The nursing shortage in the United States of America: an integrative review of the literature

AIM: The aims of this paper are to review the literature to determine what factors are contributing to the nursing shortage in the United States of America (USA) and discuss possible solutions to this current and future nursing shortage. BACKGROUND: The need for nurses is often depicted as cyclical in nature. Throughout history, the USA has experienced a series of nursing surpluses and shortages. However, the current shortage has been characterized as being unlike those experienced in the past. Trends of an ageing Registered Nurse (RN) workforce and limited supply to fill the impending vacancies are some of the unique aspects that bring a new dimension to an old problem. Today's nursing shortage will not be resolved by simply returning to the solutions of yesteryear, and strategies to reduce its impact will have to be more creative and focus on the long-term. METHODS: Integrative literature review of published literature on the current nursing shortage in the USA from 1999 to 2001. DISCUSSION: Four main areas were identified as the major contributors to the nursing shortage in the USA: the ageing RN workforce; declining enrollment; the changing work climate; and the poor image of nursing. Solutions to the shortage followed similar themes to the contributing factors and encompassed four main areas: exploring recruitment efforts; exploring retainment efforts; improving the image of nursing; and supporting legislation that helps to rectify the shortage. CONCLUSION: There is firm evidence that the USA amidst a nursing shortage. Much is known about the many contributing factors but now nurses need to become proactive to help secure the future of their workforce. By forming partnerships within the profession and with other influential parties, nurses can be in the forefront of resolving their workforce issues.     

Teaching strategies of clinical reasoning in advanced nursing clinical practice: A scoping review

Aim/objectiveTo report and synthesize the main strategies for teaching clinical reasoning described in the literature in the context of advanced clinical practice and promote new areas of research to improve the pedagogical approach to clinical reasoning in Advanced Practice Nursing.BackgroundClinical reasoning and clinical thinking are essential elements in the advanced nursing clinical practice decision-making process. The quality improvement of care is related to the development of those skills. Therefore, it is crucial to optimize teaching strategies that can enhance the role of clinical reasoning in advanced clinical practice.DesignA scoping review was conducted using the framework developed by Arksey and O’Malley as a research strategy. Consistent with the nature of scoping reviews, a study protocol has been established.MethodsThe studies included and analyzed in this scoping review cover from January 2016 to June 2022. Primary studies and secondary revision studies, published in biomedical databases, were selected, including qualitative ones. Electronic databases used were: CINAHL, PubMed, Cochrane Library, Scopus, and OVID. Three authors independently evaluated the articles for titles, abstracts, and full text.Results1433 articles were examined, applying the eligibility and exclusion criteria 73 studies were assessed for eligibility, and 27 were included in the scoping review. The results that emerged from the review were interpreted and grouped into three macro strategies (simulations-based education, art and visual thinking, and other learning approaches) and nineteen educational interventions.ConclusionsAmong the different strategies, the simulations are the most used. Despite this, our scoping review reveals that is necessary to use different teaching strategies to stimulate critical thinking, improve diagnostic reasoning, refine clinical judgment, and strengthen decision-making. However, it is not possible to demonstrate which methodology is more effective in obtaining the learning outcomes necessary to acquire an adequate level of judgment and critical thinking. Therefore, it will be necessary to relate teaching methodologies with the skills developed.     

A genetics course for advanced clinical nursing practice

PURPOSE: To describe a genetics course for advanced clinical nursing practice. BACKGROUND: The Human Genome Project is yielding new discoveries in genetics. The sheer volume of new information threatens to overwhelm healthcare providers as they must find ways to interpret and use these discoveries. DESCRIPTION OF PROJECT: The course was developed in recognition of the fact that graduate nursing students in advanced practice programs need to understand and apply genetic information in the care of their patients. The course builds on core competencies identified by the National Coalition for Health Professional Education in Genetics and the International Society of Nurses in Genetics. OUTCOMES: Students demonstrate that they can access, evaluate, and synthesize current information on a genetic condition and develop a comprehensive plan of care for patients with the selected condition. INTERPRETATION/CONCLUSION: Students learn basic and applied genetic concepts and skills. They are able to utilize resources appropriately to identify patient care needs and develop strategies for meeting those needs. IMPLICATIONS FOR NURSING PRACTICE: The need to remain current in understanding emerging technologies and genetic information will continue to grow as scientific discoveries are made that affect greater numbers of the public. Nurses in advanced practice are in a position to support patients and their families as they deal with the significance of these discoveries for their current and future health.     

