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.     

Coping with transition: neonatal nurse practitioner education for the 21st century

As neonatal intensive care nurses face downsizing and/or cross-training, new opportunities are emerging for advanced practice nurses in follow-up care of neonatal intensive care unit graduates, case management, quality improvement, and community hospital care. This article identifies current issues in neonatal nurse practitioner (NNP) education as the model has shifted from hospital-based, certificate programs to graduate degree programs offered by colleges/universities of nursing. Opportunities for increasing NNP role flexibility and recommendations for bridging the transition to a 21st century education model for neonatal advanced practice nurses are also discussed. Despite the turmoil of change and uncertainty, the future for neonatal advanced practice nurses is positive. Successful nurses will master the skills of adaptability, flexibility, self-directed learning, leadership, and the provision of relationship centered care. Neonatal nursing educators must constantly monitor clinical practice and re-evaluate the curriculum to ensure the necessary knowledge and skills for successful practice can be achieved from the educational program. It is critical that faculty are cognizant of emerging trends and changing roles in the practice area. Additional learning opportunities may be required for graduates to successfully move into the next century.     

Isolation and characterization of apoptosis-resistant mutants from a radiosensitive mouse lymphoma cell line

This paper reports the findings of a research study funded by the English National Board for Nursing, Midwifery and Health Visiting (ENB), which explored the impact of community care reforms on mental health and learning disability nurses and their practice. In this study we were struck by the divergent views of our respondents about the nature of mental health and learning disability nursing as practice disciplines and the implications of these views for the future shape of preregistration educational preparation. We noted, in particular, the debate between those who advocate what is referred to as specialist educational preparation and others who favour generic preparation. The specialist-generic debate is relevant to nursing as a whole but was magnified in the context of our study because genericism was perceived by many of our respondents as a threat to the minority branches and especially to those (arguably mental health and learning disability) that are not rooted in the biomedical tradition of general nursing. This paper seeks to contribute to this debate as it impinges on the two nursing specialties by developing models of future nurse education grounded in the empirical data from our research and interrogating them to draw out their central features. Two models are clearly independent: the 'specialist' and the 'generic' models. Another three models are partial in that they draw upon the first two: the 'pragmatic' model, the 'unity-of-nursing' model, and the 'social care' model. A common feature of the pragmatic and unity-of-nursing models is that they support the existing DipHE programme, which is now the dominant form of preregistration nurse preparation in the UK. The social care model is applicable principally to learning disability nursing.     

Negotiating the role of the practice nurse in general practice

The debate about the role of the practice nurse is not only about practice nursing per se, but raises broader issues about the organization of primary health care. Two related issues emerge as significant: the role of the practice nurse in providing primary health care; and the effective use of the practice nurse resource in the 'new' National Health Service. This paper, by drawing on material from a qualitative study, specifically examines the type of work performed by practice nurses and the factors that influence this. The responses of practice nurses, general practitioners, Family Health Service Authority (FHSA) advisers, community nurse purchasers and managers of community nursing provider units suggest that a consensus on the future development of practice nursing is unlikely. The different stakeholders emphasized different issues, reflecting their own priorities and backgrounds. Practice nurses' accounts of the future, for example, focused on professional issues. General practitioners stressed the importance of role development which met their General Medical Service responsibilities. Purchasing agencies, provider units and FHSAs adopted a wider perspective and were more concerned to develop an effective and integrated primary health care service. The tensions generated by their different interests and perspectives, and the subsequent organizational and policy initiatives that emerge, will provide the context in which the role of practice nurses will be negotiated.     

The role of the psychiatric nurse practitioner

Policy, organizational management, and research roles have received little attention in this article because the focus has been on the practice role. It must be noted, however, that psychiatric nurse practitioners often assume these roles. Many psychiatric nurse practitioners have discovered that their expertise in communication and systems assessment prepares them well for policy and management positions. The influence of public and private policy on practice and the lives of mentally ill persons has led psychiatric nurse practitioners to become active in the public policy arena. Similarly, psychiatric nurse practitioners' grounding in practice and training in research allows for participation in planning and conducting studies that will inform policy makers as the mental health reform process continues. The psychiatric nurse practitioner title and role have evolved in response to regulatory desire for consistent titling of advanced practice nurses and community need for practitioners with the skills in assessment, psychotherapy, psychopharmacology, and care management. Nursing academic institutions are working to develop new programs to prepare the psychiatric nurse practitioners of the future in the wide range of skills needed for this role. Practice subspecialties and settings vary, but in all instances the psychiatric nurse practitioner offers a blend of nursing and psychiatric specialty care that, in many cases, is substitutive for that of a psychiatrist. In the current era of health-care reform, fiscal constraint, and burgeoning health-care technology, the practice, research, and policy roles available to and occupied by psychiatric nurse practitioners are many. The primary threat to full actualization of the psychiatric nurse practitioners' potential is that advanced practice nursing will choose to be wedded to anachronistic ideologies regarding nurse practitioners and clinical specialists.     

