The role of advanced practice nurses in surgical services

Many of the changes in health care delivery systems have had detrimental effects on nurses; however, some of these same changes are providing opportunities for acute care advanced practice nurses. Advanced practice nurses ensure continuity of care, manage use of resources, and coordinate patient services, which often results in cost savings. This article describes how advanced practice nurses in the department of surgery at Memorial Health Care, Worcester, Mass, are caring for surgical patients with acute and chronic conditions.     

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.     

The 1997 Schering Lecture. Quality of life in oncology: nurses' perceptions, values and behaviours

Quality of life is an important dimension of cancer care. Yet, within our current environment of fiscal restraint, restructuring and cancer care system reform, pressures exist which may make it difficult to provide care which attends to issues of quality of life. Oncology nurses are key providers of cancer care and their perspectives on quality of life for cancer patients are very important. In addition, much of the satisfaction oncology nurses experience in their practice emerges from matters related to attending to quality of life issues. Are oncology nurses currently able to incorporate quality of life issues into their daily care of patients? How are they doing so? The purpose of this qualitative study is to identify major themes and dimensions of nurses' perceptions and values related to quality of life and create a profile of the oncology nurse's role in integrating quality of life in nursing practice. A total of 25 oncology nurses in regional cancer centres across Ontario were interviewed. Each semistructured interview was taperecorded and transcribed. Analysis was completed to identify the major themes and dimensions. This presentation will report the findings from the study and will focus on understanding the existing values oncology nurses hold surrounding quality of life, how quality of life is conceptualized, and the patterns of practice and decision-making regarding quality of life.     

Loss of lifetime due to radiation exposure-averaging problems

The transformation of health care in the United States necessitates developing creative strategies to provide quality and cost-effective care for the critically ill obstetric patient population. A discussion of the care of these patients is presented in a multidisciplinary framework, using a case study to illustrate the management process. The significance of contributions and collaboration of advanced practice nurses in perinatology and critical care in the care management of the critically ill obstetric patient is described. Such strategies as location of the patient and educational preparation for nurses caring for these complex patients are offered for consideration. Implications are described and recommendations are made for administrative and clinical practice.     

Advanced practice nursing in community: nursing's opportunity

This article explicates the concept of community as the relational processes that constitute a coming togetherness and explores the role of advanced practice nursing in community. Community as process and health as process are described from the theoretical perspectives of Parse's nursing theory of human becoming and Newman's theory of health as expanding consciousness. Advanced practice nurses, in engaging with community, participate in a nurse-person-community-health process. This engagement occurs in the reality of managed health care. The focus of advanced practice nursing in community is health, wholeness, and quality of life. To participate with presence in the nurse-person-community-health process is viewed as nursing's opportunity.     

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.     

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.     

Discharge planning for the patient requiring home intravenous antimicrobial therapy

Home intravenous (IV) antimicrobial therapy is a well accepted and widely practiced form of home infusion therapy. Orthopaedic-related infections, often requiring long courses of therapy, are commonly treated in the home setting after a brief hospitalization. Hospital orthopaedic nurses play an important role in preparing patients for home care. This article addresses patient selection for home IV therapy, the discharge planning process, and educational preparation of the patient. The role of the home care nurse is briefly presented to enhance the orthopaedic nurse's knowledge of the continuum of care.     

Concentration and temperature dependence of viscosity in lysozyme aqueous solutions

Women scheduled for breast biopsy procedures experience heightened anxiety about the outcomes of their diagnostic procedures. Perioperative nurses have unique opportunities to provide quality nursing care for patients awaiting breast biopsy procedures and their definitive diagnoses. The prevalence (ie, 50%) of benign breast disease in women of reproductive age and the anxiety related to the threat of breast cancer are important nursing concerns. This article addresses the breast clinic nurse's role in meeting the emotional and informational needs of women scheduled for breast biopsy procedures. The human response to illness (HRI) model is used as a framework for understanding the phenomenon of anxiety within this context. The HRI model provides a basis for delivering quality nursing care through the development of an enhanced role for the breast clinic nurse.     

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.     

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.     

Cadmium suppresses delta 9 desaturase activity in rat hepatocytes

This paper challenges contemporary portrayals in the nursing literature of the spaces within which care of patients in hospital settings is conducted. Within the wider discourse of fiscal restraint on health care spending, professional nursing has cast its disciplined eyes on details of the nurse-patient relationship for the ostensible purpose of repairing that which is treated as individual failings of nurses to practice in ways prescribed by nursing theories. Set aside in this approach to the so-called 'problems' of nursing practice has been an examination of the conditions within which nurses come in contact with patients, and a critical recognition that such contacts represent skilled accomplishments of social action. In this paper, these conditions are treated as resources available to both nurses and patients to generate accounts for the nurse's presence as well as the nurse's absence. Examples from an ethnographic study of nursing practice are used to illustrate how the spaces operating between nurses and patients are not empty voids but are social spaces through which particular meanings about nursing care can be conveyed.     

The chief of nursing practice: a model for nursing leadership

The role and structure of the Canadian Health Care System and its facilities are changing rapidly. Regionalization, decentralization, and flattening of hierarchical structures have occurred in governments and institutions. Traditional management roles, including the Vice President/Director of Nursing have been eliminated. There is a need to create a new model of nursing leadership if nurses are to continue to provide quality patient care. This article describes the initiative at Women's College Hospital to meet the expressed needs of nurses by developing a unique nursing role. The development of the chief of nursing practice role is defined within the context of the changing environment and Kanter's theory of empowerment. The position of the chief of nursing practice is a role model for nursing leadership and one that is pivotal for the professional identity of nursing, and for the provision of high quality patient care.     