Aromatherapy practice in nursing: literature review

BACKGROUND: The use of aromatherapy in nursing care continues to be popular in many settings. Most of the nursing literature relates to the use of essential oils in low doses for massage or use of the oils as environmental fragrances. Information from the wider literature may add to the evidence base for use of this therapy in nursing. AIM: This paper reports a literature relating to the use of aromatherapy by nurses and critically evaluates the evidence to support this practice. METHOD: Medline, CINAHL, MANTIS and EBSCO Host databases were searched for papers related to use of essential oils and/or aromatherapy. Papers were also obtained through cross-checking of reference lists. A total of 165 articles have been included in this review. Nursing papers were published since 1990 were included, but some references from 1971 onwards relating to scientific research conducted on essential oils were also included. These remain valuable as they are probably the only reference available for a specific oil or property, or show the development of knowledge in this area. Papers were excluded if they consisted only of brief case studies presented in abstract form. The review covers key professional issues and the principal areas of clinical practice where aromatherapy is used. FINDINGS: Despite calls for more research in the 1980s and 1990s, there is still little empirical evidence to support the use of aromatherapy in nursing practice beyond enhancing relaxation. Its popularity needs to be balanced against the potential risks related to allergies, safety and inappropriate use by inexperienced users. CONCLUSIONS: There is great potential for more collaborative research by nurses to explore the clinical applications in greater detail and to move beyond the low dose paradigm of application of essential oils.     

护生基础护理实习现状及对策

综述了护生的职业态度、对基础护理的认知及能力现状,提示应重视护生专业思想和职业道德教育、培养护生服务意识及加强护生临床带教管理等对策,以提高和完善护生对基础护理的认知,规范其临床基础护理实践,促进个人发展,利于其牢固专业思想。     

美国护理专业学位博士教育发展与启示

该文对美国护理专业学位博士教育的产生与发展、培养目标、核心能力、专业方向、课程体系、师资储备等进行介绍,并结合我国国情探讨其对我国护理专业学位教育的启发作用,为培养具有高级实践能力的护理人才提供参考。     

A review of forgiveness literature with implications for nursing practice

This article describes clinical practice where forgiveness is a central patient/family issue. In this case, the professional nurses learned substantively from the family about the tragic consequences of forgiveness withheld and the transformative nature of forgiveness extended. The concept of forgiveness is defined and forgiveness as a primary, secondary, and tertiary intervention is considered. Implications for professional practice are developed. Practical forgiveness-based assessment questions are included. A review of instrumentation from other disciplines measuring interpersonal dimensions of forgiveness is offered. Significant aspects of the process of forgiveness are elucidated and opportunities for forgiveness-related nursing research are identified.     

美国实践型护理博士项目对我国高级护理实践发展的启示

实践型护理博士项目的兴起,极大地加快了美国高级护理实践的发展,在培养大批护理人才的同时,也规范、提高了护理实践活动质量,使护理实践活动得到了广泛的认可和支持。我国的高级护理实践活动起步较晚,发展缓慢,且没有形成统一规范的标准,借鉴美国的实践型护理博士项目发展我国护理实践活动,不仅是培养专科护士的途径之一,也是我国护理研究生多元化教育的重要形式。     

美国杜克大学临床型护理博士项目介绍

美国杜克大学临床型护理博士项目在全美护理院校中名列前茅,旨在培养多学科合作医疗团队中的护理领导者、促进护理实践变革和为患者提供高质量护理的高级护理专家。以在线学习为主、面授学习为辅的教学形式,为有知识提升需求的临床护理人员的继续教育提供了契机。该项目遴选具有丰富的高级护理实践、科研和教学经验的临床护理专家、护理领导者和研究者作为导师团队指导学生以保证学业质量。该文介绍该项目的开展情况,分析经验与现存问题,以期为我国护理学博士专业学位教育的开展提供借鉴和思考。     

Characteristics of unsafe undergraduate nursing students in clinical practice: an integrative literature review

Providing quality clinical experiences for nursing students is vital to the development of safe and competent professional nurses. However, clinical educators often have difficulty identifying and coping with students whose performance is unsatisfactory. The purposes of this integrative review were to examine the extent and quality of the literature focusing on unsafe nursing students in clinical settings and to describe the characteristics of nursing students considered unsafe in clinical settings. A structured literature search yielded 11 relevant articles: five theoretical articles and six research studies. Analysis of findings revealed three themes: ineffective interpersonal interactions, knowledge and skill incompetence, and unprofessional image. The themes reflected the attitudes, actions, and behaviors that influenced students' ability to develop a safe milieu for client care. The findings provide clarity for early identification of students in need of increased support and facilitate clinical educators in meeting students' learning needs to ensure patient safety.     

Competence in nursing practice: A controversial concept--A focused review of literature

The competency-based approach to education, training and assessment has surfaced as a key policy in industrialised nations. Following the transition of nurse preparation to the higher education sector the need to attenuate the tension of interests between employer and educator arose. While the competency-based approach has the potential to fulfil this, the application of competence to nursing is controversial and little consensus exists on definition. This paper synthesises a significant volume of literature relating to the acceptability and definition of the concept of competence with regard to nursing practice. Subsequent to a focused review of literature, problems inherent to the definition and utilisation of the concept of nursing competence are discussed. Because nursing requires complex combinations of knowledge, performance, skills and attitudes, a holistic definition of competence needs to be agreed upon and operationalised. This could facilitate greater acceptance of the concept and also underpin the development of competency standards and the tools required for the assessment of such.