Differentiated practice: The evolution of professional nursing

Differentiated practice identifies and uses three distinct nursing roles to create a comprehensive nursing care delivery system that meets client needs across the health care continuum. Clearly defined associate degree in nursing, bachelor's of science in nursing, and master's science in nursing competencies present career opportunities for professional nurses at the bedside providing, integrating, or managing client care as well as options in management, education, and regulation. An evolutionary paradigm shift required of all nurses is the awareness that each nurse is not the whole of nursing, but rather each nurse contributes to the whole of nursing. A nursing community comprised of differentiated roles that are mutually valued and well integrated will position nursing as a powerful force in meeting the diversity and complexity of health care needs in contemporary society.     

Health advocacy for young, low-income, inner-city women

The Urban Women's Health Advocacy Training Project was a university-based demonstration program designed to collect data on the health status of urban women and to test nursing interventions for training community health advocates. Thirty Hispanic and black trainees between 17 and 21 years of age were selected to participate in an eight-week, 20-h/w program emphasizing women's health education, health advocacy skills, and career awareness. This project has many implications for nursing practice with young, inner-city women. Enhancing the self-care and advocacy skills of these women maximizes their potential for use of available health services and their ability to influence the expansion of the services required to meet their own and their families' health care needs. Problems in funding and conducting such demonstration projects are discussed.     

慢性老年病人的社区护理分析

目的:通过对老年病人的社区护理进行探讨,阐明社区护理对提高老年慢性病病人生活质量的有效性.方法:2010年1月～2011年8月随机抽取482例慢性老年病人的临床资料进行回顾性分析,并将其随机分为两组,对照组(n=241)实施常规护理,观察组(n=241)实施优质护理、健康教育等内容的社区护理服务.通过家庭随访对护理效果以及病人对社区护理的满意度进行观察.并采用焦虑自评量表(SAS)及抑郁自评量表(SDS)对两组病人的心理状况进行对比;对两组病人健康知识知晓度、自我保健意识以及健康习惯的养成等方面进行对比分析.结果:观察组SAS与SDS得分均比对照组低,且存在统计学意义(P＜0.05);在健康知识知晓度、自我保健意识以及健康习惯的养成等方面,对照组所占的比例均低于观察组,且存在显著的统计学意义(P＜0.01).结论:对慢性老年病人进行社区护理,能改善病人的不良心理状态,还能提高病人健康知识的知晓率与自我保健意识.     

Professional excellence and career advancement in nursing: a conceptual framework for clinical leadership development

Increasingly, stakeholders in the health care community are recognizing nursing as key to solving the nation's health care issues. This acknowledgment provides a unique opportunity for nursing to demonstrate leadership by developing clinical nurse leaders to collaborate with the multidisciplinary care team in driving evidence-based, safe quality, cost-effective health care services. One approach for nursing success is standardizing the entry-level education for nurses and developing a uniform professional development and career advancement trajectory with appropriate incentives to encourage participation. A framework to guide and provide scientific evidence of how frontline nurses can be engaged will be paramount. The model for professional excellence and career advancement provides a framework that offers a clear path for researchers to examine variables influencing nurses' professional development and career advancement in a systematic manner. Professional Excellence and Career Advancement in Nursing underscores professional preparedness of a registered nurse as central to leadership development. It also describes the elements that influence nurses' participation in professional development and career advancement under 4 main categories emphasizing mentorship and self-efficacy as essential variables.     

Attitudes toward nursing as expressed by nursing and non-nursing college males

One way to address the increasingly critical shortage of nurses in the health care system is to recruit more men into nursing. To do so effectively one must understand the attitudes that potential male recruits have toward nursing as a career. This investigation was undertaken to determine differences in attitudes toward nursing as a career held by men in various majors. The Attitudes Toward Nursing Scale (ATNS), developed by the investigators, was used to measure five categories of attitudes toward selecting nursing as a career frequently cited in the literature. A sample of 247 male non-nursing and 94 male nursing community college students completed the scale. Analysis of demographic variables revealed that the nursing students were more likely to be older, married, and have military corpsman experience than were the non-nursing students. Additional statistical analysis revealed that communication majors (i.e., English, Drama, Speech) were most similar and mathematics majors were least similar to nursing majors in various attitudes. Also, a substantial percentage of non-nursing majors were potential recruits for nursing in that they indicated interest in nursing as an alternative career. Recruitment of men into nursing programs will not solve the current shortage of nurses. However, men as a viable source should not be treated lightly. Recruitment efforts should focus on recognizing interested students, and recruiting those who have attitudes toward nursing as a career which are similar to those of nursing majors.     

