.W. & R. Bell's experiential learning model (1979), in which teaching-learning process was divided into five steps-exposure, participation, identification, internalization, and dissemination. Three hypotheses were postulated as follows: 1-1. Guidance given to nursing students to use touching in nursing care will make them conscious of the efficiency of touching. 1-2. Nursing students will grasp the efficiency of their nursing action by "cause and effect" relations. 2-0. Guidance given to nursing students to use touching in their nursing care will allay and soften their anxiety and tension toward such nursing practices. 3-0. Nursing intervention by touching will heighten the clinical judgement ability of nursing students. The teaching-learning plan was carried out in a nursing school in Kitakyushu-shi. Fifteen nursing students studied by this plan. The results was as follows: a. Hypotheses 1-1, 1-2, 2-0, were confirmed. b. Hypothesis 3-0, was not confirmed.
Harvey, Simone T; Fisher, Lisa J; Green, Vicki M
In Australia, perinatal mental illness is common, although poorly identified and treated. Improved perinatal mental health depends on service provision models that reflect a focus on promotion, prevention, and early intervention, while facilitating improved referral pathways between primary health and specialist mental health services. In 2008, a contemporary community-based model of mental health service provision was developed as an alternative to the pre-existing hospital-based service model. The model is delivered primarily by mental health nurses using a consultation liaison framework. It provides for specialist mental health assessment and brief intervention in collaboration with the general practitioner, who remains the primary health provider. It also aims to raise community awareness and build capacity for the management of perinatal disorders in the primary care sector. Evaluation of the clinical effectiveness of the model, and the improvement in access for primary health providers and women, was conducted at 2 years from its implementation. Clinical effectiveness was evaluated by using comparative data from the Edinburgh Depression Scale and Depression Anxiety and Stress Scale, and the results demonstrated clinical efficacy. Improved attendance rates indicated that women preferred this community-based service model as an alternative to the pre-existing service model.
Walker-Cillo, Gayle A; Harding, Andrew
One of the most difficult arenas in the emergency environment for the new and seasoned clinical nurse specialist is the clinical remediation of professional nursing staff. It is easy to say that each person must be treated the same, but the foundation of each practice issue and problem is unique. Identifying and utilizing a standardized process with which concerns are addressed on the basis of theoretical models, expert nursing knowledge, and standards of practice are the keys to success.
Hagbaghery, Mohsen Adib; Salsali, Mahvash; Ahmadi, Fazlolah
Background Nurses' practice takes place in a context of ongoing advances in research and technology. The dynamic and uncertain nature of health care environment requires nurses to be competent decision-makers in order to respond to clients' needs. Recently, the public and the government have criticized Iranian nurses because of poor quality of patient care. However nurses' views and experiences on factors that affect their clinical function and clinical decision-making have rarely been studied. Methods Grounded theory methodology was used to analyze the participants' lived experiences and their viewpoints regarding the factors affecting their clinical function and clinical decision-making. Semi-structured interviews and participant observation methods were used to gather the data. Thirty-eight participants were interviewed and twelve sessions of observation were carried out. Constant comparative analysis method was used to analyze the data. Results Five main themes emerged from the data. From the participants' points of view, "feeling competent", "being self-confident", "organizational structure", "nursing education", and "being supported" were considered as important factors in effective clinical decision-making. Conclusion As participants in this research implied, being competent and self-confident are the most important personal factors influencing nurses clinical decision-making. Also external factors such as organizational structure, access to supportive resources and nursing education have strengthening or inhibiting effects on the nurses' decisions. Individual nurses, professional associations, schools of nursing, nurse educators, organizations that employ nurses and government all have responsibility for developing and finding strategies that facilitate nurses' effective clinical decision-making. They are responsible for identifying barriers and enhancing factors within the organizational structure that facilitate nurses' clinical decision-making. PMID
Hagbaghery, Mohsen Adib; Salsali, Mahvash; Ahmadi, Fazlolah
BACKGROUND: Nurses' practice takes place in a context of ongoing advances in research and technology. The dynamic and uncertain nature of health care environment requires nurses to be competent decision-makers in order to respond to clients' needs. Recently, the public and the government have criticized Iranian nurses because of poor quality of patient care. However nurses' views and experiences on factors that affect their clinical function and clinical decision-making have rarely been studied. METHODS: Grounded theory methodology was used to analyze the participants' lived experiences and their viewpoints regarding the factors affecting their clinical function and clinical decision-making. Semi-structured interviews and participant observation methods were used to gather the data. Thirty-eight participants were interviewed and twelve sessions of observation were carried out. Constant comparative analysis method was used to analyze the data. RESULTS: Five main themes emerged from the data. From the participants' points of view, "feeling competent", "being self-confident", "organizational structure", "nursing education", and "being supported" were considered as important factors in effective clinical decision-making. CONCLUSION: As participants in this research implied, being competent and self-confident are the most important personal factors influencing nurses clinical decision-making. Also external factors such as organizational structure, access to supportive resources and nursing education have strengthening or inhibiting effects on the nurses' decisions. Individual nurses, professional associations, schools of nursing, nurse educators, organizations that employ nurses and government all have responsibility for developing and finding strategies that facilitate nurses' effective clinical decision-making. They are responsible for identifying barriers and enhancing factors within the organizational structure that facilitate nurses' clinical decision-making.
Describes the development and testing of a clinical evaluation tool for a community health nursing course for registered nurses through review of the literature and focus groups with community health nurses and faculty. The article contains 22 references and an abbreviated form of the evaluation tool. (Author/JOW)
The aim of this study was to determine nursing teachers' and students' attitudes to and experiences of using an electronic assessment and feedback tool in supervision of clinical training. The tool was called eTaitava, and it was developed in Finland. During the pilot project, the software was used by 12 nursing teachers and 430 nursing students.…
Clinical judgment, defined as "the application of the nurse's knowledge and experience in making decisions about client care" (The National Council of State Boards of Nursing, 2005, p. 2), has been recognized as a vital and essential skill for healthcare providers when caring for clients. Undisputedly, nurses represent the largest…
O'Connor, S. E.; Pearce, J.; Smith, R. L.; Voegeli, D.; Walton, P.
Senior nurses' (n=139) expectations of 36 beginning nurses were compared with the beginners' competence ratings by their clinical preceptors. Senior nurses' expectations were lower than the actual competence demonstrated by the graduates, suggesting that assessment instruments should not be derived solely from supervisor expectations. (SK)
Saied, Hala; James, Joemol; Singh, Evangelin Jeya; Al Humaied, Lulawah
Clinical training is of paramount importance in nursing education and clinical evaluation is one of the most challenging responsibilities of nursing faculty. The use of objective tools and criteria and involvement of the students in the evaluation process are some techniques to facilitate quality learning in the clinical setting. Aim: The aim of…
... of Iowa Hospitals and Clinics Neurofibromatosis Clinic • Iowa City, IA Illinois Ann and Robert H. Lurie Children’s ... Sciences Center University of Oklahoma NF Clinic • Oklahoma City, OK Pennsylvania The Children’s Hospital of Philadelphia University ...
Delunas, Linda R; Rooda, Linda A
As the nursing faculty shortage worsens nationwide, schools of nursing must be creative in developing models of clinical instruction for undergraduate students that ensure both quality instruction and quality patient care. Partnerships with clinical agencies can be creatively designed to allow full-time faculty greater access to students and agency nurses recognition for clinical expertise. The model for clinical instruction proposed here is also useful for introducing staff nurses to the role of faculty. The program described here was piloted for one semester; proposed advantages and disadvantages are described, and feedback from students is presented.
Christensen, Alice; Phafoli, Semakaleng; Butler, Johannah; Nyangu, Isabel; Skolnik, Laura; Stender, Stacie C
In Lesotho, primary healthcare is the main access point for health services. While nurses and midwives provide most of the care at this level, assessments of the clinical education programs have highlighted gaps in primary healthcare experiences for nursing and midwifery students. This case study examines placement of nursing and midwifery students in primary health clinics alongside preceptors. The placements provide students with varied clinical experience, better preparing them to practice in primary healthcare clinics. To date, more than 700 nursing and midwifery students have been placed in 40 rural health centres and 228 preceptors have been trained. The government is scaling up the program nationally.
Brendtro, Mary J.; Leuning, Cheryl
Describes the emergence of parish nursing as a specialty practice within community health nursing. Parish nurse roles include health educator, health counselor, liaison to community resources, and clarifier of the relationship between faith and health. (JOW)
Cai, Chunfeng; Zhou, Zongkui
The purpose of this study was to examine the levels of workplace structural empowerment perceived by Chinese clinical nurses, as well as to identify the relationship between nurses' perceptions of empowerment and job satisfaction, and turnover intention. A total of 189 staff nurses from two hospitals in central China completed a self-administered questionnaire. The results indicated that these nurses perceived moderate levels of workplace empowerment. Structural empowerment and job satisfaction were found to be negatively related to turnover intention. These findings have important implications for administrators providing an effective work environment for clinical nurses.
Sobieraj, Josef; Ortega, Claudia; West, Iris; Voepel, Leo; Battle, Steven; Robinson, DaShawn
The audibility of patient clinical alarms to nursing personnel was tested during the first shift on a medical/surgical in-patient ward at William Beaumont Army Medical Center. This study was conducted during normal hospital operations, and we tested the Joint Commission on Accreditation of Healthcare Organizations 2004 National Patient Safety Goal, Section 6b to determine whether patient alarms could sufficiently compete against environmental background noises. Patient clinical alarms were audible at distances of > or = 95 feet with room doors open but were not sufficiently audible to hospital staff members when room doors were closed or during floor-buffing activities. This study suggests that, under these circumstances, hospitals may not meet Joint Commission on Accreditation of Healthcare Organizations 2004 National Patient Safety Goal, Section 6b. Because the audibility of patient clinical alarms directly affects patient safety, satisfaction, and quality of care, we provide recommendations for engineering controls and modifications to work routines.
Smith, Carolyn R.; Gillespie, Gordon Lee; Brown, Kathryn C.; Grubb, Paula L.
Background Bullying remains a troubling problem in the nursing profession. Nursing students may encounter bullying behavior in clinical settings. However nursing students may not be adequately prepared to recognize and handle bullying behavior when it occurs. The purpose of this study was to gain greater understanding of nursing students’ experiences of bullying behaviors in the clinical setting. Method Using a descriptive qualitative approach, eight focus groups were held with 56 undergraduate baccalaureate nursing students from four college campuses. Focus group data were coded and analyzed for themes. Results Four categories of themes were identified: bullying behaviors, rationale for bullying, response to bullying, and recommendations to address bullying. Each category and its corresponding themes are presented. Conclusion Interventions for nurse educators to address bullying of nursing students in clinical settings are presented. PMID:27560118
Collins, Sarah; Bakken, Suzanne; Cimino, James J; Currie, Leanne M
Nurses information needs relate to nursing orders and nursing orders have many contexts including body systems, safety practices and other clinical categories. When searching for information related to orders one search term might retrieve documents related to multiple orders. We clustered nursing orders into sets that are related by the same logical clinical context. We then generated clusters and their search terms from a data set of 636 orders obtained from a CIS/CPOE system at an academic medical center. We refined those cluster search terms by searching an electronic nursing procedure manual to retrieve resources that could answer one of six generic nursing questions. Sixty-three cluster search terms were identified. The search terms for 100 (16%) of the orders were validated in a second hospitals electronic nursing procedure manual; precision was 32.5%.. Our process of identifying cluster search terms may be a useful method to obtain clinically relevant information resources.
Klarman, K L; Mateo, M A
When staff development specialists help nurses gain presentation skills, they benefit by increasing the pool of clinically expert nurses who can share information and ideas. In this article, the authors describe an approach that includes conducting a workshop and providing opportunities for participants to make a presentation. Strategies to enhance presentations and reduce fear are addressed.
Buus, Niels; Cassedy, Paul; Gonge, Henrik
In this article, we report findings from a study aimed at developing the content and implementation of a manual for a research-based intervention on clinical supervision of mental health nursing staff. The intervention was designed to strengthen already existing supervision practices through educational preparation for supervision and systematic reflection on supervision. The intervention consists of three sessions and was implemented on two groups of mental health hospital staff. We present an outline of the manual and explain how the trial sessions made us adjust the preliminary manual. The effects of implementing the manual will subsequently be analysed in an independent randomised controlled trial.
Muñoz-Fernández, Santiago; Aguilar, Ma Dolores; Almodóvar, Raquel; Cano-García, Laura; Fortea, Sandra; Alcañiz-Escandell, Cristina Patricia; Rodríguez, José R; Cebrián, Laura; Lázaro, Pablo
Nursing clinics in rheumatology (NCR) are organizational care models that provide care centred within the scope of nurses abilities. To analyse patients differences in the knowledge of the disease, adherence to the treatment, quality indicators of the Rheumatology Departments included quality perceived by the patients with and without NCR. National multicenter observational prospective cohort study 1 year follow-up, comparing patients attending rheumatology services with and without NCR. NCR was defined by the presence of: (1) office itself; (2) at least one dedicated nurse; (3) its own appointment schedule, and (4) phone. Variables included were (baseline and 12 months) Batalla, Haynes-Sackett, Morisky-Green and quality perceived tests. In addition, another specific questionnaire was drawn up to collect the healthcare, teaching and research activities of each Rheumatology Department. A total of 393 patients were included; 181 NCR and 212 not NCR, corresponding to 39 units, 21 with NCR and 18 without NCR (age 53 ± 11.8 vs 56 ± 13.5 years). Significant differences in favour of the NCR group were found in Haynes-Sackett (p = 0.033) and Morisky-Green (p = 0.03) tests in the basal visit. Significant differences were found in questions about "the courtesy and/or kindness received by the nurse", being "good or very good" in greater proportion in the NCR group. The publications from the last 5 years were significantly higher in the NCR group in both, national (p = 0.04) and international (p = 0.03) journals. A higher research activity and quality perceived by the patients are observed in the Rheumatology Departments with NCR.
The Institute of Medicine and American Association of Colleges of Nursing are calling for curriculum redesign that prepares nursing students with the requisite knowledge and skills to provide safe, high quality care. The purpose of this project was to improve nursing students' knowledge of quality and safety by integrating Quality and Safety Education for Nurses into clinical nursing education through development of a dedicated education unit. This model, which pairs nursing students with front-line nursing staff for clinical experiences, was implemented on a medical floor in an acute care hospital. Prior to implementation, nurses and students were educated about the dedicated education unit and quality and safety competencies. During each clinical rotation, students collaborated with their nurses on projects related to these competencies. Students' knowledge was assessed using questions related to quality and safety. Students who participated in the dedicated education unit had higher scores than those with traditional clinical rotations. Focus groups were held mid-semester to assess nurses' perceptions of the experience. Five themes emerged from the qualitative data including thirsting for knowledge, building teamwork and collaboration, establishing trust and decreasing anxiety, mirroring organization and time management skills, and evolving confidence in the nursing role.
Lynch, V A
Forensic nursing is one example of an innovative expansion of the role nurses will fill in the health care delivery system of the future. Because current policies of advocacy programs mandate the inclusion of criminal justice and health care providers, it is especially timely to propose that the forensic nursing specialist be placed in the trauma treatment environs to serve as a valuable link in interagency cooperation, ensuring that human needs and medicolegal interests are served. Because most emergency personnel and prehospital care providers ordinarily have only secondary interests in forensic matters, the motivated and skilled forensic nurse can serve as an invaluable resource for the criminal justice system, the hospital, and the patient.
Berlin, Linda E.; Harper, Doreen; Werner, Kathryn E.; Stennett, Janis
Based on a survey of master's level nurse practitioner (NP) educational programs, this report presents data on: (1) types of programs and their characteristics; (2) programs by NP role preparation (single track, dual track, or combined NP/clinical nurse specialist); (3) course content areas included in core master's and clinical (didactic and/or…
Heale, Roberta; Butcher, Marilyn
Canada's first nurse practitioner-led clinic opened in 2007 after a period of intense lobbying. The development of this clinic has received a great deal of attention in the nursing world and among the general public, but the factors that enabled it have not been examined. The antecedents outlined in healthcare innovation concept analysis - including leadership, financial considerations, idea generation, teamwork, culture and demand - provide a framework for examination of the campaign for the nurse practitioner-led clinic. This review demonstrates the complex interplay of factors that drive healthcare innovation and expands understanding of the leadership and change competencies of the advanced practice nurse.
Incivility and bullying in nursing are complex problems that have garnered much attention in recent years. Emerging evidence suggests that incivility in the workplace has significant implications for nurses, patients, and health care organizations. Because today's students are tomorrow's colleagues, conversations regarding how to address incivility and bullying should include specific aspects of nursing academia and the preparation of new nurses.
de la Torre Aboki, Jenny
The goal of a nurse-led clinic in the management of rheumatoid arthritis patients is to promote patient independence. Patient education and empowerment are efficacious tools for achieving this. The main nursing care roles are vigilance of physical symptoms, drug toxicity and co-morbidities; management of physical and psychological symptoms; to provide continuity of care. There is evidence supporting the effectiveness of nurse-led clinics and the economic benefits related to it.
