Beyond the essentials. Teaching critical care to undergraduate and graduate students in nursing

With more new graduates entering the critical care setting and with the evolving role of the advanced practice nurse, teaching critical care content to students in nursing is a challenge for faculty. The burden to educate undergraduate novices and advanced practice nurses to care for the complex critically ill patient is costly for health care agencies. To help prepare the generalist to enter a world of specialty, precepted critical care experiences, faculty/critical care nurse collaboration, critical care simulation experiences, a computerized entry-level critical care examination, and a National Fellowship critical care registry are suggested. Teaching strategies for the advanced practice nurse beyond the American Association of Colleges of Nursing's "essentials" document include consideration of expanded science education, simulation for psychomotor skills and diagnostic reasoning cases, and interdisciplinary education for bioethics and business courses. Although such controversies as preparing the generalist for a specialty and the availability of preceptors continue to be debated, the future of critical care education is exciting and challenging. As technology continues to evolve, and the consumer in a market-driven society becomes more involved and inquisitive, the need for caring remains. That is the joy of teaching critical care nursing.     

Family nursing education and family nursing practice in Nigeria

A survey of six Nigerian nursing program curricula was conducted to determine the extent to which family nursing theory was used as a reference for conceptualizing nursing care in Nigeria. In addition, 25 nurse clinicians were purposely selected from three levels of primary, secondary, and tertiary health care units in Ile-Ife, Nigeria, and were interviewed to determine the extent to which nurses in practice reported using family assessment tools in their practice. The survey of the postgraduate curricula showed that master's and doctorally prepared nurses specializing in community health nursing have a theoretical base in family nursing theory. The limited focus on family nursing theory in basic, postbasic, and first-degree nursing curricula was deemed inadequate to develop the knowledge and skills necessary for all practicing nurses to embrace family-focused care in Nigeria. In nursing practice, families were seen to be involved in nursing care only to the extent of meeting financial and physical care needs of their family members. Findings from this study point to the need for a reorientation of the nursing curricula in Nigeria to include more family nursing theory. Specialized education of family nurse practitioners who would function at all levels of care also is a desirable goal to provide holistic health care to Nigerian families.     

State-of-the-art patient care. The impact of doctorally prepared clinical nurses

Delivery of state-of-the-art patient care requires new models to foster the development of professional nurses and integrate practice, research, and education. The Chief Nursing Officer of University Hospital/Associate Dean of the College of Nursing at a tertiary health science center positioned doctorally prepared nurses in clinical practice settings to assist in actualizing a vision of state-of-the-art patient care. Strategic targets for performance improvement included building collaboration between the college and hospital, supporting advanced education for nurses, moving the nursing culture from one of co-dependence to one of professionalism, fostering research at the unit level, and capitalizing on the strengths of nurse leaders. Creating an environment where staff nurses use critical thinking skills and access their advanced practice nurse (APN) resources as they do their work has been a win-win-win situation for the patients, the hospital, and the college at the health science center.     

Advanced practice nursing role: clinical nurse specialist

The public continues to demand quality health care that focuses on the achievement of quality patient outcomes. The clinical nurse specialist is an advanced practice role that originated in the early 1900s as a result of similar public demand, and continues to evolve to meet quality health care needs. Advanced practice nurses have many opportunities to create expanded nursing roles. Orthopaedic nurses also continue to refine their practice roles, and the clinical nurse specialist is one such example.     

The education of advanced practice nurses: a contemporary approach

The Advanced Practice Nursing of Adults and the Elderly graduate program at San Diego State University School of Nursing prepares experienced professional nurses with primary and specialized care (acute or critical care) knowledge and skills to deliver health care to adults and elders across practice settings as nurse practitioners and clinical nurse specialists. Emphasis is placed on health care that is research based and congruent with national standards of practice. This approach to graduate education is congruent with recommendations of professional nursing organizations and responds to the educational needs of professional nurses and the health care needs of adult and elders.     

Physical assessment skills: a developing dimension of clinical nursing practice.

