Praxis and the role development of the acute care nurse practitioner

Acute care nurse practitioner roles have been introduced in many countries. The acute care nurse practitioner provides nursing and medical care to meet the complex needs of patients and their families using a holistic, health-centred approach. There are many pressures to adopt a performance framework and execute activities and tasks. Little time may be left to explore domains of advanced practice nursing and develop other forms of knowledge. The primary objective of praxis is to integrate theory, practice and art, and facilitate the recognition and valuing of different types of knowledge through reflection. With this framework, the acute care nurse practitioner assumes the role of clinician and researcher. Praxis can be used to develop the acute care nurse practitioner role as an advanced practice nursing role. A praxis framework permeates all aspects of the acute care nurse practitioner's practice. Praxis influences how relationships are structured with patients, families and colleagues in the work setting. Decision-makers at different levels need to recognize the contribution of praxis in the full development of the acute care nurse practitioner role. Different strategies can be used by educators to assist students and practitioners to develop a praxis framework.     

Interactive,Case-Based Teaching Design Strategies for Nurse Practitioner Students

The Centers for Disease Control and Prevention reports that 7.5% of children under the age of 18 in the United States have an asthma diagnosis. Nurse practitioners will manage asthma for pediatric patients in well and acute primary care clinic visits. In both types of visits, nurse practitioner students must be able to assess the child and develop a treatment plan. When presented with a patient case, learners must have opportunities to demonstrate clinical reasoning progress through appropriate assessment and the ability to develop an evidence-based intervention or plan of care. This article describes an interactive, online, self-paced learning activity delivered via an online format designed to challenge learners to build these skills via an interactive, nonlinear, simulated patient visit.     

Faculty Development for Fostering Clinical Reasoning Skills in Early Medical Students Using a Modified Bayesian Approach

Problem: Clinical reasoning is a necessary skill for medical students to acquire in the course of their education, and there is evidence that they can start this process at the undergraduate level. However, physician educators who are experts in their given fields may have difficulty conveying their complex thought processes to students. Providing faculty development that equips educators with tools to teach clinical reasoning may support skill development in early medical students. Intervention: We provided faculty development on a modified Bayesian method of teaching clinical reasoning to clinician educators who facilitated small-group, case-based workshops with 2nd-year medical students. We interviewed them before and after the module regarding their perceptions on teaching clinical reasoning. We solicited feedback from the students about the effectiveness of the method in developing their clinical reasoning skills. Context: We carried out this project during an institutional curriculum rebuild where clinical reasoning was a defined goal. At the time of the intervention, there was also increased involvement of the Teaching and Learning Center in elevating the status of teaching and learning. Outcome: There was high overall satisfaction with the faculty development program. Both the faculty and the students described the modified Bayesian approach as effective in fostering the development of clinical reasoning skills. Lessons Learned: Through this work, we learned how to form a beneficial partnership between a clinician educator and Teaching and Learning Center to promote faculty development on a clinical reasoning teaching method for early medical students. We uncovered challenges faced by both faculty and early learners in this study. We observed that our faculty chose to utilize the method of teaching clinical reasoning in a variety of manners in the classroom. Despite obstacles and differing approaches utilized, we believe that this model can be emulated at other institutions to foster the development of clinical reasoning skills in preclerkship students.     

护理专业化发展过程中的角色区别

文章总结了作为高级实践护士的临床护理专家和开业护士以及作为其前身的专科护士之间的区别,分别从其起源、概念和角色职能、培养认证、工作场所及处方权方面进行了阐述,以帮助护理人员正确认识护理专业中的多种角色。     

A New Approach for Solving an Old Problem in Nurse Practitioner Clinical Education

Increasing enrollment in nurse practitioner programs to meet the current demand for primary care providers is a major focus of schools of nursing across the United States. Competition with other schools for clinical sites and a labor-intensive 1:1 preceptor/student education model limit the number of sites available for educational experiences. This article explains some of the barriers to obtaining clinical sites and how 1 school changed clinical education.     

