Credentialing in advanced practice nursing

The essential elements: calcium (Ca), magnesium (Mg), sodium (Na) potassium (K) and phosphorus (P) were analyzed in fresh asparagus to determine the effect of the ripening of the asparagus on the mineral content. Asparagus samples were classified in two groups by diameter (< 11 mm and > 14 mm). Asparagus from a sample group with the same diameter were divided into two portions (apical and basal) according to distance from the tip. The concentrations of calcium, magnesium and phosphorus increased with the ripening process of the asparagus while the content of sodium decreased when the white asparagus turned into a green ripening state. No significant differences were established for potassium. The green ripening state was the group with the greater concentration of calcium, magnesium and phosphorus. Statistically significant differences (p < 0.001) were observed between portions of asparagus (tip and rest of stem) in the contents of the five mineral elements analyzed. The levels of mineral elements investigated increased notably in the tip of the asparagus with the exception of sodium and potassium of which the levels in the apical portion decreased or hardly modified. The variance analyses determined statistically significant differences (p < 0.001) in the concentration of magnesium, sodium and phosphorus between asparagus diameters (< 11 and > 14 mm) and no significant differences (p > 0.05) were found for calcium and potassium. The mean element levels were (mg/kg dry weight): Ca = 324 +/- 1186; Mg = 1818 +/- 490; Na = 368 +/- 86; K = 37297 +/- 4167 and P = 6809 +/- 2481.     

Shadow consultation: A reflective approach for preventing practice disasters.

Shadow consultation is widely practiced in the field of organization development. However, the empirical, conceptual, and practice literature is scanty at best. This article provides a conceptual framework from which shadow consultation can be conducted and describes and discusses some typical goals, areas of expertise, the process of shadow sessions, methods that can be used, and some of the similarities and differences between shadow consultation and management and supervision. Two case studies are presented as a way of describing and illustrating the shadowing process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Striving for quality in advanced practice nursing education

The issue of establishing and maintaining high-quality advanced practice educational programs, practice competencies, and certification criteria is currently the focus of much debate and discussion within nursing. This article focuses on the issue of accreditation for advanced practice nursing educational programs in four areas: (1) history of accreditation in nursing education; (2) accreditation of educational programs for clinical nurse specialists, nurse midwives, and nurse anesthetists; (3) accreditation of programs for nurse practitioners; and (4) current and future educational issues and challenges. To participate in shaping the changes occurring in the current health delivery system, the nursing profession and advanced practice nursing educators must present a strong, visionary, and collaborative voice concerning quality educational programs.     

A collaborative program for advanced practice in trauma/critical care nursing

The students and faculty enrolled in the first TNP class have set a standard for future TNPs: a rigorous course of education with advanced practice and scholarship within an advanced practice collaborative model. Because of the increasingly number of trauma victims and the highly specialized care they require, nurses must come forward and provide quality care. The TNPs and their faculty must promote further recognition of the TNP role, become leaders in the field of acute care, and continue to develop and maintain collaborative relationship with physicians in support of advanced practice nursing in many areas of tertiary care. The first three graduates of the trauma/critical care practitioner class are now employed in advanced practice roles and are applying their education within trauma/critical care settings. Two of the students are trauma nurse practitioners in a community hospital, and one is a critical care nurse practitioner in a university hospital. Currently, there is an acute care nurse practitioner certification examination that is appropriate for nurses in the field of trauma/critical care. Co-sponsored by the AACN Certification Corporation and the American Nurses Credentialing Center, this examination is offered twice a year, in June and October. AACN is active in supporting and promoting the TNP role and, in conjunction with the American Nurses Association, has developed new standards of care and scope of practice to include this expanded role for the advanced practice nurse. The future for this exciting and demanding role looks bright for the advanced practice nurse interested in the care of the acutely ill patient. The time is right for this collaboration between nurses and physicians.     

Teaching pharmacology to advanced practice nursing students: issues and strategies

A pharmacology course should prepare the advanced practice nursing student to understand the cellular mechanisms of drug action and physiologic outcomes (pharmacodynamics); mechanisms of absorption, distribution, metabolism, and excretion of drugs (pharmacokinetics); and the clinical use of drugs in the diagnosis, prevention, and treatment of disease (pharmacotherapeutics). The goal of a pharmacology course for advance nursing practice is to provide practitioners with knowledge that provides a rational basis for pharmacologic management of patients with complex health problems. A pharmacology course should teach the student the principles of pharmacology along with the process of pharmacologic reasoning.     

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

The purpose of this study was to compare persons with antisocial personality disorder (ASP) with those who meet the adult criteria for ASP but fail to meet the criteria for childhood conduct disorder. Sociodemographic data, medical history, and psychiatric symptoms exhibited during a recent hospital admission were compared in the two groups by chart review. The two groups were virtually indistinguishable, except that patients without childhood conduct disorder were less likely to smoke or consume alcohol, were less likely to have spent time in a training school/boot camp as a child or adolescent, were less likely to have been admitted for a recent suicide attempt, and were less likely to have conned others. We conclude that persons meeting the adult criteria for ASP but not the childhood conduct disorder criteria essentially suffer the same disorder as those who meet full ASP criteria but are less severely affected.     

