Innovations in United States genetics nursing: Practice and research

Aim: Clinical and research applications from human genome discoveries are growing and creating both opportunities and challenges to the integration of genetic concepts into practice and research. Nurses have a long history of caring for individuals, families, and groups with genetic conditions. In the past two decades, a small group of nurses in the USA have used a variety of strategies to further develop the field of genetics nursing. In this paper we identify innovative approaches to identifying genetics‐related nursing roles and opportunities, as well as successful collaborative efforts beyond nursing to address the emerging health and societal challenges related to human genetics discoveries. Methods: The information presented here comes from a variety of sources where the authors or genetics nurses directly participated, including: (i) a systematic literature review of genetics nursing; (ii) a comprehensive research study of models of delivering clinical genetics services and the roles of health professionals; and (iii) participation in numerous national research, planning, programmatic, and advisory groups involved with clinical genetics‐related health services, research, education, and public policy. Results: Genetics nurses in the US have developed innovative responses to genetics‐related challenges within and beyond the profession of nursing. These include: (i) establishing an organization for nurses in genetics and gaining formal recognition of genetics as a specialty of nursing; (ii) defining the scope of genetics nursing practice and developing a new genetics nursing credential; (iii) establishing a multiprofessional genetics education coalition and defining genetic competency for health‐care practice; (iv) creating new clinical practice roles for nurses that integrate emerging genetics concepts and skills into diverse clinical practice areas; (v) expanding nursing involvement in genetics‐related research; and (vi) participation in high‐level genetics advisory groups. Conclusions: The US experience shows that nurses have made substantial progress in expanding their involvement in genetic services through visionary leadership, innovative approaches to challenges, establishing support with nurse colleagues, and engaging in multiprofessional efforts. The most important first step is developing a supportive environment for nurse advancement. In the US, the genetics nurses’ organization known as the International Society of Nurses in Genetics (ISONG) has provided this base.     

Education outcomes related to including genomics activities in nursing practice in Singapore

Pestka E, Lim SH, Png HH. International Journal of Nursing Practice 2010; 16 : 282–288
Education outcomes related to including genomics activities in nursing practice in Singapore The purpose of this study was to describe the impact of a genomic educational intervention by measuring the extent participants could apply the class content to practice. A sample of 76 nurses employed by Singapore Health Services, Singapore, participated in a nursing genomics seminar in 2008 and completed a survey form with a response rate of 89%. Every respondent was able to identify use of a genomic assessment or intervention item with a patient from their clinical practice. The mean use of genomic assessment and intervention items was 5.8 out of a possible 10. The most frequently used items were assessment of family history information, environmental factors and genomic physical findings. Findings provide evidence that nurses are able to include genomic assessments and interventions in their practice following targeted education. This study highlights how informed nurses are able to apply genomic assessments and interventions to individualize patient care.     

Using the NHS sustainability framework to understand the activities and resource implications of Canadian nursing guideline early adopters

Aims and objectives. To examine the activities and resource implications for the initial cohort of healthcare organisations involved in the introduction of multiple nursing guidelines. Background. The Best Practice Spotlight Organization initiative was launched in 2003 as part of the Registered Nurses’ Association of Ontario’s Best Practice Guidelines programme. While previous research has evaluated improvements in patient care and outcomes, there has been limited research from an organisational perspective on the activities conducted to introduce nursing guidelines. Design. Secondary analysis of retrospective narrative data. Methods. We conducted a content analysis of the 2004–2006 annual reports from the seven participating sites. We used both deductive and inductive approaches to categorise the guideline implementation activities and their resource implications. Results. All sites reported implementing multiple guidelines (four to nine guidelines per site) and used a wide range of implementation activities that clearly addressed nine of the 10 NHS Sustainability dimensions. The dimension not reported was benefits beyond helping patients. All sites established steering committees that involved staff and senior leaders, reviewed selected guidelines and recommendations, reviewed existing policies and procedures and developed new policies and procedures, recruited champions or peer mentors, applied for additional external funding to support activities, developed relationships with external clinical partners, included guideline implementation in orientation, developed intra‐agency web‐based and print communications for the project, and evaluated practice changes. For each of these activities, the sites reported expenditures and resource usage. Conclusions. The organisational processes used for the introduction of new nursing guidelines in Canada are remarkably consistent with factors identified by leaders and change agents in the UK who developed the NHS Sustainability Model. Relevance to clinical practice. A multidimensional framework for sustainability is useful for planning successful guideline implementation across an organisation. Examples of specific activities and resource implications for organisational change are provided.     