护理专业临床教学中学生的角色分析

对临床教学中学生的角色进行分析将有助于提高临床教学的质量。学生在临床的角色重心是“学生” ,她们是学习活动的主体 ,学生同时又承担着临床护士的实践角色。值得注意的是 ,学生作为一个整体的人 ,具有各种不同层次的需要 ,存在着个体的差异性和共性 ,并且具有独特的价值观。学生的性格特点将影响她们在临床中的表现。     

A Mock Telephone Triage Experience for Nurse Practitioner Students

The ability to manage patient telephone calls competently and confidently is an important skill for nurse practitioners (NPs). A curriculum intervention was implemented in a pediatric NP program to promote this skill. Thirty-nine NP students participated in a mock telephone triage experience to determine whether triage, involving student/faculty mock parent telephone calls, would increase the student’s confidence and competence. A Likert scale pre/post questionnaire surveying perceived confidence, competence, and readiness to practice revealed an increase in students’ confidence in decision making, assessing the patient, and making a diagnosis over the phone.     

Alignment of Pediatric Nurse Practitioner Licensure,Accreditation, Certification,and Education for Employers

Advanced practice registered nurses (APRNs) are a critical member of the health care team, providing essential frontline care to patients and families. Given the evolution of the use of pediatric-focused APRNs in more acute and critical care settings, it is essential to understand the APRN consensus model. Understanding the APRN consensus document and its relationship to selecting the pediatric nurse practitioner who is appropriately qualified for the population of interest is crucial. Compliance with regulatory guidelines during the credentialing and privileging processes, along with organized clinical onboarding after hire, can optimize outcomes for employers and providers alike.     

Preparing the FNP Workforce for the Increasingly Complex Work Environment

In 1965, the University of Colorado became the first university to develop a curriculum for the nurse practitioner role, preparing clinicians to meet contemporaneous, across-the-life span, general-practice health care needs. However, in the succeeding 5 decades, individual- and population-level health care needs have grown both in scope and complexity (eg, management of multifaceted chronic diseases and behavioral health conditions). Therefore, family nurse practitioner (FNP) education programs must themselves evolve to match the current, evolving health care environment. This article reviews how an FNP curricular redesign at a college of nursing assisted the faculty in meeting this charge.     

Collaborating with practitioners in teaching and research: a model for developing the role of the nurse lecturer in practice areas

Collaborating with practitioners in teaching and research: a model for developing the role of the nurse lecturer in practice areas The integration of nurse education with higher education in the United Kingdom, has highlighted an uncertainty over the clinical role of nurse lecturers. Although benefits have been identified from lecturers maintaining strong links with clinical practice, the evidence suggests that nurse lecturer participation in practice areas is limited. This paper reports a strategy for developing the clinical role of the nurse lecturer through collaborating with practitioners in teaching and research. An action research project designed to implement and evaluate a teaching programme for pre-registration nursing students was developed. The research aimed to evaluate the programme and identify the benefits for students, practitioners and the nurse lecturer in collaborating in teaching on the programme. Ethical approval was granted from the local research ethics committee. Data were collected in three ways: questionnaires to 17 students; focused interviews with nine practitioners; and analysis of the reflective diary kept by the lecturer. Findings identified the success of the teaching programme and also revealed substantial benefits for students, practitioners and the lecturer. Selected findings are used to demonstrate how the liaison, teaching, clinical practice and research elements of the nurse lecturer's clinical role could be developed. The project was small scale and grounded within a specific context and thus may not be applicable to other settings. However, it is suggested that collaboration between nurse educationalists and practitioners in this way offers a potential model for developing the clinical role of the nurse lecturer.     

Responsive Podcast Curriculum Development for Asynchronous Nurse Practitioner Students

Asynchronous nurse practitioner students lack the benefit of live classroom discussions to synthesize and apply didactic knowledge. Responsive podcasts can remotely address identified student learning needs for improved practical application while remaining entertaining. This feasibility study produced a responsive, topical podcast to meet student learning needs. Episodes were electronically distributed and publically available.By January 2022, “The Peds NP” podcast had 39 episodes with a total of 5,477 downloads reaching 43 countries. Podcasts are succinct, focused microlearning tools that are easily produced, distributed, and consumed. Faculty can use them to augment traditional curricula and enhance the applicability of didactic teaching.     