A data-driven approach to work redesign in nursing units

Our medical center leaders targeted a $30 million savings over 3 years. To achieve this goal a data driven work redesign approach was adopted and a series of time motion studies were performed. For each of 3 years, every hospital worker recorded and summarized their activity in blocks of time during 1 week. By 1995, nursing results were radically different from the previous 2 years. Bathing, turning patients, and gathering intake and output disappeared from the top 10 registered nurse (RN) activities, While professional judgement, patient education and data assessment entered the top 10. Initiatives involving skills mix and care delivery changes resulted in more focused and activity-appropriate use of RN time.     

Applying nursing theory to perioperative nursing practice

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).     

Changing practice to primary nursing

Primary nursing is now seen as popular method of delivering nursing care. The process of introducing this system requires prior planning, involving all members of nursing staff. A change in philosophy, culture and roles occurs with the introduction of primary nursing. Evaluation of this change is necessary, to determine if it is beneficial both to patients and the multidisciplinary team.     

Incorporating the service accomplishments into pre-registration curriculum to enhance reflective practice

Much emphasis is being placed on the importance of reflective practice as a means to ensure that practitioners are competent in their practice. It is therefore important to ensure that student nurses acquire these reflective skills as part of their development throughout pre-registration curricula. Although reflective practice is seen as a major part of curricula activity, the style in which reflection is advocated takes many different formats. Strategies for developing reflection which focus on outcomes for students can become subjective and fail to place healthcare practice within the context of social structures and values. This paper offers a framework for reflection that promotes an outlook which is both objective and subjective, based on Mezirow's six levels of reflection (as adapted by Powell 1989) and O'Brien's (1987) five service accomplishments. Focus of reflection within the wider context of society and healthcare policy should enable development of a practitioner who is both competent in practice and can analyse and evaluate their practice.     

The theory and practice of health education applied to nursing: a bi-polar approach

Because CD1-restricted T cells lack CD4 but produce IFN-gamma in response to nonpeptide mycobacterial antigens, they could play a unique role in immunity to tuberculosis. We studied CD1-restricted T cells in the context of HIV infection by expanding CD4(-) T cell lines from 10 HIV-infected patients. Upon stimulation with Mycobacterium tuberculosis antigen or upon exposure to macrophages infected with M. tuberculosis, these T cell lines proliferated, produced IFN-gamma, and showed cytolytic T cell (CTL) activity against macrophages pulsed with mycobacterial antigen, findings consistent with a protective role against M. tuberculosis. Anti-CD1b antibodies abrogated T cell proliferation, IFN-gamma production, and CTL activity, demonstrating that these T cells are CD1 restricted. IFN-gamma production in response to M. tuberculosis was enhanced by antitransforming growth factor-beta in 8/10 lines, and by IL-15 in 2/10 lines. IFN-gamma production was augmented in a nonantigen-specific manner by IL-12 in 4/8 lines. When live HIV was cocultured with CD1-restricted T cell lines, p24 antigen and proviral DNA were not detected, indicating that the T cells were not infectable with HIV. Vaccination strategies aimed at activation and expansion of M. tuberculosis-reactive CD1-restricted T cells in HIV-infected patients may constitute a novel means to provide protection against tuberculosis, while minimizing the risk of enhancing HIV replication through stimulation of CD4(+) cells.     

Ombudsman: a new role for advanced practice nurses in psychiatric-mental health nursing

TOPIC: The role of ombudsman for advanced practice nurses in psychiatric mental health nursing. PURPOSE: To describe the role of ombudsman and its fit with nursing as seen in the Price Spratlen Ombudsing Model. SOURCE: The author's own experiences as both an advanced practice nurse and an ombudsman. CONCLUSION: Because of downsizing, reorganization, and a general trend toward mutual distrust in large organizations, being an ombudsman has been named one of the "25 hottest careers." Advanced practice nurses in psychiatric mental health nursing, by virtue of their knowledge of interpersonal, preventive, and systems theories, are in a unique position to fill this role.     

A "thinking-in-action" approach to teaching clinical judgment: a classroom innovation for acute care advanced practice nurses

The complexity of the evolving advanced practice nurse (APN) role demands new teaching strategies. Based on the challenges that clinicians face daily, we have developed a teaching-learning strategy that addresses five central issues: (a) learning to perceive or identify relevant clinical problems; (b) learning to address the limits of formalism by situating clinical problem solving according to the most relevant goals and intents; (c) learning to reason in transition about the particular clinical situation; (d) learning the ethical skill of problem engagement and interpersonal involvement; and (e) learning to take a stand as a responsible agent by making clinical judgments, acting on them, and advocating for the patient/family. Although these five central issues are typically excluded from classic academic approaches, they are addressed in the "Thinking-in-Action" approach. This teaching-learning strategy offers a different way of teaching clinical judgment that closely resembles the way in which expert nurses actually think and reason in patient situations as they unfold.     

Making career decisions: A sequential elimination approach.

Presents a model for career decision making based on the elimination of occupational alternatives, which is an adaptation for career decisions of A. Tversky's (see record 1973-00249-001) elimination-by-aspects theory of choice. Each occupational alternative is viewed as a set of aspects, and at each stage an aspect is selected according to its importance; alternatives lacking the selected aspect are eliminated. This process continues until only a few alternatives, or a single alternative, remain. The expected utility approach is reviewed as a representative compensatory model for career decisions. The advantages and the disadvantages of the sequential elimination and the expected utility approaches are examined. The possible combination of the 2 approaches is explored, and the implications for career counseling, computerized career decision-making systems, and research issues are discussed. (53 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)