Developing competencies in genetics nursing: Education intervention for perinatal and pediatric nurses

Nurses need to be appropriately trained in genetics to provide clinical care based on best practice for patients and families. This exploratory study describes an educational intervention using authentic stimulus material centered on a clinical case study of a family with a baby with Down syndrome. Quantitative and qualitative data were collected from a sample of 15 nurses and 27 students from three universities in Japan before and after completing an entry‐level workshop on competency‐based genetics nursing. Participants reported increased perceived genetics knowledge and clinical confidence. Despite more than 90% of the participants reporting that they understood the underlying genetics knowledge, their confidence and the ethical aspects of genetics nursing had not been promoted after the seminar. In contrast, the reflections, coded into three categories, showed they recognized families' needs for psychological support, family decision making, and protection and privacy and suggested that nurses had undergone a profound shift in understanding about these issues. Although indicating that a single seminar was insufficient, the study findings will be useful to develop educational materials on genetics for both students and nurses.     

Midwives' view of the importance of genetics and their confidence with genetic activities in clinical practice: implications for the delivery of genetics education

Aims and objectives. The aim of the study was to ascertain the level of importance midwives attach to integrating genetics into midwifery care and to compare that with their self‐reported level of confidence in incorporating genetics into their clinical practice. Background. Previous work has shown that many midwives feel ill‐prepared for the increased integration of genetics into clinical practice and often only limited genetics education provision is in place. With the application of genetics to midwifery practice increasing, it is important that midwives develop their knowledge and skills to meet this growing clinical role. This study was therefore developed to ascertain the attitudes and educational needs of midwives by exploring genetic issues likely to arise in clinical practice and the confidence individuals felt in dealing with them. Design. A survey questionnaire with open and closed questions. Methods. All midwives working in four National Health Service trusts (n = 817) were invited to self‐complete the validated questionnaire anonymously. Data were collected on demographics and preferred continued professional development options for future educational programme development. Likert scales were used to rate the importance of genetic activities and midwives’ confidence to perform them based on the genetic activities which were first listed and then presented embedded within specific clinical scenarios. Results. The response rate was 51% (n = 416). The majority of midwives felt that genetics was important but many did not feel confident about integrating it into their clinical practice. Across all scenarios >60% of midwives were not confident on any risk identification or risk communication activities. The majority of midwives were receptive to genetics education particularly if delivered from a clinical rather than a psychosocial or scientific perspective. Conclusion. This study demonstrates the need for midwives’ pre‐ and postregistration education to include clinically relevant genetics. The evidence presented here can inform the design, development and delivery of future educational initiatives. What this study adds. This study was the first to identify the educational needs of midwives related to integrating genetics into midwifery clinical practice. It provides evidence of key topics to be included in educational programmes: referring to specialist genetics services, genetic testing, risk and communicating genetic information. It shows the type and format of course preferred by clinically based midwives: interactive workshops and lectures using clinical patient‐based case examples will attract midwives to participate and will be better received by their managers. Relevance to clinical practice. Midwives view genetics as important in their clinical practice. However, they have little confidence in their ability to integrate genetic activities in their current clinical practice. Midwives are receptive to additional genetics education and training. Antenatal and community‐based midwives could be targeted initially. Organizers must be responsive to work patterns in planning education sessions, and encourage and support champions from previous courses and specialist areas to promote genetics education in maternity units.     

评选护理服务明星护士的做法与体会

目的树立以人文关怀为特征的护理理念,为病人提供个性化、人性化护理服务,提高护理质量。方法连续3年评选护理服务明星护士,并进行考核、评价、奖励等系统管理。结果科室护理各项指标(护理质量、基本理论、技术操作、病人满意度)显著上升,病人投诉率逐年下降。结论评选护理服务明星护士可以激发护士潜能,建立医院护理服务文化,提高医院核心竞争力,促进医院可持续发展。     

Using theory to guide the diffusion of genetics content in nursing curricula

Completion of sequencing the human genome will lead to identifying the genetic basis for health and disease and affect diagnosis and treatment in virtually every aspect of medicine and nursing. In this paper we describe the process of incorporating genetic content into the undergraduate and graduate curricula. Rogers' innovation-diffusion theory was used to guide organizational change. Faculty development was foundational to incorporating innovative content in nursing courses. Creation of an elective nursing course on genetics was a practical initial strategy that allowed for evaluation of the course content and students' responses to the new course. Ongoing faculty development is planned in order to sustain the impetus of increasing faculty competence in this area of health care. The long-term goal is to have every lecture that addresses specific health conditions to include the genetic basis for the condition.     

