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 geropsychiatric clinical nurse specialist in home care

Home care nurses often are asked to provide care to older adults with multiple problems, including psychiatric diagnoses. This article identifies areas of knowledge a general nurse needs to provide care for geropsychiatric patients and describes the role of the geropsychiatric clinical nurse specialist as part of a home care team.     

Expanding the role of the nurse in the Accident and Emergency department

In response to the increasing demands upon the Accident and Emergency department and supported by changes within the scope of professional practice of the qualified nurse, Accident and Emergency nurses have expanded their role within the multidisciplinary team. The article reviews the development of this expanded role for the nurse within the Accident and Emergency team and discusses its implications.     

Maintaining patient endurance. The comfort work of trauma nurses

The purpose of this article is to explicate patterns of comforting that assist the seriously injured patient to endure the pain of injury and subsequent treatments and to remain controlled. The care provided to 67 trauma patients in two trauma centers was videotaped and analyzed using observational methods and linguistic analysis. During painful procedures, when patients exhibited extreme distress, one nurse usually assumed the role of comforter. The nurses used a patterned mode of speech ("comfort talk"), touch, and distinctive posturing behaviors that enabled the patient to endure the agony and maintain control. In this article, the authors describe the comfort work of nursing in emerging situations, further develop the Comfort Talk Register, and describe the concomitant behaviors that facilitate patient endurance. They suggest that the comfort work of nurses in this situation enables patients to endure and reduces shock and posttraumatic stress following trauma care.     

Analog-digital conversion using pCLAMP and DOS/V

Multiply injured trauma patients present a major challenge for the critical care nurse. Should the patient survive the initial injuries, the third phase of mortality (five to seven days following injury) is sepsis. Research findings document a strong link between trauma and immune dysfunction. This article highlights the main immunological defects and underlying mechanisms for trauma-induced immune dysfunction. It provides the theoretical foundation that underlies the rationale for current and future immune-based therapy for trauma patients. Because of the complexity of caring for and preventing septic complications in the trauma patient, advanced practice nurses and nurse educators can use this material to update the knowledge and skills of critical care nurses.     

The role of the clinical nurse co-ordinator in the provision of cost-effective orthopaedic services for elderly people

Positions for nurses as coordinators and case managers have developed in response to demands for increased efficiency in the provision of hospital care. The Fractured Hip Management Programme in Western Sydney is one example of this development. The programme was introduced in response to mounting concern about the demands on hospital resources from elderly patients with hip fracture. A central feature of the programme is the pivotal role given to the nurse coordinator working within a multi-disciplinary team. This is not a new nursing role; rather it explicitly recognizes skills developed as part of the traditional nursing role. Evaluation of the programme found that patients received surgery sooner and spent less time in hospital, without adverse affects on outcome. The results show that recognition of the role of the nurse as patient advocate and care manager can lead to more cost-effective and higher-quality 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.     

OR resuscitation for trauma patients

1. The results of multiple studies have shown evidence that immediate access to the operating room has significantly contributed to improved outcome in several categories of trauma patients. 2. "Walk through" table top exercises were held in the OR suite to identify problems. These mock resuscitations were particularly helpful in solving logistical and equipment problems. 3. Prehospital care providers were given classes regarding triage criteria and operating room logistics. 4. Continuing education for OR and trauma nurses included videotape review and critique of ORR, trauma-specific inservice programs presented by the trauma coordinators and physicians, and attendance at weekly videotape review and trauma conference presented by the Division of Trauma. Easy recognition of individual team members, an important issue, required the use of name badges.     

Staff nurses' ability to assess community patients: a study

This article describes a project to evaluate the effectiveness of staff nurses undertaking patients' first assessment, within the community setting. District nurses selected appropriate groups of patients to delegate to the staff nurses and remained accountable for care throughout the project. Patient documentation, patient satisfaction, and GP, district nurse and staff nurse satisfaction were all audited at the end of the study period. The authors found that while the district nurses remained essential to the management of care, some work could be delegated appropriately to selected staff nurses. The standard of care was not adversely affected by the alteration in working practice.     

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.     

Trauma care strategies for changing economic forces

Nurses have expertise in wellness, health promotion, delivery of acute care, and rehabilitation. As the venture into healthcare reform deepens, nurses must take a more proactive role in redirecting the delivery of trauma care in such a way that optimal provision of healthcare services is maintained while costs of providing care are reduced across the continuum of care. Efforts must focus on preventing traumatic injuries, restructuring healthcare delivery systems to meet the needs of patients with traumatic injuries, and reducing healthcare expenditures. Table 3 outlines strategies used by our facility to decrease cost without compromising patients' care. The current era is fraught with rapid changes that necessitate a creative, rational, and organized approach to making decisions about the delivery system for patient-focused care. Nurses are in an optimal position to develop and implement interdisciplinary, creative strategies that will maximize the delivery of trauma care services to the community. Each institution must evaluate the processes involved in its delivery of trauma care services. Strategies to contain costs must focus on processes implemented to achieve optimal outcomes of patients' care. The economic marketplace will evaluate care on the basis of outcome statistics and cost analysis. Thus, nurses must continue to be critical evaluators of nursing practice, always striving for the best healthcare delivery system possible during these turbulent economic times.     