Debrew, Jacqueline Kayler; Lewallen, Lynne Porter; Chun, Edna
Cultural competence is a stated value of nursing and nursing education. However, some institutional and traditional practices in nursing education can unintentionally impede nurses from achieving cultural competence. Both the literature and interviews with nurse educators show that despite educators' intentions to treat all students the same, nontraditional students may feel singled out and may in fact be singled out for closer scrutiny because of their difference from the demographic norms of nursing students. To ensure that the nursing profession reflects the composition of the patient population it serves, nurse educators must first acknowledge the Eurocentric culture of nursing education and, then, work to change the environment in which students are recruited, learn, and take on the role of beginning practicing nurses.
Kim, MinYoung; Oh, Seieun
The purpose of this study was to generate a substantive model that accounts for the explanatory social processes of communication in which nurses were engaged in clinical settings in Korea. Grounded theory methodology was used in this study. A total of 15 clinical nurses participated in the in-depth interviews. "Assimilating to the hierarchical culture" emerged as the basic social process of communication in which the participants engaged in their work environments. To adapt to the cultures of their assigned wards, the nurses learned to be silent and engaged in their assimilation into the established hierarchy. The process of assimilation consisted of three phases based on the major goals that nurses worked to achieve: getting to know about unspoken rules, persevering within the culture, and acting as senior nurse. Seven strategies and actions utilized to achieve the major tasks emerged as subcategories, including receiving strong disapproval, learning by observing, going silent, finding out what is acceptable, minimizing distress, taking advantages as senior nurse, and taking responsibilities as senior nurse. The findings identified how the pattern of communication in nursing organizations affected the way in which nurses were assimilated into organizational culture, from individual nurses' perspectives. In order to improve the rigid working atmosphere and culture in nursing organizations and increase members' satisfaction with work and quality of life, managers and staff nurses need training that focuses on effective communication and encouraging peer opinion-sharing within horizontal relationships. Moreover, organization-level support should be provided to create an environment that encourages free expression.
Marks, I M; Hallam, R S; Philpott, R; Connolly, J C
Five registered mental nurses (R.M.N.s) were trained over two years to become behavioural psychotherapists for adult neurotic disorders. They achieved results comparable to those obtained with similar patients and methods by psychologists and psychiatrists. Similar results were maintained when over a third year the therapists were seconded to work in four hospitals and a general practice. Patients were satisfied at being treated by nurses. After initial teething difficulties nurse therapists became valuable members of treatment teams during both training and secondment, becoming accepted by most nurses, psychologists, and psychiatrists with whom they came into contact. The training of further nurse therapists would facilitate treatment of many disabled neurotics who would otherwise go without effective treatment. Training nurse therapists takes less time and money than training psychologists and psychiatrists because less of their education is redundant to the skills involved. The pool of R.M.N.s suitable for training is much larger than that of psychiatrists and psychologists. The nurse therapists can be integrated relatively easily into treatment teams. The present nursing structure imposes restrictions on the advancement of clinical nurse specialists and a clinical tree is badly needed parallel with present administrative and teaching hierarchies. An 18-month course in adult behavioural psychotherapy has been recognized by the Joint Board of Clinical Nursing Studies for England and Wales so that nurse therapists seem destined to be a lasting feature of future treatment teams. PMID:1139262
Drawing on the evidence base on the core clinical skills and competencies required by newly qualified nurses, this comprehensive text provides useful learning outcomes, activities to encourage reflection, and top tips to expand readers' knowledge and practice.
Jervis, Anne; Tilki, Mary
This article reports findings from a qualitative study exploring mentors' reluctance to refer students who did not perform adequately in clinical settings. A focus group and individual semi-structured interviews were undertaken with experienced stage two mentors in an NHS trust. Mentors spoke of having to balance objectivity and intuition when dealing with upset or angry students, those who were popular or those who tried hard but did not perform adequately. They describe a number of factors that led them to pass a student who was less than satisfactory. In particular the findings highlight difficulties with measuring and recording attitudes. The data demonstrate the willingness and motivation of mentors to keep up to date and learn from their students. However, findings also suggest the need for mentors to have greater confidence in their own clinical abilities. Recommendations are made for training strategies to address these barriers in order to ensure that only competent, caring nurses are allowed to register.
Maraolo, A E; Ong, D S Y; Cortez, J; Dedić, K; Dušek, D; Martin-Quiros, A; Maver, P J; Skevaki, C; Yusuf, E; Poljak, M; Sanguinetti, M; Tacconelli, E
The purpose of this investigation was to assess the balance between the personal and professional lives of trainees and young European specialists in clinical microbiology (CM) and infectious diseases (ID), and determine differences according to gender, country of training, workplace and specialty. The Steering Committee of the Trainee Association of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) devised a questionnaire survey consisting, beyond the demographic questions, of nine yes/no questions, 11 Likert scale self-evaluations and one open-response item on parenthood, working conditions, quality of life, alcohol consumption and burnout. This anonymous survey in English was held between April and July 2015 among European CM/ID trainees and young specialists (<3 years after training completion). Responses from 416 participants with a mean age of 32 years [standard deviation (SD) 5 years] were analysed. Females and physicians from Northern/Western Europe (NWE) benefit more from paternity/maternity leaves even during training than their counterparts. Among all respondents, only half of breastfeeding mothers enjoyed the benefit of working hours flexibility. Only two-thirds of respondents found their working environment stimulating. In comparison to colleagues from other parts of Europe, trainees and young specialists from Southern/Eastern Europe (SEE) had less frequent regular meetings with mentors/supervisors and head of departments where trainees' issues are discussed. Also, physicians from SEE were more frequently victims of workplace mobbing/bullying in comparison to those from other regions. Finally, multivariate analysis showed that female gender, SEE region and ID specialty were associated with burnout feelings. Female gender and country of work from SEE largely determine satisfactory working conditions, the possibility of parenthood leaves, amount of leisure time, mobbing experiences and burnout feelings among European CM
If we subscribe to the notion that nursing is an action profession, that nurses learn by doing [Neary, M., 2000. Responsive assessment: assessing student nurses' clinical competence. Nurse Education Today 21, 3-17], then the mastery of fundamental clinical skills must be a key component of courses leading to registration. The last two decades have seen widespread changes to nurse education but the clinical field remains an invaluable resource in preparing students for the reality of their professional role supporting the integration of theory and practice and linking the 'knowing what' with the 'knowing how'. The clinical-learning environment represents an essential element of nurse education that needs to be measurable and warrants further investigation. This exploratory cohort study (n = 67) examined pre-registration student nurses' perception of the hospital-learning environment during clinical placements together with the key characteristics of the students' preferred learning environment utilising an established tool, the clinical-learning environment inventory (CLEI) tool [Chan, D., 2001a. Development of an innovative tool to assess hospital-learning environments. Nurse Education Today 21, 624-631; Chan, D., 2001b. Combining qualitative and quantitative methods in assessing hospital-learning environments. International Journal of Nursing Studies 3, 447-459]. The results demonstrated that in comparison with the actual hospital environment, students would prefer an environment with higher levels of individualisation, innovation in teaching and learning strategies, student involvement, personalisation and task orientation.
Harper, Christopher R.; Liddon, Nicole; Dunville, Richard; Habel, Melissa A.
Access to school health clinics and nurses has been linked with improved student achievement and health. Unfortunately, no studies have examined how many students report using school clinics or nurses and for which services. This study addressed this gap with data from a nationally representative sample of 15- to 25-year-olds. Respondents who…
Pipkin, Jessica Monique
A high-demand is placed on healthcare providers to be educators during student clinical training evolutions. Certified registered nurse anesthesia clinical educators (CRNACEs) affiliated with nurse anesthesia education programs (NAEPs) in the United States face the complex duality of assuming the combined role of teacher and anesthesia provider.…
Mindel, A; Fennema, J S A; Christie, E; van Leent, E
The aim of this study was to evaluate staff perception of a nurse-led sexually transmitted infection (STI) clinical service. The staff at the Amsterdam STI clinic were interviewed using a standardized questionnaire. A series of eight questions was designed to determine the perceived advantages or disadvantages of nurse-led clinics, based on personal experience, using a Likert scale. After completion of the structured interview, the staff were offered the opportunity of providing comments. All 36 members of staff completed the survey. Twenty-seven (75%) agreed or strongly agreed that nurse-led clinics provided more time with patients. Sixty-four percent agreed or strongly agreed that such a service provided greater confidentiality and 94% agreed or strongly agreed that 'nurse-led clinics provided a high level of job satisfaction for nurses.' In contrast, only 64% agreed or strongly agreed that nurse-led clinics provided a high level of job satisfaction for doctors. When staff comments were evaluated, four common themes emerged. First, that this was an efficient way of providing services; second, that the clinic was a pleasant environment, there was excellent teamwork and greater job satisfaction; third, that a good deal of rivalry existed between doctors and nurses and finally, that there was a need for and importance of protocols, rules and staff training and development. In conclusion, there was a high level of staff satisfaction with the service. Nurse-led STI clinics may be a useful adjunct to existing STI facilities.
Franklin, Ruth H.
As part of a Geriatric Education and Health Management program, a model nurse-managed free clinic has been established at an urban senior center by faculty and students of the University of New Mexico College of Nursing. Funded by a 3-year grant from the Department of Health and Human Services, the weekly clinic is based on Orem's self-care theory…
Manninen, Katri; Henriksson, Elisabet Welin; Scheja, Max; Silen, Charlotte
Purpose: This study aims to explore and understand first year nursing students' experiences of learning at a clinical education ward. Design/methodology/approach: The setting is a clinical education ward for nursing students at a department of infectious diseases. A qualitative study was carried out exploring students' encounters with patients,…
Johnson, Kelly Vowell
Utilization of adjunct nursing instructors to teach clinical courses is a common occurrence in nursing programs. Adjunct clinical instructors are often expert clinicians, but they have limited experience in teaching and lack the expertise needed to be successful in the educator role, such as knowledge of student assessment. Faculty development…
Neill, Jane; Taylor, Kerry
Two urban Australian nursing students' stories of their experiences in clinical placements in rural and Aboriginal communities indicate their interest in and enthusiasm for returning to rural nursing after graduation. Unfortunately, many urban students are disadvantaged financially by the added expense of their rural clinical rotation. Assisting…
Barnett, Tony; Cross, Merylin; Jacob, Elisabeth; Shahwan-Akl, Lina; Welch, Anthony; Caldwell, Alison; Berry, Robyn
The current workforce crisis mandates that education providers increase the number of graduates from nursing courses. In a practice-based profession however, any growth in student numbers is constrained by the ability of clinical venues to accept students for clinical experience. Factors within the operating environment such as bed capacity, staffing mix and shortage of experienced clinicians to act as preceptors, clinical teachers, mentors or role models; limit the number of students that can be accommodated and both the quality and level of educational support provided. These factors are compounded in rural hospitals, where opportunities for placements can be also overlooked or ineffectively utilised. This paper reports on a project undertaken by a rural health service, two universities and a TAFE institute. It demonstrates that a greater number of students can be accommodated when all major stakeholders accept responsibility and agree to work together to create a learning community and find ways to overcome barriers and impediments that constrain capacity. It is concluded that the capacity of a rural hospital to accept students for placement can be increased when cancellation rates are reduced, the clinical timetable rationalised and more collaborative approaches to clinical education are implemented.
Shahsavari, Hooman; Yekta, Zohreh Parsa; Zare, Zahra; Sigaroodi, Abdolhossain Emami
Background: Clinical education is the heart of the nursing education program. Effective nursing clinical instructors are needed for graduating the future qualified nurses. There is a well-developed body of knowledge about the effectiveness of clinical teaching and the instructors. However, translating this knowledge into a context-based evaluation tool for measuring the effectiveness of Iranian clinical nursing instructors remains a deficiency. The purpose of this study is to describe the development and psychometric testing process of an instrument to evaluate the characteristics of Iranian effective clinical nurse instructor. Materials and Methods: Following a precise review of Iranian literatures and expert consultation, 83 statements about the characteristics that make clinical nurse instructors effective were extracted. In the next phase, the psychometric properties of the instrument were established by looking at the content validity, face validity, and internal consistency. Content validity of the instrument was assessed based on the comments of an expert panel including 10 nursing faculty members. During this phase, 30 items of the instrument were omitted or merged. Face validity of the instrument was assured based on the advices of 10 nursing students and 10 nursing faculty members. Finally, in the pilot test, the data of 168 filled questionnaires were gathered and analyzed by an exploratory factor analysis to reduce the items and identify the factor structure of the instrument. Results: Through subsequent analyses, of the 83 items, 31 items were merged or omitted. At last, 52 retained items were divided into four subscales including student-centric behaviors, clinical performances, planning ability, and personality traits. The Cronbach's alpha level of the inventory was 0.96, with the value for each domain ranging from 0.87 to 0.94. Conclusions: Iranian Effective Clinical Nurse Instructor evaluation tool has acceptable psychometric properties and can be
Cassata, Linda C; Cox, Tina M
One of the challenges nurse educators face is choosing a textbook that ensures congruency within the discipline of nursing, national and global health priorities, and the mission of the university. This article discusses the development of a tool that evaluates course content concurrently with evidence. The need to critically link content analysis and evidence within clinical nursing textbooks is deemed important given the discipline's imperative to prepare nurses to use the best evidence available for practice. The history and concept of evidence-based nursing practice is explored to develop an operational definition for the tool, which was designed to guide a realistic and expeditious process for this important faculty responsibility.
Recognition and avoidance of further clinical deterioration can be termed a critical success factor in every care delivery model. As care resources become more constrained and allocated to the most critical of patients, some patients are being shifted to less intense and costly care settings where continuous physiologic monitoring may not be an option. Nurse executives are facing these complex issues as they work with clinical experts to develop systems of safety in the patient care arena. A systematic review of the literature related to the recognition of clinical deterioration is needed to identify areas for further leadership, research, and practice advancements.
Andrea Sullivan, E
Nurse educators recognize that many nursing students have difficulty in making decisions in clinical practice. The ability to make effective, informed decisions in clinical practice requires that nursing students know and apply the processes of critical thinking. Critical thinking is a skill that develops over time and requires the conscious application of this process. There are a number of models in the nursing literature to assist students in the critical thinking process; however, these models tend to focus solely on decision making in hospital settings and are often complex to actualize. In this paper, Paul's Model of Critical Thinking is examined for its application to nursing education. I will demonstrate how the model can be used by clinical nurse educators to assist students to develop critical thinking skills in all health care settings in a way that makes critical thinking skills accessible to students.
O'Connor, Siobhan; Andrews, Tom
Nursing students face a variety of challenges to learning in clinical practice, from the theory-practice gap, to a lack of clinical supervision and the ad hoc nature of learning in clinical environments. Mobile technology is proposed as one way to address these challenges. This article comprehensively summarizes and critically reviews the available literature on mobile technology used in undergraduate clinical nursing education. It identifies the lack of clear definitions and theory in the current body of evidence; the variety of mobile devices and applications used; the benefits of mobile platforms in nursing education; and the complexity of sociotechnical factors, such as the cost, usability, portability, and quality of mobile tools, that affect their use in undergraduate clinical nursing education. Implications for nursing education and practice are outlined, and recommendations for future research are discussed.
Background Clinical research plays an important role in establishing new treatments and improving the quality of medical practice. Since the introduction of the concept of clinical research coordinators (CRC) in Japan, investigators and CRC work as a clinical research team that coordinates with other professionals in clinical trials leading to drug approval (registration trials). Although clinical nurses collaborate with clinical research teams, extended clinical research teams that include clinical nurses may contribute to the ethical and scientific pursuit of clinical research. Methods As knowledge of clinical research is essential for establishing an extended clinical research team, we used questionnaires to survey the knowledge of clinical nurses at Tokushima University Hospital. Five-point and two-point scales were used. Questions as for various experiences were also included and the relationship between awareness and experiences were analyzed. Results Among the 597 nurses at Tokushima University Hospital, 453 (75.9%) responded to the questionnaires. In Japan, registration trials are regulated by pharmaceutical affairs laws, whereas other types of investigator-initiated research (clinical research) are conducted based on ethical guidelines outlined by the ministries of Japan. Approximately 90% of respondents were aware of registration trials and clinical research, but less than 40% of the nurses were aware of their difference. In clinical research terminology, most respondents were aware of informed consent and related issues, but ≤50% were aware of other things, such as the Declaration of Helsinki, ethical guidelines, Good Clinical Practice, institutional review boards, and ethics committees. We found no specific tendency in the relationship between awareness and past experiences, such as nursing patients who were participating in registration trials and/or clinical research or taking a part in research involving patients as a nursing student or a nurse
Streeter, Bonnie L
Clinical advancement programs have been in use for almost 30 years. Although clinical advancement programs have been designed for many areas, it appears that one has never been developed specific to the outpatient-focused registered nurse. This article describes the development of a clinical advancement program for non-hospital-based registered nurses employed at the Guthrie Clinic in Sayre, Pennsylvania and highlights recommendations for instituting this program in any outpatient setting.