Development and psychometric testing of the EverCare Nurse Practitioner Role and Activity Scale (ENPRAS)

PURPOSE: To develop and test an instrument measuring the frequency of the performance of role activities by EverCare nurse practitioners (NPs), who provide primary care to nursing home residents. DATA SOURCES: One hundred thirty-one EverCare Nurse Practitioner Role and Activity Scale (ENPRAS) activities were identified through telephone interviews (n= 11), participant observation (n= 5), and a focus group (n= 4). CONCLUSIONS: Two content validity tests (n= 11; n= 15) (Content Validity Index > or = .78 for all retained items) and internal consistency reliability testing (n= 127; Cronbach's alpha = .78-.96) yielded 99 activities arranged in six role subscales-Collaborator, Clinician, Care Manager/Coordinator, Counselor, Communicator/Cheerleader, and Coach/Educator. IMPLICATIONS FOR PRACTICE: The ENPRAS can be used to measure similarities and differences in NP practice activities performed by EverCare NPs working at different EverCare program sites and to compare practice activities performed by EverCare NPs and other NPs. The EverCare program is sponsored by United Health Care, which leads the field in collaborative NP/MD primary care in nursing homes. Future studies should be directed toward testing the generalizability of the ENPRAS with NPs working in other collaborative models, as well as NPs in noncollaborative models of care delivery in the long-term care setting.     

A Dimensional Analysis of Role Enactment of Acute Care Nurses

PURPOSE: To identify dimensions of the role enactment process of acute care nurses. DESIGN: Dimensional analysis, rooted in grounded theory methodology, was used to analyze the role enactment process. METHODS: Twenty-eight articles related to acute care staff nurse roles were selected for analysis. Articles were from eight countries and were published between 1995 and 2002. Significant phrases or themes from each document were categorized to identify themes. FINDINGS: Initial analysis of the articles indicated 37 separate dimensions in the role enactment process of acute care nurses. The final, integrative analysis reduced the initial 37 to 7 core dimensions: care delivery, autonomy, culture management, information management, leadership, psychologic management, and relationship management. The analysis showed a role that is rooted in management processes. CONCLUSIONS: The multidimensional nature of the role of acute care nurses was indicated in the dimensional analysis. The findings have implications for the administration and education of nurses, as well as for human resource development of nurses in many parts of the world.     

Need for Clinical Rotation in Correctional Facilities for Nurse Practitioners

Correctional nursing is an area in nursing care that has not received much attention from nursing programs. There is a lack of emphasis on clinical rotation in correctional facilities. As a result, there is a cloud of negative perception of the correctional environment among some nurse practitioners (NPs), leading to decreased enthusiasm about being a correctional NP. This gap in nursing curriculum can be improved by coordinating clinical nursing rotation for NPs in correctional facilities. I suggest that nursing programs, especially those affiliated with correctional managed care, introduce clinical rotations in correctional facilities. Including correctional health care as a care environment in the curriculum will debunk any negative ideas about working in correctional institutions and foster interest in being a correctional NP.     

Development and implementation of the specialized nurse practitioner role: Use of the PEPPA framework to achieve success

In 2003, amendments to the Nurses' Act in Quebec, Canada, allowed for an expanded nursing role. Specialized nurse practitioners were introduced to the health-care system in 2005. By merging medical knowledge with advanced practice nursing, the specialized nurse practitioner is gaining in popularity and acceptance with staff members and patients. To guide our team through the process, we used the PEPPA (participatory, evidence-based, patient-focused process for guiding the development, implementation, and evaluation of advanced practice nursing) framework. By using a framework specifically designed for the development, implementation, and evaluation of an advanced practice nursing role, we were better prepared for the path that lay ahead. Ultimately, the goal of the implementation of the specialized nurse practitioner role is to improve the quality of care to a specific population of patients, whether it is through individualized clinical follow-up, evidence-based practice, patient teaching, or promoting continuous education for the nurses.     

Provider,Staff, and Patient Perspectives on medical Visits Using Clinical Video Telehealth: A Foundation for Educational Initiatives to Improve Medical Care in Telehealth

Clinical video telehealth (CVT) allows geographically separated care; however, this separation may affect participants behaviors. We interviewed CVT nurse practitioners (NP), staff, and patients at a Veterans Affairs Medical Center about perspectives on how CVT affects communication, identifying 3 themes. Participants remarked on the complexity of scheduling appointments, local barriers to care, and remotely managing acutely ill patients. NPs noted that CVT alters sensory data collection during visits and how it alters building provider–patient relationships. Patients’ perceptions mirrored these themes. NPs and patients both noted that CVT requires modifications to workflow, behaviors, and use of their senses compared with in-person visits.