Assessing ethnicity in preconception counseling: genetics--what nurse practitioners need to know

PURPOSE: To define and discuss five genetic disorders--Tay-Sachs, sickle cell anemia, Canavan's disease, thalassemia, and cystic fibrosis (CF)--and to explain the importance of the nurse practitioner's (NP's) assessment of clients' ethnicity during preconception counseling, which should address these genetic conditions. DATA SOURCES: Review of literature from professional journals, professional organizations' Web sites, guidelines from the American College of Obstetricians and Gynecologists, the National Institute of Health Consensus Statement, and the authors' professional clinical experience. CONCLUSIONS: The goal of preconception counseling is to identify potential or actual medical, psychological, or social conditions that may affect the mother or fetus. NPs are often the health care providers that initiate preconception counseling to women in varied primary care settings. NPs must be familiar with ethnicity-related inheritable conditions in order to provide appropriate client information and education and to implement testing and, when needed, referral for genetic counseling to individuals and families at risk for genetic disorders such as Tay-Sachs, Canavan's disease, CF, sickle cell anemia, and thalassemia. IMPLICATIONS FOR PRACTICE: NPs providing health care to women of child-bearing age should assess the client's use of contraception and intent for future pregnancy. Preconception counseling when indicated should be initiated to all women to increase their potential for healthy pregnancy outcomes. Although a comprehensive personal, family, medical, and psychosocial history and initiation of folic acid are the mainstays of preconception counseling, assessment for risk of ethnicity-related genetic conditions must also be included in prepregnancy health care.     

The health styles of nurse practitioners

PURPOSE: To examine the formal and informal health care beliefs, behaviors, and practices of nurse practitioners (NPs). DATA SOURCES: A self-administered questionnaire with a primarily closed-ended format was distributed over a 3-day period to a convenience sample of 321 NPs attending a national NP conference. CONCLUSIONS: The overall health status and health practices of NPs were found to be fairly good, but there was room for improvement, particularly with regard to nutrition, health responsibility, physical activity, and stress management. IMPLICATIONS FOR PRACTICE: Respondents were more likely to self-diagnose and self-treat minor illnesses and largely received their primary health care from physicians. The majority of NPs indicated a willingness to receive health care from an NP; however, the nonavailability of NPs restricted this option.     

Integration of spirituality into health care practice by nurse practitioners

Although conceptualizations of mind, body, and spirit are ancient, spiritual aspects have not been readily integrated into health care. Western medicine's mechanistic model, with its "fix-broken-parts" paradigm, focuses on the physical body, with occasional consideration given to emotional and mental aspects. One's view of self in relation to a Supreme Being, and one's existence and purpose for life is central to health at all levels, e.g., spiritual, physical, emotional, and cognitive. The purpose of this article is to describe the role that nurse practitioners can and should take with patients and their families in integrating spirituality into health care practice.     

Primary health care nurse practitioners in Canada

Canada, like many countries, is in the midst of primary health care reform. A key priority is to improve access to primary health care, especially in remote communities and areas with physician shortages. As a result, there is an increased emphasis on the integration of primary health care nurse practitioners. As of March 2006, legislation exists in all provinces and two territories in Canada that allows nurse practitioners (NPs) to implement their expanded nursing role. In this paper, we will briefly review the historical development of the NP role in Canada and situate it in the international context; describe the NP role, supply of NPs in the country, and the settings in which they work; propose an NP practice model framework; summarize facilitators and barriers to NP role implementation in primary health care delivery; and outline strategies to address the barriers.     

Preparing psychosocial nurse practitioners for health care delivery

A central task for faculty in programs preparing health care practitioners is to remain timely in educating for the prevailing and future social and health services context. Current considerations in preparing advanced practice psychiatric nurses include the need for greater recognition of comorbidity, concerns about health care access and utilization for vulnerable populations, and changing patterns of practice. In addition, there is a great need to expand the cultural competence and diversity of the population of advanced practice nurses who deliver care to recipients in an increasingly multicultural society. This article describes the educational program developed at the University of Washington to prepare expanded role Psychosocial Nurse Practitioners and sets forth the rationale for major decisions and current directions.     