Saarikoski, Mikko; Warne, Tony; Kaila, Päivi; Leino-Kilpi, Helena
This paper focuses on the role of the nurse teacher (NT) in supporting student nurse education in clinical practice. The paper draws on the outcomes of a study aimed at exploring student nurse experiences of the pedagogical relationship with NTs during their clinical placements. The participants (N=549) were student nurses studying on pre-registration nursing programmes in Finland. Data were analysed using descriptive statistics, cross-tabulation and ANOVA. The study showed that the core aspect of NTs work in clinical practice revolved around the relationship between student, mentor and NT. Higher levels of satisfaction were experienced in direct proportion to the number of meetings held between the student and NT. However, whilst the importance of this relationship has been reported elsewhere, an additional aspect of this relationship emerged in the data analysis. Those NT who facilitated good face to face contact also used other methods to enhance the relationship, particularly e-mail, virtual learning environment and texting. This outcome suggests that NT's interpersonal and communicative skills are as important as their clinical knowledge and skills in promoting effective learning in the clinical practice area. The paper argues for such approaches to be utilised within the emergent opportunities afforded by new communication and educational technologies.
Harrison, Roberta L; Lyerla, Frank
The Health Information Technology and Clinical Health Act (one component of the American Recovery and Reinvestment Act) is responsible for providing incentive payments to hospitals and eligible providers in an effort to support the adoption of electronic health records. Future penalties are planned for electronic health record noncompliance. In order to receive incentives and avoid penalties, hospitals and eligible providers must demonstrate "meaningful use" of their electronic health records. One of the meaningful-use objectives established by the Centers for Medicare & Medicaid Services involves the use of a clinical decision support rule that addresses a hospital-defined, high-priority condition. This article describes the Plan-Do-Study-Act process for creating and implementing a nursing clinical decision support system designed to improve guideline adherence for hypoglycemia management. This project identifies hypoglycemia management as the high-priority area. However, other facilities with different high-priority conditions may find the process presented in this article useful for implementing additional clinical decision support rules geared toward improving outcomes and meeting federal mandates.
Abdallah, Bahia; Irani, Jihad; Sailian, Silva Dakessian; Gebran, Vicky George; Rizk, Ursula
Nursing faculty teaching medical students a module in clinical skills is a relatively new trend. Collaboration in education among medical and nursing professions can improve students’ performance in clinical skills and consequently positively impact the quality of care delivery. In 2011, the Faculty of Medicine in collaboration with the Faculty of Health Sciences at the University of Balamand, Beirut, Lebanon, launched a module in clinical skills as part of clinical skills teaching to first-year medical students. The module is prepared and delivered by nursing faculty in a laboratory setting. It consists of informative lectures as well as hands-on clinical practice. The clinical competencies taught are hand-washing, medication administration, intravenous initiation and removal, and nasogastric tube insertion and removal. Around sixty-five medical students attend this module every year. A Likert scale-based questionnaire is used to evaluate their experience. Medical students agree that the module provides adequate opportunities to enhance clinical skills and knowledge and favor cross-professional education between nursing and medical disciplines. Most of the respondents report that this experience prepares them better for clinical rotations while increasing their confidence and decreasing anxiety level. Medical students highly appreciate the nursing faculties’ expertise and perceive them as knowledgeable and resourceful. Nursing faculty participating in medical students’ skills teaching is well perceived, has a positive impact, and shows nurses are proficient teachers to medical students. Cross professional education is an attractive model when it comes to teaching clinical skills in medical school. PMID:25419165
Cleary, Michelle; Horsfall, Jan
In clinical settings, nursing staff often find themselves responsible for students who have varying time management skills. Nurses need to respond sensitively and appropriately, and to teach nursing students how to prioritize and better allocate time. This is important not only for developing students' clinical skills but also for shaping their perceptions about the quality of the placement and their willingness to consider it as a potential work specialty. In this column, some simple, practical strategies that nurses can use to assist students with improving their time management skills are identified.
Beitz, J M
Clinical nursing education represents one of the most challenging aspects of the faculty role because nursing educators are being required to teach crucial aspects of comprehensive clinical practice to students in limited time periods and in increasingly demanding, high-acuity affiliation sites. State-of-the-art research in metacognition provides a stimulating array of instructional strategies that can assist in this process and provide an impetus for further cognitive inquiry in nursing. The article analyzes metacognition, explores its historical roots, delineates its relationship to memory theory, and describes a range of metacognitive strategies that are useful to faculty and students in nursing.
Hogewood, Connie; Smith, Tedra; Etheridge, Sherita; Britt, Sylvia
Obstetric and pediatric patients require unique specialized care not included in traditional adult health education. To prepare nursing students for clinical rotations beginning the second week of class, faculty developed an innovative one-day simulation seminar, the OB/PEDS Boot Camp, in which groups of students rotated through six stations of obstetric and pediatric simulation exercises. This article provides insight on the development and implementation of the OB/PEDS Boot Camp.
Wilkes, Lesley M; Mohan, Shantala
This project aimed to explore the application and relevance of a PhD to nurses working in the clinical area. The complexity of nursing practice requires clinical nurses to be competent as investigators and professional leaders who could help structure nursing practice in more efficient ways. Research proposes that a PhD offers Limited employment opportunities, is mainly research oriented and tends to direct a nurse away from the clinical field. A mixed method study design utilising surveys and interviews was chosen to collect data for this study. Participants were nurses with a doctoral degree working/having worked in a clinical area after obtaining their PhD Nurses were recruited through student databases from Australian universities that offer doctoral degrees in nursing and also by using a snowball sampling technique. The majority of the 19 nurses who participated in the study had: varied expectation of doing a PhD; maintained their clinical positions after obtaining their doctoral degree, considered that the degree helped them to obtain better jobs/promotions and acknowledged the value of the PhD in patient care, in improving research and informing health policy. This study has exposed the positive aspects of completing a PhD and identifies its constructive application in the clinical area. It is essential to provide support and opportunities for nurses working in the clinical area to pursue doctoral degrees in order to enable them to enhance knowledge and build confidence and leadership skills and contribute to the improvement of nursing practice and the continued development of the profession.
McKenna, Lisa; Wellard, Sally
Clinical education is an important component of undergraduate nurse education, in which clinical teachers facilitate students' application of theoretical classroom knowledge into the clinical practice setting. Mothering as part of clinical teachers' work was a major finding from a larger study exploring clinical teaching work to identify what…
Jeffers, Brenda Recchia
Review of professional nursing statements, federal policy, and recommendations for protection of human research subjects resulted in a topic and content outline for research ethics training for nurses. Suggestions for continuing education programs on research ethics were formulated. (SK)
Flick, L H; Reese, C; Harris, A
Debate continues about the appropriateness of clinical experiences targeting aggregates in undergraduate community health nursing education. This paper describes a practical model to teach, through experience, the concepts of aggregate/community-centered practice at the baccalaureate level. As a voluntary alternative to the usual community assessment paper, groups of students worked in partnership with community groups to define health needs and to address one need. Sequential student groups focused the assessment and implemented a plan. The required time for each project varied. One project is described to illustrate the model. While independent community-centered practice is not expected of the B.S.N. graduate, the model described here develops comprehension of the concepts and process of such practice.
Flogen, BettyAnn R; Stern, Bianca; Wagner, Laura M
In this paper we described our approach to the development of the role of a nurse within a stroke and cognition ambulatory clinic at Baycrest. In developing this approach we integrated Baycrest's commitment to clients and family-focused care, our focus on interdisciplinary collaborative practice, the position of the post-rehabilitation clinic in the continuum of care, the clinical experience of the nurse and director, and the relevant scholarly literature. The role of the nurses in the stroke and cognition clinic includes assessment, interdisciplinary care planning, client/family support, and knowledge transfer.
Elisabeth, Carlson; Christine, Wann-Hansson; Ewa, Pilhammar
The preceptor is a nurse who teaches and supports the student and is seen as pivotal to student learning within the clinical setting. Earlier studies have shown that preceptors' pedagogical competence is significant for facilitating learning during clinical practice. However, studies describing pedagogical competence, especially in terms of teaching strategies, seem to be scarce. The aim of this study was to describe which strategies and techniques preceptors use to teach undergraduate nursing students during clinical practice. The study had an ethnographic approach; methods used were participant observations and focus group interviews with nurses who were experienced in precepting undergraduate nursing students. Findings illustrated how preceptors used different strategies and techniques in a continuous process of adjusting, performing and evaluating precepting. Increased knowledge on how the preceptors actually teach student nurses during clinical practice will help facilitate educational programmes for preceptors, which will enhance their pedagogical skills and competences.
Nielsen, Ann; Lasater, Kathie; Stock, Mary
In today's complex, fast-paced world of hospital nursing, new graduate nurses do not have well-developed clinical judgment skills. Nurse preceptors are charged with bridging the gap between new graduates' learning in school and their autonomous practice as RNs. In one large, urban medical center in the U.S., a clinical judgment model and rubric were used as a framework for a new evaluation and orientation process. Preceptors of new graduate nurses who had used the former and new processes described their experiences using the framework. The findings indicated that having a structured framework provided objective ways to evaluate and help develop new graduate nurses' clinical judgment. It is hypothesized that academic clinical supervisors may find such a framework useful to prepare students for transition to practice.
Dimitriadou, Maria; Papastavrou, Evridiki; Efstathiou, Georgios; Theodorou, Mamas
This study is an exploration of nursing students' experiences within the clinical learning environment (CLE) and supervision provided in hospital settings. A total of 357 second-year nurse students from all universities in Cyprus participated in the study. Data were collected using the Clinical Learning Environment, Supervision and Nurse Teacher instrument. The dimension "supervisory relationship (mentor)", as well as the frequency of individualized supervision meetings, were found to be important variables in the students' clinical learning. However, no statistically-significant connection was established between successful mentor relationship and team supervision. The majority of students valued their mentor's supervision more highly than a nurse teacher's supervision toward the fulfillment of learning outcomes. The dimensions "premises of nursing care" and "premises of learning" were highly correlated, indicating that a key component of a quality clinical learning environment is the quality of care delivered. The results suggest the need to modify educational strategies that foster desirable learning for students in response to workplace demands.
Yao, Yachun; Xu, Li; Du, Kun; Zhang, Jiajun
To investigate the effect and clinical application of the homemade tracheotomy incision nursing pads. 83 patients suffering tracheotomy were randomly divided into experimental and control groups. The experimental group was treated with the homemade tracheotomy incision nursing pads, and the control group was treated with the traditional tracheotomy nursing pads. Subsequently, the number of nursing pads used in 2 weeks, tracheotomy incision bacterial colonies and the comfort of patient between the two groups of pads was compared. The number of nursing pads used by the experimental group was smaller than the control group, and the tracheotomy incision bacterial colonies in the experimental group were fewer than the control group (P < 0.01). However, the differences observed for the skin irritation and gas permeability between the two groups were not statistically significant (P > 0.05). Thus, the results show that the effect of homemade tracheotomy incision nursing pads is greater compared to the traditional nursing pads.
Wu, Min; Yang, Jinqiu; Liu, Lingying; Ye, Benlan
This study aims to investigate the influencing factors on nurses' clinical decision-making (CDM) skills. A cross-sectional nonexperimental research design was conducted in the medical, surgical, and emergency departments of two university hospitals, between May and June 2014. We used a quantile regression method to identify the influencing factors across different quantiles of the CDM skills distribution and compared the results with the corresponding ordinary least squares (OLS) estimates. Our findings revealed that nurses were best at the skills of managing oneself. Educational level, experience, and the total structural empowerment had significant positive impacts on nurses' CDM skills, while the nurse-patient relationship, patient care and interaction, formal empowerment, and information empowerment were negatively correlated with nurses' CDM skills. These variables explained no more than 30% of the variance in nurses' CDM skills and mainly explained the lower quantiles of nurses' CDM skills distribution.
The study of biosciences by nursing students, while perceived by most as relevant, presents particular challenges for many during pre- registration programmes. This article describes a literature review of the teaching and learning of biosciences in nursing curricula. Four areas are explored: the relevance of bioscience in pre-registration nursing; difficulties experienced by nursing students learning biosciences; lecturer attributes in facilitating learning; and teaching and assessment methods.
Sousa, Vanessa E C; Lopez, Karen Dunn; Febretti, Alessandro; Stifter, Janet; Yao, Yingwei; Johnson, Andrew; Wilkie, Diana J; Keenan, Gail M
Our long-term goal was to ensure nurse clinical decision support works as intended before full deployment in clinical practice. As part of a broader effort, this pilot project explored factors influencing acceptance/nonacceptance of eight clinical decision support suggestions displayed in an electronic health record-based nursing plan of care software prototype. A diverse sample of 21 nurses participated in this high-fidelity clinical simulation experience and completed a questionnaire to assess reasons for accepting/not accepting the clinical decision support suggestions. Of 168 total suggestions displayed during the experiment (eight for each of the 21 nurses), 123 (73.2%) were accepted, and 45 (26.8%) were not accepted. The mode number of acceptances by nurses was seven of eight, with only two of 21 nurses accepting all. The main reason for clinical decision support acceptance was the nurse's belief that the suggestions were good for the patient (100%), with other features providing secondary reinforcement. Reasons for nonacceptance were less clear, with fewer than half of the subjects indicating low confidence in the evidence. This study provides preliminary evidence that high-quality simulation and targeted questionnaires about specific clinical decision support selections offer a cost-effective means for testing before full deployment in clinical practice.
cognitive theory of moral development as set forth by Kohlberg. Crisham explained building on the works of Piaget in the early 30’s, Kohlberg (1976...late 1980s, nursing research has addressed caring as a central theme to nursing. In 1989, Jean Watson’s philosophy and theory of human caring in nursing
Matsumura, Geraldine; Callister, Lynn Clark; Palmer, Sheri; Cox, Amy Harmer; Larsen, Larissa
This study is a replication and extension of Grindel and associates' 2001 study of the perceptions of staff nurses (psychiatric, perinatal, and medical/surgical) regarding the benefits of having students from a baccalaureate nursing program work in clinical agencies. Using the Nursing Students' Contributions to Clinical Agencies tool, the overall perception of students' contributions ranged from -4 to +5, with a mean of 2.50. The two highest ranked items were "allows opportunities for mentoring" and "threatens professional role development," indicating the ambivalence staff nurses feel toward nursing students. Qualitative data also demonstrated the benefits and challenges of working with students. Recommendations are made for the creation of a positive, nurturing learning environment through closer collaboration between nursing education and service.
Wyte-Lake, Tamar; Tran, Kim; Bowman, Candice C; Needleman, Jack; Dobalian, Aram
This systematic review provides a comprehensive assessment of models used to expand the ranks of clinical nursing faculty. Nursing faculty shortages constrict the pipeline for educating nurses and make addressing the projected nursing shortage more difficult. Schools of nursing have denied admission to qualified applicants, citing insufficient numbers of nursing faculty as one major reason. Using key search terms in PubMed(®) and CINAHL(®), we identified 14 peer-reviewed articles published between 1980 and 2010 about models for expanding clinical faculty. Partnership models (n = 11) and expanded use of faculty resources (n = 9) were the most common strategies. Few (n = 8) studies assessed program efficacy. A need was identified for studies to assess the effect of alternative models on educational capacity and student performance and to examine the subcomponents of academic-practice partnerships and other innovative approaches to understand the essential factors necessary to implement successful programs.
Lyn, S Lindpaintner
Clinical Assessment by professional nurses relies upon appropriate gathering and interpretation of relevant subjective and objective biopsychosocial data. The physical examination provides primary objective data through the use of four techniques: inspection, percussion, palpation, and auscultation. In many countries the physical examination of patients is regarded as a standard source of clinical information for nurses. In daily nursing practice problem-focused physical examination is the rule, though complete physical examinations are commonly used in advanced nursing practice at the Master level. In this article the role of physical examination in professional nursing assessment is described, physical examination techniques are introduced and illustrated via case examples. The importance of including assessment competencies in academic nursing education is emphasized.