This paper proposes that the current use of physical assessment skills within critical care nursing practice is part of a on-going nursing role development process. A review of the critical care nursing role highlights how nurses in this setting have always been responsive to patient management needs. In exploring one recent nursing role development, the critical care outreach nurse, it is suggested that enhanced assessment skills enable these practitioners to safely and competently assess critically ill patients out of the intensive care environment. The use of patient case studies in this paper, demonstrate how the theory of a more intensive physical assessment knowledge base can be applied in the everyday practice of an critical care outreach nurse. Through such systematic patient review, patient management plans can be agreed and ward based practitioners can be supported in the on-going treatment of sick ward patients. The use of the cases presented also highlights the complexity of the outreach nurse's practice in addressing clinical management and team management issues.     

Does Advanced Community/Public Health Nursing Practice Have a Future?

Societal trends and predicted needs of the health care system indicate that there will be increasing demands for health care professionals who can effectively manage the health needs of populations and communities. Nurses who have master's degrees in community/public health nursing have the educational background to provide this expertise. Although the Association of Community Health Nursing Educators and many nursing leaders maintain that these nurses are advanced practice nurses, most leading nursing organizations and state nurse practice acts do not include population and community health management skills in their definitions of advanced practice nursing. These exclusions have produced a serious status problem for master's programs in community/public health nursing. This article examines issues affecting the current and future status of master's-level community/public health nursing. Solutions are suggested for ensuring the viability of this specialty area.     

The challenge facing critical care nurses in the UK: a personal perspective.

Wide-reaching professional, organisational and technological changes within healthcare have impacted on the role of the critical care nurse over the past decade. The major challenge to critical care nurses is to remain focused on providing quality care, optimistic about what can be achieved and realistic given the finite resources available. Suggestions as to how the future of critical care nursing may look are raised. Strategies to ensure that best practice and innovation continues within critical care are discussed, ensuring that patient and family needs remain a priority.     

Implementing the clinical nurse specialist role in a regional state psychiatric hospital

Clinical nurse specialists (CNSs) are essential to enhancing psychiatric-mental health nursing within state psychiatric hospital settings. This article presents a project focused on the CNSs in a state psychiatric hospital to expand their clinical role to increase the quality of care to individuals with serious mental illness and their numbers in other state psychiatric hospitals. As the patient population served in these settings becomes more complex, it is critical that advanced practice nurses are provided with appropriate updated state-of-the-art advanced knowledge and skills to collaborate within the interdisciplinary team. Furthermore, because of the complexity of the client and systems characteristics, the CNSs' clinical leadership is critical to promote the best practices in direct care services as well as provide support to various levels of nursing through staff development and training, role modeling, and mentoring of new staff.     

Advanced practice nursing in the Nordic countries

? Changes in the delivery of health care and changes in population characteristics and health care requirements mandate changing requirements in nursing education. ? This is necessary to meet patient and family needs and to deliver quality health care. ? This paper describes the background to nursing education in the Nordic countries and gives an account of an initiative in Norway to prepare advanced practice nurses for clinical practice in this dynamic environment.     

Education for differentiated role development for NP and CNS practice: one nursing program''s approach

Development of nurse care providers who best meet the public's health care needs is imperative. Some nurses believe the functions of nurse practitioners and clinical nurse specialists should be combined. However, the experience of the authors' nursing program argues otherwise. Two graduate nursing tracks, family nurse practitioner and rural health specialist, were developed to meet the health care needs of rural populations. Although the two tracks share expected competencies and areas of expertise to some extent, differences in practice are apparent in identified domains of practice and terminal competencies. Family nurse practitioner practice focuses on assessment, diagnosis, and management of health and illness conditions of individuals and families across the life span. Clinical nurse specialist practice incorporates traditional roles of client assessment, monitoring and coordination of care, outcome assessment, and client, family, and community education, with a new focus on case management strategies. These differences are important to care delivery in the managed care era.     

Advanced practice nursing and the role of the pediatric critical care nurse practitioner

Advanced practice nursing, since its inception in the early 1960s, has constantly changed in an effort to establish standardized core graduate education, specialization of practice, and autonomy, now common in the 1990s. Nurse practitioners, nurse midwives, and certified registered nurse anesthetists have followed in the footsteps of the clinical nurse specialist by enhancing their practice through advanced education. Nurses in these advanced areas are graduating from established programs with a master's of science in nursing and a specialty in their chosen field. The pediatric critical care nurse practitioner is one such specialty. This article highlights the results of a national survey that described pediatric critical care nurse practitioner practice over a broad geographic area. With change as a constant, nurses will look to the future of advanced practice roles, which are ever changing, and continue to provide safe, quality care to patients.     