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.     

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.     

Utilizing collaborative practice to achieve quality outcomes in gentamicin administration

Nurses have become increasingly interested and involved in the area of outcomes to assure that the patient is represented as more than a composite of physiological variables. The use of outcome measures has helped nurses articulate their unique value and contribution to the well being of patients. Nevertheless, many measures presently used to evaluate an outcome do not identify or acknowledge the unique contribution of nurses. Clinical nurse specialists and other advanced practice nurses must use their "ways of knowing" to develop appropriate measures and outcomes. Through this careful inquiry, nurses will then be equipped to ask "nurse-driven" questions regarding the development of appropriate outcomes and outcome measures and to analyze the models in which care is presently delivered.     

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.     

Sexual behavior of HIV-seropositive young men with congenital coagulopathies. Hemophilia Behavioral Intervention Projects (HBIEP) Study Group

The purpose of this study was to investigate the attitudes towards attempted suicide patients among registered nurses involved in the somatic care of such patients, and to compare them with those of psychiatric nurses. The attitudes were measured on a newly constructed scale, the Understanding of Suicide Attempt Patients Scale (USP-Scale), and three brief clinical vignettes with the answer format of a visual analogue scale (VAS). The nurses working within the psychiatric services were more understanding and more willing to nurse suicide attempt patients than nurses in somatic disciplines. Among all the nurses, older personnel were more favourably disposed than the younger, and more frequent contact with suicide-prone patients was related to more positive attitudes. The perceived need for further training in suicidology was significantly stronger among the nurses in the general hospitals. This suggests that their 'negative attitudes' may to some extent be a result of lack of knowledge and uncertainty rather than a hostile attitude. The nurse has a responsibility to create a positive climate in the patient's encounter with the health services. Knowledge and understanding are needed to enable the nurse to provide professional care for a difficult and challenging patient group.     

Surgeons' assistants: a new role for operating theatre nurses?

In the current climate of changing nursing and medical roles, discussions about the role of the operating theatre nurse have been rekindled, with particular emphasis being placed on the role of the nurse as 'assistant' to the surgeon. This article examines perioperative roles and identifies and discusses the factors that have stimulated their development. It is argued that these roles are not necessarily new and that their recent re-emergence may have as much to do with the sustained drive to reduce junior doctors' hours as the need to enhance the quality of patient care. However, they may offer operating theatre nurses clearer direction and purpose to practice. Provided they can improve the quality of patient care and are given careful consideration, they may prove to be an opportunity worth exploiting.     

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.     

The Diabetes Center home care nurse: an integral part of the diabetes team

The changing face of health care and the widely variable needs of families have forced practitioners to change the traditional education approaches for pediatric patients with diabetes. Initial management and education for pediatric patients with newly diagnosed type 1 diabetes is now moving to the outpatient setting. The Diabetes Center for Children (DCC) at The Children's Hospital of Philadelphia has created an innovative program using a diabetes home care nurse as its coordinator. The role of the home care nurse is to manage and coordinate all of the diabetes education done by the field nurses in the Children's Hospital home care department. This program has enabled the DCC to manage and educate families during an initial 3-day inpatient stay, providing a safe transition to home. With follow-up by trained home care nurses, the families receive advanced education and support in their homes. The evolution of this program over the last several years has shown that patient care can be moved safely from a complete inpatient format to one that includes a large outpatient component.     

Intravenous therapy: current practice and nursing concerns

The field of intravenous (i.v.) therapy has been subject to major change, with increasing numbers of nurses taking on the high profile, technical aspects of care. The transfer of previously medicalized tasks such as cannulation has been welcomed by nurses who are keen to develop practical skills in order to embrace the concept of holistic patient care. This literature review aims to clarify the role of the nurse in i.v. therapy, exploring cannulation as a specific issue. Legal and professional aspects are discussed in terms of extended/expanded practice and practical aspects in terms of i.v. access and maintenance. Discussion focuses on a team approach to the management of i.v. therapy. Finally, the nursing process is applied to an i.v. therapy scenario. Exploration of the nursing issues enables practitioners to justify the expansion of individual practice in order to deliver holistic care and improve standards of service. The review concludes that nurses cannot afford to lose sight of the caring component of their role as a result of immersion in the culture of technical skill acquisition.