Maja, T M M; Motshudi, M J
Protection of health care workers including students from being infected when caring for high risk patients is a major cause for concern to all promoting occupational health. Safety of every employee is mandatory. Furthermore, universal guidelines for precautions must be used by all interacting with high risk patients and clients to protect themselves and prevent the spread of infection. The aim of this paper was to ascertain the availability of universal guidelines for precautions against the spread of infection in clinical settings and determine the precautions used by OHN students during their clinical placements. To realise these objectives, a quantitative and descriptive design was followed. A purposive sampling method was used to select 45 Occupational health nursing students who participated in the study. Data was collected with the use of a structured questionnaire and the results revealed that: most units where OHN students were placed for clinical experience had guidelines for universal precautions although these were not always accessible to them; regarding compliance to universal precautions, OHN students were reportedly aware of the hazards of failure to comply although in some emergencies and where personal protective material was not available, they had to provide care without using protective equipments. Recommendations made include that employers and staff at all occupational settings must ensure that updated guidelines for universal precautions are available and accessible to every body interacting with high risk patients; health care providers and students must be fully informed about and should always adhere to universal precautions.
Santos, Adriano A; Moura, J Antão B; de Araújo, Joseana Macêdo Fechine Régis
Mitigating uncertainty and risks faced by specialist physicians in analysis of rare clinical cases is something desired by anyone who needs health services. The number of clinical cases never seen by these experts, with little documentation, may introduce errors in decision-making. Such errors negatively affect well-being of patients, increase procedure costs, rework, health insurance premiums, and impair the reputation of specialists and medical systems involved. In this context, IT and Clinical Decision Support Systems (CDSS) play a fundamental role, supporting decision-making process, making it more efficient and effective, reducing a number of avoidable medical errors and enhancing quality of treatment given to patients. An investigation has been initiated to look into characteristics and solution requirements of this problem, model it, propose a general solution in terms of a conceptual risk-based, automated framework to support rare-case medical diagnostics and validate it by means of case studies. A preliminary validation study of the proposed framework has been carried out by interviews conducted with experts who are practicing professionals, academics, and researchers in health care. This paper summarizes the investigation and its positive results. These results motivate continuation of research towards development of the conceptual framework and of a software tool that implements the proposed model.
Kossman, Susan P; Bonney, Leigh Ann; Kim, Myoung Jin
Nurses need to quickly process information to form clinical judgments, communicate with the healthcare team, and guide optimal patient care. Electronic health records not only offer potential for enhanced care but also introduce unintended consequences through changes in workflow, clinical judgment, and communication. We investigated nurses' use of improvised (self-made) and electronic health record-generated cognitive artifacts on clinical judgment and team communication. Tanner's Clinical Judgment Model provided a framework and basis for questions in an online survey and focus group interviews. Findings indicated that (1) nurses rated self-made work lists and medication administration records highest for both clinical judgment and communication, (2) tools aided different dimensions of clinical judgment, and (3) interdisciplinary tools enhance team communication. Implications are that electronic health record tool redesign could better support nursing work.
Hovde, Birgit; Jensen, Kari H; Alexander, Gregory L; Fossum, Mariann
Computerized clinical guidelines are frequently used to translate research into evidence-based behavioral practices and to improve patient outcomes. The purpose of this integrative review is to summarize the factors influencing nurses' use of computerized clinical guidelines and the effects of nurses' use of computerized clinical guidelines on patient safety improvements in hospitals. The Embase, Medline Complete, and Cochrane databases were searched for relevant literature published from 2000 to January 2013. The matrix method was used, and a total of 16 papers were included in the final review. The studies were assessed for quality with the Critical Appraisal Skills Program. The studies focused on nurses' adherence to guidelines and on improved patient care and patient outcomes as benefits of using computerized clinical guidelines. The nurses' use of computerized clinical guidelines demonstrated improvements in care processes; however, the evidence for an effect of computerized clinical guidelines on patient safety remains limited.
Edgecombe, Kay; Jennings, Michele; Bowden, Margaret
This paper reviews the sparse literature about international nursing students' clinical learning experiences, and also draws on the literature about international higher education students' learning experiences across disciplines as well as nursing students' experiences when undertaking international clinical placements. The paper aims to identify factors that may impact international nursing students' clinical learning with a view to initiating further research into these students' attributes and how to work with these to enhance the students' clinical learning. Issues commonly cited as affecting international students are socialisation, communication, culture, relationships, and unmet expectations and aspirations. International student attributes tend to be included by implication rather than as part of the literature's focus. The review concludes that recognition and valuing of international nursing students' attributes in academic and clinical contexts are needed to facilitate effective strategies to support their clinical practice in new environments.
Löfmark, Anna; Thorell-Ekstrand, Ingrid
Assessment of students' learning is a crucial question when great changes occur in the higher education sector. One such educational reform is the Bologna declaration, the requirements of which have resulted in significant modifications in documents as assessment forms for clinical education. The aim of this study was to investigate students' and preceptors' perceptions of using the revised version of an assessment form, the AssCE form. Using convenience sampling, a questionnaire survey was completed by 192 nursing students and 101 preceptors. Most of the participants found that the revised AssCE form was possible to use during different years of the programme, and factors in the AssCE form were possible to combine with learning outcomes in the course syllabus. Most participants perceived that the scale added to each factor facilitated the assessment dialogue and offered possibilities to illustrate the students' development during clinical periods. Findings also showed that students were most often prepared with self-assessment before the assessment discussions. More information about the use of the AssCE form, also in combination with learning outcomes in the course syllabus, may further support the use of the form and contribute to students' development during clinical practice.
Skúladóttir, Hafdís; Svavarsdóttir, Margrét Hrönn
The aim of this study was to develop a valid assessment tool to guide clinical education and evaluate students' performance in clinical nursing education. The development of the Clinical Assessment Tool for Nursing Education (CAT-NE) was based on the theory of nursing as professional caring and the Bologna learning outcomes. Benson and Clark's four steps of instrument development and validation guided the development and assessment of the tool. A mixed-methods approach with individual structured cognitive interviewing and quantitative assessments was used to validate the tool. Supervisory teachers, a pedagogical consultant, clinical expert teachers, clinical teachers, and nursing students at the University of Akureyri in Iceland participated in the process. This assessment tool is valid to assess the clinical performance of nursing students; it consists of rubrics that list the criteria for the students' expected performance. According to the students and their clinical teachers, the assessment tool clarified learning objectives, enhanced the focus of the assessment process, and made evaluation more objective. Training clinical teachers on how to assess students' performances in clinical studies and use the tool enhanced the quality of clinical assessment in nursing education.
Al-Dossary, Reem Nassar; Kitsantas, Panagiota; Maddox, P J
Nurse residency programs have been adopted by health care organizations to assist new graduate nurses with daily challenges such as intense working environments, increasing patient acuity, and complex technologies. Overall, nurse residency programs are proven beneficial in helping nurses transition from the student role to independent practitioners and bedside leaders. The purpose of this study was to assess the impact of residency programs on leadership skills of new Saudi graduate nurses who completed a residency program compared to new Saudi graduate nurses who did not participate in residency programs. The study design was cross-sectional involving a convenience sample (n = 98) of new graduate nurses from three hospitals in Saudi Arabia. The Clinical Leadership Survey was used to measure the new graduate nurses' clinical leadership skills based on whether they completed a residency program or not. Descriptive statistics, correlation, and multiple linear regression analyses were conducted to examine leadership skills in this sample of new Saudi graduate nurses. A significant difference was found between residents and nonresidents in their leadership skills (t = 10.48, P = .000). Specifically, residents were significantly more likely to show higher levels of leadership skills compared to their counterparts. Attending a residency program was associated with a significant increase in clinical leadership skills. The findings of this study indicate that there is a need to implement more residency programs in hospitals of Saudi Arabia. It is imperative that nurse managers and policy makers in Saudi Arabia consider these findings to improve nurses' leadership skills, which will in turn improve patient care. Further research should examine how residency programs influence new graduate nurses' transition from student to practitioner with regard to clinical leadership skills in Saudi Arabia.
Stergiannis, Pantelis; Intas, Georgios; Toulia, Georgia; Tsolakoglou, Ioannis; Kostagiolas, Petros; Christodoulou, Eleni; Chalari, Eleftheria; Kiriakopoulos, Vasilios; Filntisis, Georgios
The aim of this study was to investigate the clinical use of smartphones among medical and nursing staff in Greece. This study used a 17-item questionnaire that was administered to the participants by the authors. The sample consists of 974 participants of 1200 who were asked to participate (ie, a response rate of 81.3%). The survey was open to all categories of medical and nursing staff (junior doctors, specialized doctors, assistant nurses, and RNs). In total, 167 participants (18.5%) were nurse assistants; 385 participants (42.6%), nurses; 154 participants (17%), specialized doctors; and 198 participants (21.9%), junior doctors. The data analysis was performed using SPSS Statistics (version 21), and the significance level was set to .05. Medical doctors own smartphones on a higher percentage in comparison with nurses. Among smartphone owners, medical doctors use their devices for clinical issues more frequently compared with nurses. Although medical doctors believe that smartphones can be a great tool for their work, they state that they do not use it for clinical reasons. Nurses state that they do not use their smartphones for clinical reasons because they are not aware of the existence of applications that can be used to assist them in their daily clinical tasks.
Zilembo, Melanie; Monterosso, Leanne
A recent study undertaken by the authors (2007) highlighted that undergraduate nursing students were subjected to varying experiences in clinical practice, which were mediated by a number of factors. Mediating factors included continuity of preceptors, student attitudes, the clinical setting environment, student and preceptor expectations of the clinical practice experience and interactions between the student and preceptor. Of note, interactions with preceptors were seen to 'make or break' the practical experience. Therefore, the relationship that is forged between preceptor and student is vital in shaping the student's experience of the clinical area and of the real world of nursing work. Early positive socialisation experiences have been shown to improve retention rates of new nurses (Greene & Puetzer 2002), which are issues of prime concern in an era of worsening nursing shortages at all levels of the profession. A conceptual framework designed to guide preceptorship may help alleviate some of the difficulties experienced by undergraduate nurses in building relationships within the complex interactions of the nursing environment. The framework proposed in this paper offers a conceptual model that links positive preceptor leadership qualities (such as compassion, care and empathy) with student characteristics. This model proposes that synergistic interactions between nursing students and preceptors results in positive implications for the nursing workforce. This framework also has the potential for further development to fill the void created by a lack of conceptual guidance for supervisory interactions within the undergraduate clinical context.
White, Robert; Taylor, Shirley
The British model of nurses as finders, appraisers, and users of research in practice is unattainable, given the technical complexity of research and the skills and time required. Clinical governance mechanisms and accountability demands further undermine the approach. An alternative is development of nursing research specialists and…
Elfrink, V L; Davis, L S; Fitzwater, E; Castleman, J; Burley, J; Gorney-Moreno, M J; Sullivan, J; Nichols, B; Hall, D; Queen, K; Johnson, S; Martin, A
As health care becomes more information-intensive and diverse, there is a need to integrate information technology (IT) into clinical education. Little is known, however, about how to design instructional strategies for integrating information technology into clinical nursing education. This article outlines the instructional strategies used by faculty in five nursing programs who taught students to use a point-of-care information technology system. The article also reports students' computer acceptance and summarizes IT clinical teaching recommendations.
Shellenbarger, Teresa; Robb, Meigan
Faculty face the demand of preparing nursing students for the constantly changing health care environment. Effective use of online, classroom, and clinical conferencing opportunities helps to enhance nursing students' clinical reasoning capabilities needed for practice. The growth of technology creates an avenue for faculty to develop engaging learning opportunities. This article presents technology-based strategies such as electronic concept mapping, electronic case histories, and digital storytelling that can be used to facilitate clinical reasoning skills.
Abdal, Marzieh; Masoudi Alavi, Negin; Adib-Hajbaghery, Mohsen
Background: Clinical education has a basic role in nursing education, and effective clinical training establishes a sense of clinical self-efficacy in senior nursing students. Self-efficacy is a key component for acting independently in the nursing profession. Objectives: This study was designed to outline senior nursing students’ views about clinical self-efficacy and to determine its level in nursing students. Patients and Methods: A mixed-methods approach, including a quantitative cross-sectional study and qualitative content analysis,was used in this study. Participants were senior nursing students who were in their two last semesters. During the initial quantitative stage, all students in the 7th and 8th semesters of the nursing major were invited to participate. They were asked to complete the Nursing Clinical Self-Efficacy Scale (NCSES) and, during the subsequent qualitative stage, the 14 students in the 7th and 8th semesters were asked to participate in semi-structured interviews. Results: In the quantitative part, 58 students completed the self-efficacy questionnaire; the mean score was 219.28 ± 35.8, which showed moderate self-efficacy in students. Self-efficacy was different across skills. In the qualitative part, the 355 open codes that were extracted from the interviews were clustered to 12 categories and 3 themes. The main themes included the factors related to self-efficacy, outcomes of self-efficacy, and ways to improve self-efficacy. Conclusions: Students had moderate self-efficacy. Several factors such as environment, nursing colleagues, and clinical educators could influence the creation of clinical self-efficacy in nursing students. PMID:26576443
Saleem, Jason J.; Patterson, Emily S.; Militello, Laura; Anders, Shilo; Falciglia, Mercedes; Wissman, Jennifer A.; Roth, Emilie M.; Asch, Steven M.
Objective Computerized clinical reminders (CRs) were designed to reduce clinicians’ reliance on their memory and to present evidence-based guidelines at point of care. However, the literature indicates that CR adoption and effectiveness has been variable. We examined the impact of four design modifications to CR software on learnability, efficiency, usability, and workload for intake nursing personnel in an outpatient clinic setting. These modifications were included in a redesign primarily to address barriers to effective CR use identified during a previous field study. Design In a simulation experiment, 16 nurses used prototypes of the current and redesigned system in a within-subject comparison for five simulated patient encounters. Prior to the experimental session, participants completed an exploration session, where “learnability” of the current and redesigned systems was assessed. Measurements Time, performance, and survey data were analyzed in conjunction with semi-structured debrief interview data. Results The redesign was found to significantly increase learnability for first-time users as measured by time to complete the first CR, efficiency as measured by task completion time for two of five patient scenarios, usability as determined by all three groupings of questions taken from a commonly used survey instrument, and two of six workload subscales of the NASA Task Load Index (TLX) survey: mental workload and frustration. Conclusion Modest design modifications to existing CR software positively impacted variables that likely would increase the willingness for first-time nursing personnel to adopt and consistently use CRs. PMID:17600106
MacKay, Lyndsay Jerusha; Bellamy-Stack, Catherine
The pediatric oncology nursing unit at the Alberta Children's Hospital experienced a large influx of new staff nurses between May 2008 and November 2008. There were 16 in total, and only a few had previous experience, whereas the majority was newly graduated nurses. As a solution to the high numbers of new staff nurses, the role of a Resource Nurse was developed as a temporary position to assist new staff nurses with their patient assignment, prioritize their day, and deal with complex patient procedures/treatments. Also, the Resource Nurse assisted all staff on the unit in dealing with increased patient acuity, chemotherapy administration, acuity issues, family teaching, and complicated family situations. A total of 55 prebooked shifts were scheduled from November 2008 to January 2009. A questionnaire was handed out to the staff nurses as a means to determine the effectiveness of having a Resource Nurse work on the unit. Twenty-three nurses responded by filling out the confidential questionnaire. Overall, respondents reported that the Resource Nurse was beneficial to their practice on the unit.
Bricker, Diedre J; Pardee, Connie J
This article outlines a high-fidelity simulation project developed and implemented by expert staff nurses at a specialty rehabilitation hospital. The project is designed to educate new graduate nurses on appropriate care for patients after a rare spinal cord surgical procedure. Due to the complicated nature of the surgery, patients are highly acute and may present with specific complications that need to be addressed for positive patient outcomes. Expert staff nurses imparted their knowledge in developing a scenario emphasizing common and unusual postsurgery patient presentations. The scenario was implemented as a teaching exercise for new graduate nurses, with experienced staff nurses as facilitators of learning in a safe, nonthreatening environment. New graduate nurses were overwhelmingly positive in the postsimulation debriefing, reporting increased confidence and knowledge necessary to care for these patients. Future endeavors include expanding involvement of staff nurses in simulation education and researching new graduate transition through simulation.
Wesolowski, Michael S; Casey, Gwendolyn L; Berry, Shirley J; Gannon, Jane
The U.S. Veterans Administration (VA) has implemented the clinical nurse leader (CNL) role nationwide. Nursing leaders at the Malcolm Randall VA Medical Center in Gainesville, Florida, implemented the development of the CNL role in the perioperative setting during the summer of 2012. The perioperative department developed the position in partnership with the University of Florida College of Nursing, Gainesville, Florida. The team developed a description of the roles and experiences of the preceptors, the clinical nurse leader resident, and the University of Florida faculty member. The clinical nurse leader resident's successes and the positive outcomes, such as improved patient outcomes, experienced by the perioperative department demonstrated the importance of the CNL role.