'Back to the bedside': graduate level education in critical care

The need for post registration education for nurses practising at specialty level in critical care environments is widely acknowledged in nursing and educational literature. There is also clear consensus that the ultimate aim of educational preparation and practice development is to improve the delivery of nursing care to patients who are critically ill and provide support for their families. Yet the 'right' approach to educational delivery and evaluation is less clear and stimulates considerable debate amongst nursing educators, care providers, learners and regulatory bodies. The need for critical care nurses to apply advanced knowledge and technical skills to complex and dynamic practice situations necessitates the development of critical thinking and a problem-solving approach to clinical practice that can be fostered through education and experience. This paper explores the relationships within teaching, learning and practice development in critical care nursing and questions the popular assumption that 'post graduate (Master's level) education fits all'. Discussion focuses on the successful development and implementation of graduate level education for critical care nurses in the South Island of New Zealand and how this development is challenging existing approaches to the provision and evaluation of formal critical care education in New Zealand.     

Perceptions and expectations of Baccalaureate-prepared nurses in Jordan: Community survey

The overall purpose of this paper is to describe the process of utilizing community participation for curriculum design to develop a new school of nursing. A brief Community Needs Assessment Survey was carried out in order to explore community perceptions and expectations of Baccalaureate-prepared nurses in Jordan. The sample consisted of 152 participants who were staff nurses, nurse administrators, nurse supervisors, nurse educators, physicians, pharmacists and consumers of services. Data were collected through a self-administered survey form using open-ended questions. Participants were asked to describe their perceptions of nursing and nurses, the desired professional skills and personal characteristics of the Baccalaureate-prepared nurse, important curriculum contents and to provide suggestions or comments for improving the preparation of Bachelor of Science in Nursing (BSN) nurses. The findings indicated that nursing was viewed as a caring profession where nurses care for the person both in sickness and health. Several professional skills and personal characteristics emerged as being important for the BSN nurse, including clinical competence, the desire to continue learning, communication skills, ethical and moral character, critical thinking, assessment skills, and computer and English-language skills. The participants provided the desired curriculum contents and suggestions related to the expected skills. Implications for nursing education were discussed.     

Advances in graduate nursing education: beyond the advanced practice nurse.

Historically, graduate education in nursing has been primarily concerned with the clinical role. In recent years it has been suggested that graduate education needs to consider alternate programs of study that prepare nurses for clinical leadership that are distinct from management and advanced practice roles. Graduate education is needed that focuses on the skills required to coordinate care and implement outcome-based practice and quality improvement strategies. Two models are currently being proposed that meet these objectives. The first is the population health nurse expert that functions on the macrosystems approach and the second is the clinical nurse leader which is based on a microsystems framework. The two models are compared and a combined model where the clinical nurse leader is based on the population health framework is proposed.     

Nurse Practitioner: Is Online Learning for You?

Online or blended learning is growing as an option for nurses who want to continue their education to improve patient care outcomes, advance their careers, and contribute to a more effective and efficient health care system. As the options for education increase so do both opportunity and responsibility for the learner. Only an informed advanced practice registered nurse can decide whether an online program is right for him or her. There are both personal and institutional variables that can guide the potential student in making this choice and reliable resources and strategies for collecting critical information.     

A collaborative project: initiating a family intervention program in a medical intensive care unit

Common needs of family members of critically ill patients were identified. Each member of the family may react differently to the stress caused by hospitalization of a loved one. Dealing with families in crisis requires the coordination of the health care team. A clinical nurse specialist can act as a coordinator and continue to integrate the efforts of the nursing staff to ensure a team approach in providing a structured yet individual way to deliver emotional support to families of the critically ill. The purpose, design, implementation, and evaluation of a family intervention program in an MICU as well as suggestions for its continuation were described. Evaluations of the program revealed positive responses by the majority of families participating in the program. Findings indicated that a structured and well-planned family intervention program can increase the staff nurse's knowledge and sensitivity to the needs of families who are in a crisis situation. Further research is necessary to identify needs of a family when they are faced with an acute illness of a family member and the required nursing interventions to assure the desired outcome of care. Replication and reporting of similar intervention programs, such as the family intervention program, would help nurses plan and implement appropriate interventions to support the family during critical illness of a family member.