The school nurse practitioner: providing improved health care to children

School nurse practitioners have the competence to participate in providing a broad range of direct primary health care and services to the school-age child. Greater utilization of these specially prepared and highly qualified nurse practitioners as providers of health care in the school is a practical and effective method of adding to the quality, availability, and continuity of health care for the school-age child.     

Clinical nurse consultants: defining the role

Pressure ulcers are common among the frail elderly. Reducing the incidence of pressure ulcers requires vigilance on the part of an entire interdisciplinary team; however, gerontology nurses in particular must know how to intervene and assist in maintaining tissue integrity for older adults who are at risk. This article discusses various factors that place individuals at risk for pressure ulceration. Ways to address factors that place patients at particularly high risk for pressure damage are also suggested.     

Expanded role of the nurse: accountability confusion

Nurses are increasingly taking over the clinical activities once carried out by doctors. In some areas it has now become difficult to distinguish the boundaries between nursing and medical health care. These changes raise important legal issues which will need to be considered by a court when dealing with clinical negligence cases involving the expanded role of the nurse.     

Preoperative information: the role of the ward nurse

Many health care professionals are becoming increasingly aware of the benefits of giving preoperative information to patients. However, many nurses still view the provision of such information as a luxury, only to be afforded when all the 'proper' work is done.     

Advance directives: role of nurse practitioners

Systematical screening by cytological cervix examination has not reduced the mortality from cervical carcinoma as much as was expected. One important cause of this is the varying sensitivity of the screening owing to the large number of smears, most of which are normal. Some improvement of the effect of screening might be achieved by combination with computer-assisted microscopical evaluation and with testing for human papilloma virus (PV).     

Medical admissions units: the role of the nurse practitioner

In this article, the author describes the development of a medical admissions unit. He also highlights the introduction of an advanced nurse practitioner role and the contribution this has made to raising the quality of patient care.     

Expanding the role of the neonatal transport nurse: nurse-led teams

Nottingham neonatal service provides a unit-based interhospital transport programme for the stabilization and transportation of critically III neonates within the Trent region. The transport nurse is responsible and accountable for providing optimum care for infants in conjunction with a registrar. The quality of care received by the neonate requiring emergency transfer could be further enhanced by a team of two specifically trained transport nurses.     

Service quality in dentistry: the role of the dental nurse

Patients judge the dental service they receive by the interaction with the service providers-the dentist and his or her staff-as they are unable to judge the technical quality of the service. To perform well as a service provider, employees such as dental nurses have to be well motivated and satisfied with their position. A study of the role of the dental nurse in contributing to service quality in dentistry was carried out through interviews with dentists and nurses at 20 dental practices in the South Thames region in 1995. The results revealed that while dental staff believed that the role of the dental nurse was important in terms of the patient's view of the practice, perceptions of the nurse's role differed. The majority of dentists felt that the nurse's role should be to anticipate their needs, while the nurses' opinions were evenly divided between putting the needs of the patient first or those of the dentist. Nurses also felt that their role was stressful and reported a lack of praise and recognition of their efforts by dentists. Few practices had written contracts or performance appraisals. The results indicated a lack of effective communication in many dental practices, producing role strain for the nurse and reducing job satisfaction. Increasing job satisfaction reduces staff turnover, resulting in more consistent service quality and reducing associated costs. In order to achieve this, several recommendations are made with the aim of improving communication between staff in dental practices.     

The role of the laparoscopic nurse practitioner

Since the appointment of the author as laparoscopic nurse practitioner at Milton Keynes Hospital Trust, there have been more cholecystectomy operations, but fewer patients have required open surgery or inpatient admission, with substantial cost savings. The author describes how the role developed and the opportunities it presents for nurses.     

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.     

Becoming involved: the nurse leader''s role in encouraging teamwork

Ovine tracheal ring explants were infected with four different Mycoplasma ovipneumoniae and one M. arginini field isolate and their ability to induce cytopathic effects was tested by measuring ciliary activity and intracellular calmodulin release. Infected tracheal rings showed significantly decreased ciliary activity as compared to the non-infected control rings. There were, however, marked differences between isolates in the onset and severity of the effects which correlated with their ability to produce hydrogen peroxide. Infected tracheal rings released more calmodulin than the non-infected controls. The amount of calmodulin released also varied between isolates, and somewhat reflected the degree of loss of ciliary activity in the corresponding rings induced by the different isolates. Light and electron microscopic examinations of infected tracheal rings revealed disorganisation and sloughing of the epithelium, and association of mycoplasmas only with the cilia. Following repeated in vitro passages, the organisms had reduced ability to inhibit ciliary activity which correlated with decreased hydrogen peroxide production. Addition of catalase to the organ cultures delayed loss of ciliary activity. These results suggest that M. ovipneumoniae induced ciliostasis in ovine tracheal ring explants which correlated with hydrogen peroxide production. Furthermore, these M. ovipneumoniae-induced injuries to respiratory epithelial cells could contribute to the role that this organism may play in sheep respiratory disease.     

Lower limb amputation. 3: The role of the nurse

This article, the third in a series on lower limb amputation, examines the role of the nurse in the pre- and postoperative care of patients undergoing amputation. The nurse has an integral role not only in providing care but also in liaising with other members of the multidisciplinary team in order to ensure that the person undergoing the amputation feels prepared for both the operation and discharge home. Amputation may greatly distort an individual's vision of him/herself as a person, a partner and a parent; ways in which this distortion can be minimized are explored.     

Caring for the community: development of the advanced practice nurse role

The historical and contemporary impetus for research in nursing is presented in brief. The factors affecting research use in practice are numerous and complicated and include political, financial, ideological and professional spheres. Various strategies that may enhance research use in practice have been suggested and evaluated and these are discussed.