Peters, Kathleen; Halcomb, Elizabeth J; McInnes, Susan
As a practice-based discipline a key component of undergraduate nurse education is clinical practice experience. The quality of clinical experiences has a significant impact on the students' ability to function competently post graduation. The relationship between higher education institutions (HEIs) and health service placement providers impacts upon the quality of clinical placements. In Australia, the growth of primary care nursing and the shortage of acute clinical places has prompted HEIs to explore the placement of students in general practice. Given the increasing attention being paid to non-traditional clinical placements, it is timely to explore how universities are establishing relationships and models of clinical placement. This paper uses qualitative research methods to explore the perspectives of 12 Australian general practice nurses who have experience in facilitating undergraduate clinical placements about the relationships between HEIs and nurses. Findings are presented in the following three themes: (1) Appropriate preparation for placement: They don't know what primary health really means, (2) Seeking greater consultation in the organisation of clinical placements: they've got to do it one way for everyone, and (3) Uncertainty and lack of support: I had no contact with the university. Clinical placements in general practice can be an innovative strategy providing non-traditional, yet high quality, teaching and learning experiences for undergraduate nursing students. To optimise the quality of these placements, however, it is essential that HEIs provide appropriate support to the practice nurses mentoring these students.
O'Connor, Siobhan; Andrews, Tom
Mobile applications (apps) to train health professionals is gaining momentum as the benefits of mobile learning (mLearning) are becoming apparent in complex clinical environments. However, most educational apps are generic, off-the-shelf pieces of software that do not take into consideration the unique needs of nursing students. The proposed study will apply a user-centred design process to create a tailored mobile app for nursing students to learn and apply clinical skills in practice. The app will be piloted and evaluated to understand how nursing students use mobile technology in clinical settings to support their learning and educational needs.
Kassem, Awatef Hassan
Background: Nursing students who experienced bullying behaviors feel anger and missing their concentration, their capability to achieve a desired outcome. Also self-efficacy, often referred to as self-confidence, is essential to nursing students' ability and performance in the clinical setting. Aim: Study aimed to examine relation between bullying…
The purpose of this qualitative interpretive case study was to describe the experience of adjunct novice clinical nursing faculty who has less than three years teaching experience or feels novice in this setting. The nursing shortage in the United States is well documented and is forecasted to have significant impacts on the health care delivery…
This study focuses on the factors which influence patient satisfaction with nursing care in an Air Force outpatient clinic. The review of literature...correlated with overall satisfaction. However, the trusting relationship was most highly correlated with patient satisfaction with nursing care .
Several workshops presented at the 2005 Lilly Conference on College Teaching in Oxford, Ohio, provided the inspiration for redesigning the clinical post conference for a foundational nursing course. Given the complexity and acuity of patient conditions today, fostering critical thinking in student nurses is central to quality patient care. The…
Williams, P. Renee; Walker, Jean T.; Martin, Tina; Northington, LaDonna; Waltman, Patricia; Beacham, Tracilia; Grant, LaVerne
Nursing students with second degrees have become the focus of great interest in the last two decades in terms of being an answer to the nursing shortage. They are thought to possess greater ability to critically think and engage in self directed learning behaviours, and possess greater motivation to master clinical skills. The purpose of this…
Krumwiede, Kelly A.
Developing decision-making skills is essential in education in order to be a competent nurse. The purpose of this study was to examine and compare the perceptions of clinical decision-making skills of students enrolled in accelerated and basic baccalaureate nursing programs. A comparative descriptive research design was used for this study.…
Meyer, Rita Allen
The purpose of this study was to explore the effects of using simulation and didactic instruction on critical thinking and clinical judgment with student nurses enrolled in a fall semester medical-surgical class. Specifically, it was of interest to compare the performance of these fall semester nursing students with the performance of nursing…
Liljedahl, Matilda; Boman, Lena Engqvist; Fält, Charlotte Porthén; Bolander Laksov, Klara
This paper explores and contrasts undergraduate medical and nursing students' experiences of the clinical learning environment. Using a sociocultural perspective of learning and an interpretative approach, 15 in-depth interviews with medical and nursing students were analysed with content analysis. Students' experiences are described using a…
Al Khalaileh, Murad; Al Qadire, Mohammad; Musa, Ahmad S.; Al-Khawaldeh, Omar A.; Al Qudah, Hani; Alhabahbeh, Atalla
Background: The nursing profession is a combination of theory and practical skill, and nurses are required to generate and develop knowledge through implementing research into clinical practice. Considerable number of barriers could hind implementing research findings into practice. Barriers to research utilisation are not identified in the…
Killam, Laura A; Luhanga, Florence; Bakker, Debra
Providing quality clinical experiences for nursing students is vital to the development of safe and competent professional nurses. However, clinical educators often have difficulty identifying and coping with students whose performance is unsatisfactory. The purposes of this integrative review were to examine the extent and quality of the literature focusing on unsafe nursing students in clinical settings and to describe the characteristics of nursing students considered unsafe in clinical settings. A structured literature search yielded 11 relevant articles: five theoretical articles and six research studies. Analysis of findings revealed three themes: ineffective interpersonal interactions, knowledge and skill incompetence, and unprofessional image. The themes reflected the attitudes, actions, and behaviors that influenced students' ability to develop a safe milieu for client care. The findings provide clarity for early identification of students in need of increased support and facilitate clinical educators in meeting students' learning needs to ensure patient safety.
Chan, M F
To determine whether definable subtypes exist within a cohort of Hong Kong nurses as related to the clinical management system use in their clinical practices based on their knowledge, attitudes, skills, and background factors. Data were collected using a structured questionnaire. The sample of 242 registered nurses was recruited from three hospitals in Hong Kong. The study employs personal and demographic variables, knowledge, attitudes, and skills scale. A cluster analysis yielded two clusters. Each cluster represents a different profile of Hong Kong nurses on the clinical management system use in their clinical practices. The first group (Cluster 1) was labeled 'lower attitudes, less skilful and average knowledge' group, and represented 55.4% of the total respondents. The second group (Cluster 2) was labeled as 'positive attitudes, good knowledge but less skilful'. They comprised almost 44.6% of this nursing sample. Cluster 2 had more older nurses, the majority were educated to the baccalaureate or above level, with more than 10 years working experience, and they held a more senior ranking then Cluster 1. A clear profile of Hong Kong nurses may benefit healthcare professionals in making appropriate education or assistance to prompt the use of the clinical management system by nurses an officially recognized profession. The findings were useful in determining nurse-users' specific needs and their preferences for modification of the clinical management system. Such findings should be used to formulate strategies to encourage nurses to resolve actual problems following computer training and to increase the depth and breadth of nurses' knowledge, attitudes, and skills toward such system.
Donley, Rosemary; Flaherty, Mary Jean; Sarsfield, Eileen; Burkhard, Agnes; O'Brien, Sandra; Anderson, Kelley M
Advanced practice nurses have increased in number and public acceptance. Students preparing for these roles require quality clinical education so they are prepared to assume collaborative roles in healthcare settings. Although graduate clinical preceptors have a vitally important role in the clinical education and professional socialization of advanced practice students, there is a paucity of evidence about factors that influence their role commitment. In this article, the authors review the literature related to graduate-level, clinical-preceptor experiences; describe their study of 91 graduate clinical preceptors that identified factors influencing graduate clinical preceptors' role commitment; report and discuss their findings; as well as the limitations of this study. They conclude that the graduate clinical preceptor role needs to be more visible and better integrated into schools of nursing and healthcare organizational structures, and identify the need for intra-professional collaboration among nursing faculty, administrators, and clinicians to facilitate the recruitment, cultivation, and retention of graduate clinical preceptors.
Schäfer, Ursi Barandun; Hirsbrunner, Therese; Jäger, Susanne; Näf, Ernst; Römmich, Sabine; Horlacher, Kathrin
At the Solothurn Hospitals (soH), 13 academically educated nurses are responsible for the development of nursing care with the goal to improve patient-oriented, effective, appropriate, and economic care. The strategy contains three priorities: a) expert care of single patients in demanding situations, b) sustained application of organisational methods such as primary nursing, nursing process, and skill/grade mix, and c) design and management of practice development projects related to specific patient groups. A first evaluation with qualitative and quantitative methods showed that the exemplary care of single patients by expert nurses was evaluated as positive for the patients as well as for the teams on two wards by nurses who were interviewed. After the introduction of primary nursing, the application rate was 81 to 90 % and the introduction of fall prevention methods in geriatric rehabilitation decreased the fall rate from 8.2 to 5.5 per 1000 patient days. A comparision with the literature shows that the expert nurses of soH perform both, working at the bedside and being responsible for practice development projects, as specialised Advanced Practice Nurses (APNs). APNs at the Solothurn Hospitals work also as generalists when organisational methods need to be consolidated. Their successes depend from their integration into the hierarchy and both, into the nursing as well as into the interprofessional teams. Competencies in Transformational Leadership also are essential at all management levels.
Haley, Janice M
Although nursing is well grounded in the conceptualization of person as body-mind-spirit, there is little evidence that advanced practice nurses routinely address the spirit in giving patient care, especially with adolescents in the outpatient setting. The neglect of spiritual aspects of care may be related to lack of a framework, or education/incorporation into nurse practitioner preparation. This article describes one method of integrating adolescent spiritual/faith assessment into a nurse practitioner clinical course. Readings, assignments, and a grading rubric are offered.
Advancements in healthcare technology for patients with spasticity are promising. Nurses are expected to be well-versed in the use of technology to provide individualized and safe care. The focus of this article is on the current nursing care of patients who use technology such as intrathecal baclofen pumps to manage spasticity. Three phrases of intrathecal baclofen therapy and concurrent clinical nursing care are outlined. A fundamental understanding of the intrathecal baclofen pump allows nurses to provide cutting-edge technological and individualized care with compassion.
Cura Della Redazione, A
A research agenda for nurses, to render more visible and active their contribution to the development and implementation of clinical practice guidelines is proposed. The areas for development of multicenter research project are the epidemiology of the [non] applicability of the guidelines; a critical appraisal of existing guidelines to identify the missing recommendations relevant for nursing care; the problems orphan of recommendations. Nurses should suggest how uncertainty should be made explicit in the recommendations and promote research on nurses' decision making in protocol based care.
Effective use of simulation is dependent on a complete understanding of simulation's central conceptual elements. Deliberate practice, a constituent of Ericsson's theory of expertise, has been identified as a central concept in effective simulation learning. Deliberate practice is compatible with simulation frameworks already being suggested for use in nursing education. This paper uses Wilson's Method of concept analysis for the purpose of exploring the concept of deliberate practice in the context of clinical simulation in nursing education. Nursing education should move forward in a manner that reflects best practice in nursing education.
McKee, Sue; Bultas, Margaret; Ahearn, Tina
School nursing is a specialty that requires nurses to provide holistic health care to a diverse population. Federal disability laws make it necessary for the school nurse to maintain and competently perform higher level technical skills--outside the home or hospital setting. Skills include tracheotomy care, gastric tube care, urinary catheterizations, central line care, oxygen delivery, ostomy care, and advanced assessment skills. How do school nurses maintain these skills if they are not used frequently enough to assure competency? The authors' college of nursing and a school outreach department have partnered to offer an annual school nurse conference. One option for participants is to use the simulation laboratory to refresh these skills and to review newer equipment and technology. The simulation laboratory staff and pediatric faculty are available to demonstrate and assist participants with skills technique. Participants have responded positively to this collaborative effort.
Chen, Chien-Min; Hou, I-Ching; Chen, Hsiao-Ping; Weng, Yung-Ching
The integrity of electronic nursing records (ENRs) stands for the quality of medical records. But patients' conditions are varied (e.g. not every patient had wound or need fall prevention), to achieve the integrity of ENRs depends much on clinical nurses' attention. Our study site, an one 2,300-bed hospital in northern Taiwan, there are a total of 20 ENRs including nursing assessments, nursing care plan, discharge planning etc. implemented in the whole hospital before 2014. It become important to help clinical nurses to decrease their human recall burden to complete these records. Thus, the purpose of this study was to design an ENRs reminder system (NRS) to facilitate nursing recording process. The research team consisted of an ENR engineer, a clinical head nurse and a nursing informatics specialist began to investigate NRS through three phases (e.g. information requirements; design and implementation). In early 2014, a qualitative research method was used to identify NRS information requirements through both groups (e.g. clinical nurses and their head nurses) focus interviews. According to the their requirements, one prototype was created by the nursing informatics specialist. Then the engineer used Microsoft Visual Studio 2012, C#, and Oracle to designed a web-based NRS (Figure 1). Then the integrity reminder system which including a total of twelve electronic nursing records was designed and the preliminary accuracy validation of the system was 100%. NRS could be used to support nursing recording process and prepared for implementing in the following phase.
Gorski, Lisa; Gavin, Cara
After a short hiatus, Nurses On the Move is back and better than ever! I am excited to bring you our next nurse leader, Lisa A. Gorski MS, RN, HHCNS-BC, CRNI, FAAN. With more than 30 years in the field, Gorski is an expert in both home healthcare and infusion nursing. As a clinical nurse specialist at Wheaton Franciscan Home Health & Hospice in Wisconsin, an editorial board member of Home Healthcare Now, an associate consultant for OASIS ANSWERS, Inc., and a published author, her knowledge of the nursing profession is truly impressive.Through our phone interview, I spoke with Gorski about why she decided to enter into home healthcare, her time as president of the Infusion Nurses Society, and what advice she has for a nurse starting their career.
Aziato, Lydia; Adejumo, Oluyinka
Nurses form an indispensable part of the clinical team that manages postoperative pain (POP). Within a particular clinical context, nurses perceive and respond to pain based on specific factors. This study aimed at illuminating the perceptions and responses of Ghanaian surgical nurses regarding their patients' POP. It also identified the factors that influenced nurses' pain responses. A focused ethnography was used, and data were collected through individual interviews. Sampling was performed purposively to include junior, senior, day, and night nurses who cared for surgical patients. Concurrent data analysis was performed and data were saturated with 12 individual interviews. The findings indicated that nurses perceived POP as an individual phenomenon, and nurses responded to patients' pain by administering analgesics and by using nonpharmacologic measures. Factors that influenced the nurses' response were individual factors, such as commitment, discretion, fear of addiction, and organizational factors, such as organizational laxity and challenges of teamwork. The study recommended that nurses should be educated, supported, and encouraged to ensure pain relief after surgery and that they should see pain relief as a priority postoperative care to avert the negative repercussions of poorly managed POP.
Jacobson, Therese; Belcher, Erin; Sarr, Barbara; Riutta, Emily; Ferrier, Jennifer Douglas; Botten, Mary A
Patient safety is enhanced when nursing staff recognize and respond to subtle changes in a patient's condition. In this quality improvement project, simulated clinical scenarios were conducted with staff nurses on a multi-specialty surgical unit. Scenarios were developed from actual patient situations as well as from calls to the rapid response team. Nurses were given the opportunity to practice assessment, critical thinking, and communication skills. Pre- and post-project surveys were used to assess nurses' perceived level of confidence and skill in handling emergency situations. Post-project survey data showed that nurses perceived that the scenario exercises improved their confidence and skill in managing critical patient situations. In addition, the findings supported the continued use of the scenarios as a teaching strategy. The scenarios have increased nurses' awareness of early signs of patients' conditions deteriorating and have the potential to decrease the number of patient situations that escalate to emergencies.
Wilkes, Lesley; Cert, Renal; Beale, Barbara
This study aimed to judge the appropriateness of a particular nurse researcher's actions in a vignette from the clinical field, and to explore frameworks used to determine the appropriateness of actions. Twelve experienced nurse researchers were interviewed by telephone. They were given four vignettes of actual research situations and asked to comment and explain their judgement on the appropriateness of the nurse researcher's actions. The findings confirmed blurring of boundaries between professional and research roles for nurses. Nurses appear to use a mixture of frameworks, including scientific/rigour method, ethics, nursing competencies and their own personal-moral values. Frameworks need to be discussed and debated so that neophyte researchers are well-prepared before they enter the field to conduct research.
Welbourn, Richard; Dixon, John; Barth, Julian H; Finer, Nicholas; Hughes, Carly A; le Roux, Carel W; Wass, John
Despite increasing prevalence of obesity, no country has successfully implemented comprehensive pathways to provide advice to all the severely obese patients that seek treatment. We aimed to formulate pathways for referral into and out of weight assessment and management clinics (WAMCs) that include internal medicine/primary care physicians as part of a multidisciplinary team that could provide specialist advice and interventions, including referral for bariatric surgery. Using a National Institute of Health and Care Excellence (NICE)-accredited process, a Guidance Development Group conducted a literature search identifying existing WAMCs. As very few examples of effective structures and clinical pathways existed, the current evidence base for optimal assessment and management of bariatric surgery patients was used to reach a consensus. The model we describe could be adopted internationally by health services to manage severely obese patients.