Role orientation in novice home healthcare nurses

The focus of healthcare delivery continues to shift from hospital-based nursing practice to care in the community, which includes home health care. Many basic nursing education programs provide home healthcare clinical experiences for students. However, this may not be enough to assist nurses in achieving home health nursing competency. Most nurses recruited into home health care worked exclusively in hospitals. Many nurses are employed in a practice environment for which they lack the necessary education and skills. As the practice environment for the nurse changes, so does the role of the nurse. Nurses are having difficulty adjusting to changing roles and responsibilities. This cross-sectional research study was conducted to evaluate the extent that new home healthcare nurses understand their role. This study reveals that nurses employed in home health care for 24 months or less continue to have only a moderate degree of understanding of their new role. These data suggest that educators critically evaluate the effectiveness of orientation programs for novice home healthcare nurses.     

Advanced nursing practice in the USA: new directions for NPs

The demand for nurse practitioners (NPs) continues to increase in the USA and, as a result, the NP role is expanding. Originally, NPs were primarily based in the primary care arena; however, they are now filtering into secondary and tertiary healthcare settings, bringing with them advanced clinical skills. This has led to many clinical nurse specialists undertaking NP programmes. American nurses are now calling for a merger of these two roles and for changes in NP training programmes that will prepare practitioners for work in secondary and tertiary care environments as well as primary care settings. British nurses continue to examine the perimeters of advanced nursing practice; however, the realms of secondary and tertiary care should not be neglected, but rather incorporated into these developing roles and educational preparations.     

Roles of advanced practice nurses in oncology

Managed care is a process of health-care management that integrates financing, cost-containment strategies, and business principles with the delivery of health care. Managed care's rapid transformation of specialty practices, such as oncology, is redirecting classic nursing functions toward market initiatives that value the design of care/case management systems and the implementation of multidisciplinary "patient-centered" care models. As health-care systems continue to evolve, advanced practice nurses (APNs) are redefining their roles and enhancing their skills to meet the demands of the marketplace. Advanced practice nurses are defined as registered nurses who have met advanced educational and practice requirements and are prepared at the graduate level. This paper will identify the four established APN roles: nurse practitioner (NP), nurse anesthetist, nurse midwife, and clinical nurse specialist (CNS), as well as highlight the nurse practitioner and clinical nurse specialist as the leadership APN roles within oncology practice. The adaption to managed care has identified new functions and created opportunities for these APN specialties that are being viewed both competitively by other oncology health-care providers and creatively by managed-care organizations. The integration of these emerging roles within the new advanced nursing market and their contributions to oncology care are also discussed.     

The apparent desensitization of student nurses during their professional socialization: a cognitive perspective

It is argued that the structures and processes of traditional patterns of pre-registration nurse education in the United Kingdom led to an apparent and relative desensitization of student nurses to human need. The processes underpinning this apparent desensitization were those which promoted both a 'compartmentalization' of concepts for theory and concepts for practice in the cognitions of student nurses and their habituation to examples of poor nursing practice. These processes are described and their nursing pedagogical implications are discussed. It is suggested that unless clinical learning environments are deliberately manipulated to foster the construction and utilization of 'appropriate' action schemata, the considerable opportunities offered by the implementation of Project 2000 to improve both nursing education and nursing practice could be wasted. It is further suggested that this deliberate manipulation should include nurse tutors teaching theory and practice in clinical areas if they are seriously concerned to render nursing care more intelligently responsive to human need.     

Nurse occupational stress research. 4: The prevalence of stress

This article, the fourth in a six-part series on nurse occupational stress, reviews the prevalence of nurse stress. It will attempt to address questions which are both critical and crucial to an examination of the prevalence of nurse stress. Does the evidence support the claim that the levels of nurse stress within the new NHS are increasing? Does current nurse stress research methodology permit like-for-like comparisons of nurse stress methodology in relation to issues such as frequency and degree of stress? Are certain areas of nursing more stressful than others?     

Functional and morphologic changes in the posterior ocular field in relation to primary open-angle glaucoma. II. Relation of perimetry findings and the c/d ratio

To successfully function in the next century, a nurse will need to develop leadership characteristics. The needed characteristics include (1) changing view of clients, (2) managing the environment, (3) being a visionary, (4) utilizing sophisticated communication skills, and (5) using "new" resources. The author describes these characteristics and identifies strategies that can be used by a nurse to incorporate the characteristics into nursing practice.     