Mediating conflict and control: practice challenges for nurses working in palliative care

A work-based professional development program was offered to a group of registered nurses working in palliative care. The goal of the program was to improve skills in psychosocial care (Yates et al., 1996). Participants were encouraged to reflect critically on their practice experience within a group setting. The focus of the group discussion and reflection were shared practice incidents. Each participant was given the opportunity to identify and describe an incident from their professional practice that presented a challenging issue within palliative nursing. This paper explores the themes of conflict and control, evident within the collection of fifteen practice incidents and discusses the nurses' role as mediator. The concepts of patient advocacy and professional autonomy are challenged through the nurses' experience of providing care within a hierarchical and bureaucratic health service. The outcome of reflection for the organization is most effective when shared experience and collective action (rather than individual practice) are the focus.     

Professional practice leader: a transformational role that addresses human diversity

The role of the professional practice leader is to provide leadership in the transformation of nursing practice from a provider focused model to a patient focused model. Nursing standards for patient focused care were developed to define the quality of the nurse-person relationship in a manner consistent with Parse's theory of human becoming. Multiple strategies have been developed to challenge nurses to redefine the purpose, vision, and core values by which they practice. It is only through uncovering the values and beliefs of every person that nurses will be able to care for individuals whom they recognize as unique human beings.     

Optimizing drug therapy based on genetic differences: implications for the clinical setting

Differences in drug responses due to gene alterations are rapidly being identified. Gene alterations may inhibit the function of an enzyme so that an active drug accumulates, causing adverse reactions with normal doses. Alternatively, gene alterations may accelerate enzymatic function so that an active drug is rapidly eliminated, causing subtherapeutic responses to normal doses. Mutations and polymorphisms have been identified that affect a person's response to many currently prescribed medications including cardiovascular, anti-infective, chemotherapeutic, psychiatric, and analgesic drugs. The potential exists for drug therapy to be optimized by selecting medication and doses based on a person's genotype rather than by trial and error. In the near future, advanced practice nurses in the acute care setting may be expected to order, provide patient education about, and explain results of genetic tests before initiating a specific drug therapy. Advanced practice nurses must be knowledgeable about what genetic tests are analyzing and their benefits, limitations, and risks.     

Palliative therapy in advanced ovarian cancer: balancing patient expectations, quality of life and cost

The goals of chemotherapy for recurrent/refractory ovarian cancer are the palliation of disease-related symptoms, and improvement of quality and quantity of life. Previous studies of palliative therapy in advanced ovarian cancer have focused on surrogate measures of patient benefit rather than evaluating palliative end-points such as quality of life and clinical benefit. The impact of palliative chemotherapy on survival, quality of life and cost in advanced ovarian cancer are unknown as there have been no studies comparing palliative treatment with best supportive care. Although there is insufficient information from existing studies to determine whether palliative therapy in advanced ovarian cancer is cost-effective, there is some evidence to suggest that chemotherapy has a role in palliation of symptoms with an apparent improvement in quality of life. We relate the results of two studies. (i) A prospective study evaluating the cost of second/third-line chemotherapy as well as its effectiveness, which found the mean total cost per patient for the study period (one line of chemotherapy) was Canadian $12500. In addition, half of patients seemed to derive some palliative benefit and a quarter of patients had an objective response in their disease. (ii) A retrospective study evaluating all costs from the initiation of palliative chemotherapy until death which demonstrated a cost of Canadian $53000 per patient. Our studies demonstrate that patient expectations of palliative therapy in ovarian cancer are high and patients are willing to put up with significant toxicity for modest benefit. Although palliative therapy may be associated with high costs, even modest prolongation of survival can render such treatment cost-effective. The major cost saving associated with palliative therapy is from the reduced need for hospitalization towards the end of life. Future studies in recurrent/refractory ovarian cancer should focus on palliative end-points and include a comparison with best supportive care.     

Gene expression of mouse S100A3, a cysteine-rich calcium-binding protein, in developing hair follicle

PURPOSE/OBJECTIVES: To discuss the causes, clinical manifestations, and consequences of diarrhea in the patient with cancer; to describe the oncology nurse's role in the assessment, management, and treatment of cancer-related diarrhea. DATA SOURCES: Synthesis of published peer-reviewed data, professional experience. DATA SYNTHESIS: The many causes of cancer-related diarrhea include specific types of cancer and specific anticancer treatment regimens (e.g., chemotherapy, radiotherapy). Poorly controlled diarrhea may result in a range of physiologic and psychological effects that extend beyond the patient to significant others and caregivers. Comprehensive assessment of diarrhea is the foundation for the appropriate use of pharmacologic and supportive therapies. CONCLUSIONS: Diarrhea, much like fatigue, is a symptom that only recently has become a focus of oncology nursing research and focused intervention. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can significantly influence the quality of care given to patients who develop diarrhea as a symptom of cancer or as a sequela of cancer therapy. As such, oncology nurses are challenged to maintain current knowledge of the causes and available treatment strategies for cancer-related diarrhea. Nurses need to rely on their experiential skill and a working knowledge of published research to identify patients at risk. They also must communicate effectively with patients and caregivers in every practice setting about the nature of diarrhea and its causes, as well as develop appropriate interventions for each individual.     

Building healthier communities in a managed care environment: opportunities for advanced practice nurses

Two paradigm shifts are occurring in health care: managed care and community partnerships. The distinct principles and trends of each paradigm are certain to determine the future practice of advanced practice nurses (APNs). The impact of managed care and community partnerships will affect the resource management, clinical decision making, and time management of APNs. Concomitantly, APNs will have opportunities to influence practice guidelines, individual and community decision making, cultural competence, and the cost-effectiveness of care in communities. Capitalizing on these opportunities will enhance the value of APNs to their managed care plan employer and their community.