Adeniran, Rita Kudirat; Bhattacharya, Anand; Adeniran, Anthony A
Increasingly, stakeholders in the health care community are recognizing nursing as key to solving the nation's health care issues. This acknowledgment provides a unique opportunity for nursing to demonstrate leadership by developing clinical nurse leaders to collaborate with the multidisciplinary care team in driving evidence-based, safe quality, cost-effective health care services. One approach for nursing success is standardizing the entry-level education for nurses and developing a uniform professional development and career advancement trajectory with appropriate incentives to encourage participation. A framework to guide and provide scientific evidence of how frontline nurses can be engaged will be paramount. The model for professional excellence and career advancement provides a framework that offers a clear path for researchers to examine variables influencing nurses' professional development and career advancement in a systematic manner. Professional Excellence and Career Advancement in Nursing underscores professional preparedness of a registered nurse as central to leadership development. It also describes the elements that influence nurses' participation in professional development and career advancement under 4 main categories emphasizing mentorship and self-efficacy as essential variables.
Baldwin, William F.
Fifty nursing mothers were given regular doses of a senna compound (Senokot Granules) and 50 received mineral oil or magnesia (Magnolax) to determine whether senna was an effective laxative and whether senna affected the bowel habits of infants of nursing mothers. Senna laxative was effective in 49 of 50 mothers. Infant bowel habits were not affected by senna administration to nursing mothers. The evidence suggests that the active principles of senna if they are transmitted in breast milk have no effect on the evacuation patterns of nursed infants. PMID:14045350
DEHGHANI, MOHAMMADREZA; GHANAVATI, SHIRIN; SOLTANi, BEHROUZ; AGHAKHANI, NADER; HAGHPANAH, SEZANEH
Introduction Obtaining clinical competency in clinical education is one of the problems in nursing and use of the new methods of clinical training is very important. Clinical supervision is one of the methods used as a mechanism to promote knowledge and skill for promoting professional performance in nursing students. This study is carried out to determine the impact of clinical supervision on field training of nursing students at Urmia University of Medical Sciences. Methods In the present experimental study, 32 nursing students were enrolled in the study based on census and randomly assigned into two groups of experimental and control by block randomization. Clinical supervision was used in the experimental group and the control group received routine clinical trainings in the field. The students’ clinical skills were assessed using a researcher-made checklist, the validity of which was confirmed through content validity method by 13 faculty members and its reliability was approved by test-retest method on 20 nursing students in the form of a pilot study and through Cronbach’s alpha (87%). Data were analyzed using SPSS, version 14. Results There was a significant difference between the experimental and control groups in clinical skills such as recognition and administration of medication, team participation, patients and their relatives’ education, considering the safety, infection prevention and nursing process (p<0.005). Conclusion The study demonstrated that in clinical supervision process, students have a better communication and cooperation with their instructor and with each other and their confidence and understanding and the amount of learning in practical skills was enhanced more than routine clinical training. The implementation of this clinical training method for students of nursing and other fields of medical sciences is recommendable. PMID:27104203
Rizos, Demetrios; Karababa, Photini; Sarandakou, Angeliki; Panagiotakis, Othon; Haliassos, Alexander; Makris, Konstantinos; Psarra, Katerina; Bairaktari, Eleni; Spyropoulou, Panagiota; Nikolou, Chara; Galiatsatos, Nikolaos; Trakas, Nikolaos; Ferderigou, Angeliki; Seferiadis, Konstantin
In Greece, there is no officially organized training in clinical chemistry for scientists. The Greek Society of Clinical Chemistry-Clinical Biochemistry decided to organize an intensive educational program of 18 seminars on clinical chemistry content as it is described in the EC4 Syllabus. The duration of each seminar was about 6 hours and consisted of 6 to 9 lectures. At the end of each seminar there was a voluntary written examination, comprised of 24 multiple choice questions. Successful completion of the Educational program was leading to a Certificate of Competence. Two cycles of the 18 seminars were performed: 1st cycle from October 2003 to December 2005 and 2nd cycle from March 2005 to October 2007. One hundred eighty nine colleagues was the mean attendance per seminar for the seminars of the 1st cycle and 38 colleagues for the seminars of the 2nd cycle. The mean participation to the examination for each seminar was almost 80% for the 1st cycle and 68% for the 2nd cycle. More than 80% of the participants performed Good or Very good in the examination in both cycles. It is estimated that more than 40% of the scientists who practice Clinical Chemistry in Greece, participated to this educational activity. This program is now provided as an e-learning application, and it is open for all scientists who want to follow the discipline of clinical chemistry.
Baraz, Shahram; Memarian, Robabeh; Vanaki, Zohreh
Background: Clinical learning environment is a complex social entity. This environment is effective on the learning process of nursing students in the clinical area. However, learning in clinical environment has several benefits, but it can be challenging, unpredictable, stressful, and constantly changing. In attention to clinical experiences and factors contributing to the learning of these experiences can waste a great deal of time and energy, impose heavy financial burden on educational systems, cause mental, familial and educational problems for students, and compromise the quality of patient care. Therefore, this study was carried out with the goal of determining the learning challenges of nursing students in clinical environments in Iran. Materials and Methods: In this qualitative study carried out in 2012–2013, 18 undergraduate nursing students were selected by using purposive sampling method from the Faculty of Nursing and Midwifery of Tehran and Shahid Beheshti Universities. Semi-structured interviews were used to collect data. The content analysis method was used to determine relevant themes. Results: Two themes were derived from the data analysis, which represented the students’ clinical learning challenges. These two themes included insufficient qualification of nursing instructors and unsupportive learning environment. Conclusions: Identification of the students’ clinical learning challenges and actions to remove or modify them will create more learning opportunities for the students, improve the achievement of educational goals, provide training to nursing students with the needed competencies to meet the complex demands of caring and for application of theories in practice, and improve the quality of healthcare services. PMID:26430679
Jamshidi, Nahid; Molazem, Zahra; Sharif, Farkhondeh; Torabizadeh, Camellia; Najafi Kalyani, Majid
Background/Aim. Clinical learning is a main part of nursing education. Students' exposure to clinical learning environment is one of the most important factors affecting the teaching-learning process in clinical settings. Identifying challenges of nursing students in the clinical learning environment could improve training and enhance the quality of its planning and promotion of the students. We aimed to explore Iranian nursing students' challenges in the clinical learning environment. Materials and Methods. This is a qualitative study using the content analysis approach. The participants consisted of seventeen nursing students and three nursing instructors. The participants were selected through purposive sampling method and attended semistructured interviews and focus groups. Results. Three themes emerged after data analysis, including ineffective communications, inadequate readiness, and emotional reactions. Conclusion. Nursing students in Iran are faced with many challenges in the clinical learning environment. All challenges identified in this study affected the students' learning in clinical setting. Therefore, we recommend that the instructors prepare students with a specific focus on their communication and psychological needs. PMID:27366787
Cowley, Thomas; Sumskis, Sue; Moxham, Lorna; Taylor, Ellie; Brighton, Renee; Patterson, Chris; Halcomb, Elizabeth
In the present study, we evaluate the impact of participation in a mental health recovery camp on the clinical confidence of undergraduate nursing students in dealing with individuals with mental illness. Twenty undergraduate nursing students who participated in the recovery camp completed the Mental Health Nursing Clinical Confidence Scale both before and directly after attending the camp. Data were analysed using descriptive and inferential statistics. Participation in the recovery camp was associated with a statistically-significant increase in students' level of overall confidence between the pretest and post-test data (P < 0.005). The results also demonstrated that students over the age of 25 years and who do not have a family history of mental illness are more likely to self-report a higher level of confidence in both the pre- and post-results. The clinical confidence of undergraduate nursing students improved through participation in an immersive clinical experience within the recovery camp.
Vizoso, Hector; Lyskawa, Meg; Couey, Paul
The National Institutes of Health have developed a new organizational consortium through a funding mechanism called the Clinical and Translational Science Award. This program funds academic institutions to create a platform for research that expedites the development and delivery of new treatments through open interdisciplinary collaboration. As a result, the adult clinical research center at San Francisco General Hospital is now part of the Clinical and Translational Science Institute at the University of California San Francisco. Nurses on this research unit have begun to employ a standardized nursing care plan that focuses on the particular needs of the research participant, an advancement that if implemented nationwide among all adult clinical research centers will be of paramount importance in fostering a collaborative relationship within the new organizational structure. This standardized nursing care plan will provide research nurses with a tool that will enable them to provide safe and quality patient care.
Yang, Yu; Hu, Xinhua; Zhang, Qiang; Cao, Hui; Li, Jun; Wang, Junpeng; Shao, Yang; Xin, Shijie
The aim of this study was to assess the effect of the use of a clinical nursing pathway for patients undergoing endoscopic thyroidectomy by conducting a meta-analysis. Electronic databases were searched for relevant controlled trials published prior to August 2013. Only papers that compared the use of a clinical nursing pathway to usual care for patients undergoing endoscopic thyroidectomy were selected. The outcome measures were mean difference and 95% confidence interval for length of hospital stay and hospital charges and risk ratio for patient satisfaction. Six controlled trials were identified. The use of a clinical nursing pathway reduced the length of hospital stay and hospital charges. Furthermore, it improved patient satisfaction. This meta-analysis indicates that application of a clinical nursing pathway appears to reduce length of hospital stay and hospital charges and improve patient satisfaction for patients undergoing endoscopic thyroidectomy.
Webb, Sherry; McKeon, Leslie
Model C clinical nurse leader (CNL) programs are complex because they must meet the The Essentials of Baccalaureate Education for Professional Nursing Practice and The Essentials of Master's Education in Nursing, as well as the graduate level competencies outlined in the white paper Competencies and Curricular Expectations for Clinical Nurse Leader Education and Practice. Faculty assigned to teach in these programs may be experts in education or areas of clinical specialty, but they may not have a clear understanding of the CNL role to teach and mentor CNL students. This article describes a faculty development model that includes an introduction to the CNL role, course mapping of the essentials, integration of CNL professional values into clinical evaluation, consultation with practicing model C graduates, and participation in a comprehensive CNL certification review course. The model was effective in preparing faculty to teach and mentor students in a model C CNL program.
Grealish, Laurie; Ranse, Kristen
This study explored how first year undergraduate nursing students learn in clinical placements as part of a program informed by Wenger's (1998) social theory of learning. Forty-nine written student narrative accounts of a learning experience were analysed and three triggers for learning were identified. The first trigger is that participation (or observation) of a task or procedure leads students into a complex, dramatic reading of nursing work. The second is that when students are personally (emotionally) confronted by the work, it presents a high challenge situation, recognized by students as a significant learning opportunity. The third trigger is encounters with different nurses assist students to construct an image of what they want to be as a nurse. These three triggers appear to align with Wenger's Communities of Practice constructs for identity, engagement, imagination, and alignment, and provides preliminary evidence supportive of the social theory of learning for nursing students on clinical placement.
Heslop, Liza; Gardner, Brendon; Diers, Donna; Poh, Boon Choo
Nurses generate large quantities of data at different operational levels in a health service organization. Administrative managerial data include the number of nursing hours per patient day and cost data related to nursing services while clinical data include the documentation of direct patient care only. In this paper, we explain standard clinical data elements in the HIS (Hospital Information System). The construction of the data is traced from patients' medical records to coding procedures within ICD (International Classification of Disease) classification and DRG (Diagnostic Related Groups) of casemix. Examples are given from Australian data and definitions, but much of the same information can be found in hospital information systems throughout the world. Practical applications that demonstrate how patient data can be used for research and management purposes in nursing are given. Finally, future directions and issues related to the use of datasets for nursing research are explored.
Hubbard, Grace B
The average length of stay on psychiatric inpatient units has decreased in the past 40 years from 24.9 to 7.2 days. Inpatient psychiatric nurses are challenged to meet the standards and scope of practice despite the changing circumstances of their work environment. The amount of time student nurses spend with a given patient has been affected by changes in acute psychiatric inpatient care and decreased length of stay; however, opportunities exist for effective termination of the nurse-client relationship. Facilitation of students' awareness and understanding of the dynamics inherent in the termination process is an important teaching task for psychiatric nursing clinical instructors. In the current article, a clinically focused learning activity using structured prompts to guide and promote psychiatric nursing students' experiences with the process of termination is described and teaching strategies are discussed.
Gillette, V A
The perioperative nursing role has evolved from that of task-oriented specialists to patient-centered professionals. The concept of caring is significant to perioperative nurses and is manifested by the many caring behaviors perioperative nurses demonstrate toward surgical patients. This article describes how the element of caring is an essential function of perioperative nursing and relates the perioperative nursing role to the work of three nursing theorists (le, Florence Nightingale; Virginia Henderson, RN, AM; Carol L. Montgomery, RN, PhD).
Palmer, Sheri P; Cox, Amy Harmer; Callister, Lynn Clark; Johnsen, Vickie; Matsumura, Geraldine
This article focuses on innovative collaborative steps that were identified in recent research conducted by these authors on the relationship between academia and service. These steps are currently being implemented in the hope of improving the important role that the clinical environment plays in student nurses' education. Few factors in nursing education are as important as the clinical environment in which students do their training. This article elaborates on these steps and offers practical suggestions for improving the relationship between academia and service.
Briggs, Michelle; Closs, S José; Marczewski, Kath; Barratt, Joanne
Chronic pain is common and management hampered by lack of resources in primary and secondary care. Nurse- or pharmacist-led clinics have been shown to lead to improvements in care for patients with chronic pain. This study showed that a combined nurse/pharmacist-led clinic for managing chronic pain in primary care can lead to improvements in management of pain, reduction in use of secondary care resources and high rates of satisfaction.
Rhodes, Mattie L; Curran, Cynthia
Nurse educators are finding it increasingly more challenging to prepare undergraduate students for the ever-changing and more acute clinical environment. As an answer to this dilemma, the human patient simulator can provide students with the opportunity to enhance knowledge, to facilitate skill acquisition, to decrease anxiety, and to promote clinical judgment in a safe environment. These experiences assist the novice nursing student to progress to the advanced beginner stage of practice. This article describes how faculty used the human patient simulator in creating a case scenario that enhanced critical thinking in senior nursing students.
de Vargas, Divane
The purpose of this exploratory study was to discover nurses' attitudes towards the perceptions of personal characteristics of alcoholics. Nurses' attitudes were measuared using the Seaman-Manello Scale, the sample consisted of 171 nurses who work in a university general hospital located in the State of São Paulo, Brazil. The results evidenced that more than half of the sample (52.4%) had a professional experience with alcoholics. Nurses see the alcoholic patients as unhappy, lonely, sensitive people, who doubt their own value and have serious emotional problems. It is concluded that nurses' attitudes toward personal characteristics of alcoholic patients tend to be positive and suggests greater attention to professional training in recognition and approach of the alcoholic in general hospitals.
Joolaee, Soodabeh; Ashghali Farahani, Mansoureh; Jafarian Amiri, Seyedeh Roghayeh; Varaei, Shokoh
Background Although support is one of the most substantial needs of nursing students during clinical education, it is not clearly defined in the literature. Objectives The current study aimed to explore the concept of support in clinical settings as perceived by nursing students. Materials and Methods A qualitative content analysis was used to explore the meaning of student support in clinical settings. A purposive sampling with maximum variation was used to select the participants among bachelor nursing students in the nursing school of Babol University of Medical Sciences in the north of Iran. Semi-structured interviews were conducted to gather the perceptions and experiences of seventeen nursing students. Conventional content analysis was applied to analyze the data. Results In the current study, the main theme, nurturance, was emerged with seven subthemes of humanistic behavior with the student, respectful communication with students, accepting the student in the clinical setting, sustaining confidence, need based supervision, accepting the profession in the society and empowerment. Conclusions Nursing students support in the clinical education requires a nurturing care; a care that leads to the sense of worthiness and respectability in students and contributes to the improvement of their clinical abilities. PMID:27331057
Yang, Hui-Ling; Kao, Yu-Hsiu; Huang, Yi-Ching
This paper explored the present status of self-efficacy and job involvement of clinical nursing teachers and investigated the predictive power of teachers' personal background variables on such, as well as the relationship between self-efficacy and job involvement. A total of 419 participants in the survey sample were chosen among clinical nursing teachers at 19 public and private institutes of technology and junior colleges in Taiwan in 2004. The self-developed structural questionnaire was categorized into three sections, including personal background data, job self-efficacy related to the clinical teaching inventory and job involvement related to clinical teaching inventory. Of the total 419 questionnaires distributed for this cross-sectional survey, 266 valid copies were registered, at a recovery rate of 63%. Findings indicated that both the job self-efficacy and job involvement of clinical nursing teachers are at a medium to high level and that significant differences exist in job self-efficacy and job involvement based on differences in age, marital status, teaching seniority, teacher qualifications, and job satisfaction. Second, samples have significantly different performance in self-efficacy due to differences in education level attained and the medical institution to which nursing teachers had been assigned. Self-efficacy and job involvement are significantly positively correlated. These results can serve as a reference for the cultivation of nursing teachers and reform of clinical nursing education in the future.