护理部在推进护理学科建设中的实践

目的:探索护理部在推进医院护理学科建设中的策略。方法:①严格护理质量控制,提高临床护理服务质量;②完善人才培养机制,培养高素质护理人才;③健全护理科研体系,深入推进护理科学研究。结果:护理服务质量不断提高,各级各类护士培养取得显著成绩,护理科学研究取得丰硕成果,学科整体优势明显加强。结论:护理部主任在护理管理中,应以科学管理为根本,以人才培养为手段,以创新研究为动力,全面推进学科建设。     

Advanced nursing practice: the case of nurse practitioners in three Australian states

This paper provides insight into the work of nurse practitioners in three Australian states. Using a case study approach, the aim of the study is to give an account of some of the types of cases/patients who consult with the nurse practitioners in the states visited and to offer insight into one of the policy changes required to support the introduction of the nurse practitioner role. A snowball sampling technique was used to obtain the sample population of both 10 nurse practitioners and other health care personnel. Semi-structured interviews were conducted with the 39 respondents in both samples. The analysis of the 10 nurse practitioner interviews reported here shows that these nurses undertook a wide range of roles. The results of the semi-structured interviews with the nurse practitioners are described using four of the 10 interviews and reporting them as case studies. The results highlighted the need to address legislation issues and to prepare nurses adequately for their clinical setting and address the difficulties of continuing education of rural nurses.     

Bridging the gap between theory and practice: a supervision programme for nursing students

This paper describes nursing students' views of a supervision programme provided during the second semester of their education, which was their first period of nursing practice. A form with open questions and a 24-item questionnaire were completed by the 28 nursing students. The analysis of their responses was a combination of factor analysis and grounded theory approach, based on comparative analysis. The results indicate two specific effects of the programme: personal growth and integration of knowledge. The process of creating knowledge includes four stages: awareness of concepts and phenomena, development of a 'language of caring', development of a 'model' of communication, and reflection gained as an effect of the intervention. The nursing students reported that reflection was a way to bridge the gap between theory and practice. Their views of the effect of the supervision showed high values for the following three factors: improved interpersonal skills, improved professional skills, and improved communication skills.     

护生行为与其基护操作成绩的相关性探讨

目的 探讨护生行为与基护操作成绩的相关因素。寻求提高护生操作成绩的有效方法。方法 对98级50名护生进行问卷调查及基护操作考试。并将护生行为模式得分与基护操作得分进行相关性分析。结果 护生行为模式与基护操作成正相关性。结论 护理教学中必须注重护生行为模式的培养。才能有效提高护生操作的成绩。     

Doctors' views of clinical practice guidelines: a qualitative exploration using innovation theory

RATIONALE, AIMS AND OBJECTIVES: The authors undertook this qualitative study as part of a larger evaluation of the effect of eight clinical practice guidelines issued by an arm's-length government agency in a Canadian province. Using Orlandi and colleagues' version of the Rogers diffusion of innovation model as a framework, the authors mapped doctors' views on implementation of clinical practice guidelines. METHODS: In semi-structured interviews with 45 representative doctors, the authors elicited doctors' framework of meaning for behaviour change in general and for clinical practice guideline uptake in particular. These were then compared with the adapted Orlandi/Rogers diffusion of innovation model to confirm, amend or challenge that model. RESULTS: Doctors identified the following influences on changes to their clinical practice and on clinical practice guideline uptake, within a five-step innovation model: 1 innovation: evidence change is required, perceived need for change; 2 communication: awareness of innovation; 3 adoption: evidence of improved outcomes without increased patient risk, opinion leader support, consistency with current trends; 4 implementation: patient and family acceptability; and 5 maintenance: system support, patient and family support, observed improved patient outcomes without increased risk. CONCLUSIONS: Innovation for doctors is a complex decision process rather than a single decision point. Change occurs in the context of professional networks and patient and family support and demand.     

The value of participatory action research in clinical nursing practice

This paper demonstrates the value of participatory action research (PAR) and promotes its use by nurses in clinical practice. PAR has gained popularity in nursing and health-care research, offering a way of developing practice-based knowledge that can improve nursing care. PAR is described in detail: what PAR is, how to use PAR in clinical practice, and the steps in the PAR cycle as applied during an exemplar study in which nurses used PAR to address their concerns and develop, implement and evaluate a model of care in an acute medical ward. The authors advocate PAR as a collaborative means to improve the nursing care for patients in varied clinical practice settings.