Integration of nurse practitioners into a family health network

A randomized controlled study called Anticipatory and Preventative Team Care (APTCare) explored a new role for nurse practitioners (NPs) within a multidisciplinary team. The aim of the study was to evaluate whether integrating NPs and a pharmacist was an effective approach for the management of patients living with multiple chronic illnesses. Over an 18-month period, three part-time NPs and a pharmacist became part of a rural Family Health Network (FHN). They established relationships with study patients and collaborated to provide optimum care. Each NP had 40 patients, all of whom received care in the home. Study results showed that an initial home visit was invaluable for establishing a care plan, developing a relationship with the patient and assessing the home environment. Ongoing monitoring at home, however, was found to be an inefficient use of the NP role. By the end of the study, all clinicians agreed that the NP role had been successfully integrated into the multidisciplinary team.     

A model of succession planning for mental health nurse practitioners

This paper reviews current literature on succession planning for mental health nurse practitioners (NPs) and discusses a model of succession planning that is underpinned by principals of leadership development, workforce participation and client engagement. The paper identifies succession planning as a means of managing a present and future workforce, while simultaneously addressing individual and organizational learning and practice development needs. A discussion of the processes attendant upon sustainable succession planning – collegial support, career planning and development, information exchange, capacity building, and mentoring is framed within the potential interrelationships between existing NP, developing NP and service directors and/or team managers. Done effectively and in partnership with wider clinical services, succession planning has the potential to build NP leadership development and leadership transition more broadly within mental health services.     

提高护理专业毕业生护士执业资格考试通过率的方法与体会

护士执业资格考试是毕业生从事临床护理工作的基本条件,能否通过考试取得执业资格证书直接关系到学生就业.在领会护士资格考试政策的前提下,紧密结合学生实际,高度重视、精心组织、科学安排、抓好基础、强化技能.可以提高考试通过率.要正确看待考试成绩和通过率,把提高教学质量、培养合格人才作为学校科学发展的最终目标.     

Curriculum design for educating nurse practitioners in adolescent health care

In light of the limitation of available health care services for adolescents and of the small numbers of personnel to provide those services, it seems an opportune time for nurse practitioners to develop their role in adolescent health care. This paper describes the curriculum of the Adolescent Subspecialty Track which is a part of the Pediatric Nurse Practitioner program at the Yale University School of Nursing. One who graduates from the PNP program with a specialty in adolescent health care is able to practice as a PNP with an emphasis upon providing primary care to adolescents, to conduct clinical research, and to begin functioning as a leader in the profession. It is hoped that more nursing schools develop curricula for preparing nurse practitioners in the area of adolescent health care.     

Postpartum depression screening by family nurse practitioners

PURPOSE: The purpose of the study was to identify whether and how nurse practitioners (NPs) screen for postpartum depression, as well as to identify factors affecting such screening. DATA SOURCES: Self-report data were gathered from 159 questionnaires completed by a convenience sample of family NPs (FNPs) in Illinois and Wisconsin during July 2002. CONCLUSIONS: Despite the fact that 84% of FNP respondents saw at least one postpartum woman yearly, 42% never screened for postpartum depression in any way. The subjects' confidence in their knowledge of how to use a screening tool was the single best predictor of screening behavior (r= .487). NPs tend to follow clinical practice guidelines, but no guidelines exist to address postpartum depression specifically. Screening for postpartum depression is not universal, making it likely that prevailing estimates of the incidence of this disease are low. IMPLICATIONS FOR PRACTICE: If the number of NPs who screen for postpartum depression could be increased, many postpartum patients and families could be positively affected. Advanced practice nursing education should adequately prepare graduates to screen at-risk patients. The development of graduate curricula including thorough units on postpartum depression, as well as formulation of clinical practice guidelines for postpartum depression, could make great strides toward more and better screening, prompt diagnosis, and treatment.