Patterson, Christopher; Moxham, Lorna; Taylor, Ellie K; Perlman, Dana; Brighton, Renee; Sumskis, Susan; Heffernan, Tim; Lee-Bates, Benjamin
Preregistration education needs to ensure that student nurses are properly trained with the required skills and knowledge, and have the confidence to work with people who have a mental illness. With increased attention on non-traditional mental health clinical placements, further research is required to determine the effects of non-traditional mental health clinical placements on mental health clinical confidence. The aim of the present study was to investigate the impact of a non-traditional mental health clinical placement on mental health nursing clinical confidence compared to nursing students undergoing traditional clinical placements. Using the Mental Health Nursing Clinical Confidence Scale, the study investigated the relative effects of two placement programmes on the mental health clinical confidence of 79 nursing students. The two placement programmes included a non-traditional clinical placement of Recovery Camp and a comparison group that attended traditional clinical placements. Overall, the results indicated that, for both groups, mental health placement had a significant effect on improving mean mental health clinical confidence, both immediately upon conclusion of placement and at the 3-month follow up. Students who attended Recovery Camp reported a significant positive difference, compared to the comparison group, for ratings related to communicating effectively with clients with a mental illness, having a basic knowledge of antipsychotic medications and their side-effects, and providing client education regarding the effects and side-effects of medications. The findings suggest that a unique clinical placement, such as Recovery Camp, can improve and maintain facets of mental health clinical confidence for students of nursing.
Laschinger, H K
Kolb's Learning Style Inventory and Environmental Press Questionnaire were used to study 68 third-year baccalaureate nursing students' learning styles and perceptions of environmental press differences in medical-surgical and psychiatric nursing settings from the experiential learning theory perspective. Evidence for a hypothesized match between predominating student learning styles and predominating environmental press was sought. As hypothesized, student learning styles were found to be predominantly concrete as was the predominating environmental press in both nursing settings. Medical-surgical and psychiatric nursing settings did not differ significantly from environmental press. A profile of competencies felt to be important in nursing emerged with concrete people-oriented competencies rating higher than abstract competencies.
Burnett, Camille; Bullock, Linda; Collins, Cathleen A; Hauser, Lindsay
Residents of Southwest Virginia (SWVA) face significant barriers in accessing the most advanced forms of cancer care, cancer risk reduction, and clinical trials involvement. A collaboration between the University of Virginia (UVA) Cancer Center and UVA School of Nursing was forged with oncology caregivers in this region to build community capacity to support Cancer Clinical trials (CCT) by strengthening the workforce, and thus improving health outcomes for this underserved region of Appalachia. The UVA School of Nursing designed an educational workshop focusing on the basics of CCT to facilitate the development of a skilled nursing workforce in the SWVA region that could provide care to patients on protocol and/or to encourage residents to participate in trials. The goal of the workshop was to offer a CCT training session for oncology nurses that fostered the knowledge and skills necessary to facilitate and support CCT infrastructure across this high-risk region. This evaluation reports the learning outcomes of the CCT training on 32 nurse participants from SWVA. Evaluations of the training program showed high rates of satisfaction, increased comfort level with CCTs, and increased knowledge and attitude toward CCTs. These findings provide information about a curriculum that could be useful in educating other oncology nurses and student nurses how to care for patients who may be enrolled in a clinical trial. Nurses can also be advocates for participation in clinical trials once they have the knowledge and are comfortable in their own understanding of a trial's usefulness. Educating the nursing workforce is an essential component of building capacity and infrastructure to support clinical trials research.
Hall, Mellisa A; Daly, Barbara J; Madigan, Elizabeth A
Although the use of anecdotal notes by faculty to document clinical performance is thought to be a common practice, no empirical study of this evaluation tool has been conducted. To investigate the frequency and pattern of use, a faculty questionnaire was developed using the Context, Input, Process, Product (CIPP) evaluation model as a framework. The model was adapted to focus on clinical nursing education. Sixty-four nursing faculty from six schools participated in the regional study. A descriptive design was used to collect quantitative data from clinical faculty. Findings indicated that 97% of clinical faculty use anecdotal notes during the student evaluation process, and the majority of faculty do so on a weekly basis. Based on faculty feedback and the CIPP evaluation model, a clinical nursing faculty tool was developed after study completion to support clinical faculty in note use.
The purpose of this study was to generate a substantive model that accounts for the explanatory social processes of communication in which nurses were engaged in clinical settings in Korea. Grounded theory methodology was used in this study. A total of 15 clinical nurses participated in the in-depth interviews. “Assimilating to the hierarchical culture” emerged as the basic social process of communication in which the participants engaged in their work environments. To adapt to the cultures of their assigned wards, the nurses learned to be silent and engaged in their assimilation into the established hierarchy. The process of assimilation consisted of three phases based on the major goals that nurses worked to achieve: getting to know about unspoken rules, persevering within the culture, and acting as senior nurse. Seven strategies and actions utilized to achieve the major tasks emerged as subcategories, including receiving strong disapproval, learning by observing, going silent, finding out what is acceptable, minimizing distress, taking advantages as senior nurse, and taking responsibilities as senior nurse. The findings identified how the pattern of communication in nursing organizations affected the way in which nurses were assimilated into organizational culture, from individual nurses’ perspectives. In order to improve the rigid working atmosphere and culture in nursing organizations and increase members’ satisfaction with work and quality of life, managers and staff nurses need training that focuses on effective communication and encouraging peer opinion-sharing within horizontal relationships. Moreover, organization-level support should be provided to create an environment that encourages free expression. PMID:27253389
Chan, M F
Nurses' knowledge, attitudes, and skills regarding the Clinical Management System are explored by identifying profiles of nurses working in Hong Kong. A total of 282 nurses from four hospitals completed a self-reported questionnaire during the period from December 2004 to May 2005. Two-step cluster analysis yielded two clusters. The first cluster (n = 159, 56.4%) was labeled "negative attitudes, less skillful, and average knowledge" group. The second cluster (n = 123, 43.6%) was labeled "positive attitudes, good knowledge, but less skillful." There was a positive correlation in cluster 1 for nurses' knowledge and attitudes (rs = 0.28) and in cluster 2 for nurses' skills and attitudes (rs = 0.25) toward computerization. The study showed that senior and more highly educated nurses generally held more positive attitudes to computerization, whereas the attitudes among younger and less well educated nurses generally were more negative. Such findings should be used to formulate strategies to encourage nurses to resolve actual problems following computer training and to increase the depth and breadth of nurses' computer knowledge and skills and improve their attitudes toward computerization.
Sampselle, Carolyn M; Knafl, Kathleen A; Jacob, Jacqueline Dunbar; McCloskey, Donna Jo
CTSAs are mandated to follow a multidisciplinary model. Requests for applications direct responsive applications to "integrate clinical and translational science across multiple departments, schools," listing disciplines in addition to medicine such as engineering, nursing, and public health. This inventory of nurse engagement in CTSAs describes the extent of nursing's CTSA engagement from the perspective of participating nurse scientists within individual CTSAs, including institutional/national contributions and best practices that foster a multidisciplinary model. Of the 50 CTSAs affiliated with a nursing school, 44 responded (88% response rate). Of the ten CTSAs not affiliated with a nursing school, four responded (40% response rate). Overall funding success rates of nurse applicants are: TL1 fellowships 81%, KL2 fellowships 54%, and nurse-led pilots 58%. At most CTSAs nursing is contributing to the accomplishment of the CTSA mandate. The strongest categories of contribution are community engagement, implementation science, and training. Best practices to enhance multidisciplinary collaboration are: (1) inclusion of multiple disciplines on key committees who meet regularly to guide individual core and overall CTSA strategic planning and implementation; (2) required multidisciplinary co-mentors (ideally from different schools within the CTSA) on training grants and as co-investigators on pilot projects; and (3) documentation of multidisciplinary activity in annual reports.
Duhamel, Fabie; Dupuis, France; Turcotte, Annie; Martinez, Anne-Marie; Goudreau, Johanne
To promote the integration of Family Systems Nursing (FSN) in clinical practice, we need to better understand how nurses overcome the challenges of FSN knowledge utilization. A qualitative exploratory study was conducted with 32 practicing female nurses from hospital and community settings who had received FSN intervention training and skill development based on the Illness Beliefs Model and the Calgary Family Assessment and Intervention Models. The participants were interviewed about how they utilized FSN knowledge in their nursing practice. From the data analysis, a FSN Knowledge Utilization Model emerged that involves three major components: (a) nurses' beliefs in FSN and in their FSN skills, (b) nurses' knowledge utilization strategies to address the challenges of FSN practice, and (c) FSN positive outcomes. The FSN Knowledge Utilization Model describes a circular, incremental, and iterative process used by nurses to integrate FSN in daily nursing practice. Findings point to a need for re-evaluation of educational and management strategies in clinical settings for advancing the practice of FSN.
Lee, Eun Joo; Lee, Mikyoung; Moorhead, Sue
Increased accountability requirements for the cost and quality of healthcare force nurses to clearly define and verify nursing's contributions to patient outcomes. This demand necessitates documentation of nursing care in a precise manner. An electronic nursing record system is considered a key element that enhances nurses' ability not only to record nursing care provided to patients but also to measure, report, and monitor quality and effectiveness. Home care is a growing field as nurses attempt to meet the demand for long-term care. The development of an electronic record system for home care nursing was the immediate focus of this study. We identified the nursing content required for home care nursing using standardized nursing languages and designed linkages among medical diagnoses, nursing diagnoses, nursing interventions, and nursing-sensitive outcomes within the system. Equipping an electronic nursing record system with nursing standards is particularly critical for enhancing nursing practice and for creating refined data to verify nursing effectiveness.
da Silva, Rafael Celestino; Ferreira, Márcia de Assunção; Apostolidis, Thémistoklis; Brandão, Marcos Antônio Gomes
Objective: to propose a conceptual framework for clinical nursing care in intensive care. Method: descriptive and qualitative field research, carried out with 21 nurses from an intensive care unit of a federal public hospital. We conducted semi-structured interviews and thematic and lexical content analysis, supported by Alceste software. Results: the characteristics of clinical intensive care emerge from the specialized knowledge of the interaction, the work context, types of patients and nurses characteristic of the intensive care and care frameworks. Conclusion: the conceptual framework of the clinic's intensive care articulates elements characteristic of the dynamics of this scenario: objective elements regarding technology and attention to equipment and subjective elements related to human interaction, specific of nursing care, countering criticism based on dehumanization. PMID:26487133
Naber, Jessica L; Hall, Joanne; Schadler, Craig Matthew
This study sought to identify characteristics of clinically situated critical thinking in nursing students' reflections, originally part of a study guided by Richard Paul's model of critical thinking. Nurses are expected to apply critical thinking in all practice situations to improve health outcomes, including patient safety and satisfaction. In a previous study, Paul's model of critical thinking was used to develop questions for reflective writing assignments. Within that study, 30 nursing students completed six open-ended narratives of nurse-patient clinical encounters during an 8-week period. Improvements were seen in critical thinking scores after the intervention. This article reports the qualitative analysis of the content of six open-ended narratives. Six overarching themes were identified and combined into a tentative conceptual model. Faculty's understanding of the characteristics of critical thinking in the context of clinical education will help them to teach and evaluate students' progress and competencies for future practice.
Isfahani, Sara Shahsavari; Hosseini, Mohammad Ali; Khoshknab, Masoud Fallahi; Peyrovi, Hamid; Khanke, Hamid Reza
Background: Creativity and innovation are key elements for organization improvement, particularly in nursing, and for finding alternatives for solving nurses’ occupational problems. Nurses’ creativity is affected by motivation. Although, there are many possible sources of motivation, the Iranian nurses’ creativity is seldom clarified, and the most important factors motivating nurses to be creative in clinical settings has rarely been addressed. Objectives: The aim of this study was to explore Iranian nurses’ experiences regarding the most important factors that motivate their creativity in clinical settings. Methods: This qualitative study was conducted using conventional content analysis approach. A purposive sample of sixteen nurses was recruited from two educational hospitals affiliated to Tehran and Jahrom Universities of Medical Sciences in Iran. Data were gathered through conducting face-to-face semi-structured interviews and were analyzed by qualitative content analysis approach. Findings: Five main themes emerged from the data analysis, including: (a) Intrinsic motivators, (b) Extrinsic motivators, (c) Achievement motivators, (d) Relational or altruistic motivators, and (e) Spiritual motivators. Conclusions: Study findings indicated that nurses are creative and innovative individuals. So nurse managers and health policy makers should consider creativity as an integral part of all health and clinical strategies and policies. They should support creative and innovative efforts of nurses and provide a climate in which nurses engage in more creative and productive behaviors. PMID:26156918
Abay, Ece Şükriye; Turan, Sevgi; Odabaşı, Orhan; Elçin, Melih
Phenomenon: Clinical skills centers allow structured training of undergraduate medical students for the acquisition of clinical skills in a simulated environment. Physician, nurse, or peer tutors are employed for training in those centers. All tutors should have appropriate training about the methodology used in the clinical skills training. Many of the studies revealed the effectiveness of various types of tutors. The aim of our study was to evaluate medical students' satisfaction with clinical skills training, and their opinions about the differences in coaching skills among the physician, nurse, and peer tutors.
Baxter, Pamela E; Boblin, Sheryl L
Unethical behavior in both classroom and clinical settings is a concern for nurse educators and has the potential to greatly influence the quality of patient care. A review of the literature suggests that students may view unethical clinical behaviors as different from unethical classroom behaviors because they recognize that clinical behaviors may have a direct effect on patient care. An overview of three moral theories, proposed by Kohlberg, Gilligan, and Rest, provides insight into the reasons for unethical behavior. These theories provide the foundation for strategies nurse educators can use to help reduce unethical behavior in both classroom and clinical settings in an attempt to ensure quality patient care.
Jelly, Prasuna; Sharma, Rakesh
Introduction: Nurses are trained with specific clinical skills, and objective structured clinical examination (OSCE) could be a better approach to assess clinical skills of nursing students. Materials and Methods: A comparative study was conducted by observational checklist regarding antenatal care and opinionnaire on the usefulness of OSCE and tradition evaluation method (TEM) was used to assess the clinical skills and to get opinion. Results: The mean score of OSCE was more than TEM and the difference was statistically significant (P < 0.001). The opinion of students regarding the usefulness of OSCE was higher than TEM. Conclusions: The study concluded that implementing OSCE will overweigh the advantages of the TEM.
Mirlashari, Jila; Qommi, Robabeh; Nariman, Shahin; Bahrani, Nasser; Begjani, Jamaloddin
Introduction: Clinical competence of nurses working in the neonatal intensive care units together with advancements in medical science and technology increased the survival rate of newborns that need specialized care. To ensure the quality of care and provide the safety of patients, evaluating the clinical competence of nurses seems necessary. This study aimed to evaluate the clinical competence of nurses in the neonatal intensive care units. Methods: In this cross-sectional study, 117 nurses working in the neonatal intensive care units of the hospitals affiliated to Tehran University of Medical Sciences were selected by census method. The research tool was Development of Competency Inventory for Registered Nurses questionnaire which completed by self-assessment. The mean clinical competence scores of participants categorized into 3 levels: weak: <225, moderate: 225-273 and good: >273. Data were analyzed by SPSS version 13 using the Pearson correlation coefficient, t-test and Chi-square test. Results: The highest levels of competence were related to critical thinking and research attitude and interpersonal relationships, and the lowest level was related to training and mentoring. There was a direct statistically significant relationship between marital status, employment status, level of interest in working in the neonatal intensive-care units and the clinical competence of nurses. Conclusion: Since the clinical competence of nurses in the Neonatal Intensive Care Units is vital, some variables such as interest in the nursing profession, employment status, the neonatal intensive theoretical and practical training courses and the amount of overtime working hours should be taken into consideration. PMID:28032076
Ruth-Sahd, Lisa A; Schneider, Melissa A; Strouse, Abigail
This article focuses on the advancement of nursing education and practice through implementing "low-tech" simulation in a fundamentals nursing course to foster an awareness of scope of practice and interdisciplinary teamwork and collaboration to prepare student nurses for their critical care clinical experience. The integration of low-tech simulation during the students' first clinical course at 2 different times during the semester was utilized to accomplish this awareness. This article was added to the scant published articles that highlight the benefits of low-tech simulation in a fundamentals of nursing course.