A survey of variables related to research utilization in nursing practice in the acute care setting

Support from the work environment, attitude of nurses and availability of research findings are variables that influence the use of research in clinical practice. Acknowledging the importance of these variables in obtaining the goal of evidence based nursing practice, a nursing department of an acute care hospital determined that exploring these variables in its own setting was important to the successful planning of research education and utilization initiatives. This study describes the extent of selected factors (research support and availability, and attitude towards research) in relation to research utilization within this nursing department and based on the findings, suggests a number of ways nurse administrators can support research utilization, promote positive attitudes towards research and enhance availability of research findings in practice.     

Application of caring theory in primary care: a challenge for advanced practice

That caring is central to nursing is now axiomatic. But has this concept been transferred to advanced nursing practice in primary care? The following article will present reflections on the use of caring in advanced practice in primary care. It is suggested that the nurse practitioner's and other advanced practice nurses' (APNs') use of caring sets nursing's contributions to primary care apart from other providers' practice. A vision is discussed in which professional caring frames the delivery of primary care's nursing therapeutics. How-tos are suggested for delivering professional caring in today's hectic health care environment. Ways the APN can create strategies for renewing caring energy are presented.     

University-based psychiatric nursing education: a promise for the future?

University-based nursing education was introduced in Victoria, Australia, to redress the deficiencies attributed to the system of hospital-based training. The narrow and restrictive focus, maintenance of the subservient position of nurses, the employee status of students, an inadequate relationship between theory and practice and failure to keep pace with changes in the role of the nurse were the main deficiencies identified. This paper refers to a qualitative research study which examines the differences between graduates of a university-based and hospital-based psychiatric nursing program during the year following graduation. The findings suggest that the tertiary-based course had the potential to significantly redress some inadequacies of the hospital-based course to produce different qualities within its graduates.     

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.     

Relevance of NANDA and health promotion diagnoses to school nursing. National Association of School Nurses

This is a report of a national survey of 490 members of the National Association of School Nurses which described the relevance of 109 nursing diagnoses approved by NANDA (1992) and 29 health promotion (wellness) diagnoses developed by the authors. The relevance of these 138 nursing diagnoses for school nursing was determined by the percent of participants who checked "Yes" for the diagnostic categories they observed in their practice and for which they provided one or more interventions. More than half of the sample checked "Yes" for 67 NANDA diagnoses; health promotion diagnoses were checked "Yes" by 45% to 89% of the sample. The implications are that NANDA and health promotion diagnoses are relevant to school nursing and could readily be incorporated into practice to facilitate data collection that supports both the funding of school nurses and program development for children, families, and school staff.     

Terrible when life appears to be meaningless...]

Evidence-based practice (nursing practice that relies on information generated from the results of scientific research) is widely recommended as the method of nursing practice of the future. This is particularly the method of choice in perioperative nursing. In this article the literature on evidence-based practice is reviewed with particular emphasis on the role of the perioperative nurse, research utilization, and barriers to evidence-based practice. Suggestions for change to promote evidence-based practice are also outlined.     

Isotopic ventriculography in healthy young volunteers. Their response to different types of stress

BACKGROUND AND OBJECTIVES: This study determined the perceived characteristics of family practice residency training programs that produce a high percentage of graduates who provide maternity care. METHODS: We surveyed a Delphi panel of 28 family practice maternity care experts. RESULTS: Consensus was reached after the third survey. The characteristics of the family medicine faculty and teaching service were rated as most important. Other essential characteristics were an adequate obstetrical training volume; mutual respect between obstetric and family medicine faculty and residents; support for family practice maternity care from obstetricians, administration, and nursing staff; and family physicians being accepted in the community as maternity care providers. CONCLUSIONS: Family practice residency programs that produce a high percentage of graduates who provide maternity care have a unique, family practice maternity care-friendly environment. Residency programs wishing to increase the percentage of their graduates who provide maternity care should ensure that their faculty support family practice maternity care, are competent in maternity care, and model maternity care in their own practices. They should strive to ensure an adequate volume of obstetrical cases for resident education and work toward educating patients and local obstetricians, nursing staff, and hospital administration regarding family practice maternity care.     

Is the quest for evidence-based care detrimental to children's nursing?

Evidence-based care and the expanded role of the nurse are inexorably linked. Facets of this are found in every specialist area of nursing. Children's nurses are no exception and they have proved their commitment to family-centred care over a period of many years. However, within the ranks of nurse educationalists now employed by the universities and not the NHS new tensions have emerged. The research-led ethos of the universities demands that nurses demonstrate expertise in the field of scientific enquiry. Although the philosophy of caring and research are not incongruent, there exists the potential that family empowerment may take a back seat to academic prowess. This article examines the background to this dilemma.