Spath, M; Buttlar, L
The majority of nurses surveyed used the library on a regular but limited basis to obtain information needed in caring for or making decisions about their patients. A minority indicated that the libraries in their own institutions totally met their information needs. In fact, only 4% depended on the library to stay abreast of new information and developments in the field. Many of the nurses had their own journal subscriptions, which could account in part for the limited use of libraries and the popularity of the professional journal as the key information source. This finding correlates with the research of Binger and Huntsman, who found that 95% of staff development educators relied on professional journal literature to keep up with current information in the field, and only 45% regularly monitored indexing-and-abstracting services. The present study also revealed that nurses seek information from colleagues more than from any other source, supporting the findings of Corcoran-Perry and Graves. Further research is necessary to clarify why nurses use libraries on a limited basis. It appears, as Bunyan and Lutz contend, that a more aggressive approach to marketing the library to nurses is needed. Further research should include an assessment of how the library can meet the information needs of nurses for both research and patient care. Options to be considered include offering library orientation sessions for new staff nurses, providing current-awareness services by circulating photocopied table-of-contents pages, sending out reviews of new monographs, inviting nurses to submit search requests on a topic, scheduling seminars and workshops that teach CD-ROM and online search strategies, and providing information about electronic databases covering topics related to nursing. Information on databases may be particularly important in light of the present study's finding that databases available in CD-ROM format are consulted very little. Nursing education programs should
Collins, Shawn; Callahan, Margaret Faut
The ability to integrate theory with practice is integral to a student's success. A common reason for attrition from a nurse anesthesia program is clinical issues. To document clinical competence, students are evaluated using various tools. For use of a clinical evaluation tool as possible evidence for a student's dismissal, an important psychometric property to ensure is instrument validity. Clinical evaluation instruments of nurse anesthesia programs are not standardized among programs, which suggests a lack of instrument validity. The lack of established validity of the instruments used to evaluate students' clinical progress brings into question their ability to detect a student who is truly in jeopardy of attrition. Given this possibility, clinical instrument validity warrants research to be fair to students and improve attrition rates based on valid data. This ex post facto study evaluated a 17-item clinical instrument tool to demonstrate the need for validity of clinical evaluation tools. It also compared clinical scores with scores on the National Certification Examination.
Irvine, D; Sidani, S; Hall, L M
Fiscal constraints have heightened attention to health care costs and patient outcomes as measures of health care system effectiveness. Determining which patient and costs outcomes nurses may be held accountable for requires differentiating the impact of dependent, independent and interdependent nursing activities. A nursing role effectiveness model that includes a number of structural variables is offered to help track quality improvement and research activities. Some of the nurse-sensitive patient outcomes that have been identified include: freedom from complications, clinical outcomes, functional health outcomes, knowledge outcomes, perceived health benefit (or satisfaction), and costs outcomes. This model can be used to evaluate the effectiveness of current as well as evolving nurse roles, processes, and structural changes.
Jeddi, Fatemeh Rangraz; Hajbaghery, Mohsen Adib; Akbari, Hossein; Esmaili, Soheila
Introduction A successful implementation of an information system is impossible without sufficient knowledge of available technical resources of an institute. The aim of this study was to determine technical feasibility of a nursing clinical information system (NCIS) in Mazandaran province, Iran, 2015. Methods This cross-sectional study was conducted in three steps. In the first step, a data gathering tool was developed through an unsystematic literature review. In the second step, a questionnaire was developed and validity of the tool was confirmed by receiving opinions of faculty members and calculating indices of Content Validity Index (CVI) and Content Validity Ratio (CVR). The questionnaire reliability was confirmed by calculating Cronbach’s alpha coefficient (α= 0.72). In the third step, the feasibility of implementation of NCIS was evaluated by forming a panel of IT experts (n= 30), and through a questionnaire. Data were collected by 5-point Likert scale, very low to very high (scoring 1–5). Scores of each item were calculated and score percentage was determined. Chi-square and Fisher Exact tests were used. Results Maximum possibility of implementing NCIS were in the hardware area, additional equipment (92.6%), in the area of software, financial software (99.4%), in the area of network equipment, the possibility of integration with other internal systems, (92.6%) and in the area of network security, the possibility of backup version for security purposes (97.4%). Type of employment was statistically significant according to IT experts’ opinions (p= 0.014) Conclusion Hardware and software infrastructures for implementation of NCIS were desirable. The provision of more portable computers, advanced equipment such as barcode scanner, Radio-frequency identification (RFID), some approaches for increase accessibility of the system and essential databases from other resources and also increase of network lines’ speed are necessary. PMID:27790348
Girdley, Diana; Johnsen, Christine; Kwekkeboom, Kristine
Although delivery of safe, patient-centered care has long been a priority among nursing educators, nursing students may not be able to adequately translate concepts learned within the classroom into nursing practice. Nurse educators must develop teaching strategies to provide nursing students with the knowledge, skills, and attitudes necessary to provide quality patient care. Within the Quality and Safety Education for Nurses project, a set of key nursing competencies was established. This article describes the development and use of a clinical assessment tool in undergraduate clinical nursing courses to enhance mastery of two of these key nursing competencies: safety and patient-centered care.
Aberese-Ako, Matilda; Agyepong, Irene Akua; Gerrits, Trudie; Van Dijk, Han
Background and Objectives This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital. Methodology The study used ethnographic methods including participant observation, conversation and in-depth interviews over eleven months in a specialist referral hospital in Ghana. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings. Ethics Statement Ethical clearance was obtained from the Ghana Health Service Ethics Review board (approval number GHS-ERC:06/01/12) and from the University of Wageningen. Written consent was obtained from interview participants, while verbal consent was obtained for conversations. To protect the identity of the hospital and research participants pseudonyms are used in the article and the part of Ghana in which the study was conducted is not mentioned. Results Individual characteristics, interpersonal and organisational factors contributed to conflicts. Unequal power relations and distrust relations among doctors and nurse-anaesthetists affected how they responded to conflicts. Responses to conflicts including forcing, avoiding, accommodating and compromising contributed to persistent conflicts, which frustrated and demotivated doctors and nurse-anaesthetists. Demotivated workers exhibited poor attitudes in collaborating with co-workers in the provision of maternal and neonatal care, which sometimes led to poor health worker response to client care, consequently compromising the hospital's goal of providing quality health care to clients. Conclusion To improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur. Effective mechanisms including training managers
Chiu, Fang-Hui; Gau, Meei-Ling; Kuo, Sue-Chen; Chung, Ue-Lin
The purpose of this study was to investigate the problems commonly seen in the clinical breastfeeding practice of undergraduate nursing students. The criterion for clinical performance examination was the instructional ability index for breastfeeding determined from the competency-based clinical performance examination in maternity nursing, a model developed by Chung et al. (2001). Simple random sampling was used to access 60 participants from the 213 baccalaureate students from the second year of a nursing department who had completed obstetric nursing education. The average age of the subjects was 20.73 years. Most subjects did not have experience either in breastfeeding or in instructing others about breastfeeding. The pass rate in the clinical examination was 26.67 % (n=16), and the difference was only in obstetrics nursing practicum scores and days of practice between pass and fail, with no significant difference in demographic data. The most common mistakes found during breastfeeding instruction by students included distinguishing the infant consciousness state fit for feeding, knowing when to stop feeding, identifying when the baby is hungry or satisfactied via behavioral cues, maternal posture (cradle and football holds, and side-lying), latching on techniques, assisting mother to correctly remove infant from the breast, and overriding test categories such as sepsis, interpersonal relationship, health teaching, physical jeopardy, and bonding. The results of this study can be used by instructors to improve their teaching design in breastfeeding education, as well as by undergraduate students of nursing departments to advance their ability to instruct others about breastfeeding.
Robertson-Malt, Suzi; Chapman, Ysanne; Ingram, Gillian
For more than a decade, evidence-based practice has become the desired aim behind organized health care. Although a plethora of reasons exist as to why clinicians are reluctant to adopt research-based findings, the fundamentals relate to management of change and the nature of the individuals involved. Large organizations, with their daily routines and operations, are inherently difficult to change. Hence, one has to use the very structures that drive the organization to effect 'sustained' change. In large tertiary care facilities, such as the King Faisal Specialist Hospital and Research Centre, these structures are policies and procedures. This paper provides details of the process developed by the Nursing Affairs Practice Committee of the King Faisal Specialist Hospital and Research Centre to achieve the committee mandate of: 'Establish and implement an evidence-based process for the systematic review and revision of nursing clinical standards, policies, procedures and protocols'.
Shepard, Leslee H.
Preceptorships are models of training in which a nurse, referred to as a preceptor, is assigned to one nursing student, for the purpose of facilitating learning in the clinical setting. There is a problem in the lack of documented evidence of the effectiveness of preceptorship programs in the education of nursing students, particularly the…
Cho, Ok Min; Lee, Young Whee; Cho, Insook
Objectives The purpose of this descriptive study was to investigate the current situation of clinical alarms in intensive care unit (ICU), nurses' recognition of and fatigue in relation to clinical alarms, and obstacles in alarm management. Methods Subjects were ICU nurses and devices from 48 critically ill patient cases. Data were collected through direct observation of alarm occurrence and questionnaires that were completed by the ICU nurses. The observation time unit was one hour block. One bed out of 56 ICU beds was randomly assigned to each observation time unit. Results Overall 2,184 clinical alarms were counted for 48 hours of observation, and 45.5 clinical alarms occurred per hour per subject. Of these, 1,394 alarms (63.8%) were categorized as false alarms. The alarm fatigue score was 24.3 ± 4.0 out of 35. The highest scoring item was "always get bothered due to clinical alarms". The highest scoring item in obstacles was "frequent false alarms, which lead to reduced attention or response to alarms". Conclusions Nurses reported that they felt some fatigue due to clinical alarms, and false alarms were also obstacles to proper management. An appropriate hospital policy should be developed to reduce false alarms and nurses' alarm fatigue. PMID:26893950
McLane, Sharon; Esquivel, Adol; Turley, James P
Nurses prepare a summary of patient information that they consult and update throughout the shift. This document is believed to be integral to cognition, working memory, and decision-making. While serving as a key support to nursing practice, this summary also represents risks to patient safety. Characterized as a PCCAT, or Personally Created Cognitive Artifact, studies of this document in the context of nursing practice have not been reported. The absence of reported research, the importance of the document to nurse cognition and practice, and related safety risks prompted the research that this paper discusses. A taxonomy was developed through the analysis and coding of 151 PCCATs. Further analysis and mapping provided an ontology of the PCCAT. Content differences were noted between nursing units and among nurses. This may reflect differences in unit-based culture and/or differences in the patient complexity. The interaction between culture and perceived complexity of practice is one of the great difficulties in generating automated information systems for clinical practice settings. This paper is part of a larger research protocol that explores meta-level knowledge structures and revision to the understanding of the granularity of nursing knowledge. Development of a taxonomy and ontology of the nurse PCCAT, an important component of the larger research protocol, is described in this paper.
Ammenwerth, E; Kutscha, U; Kutscha, A; Mahler, C; Eichstädter, R; Haux, R
Documentation of the nursing process is an important, but often neglected part of clinical documentation. Paper-based systems have been introduced to support nursing process documentation. Frequently, however, problems, such as low quality and high writing efforts, are reported. However, it is still unclear if computer-based documentation systems can reduce these problems. At the Heidelberg University Medical Center, computer-based nursing process documentation projects began in 1998. A computer-based nursing documentation system has now been successfully introduced on four wards of three different departments, supporting all six phases of the nursing process. The introduction of the new documentation system was accompanied by systematic evaluations of prerequisites and consequences. In this paper, we present preliminary results of this evaluation, focusing on prerequisites of computer-based nursing process documentation. We will discuss in detail the creation and use of predefined nursing care plans as one important prerequisite for computer-based nursing documentation. We will also focus on acceptance issues and on organizational and technical issues.
This study aimed to explore the effect of standardized teaching ward rounds in clinical nursing on preventing hospital-acquired infection. The experimental group comprised 120 nursing students from our hospital selected between June 2010 and June 2012. The control group consisted of 120 nursing students selected from May 2008 to May 2010. Traditional teaching ward rounds for nursing education were carried out with the control group, while a standardized teaching ward round was carried out with the experimental group. The comprehensive application of nursing abilities and skills, the mastering of situational infection knowledge, and patient satisfaction were compared between the two groups. The applied knowledge of nursing procedures and the pass rate on comprehensive skill tests were significantly higher in the experimental group than in the control group (P < 0.05). The rate of mastery of sterilization and hygiene procedures was also higher in the experimental group than in the control group (P < 0.05). The patient satisfaction rate with infection control procedures in the experimental group time period was 98.09%, which was significantly higher than patient satisfaction in the control group time period (93.05%, P < 0.05). Standardized teaching ward rounds for nursing education expanded the knowledge of the nursing staff in controlling hospital-acquired infection and enhanced the ability of comprehensive application and awareness of infection control procedures.
Prior, Patsy; Wilkinson, Jill; Neville, Stephen
The role of practice nurses is a specific feature of the modernisation agenda of the New Zealand health service. Increasing importance is being placed on service improvement through effective decision making and enhanced clinical performance. To contribute to the development of primary health care it is crucial that nurses have the skills to appropriately implement research based and other evidence in practice. This study involved 55 West Auckland practice nurses working in the general practice setting. The aim of the study was to describe nurses' perceptions of their use of evidence-based practice, attitudes toward evidence-based practice and perceptions of their knowledge/skills associated with evidence-based practice. An additional aim was to determine the effect of educational preparation on practice, attitudes and knowledge/skills toward evidence-based practice. A descriptive survey design was selected for this study. The results demonstrated that nurses' attitudes toward evidence-based practice, knowledge and skills relevant to the implementation of evidence-based practice and the educational preparation of the nurses were important factors influencing the effective utilisation and application of research results in practice. Educational interventions are identified as an integral aspect of implementing evidence-based practice and enhancing practice nurses' knowledge and skill relevant to the use of evidence in practice. Further research is needed to assess the contextual factors which can inhibit or promote achievement of evidence-based practice by practice nurses.
Currey, Judy; White, Kevin; Rolley, John; Oldland, Elizabeth; Driscoll, Andrea
Interventional cardiology practices have advanced immensely in the last two decades, but the educational preparation of the workforce in cardiac catheter laboratories has not seen commensurate changes. Although on-the-job training has sufficed in the past, recognition of this workforce as a specialty practice domain now demands specialist educational preparation. The aim of this paper is to present the development of an interventional cardiac nursing curriculum nested within a Master of Nursing Practice in Australia. International and national health educational principles, teaching and learning theories and professional frameworks and philosophies are foundational to the program designed for interventional cardiac specialist nurses. These broader health, educational and professional underpinnings will be described to illustrate their application to the program's theoretical and clinical components. Situating interventional cardiac nursing within a Master's degree program at University provides nurses with the opportunities to develop high level critical thinking and problem solving knowledge and skills.
Neher, Margit; Ståhl, Christian; Ellström, Per-Erik; Nilsen, Per
As rheumatology nursing develops and extends, knowledge about current use of knowledge in rheumatology nursing practice may guide discussions about future knowledge needs. To explore what perceptions rheumatology nurses have about their knowledge sources and about what knowledge they use in their practice, 12 nurses working in specialist rheumatology were interviewed using a semi-structured interview guide. The data were analyzed using conventional qualitative content analysis. The analysis yielded four types of knowledge sources in clinical practice: interaction with others in the workplace, contacts outside the workplace, written materials, and previous knowledge and experience. Colleagues, and physicians in particular, were important for informal learning in daily rheumatology practice. Evidence from the medical arena was accessed through medical specialists, while nursing research was used less. Facilitating informal learning and continuing formal education is proposed as a way toward a more evidence-based practice in extended roles.
Jones, Josette; Schilling, Katherine; Pesut, Daniel
The purpose of this study was to answer the following two questions: What are clinical nurses' rationales for their approaches to finding patient educational materials on the web? What are perceived barriers and benefits associated with the use of web-based information resources for patient education in the context of nursing clinical practice?Over 179 individual data units were analyzed to understand clinical nurses' rationales for their approaches to find patient educational materials on the web. Rationales were defined as those underlying catalysts or activators leading to an information need. Analyses found that the primary reasons why clinical nurses conducted web-based information searches included direct patient requests ( 9 requests), colleague requests (6 requests), building patient materials collections (4), patients' family requests (3), routine teaching (1), personal development (1), or staff development (1). From these data, four broad themes emerged: professional reasons, personal reasons, technology reasons, and organization reasons for selecting information resources. Content analysis identified 306 individual data units representing either 'benefits' (178 units) or 'barriers' (128) to the nurses' use of web resources for on-unit patient care. Inter-rater reliability was assessed and found to be excellent (r = 0.943 to 0.961). The primary themes that emerged as barriers to the used of web-based resources included: 1) time requirements to perform a search, 2) nurses' experience and knowledge about the resources or required technology, 3) specific characteristics of individuals electronic information resources, and 4) organizational procedures and policies. Three primary themes that represented the benefits of using web-based resources were also identified: 1) past experiences and knowledge of a specific resource or the required technologies, 2) availability and accessibility on the unit, and 3) specific characteristics of individual information tool