Clinical Competencies for Community Health Nursing

Cost-containment strategies initiated in the early 1980s caused a major shift in site of care delivery for persons needing nursing care. Where once the majority of clients were cared for in the acute-care setting until they were self-sufficient, now most are discharged to the home environment still requiring acute-care nursing interventions as well as community health nursing skills. This rapid shift in practice sites has placed severe strain on community health nursing agencies. Not only are more nurses required to fill the increased demand for services, but the demand comes at a time when we are experiencing a severe nursing shortage. This has forced many agencies to hire acute care nurses who have little or no community health nursing experience. These nurses come to community health nursing expecting to use the same set of skills and knowledge base used in their acute-care practice; however, the skill levels and concepts required for community health nursing are quite different from the acute care setting. Educational preparation has not kept pace with this shift in practice. Consequently, many nurses are not adequately prepared to enter community health nursing. Preparation must include theoretical and experiential components that focus on assessment skills (of the community and individual), decision making, case management, health systems management, teaching, and leadership. Collaborative efforts between community health organizations and educational institutions would seem to be one solution that would ensure adequately prepared nurses for community health nursing. The establishment and maintenance of strong staff-development programs within community health nursing agencies are also required.     

Health care leadership academy: a statewide collaboration to enhance nursing leadership competencies

Competency in leadership skills is necessary to manage in the current chaotic health care environment and proactively participate in the creation of a better environment. Although interest in pursuing a career in health care is growing, lack of leadership competence contributes to employee frustration and dissatisfaction, which directly and indirectly impacts the supply of health care workers. To addressthe lack of leadership competence and its disturbing consequences, the Arizona nursing community designed a model for nursing leadership and created a partnership to provide a high-quality, affordable leadership education program focused on enhancing the leadership competencies of frontline nursing supervisors.     

产后抑郁症的社区护理干预

目的:探讨产后抑郁症的社区护理干预。方法:宣传和培养产妇自理意识,加强产前保健,完善产褥期家庭访视,为产妇提供高水平的社会支持和就诊指导。结果:社区妇幼保健人员把护理理念从医院延伸到社区,提高了社区护理服务技能,保证了社区护理服务质量。结论:产后抑郁严重影响产妇身心健康和婴儿生长发育,社区护理干预是降低产后抑郁发病率的重要手段。     

新疆二级及以上综合医院护士职业生涯规划认知现状调查

目的调查护士职业生涯规划认知现状,为今后建立有效的职业生涯规划程序、稳定护士队伍提供依据。方法对新疆二级及以上综合医院1 298名在职护士进行问卷调查。结果护士职业生涯规划认知得分为(3.28±0.41)分,总体偏低;职业生涯规划认知得分的影响因素包括医院等级、职称、职务、学历、职业生涯规划培训、是否重症科室、婚育情况。结论应加强对护士职业生涯规划的指导与管理,提高护士对职业生涯规划的认知度,稳定护理队伍。     

Community Analysis: A Collaborative Community Practice Project

Abstract Lack of access to health care is a concern in many communities. A group of representatives from health, social service, other community agencies and nursing education meet regularly to address issues in providing care to homeless, low-income, and uninsured persons in Spokane. Washington. This group's efforts has been hampered by lack of clearly identified factors that adversely affect access to care. One aspect of community analysis performed by this group used a collaborative community practice model. Community diagnoses were determined from information collected from service providers. Community health nursing faculty, as clinical specialists, can play a role in such a collaborative process.     

Psychiatric-mental health nursing: career characteristics, professional activities, and client attributes of members of the American Nurses Association Council of Psychiatric Nurses.

As the twenty-first century approaches, psychiatric nursing is reviewing its past and speculating about its future. This article reports on the current status of 525 psychiatric-mental health nurses. The nurses responded to a questionnaire designed to elicit information on career characteristics, professional activities, and client attributes. The nurses work primarily in acute care institutions or hospitals. The typical client is white, middle class, and adult. The focus of care in mental health is moving to the community. If psychiatric nurses want a viable role in the mental health system of the future, they must begin to develop a system of care for at-risk populations in the community now.     

Management strategies and patient needs: the provision of nursing care in the community

Community nurse managers in 17 health districts in England were interviewed about their strategies for identifying and coping with unmet need for nursing care in the community, and their efforts to plan community nursing services and to meet changing levels of demand for care. The managers were found to have access to a wide range of information for planning services, but this information did not always seem to be used most effectively. The managers' efforts to identify unmet need were often piecemeal and unco-ordinated, and this may have been, in part, because managers were facing difficulties in meeting existing demands for services. As a result, several were beginning to set priorities for care. Faced by increasing demand and limited finance, it seems likely that managers will continue to do so, and will develop more stringent criteria for nursing care.     

Education in practice: the United Kingdom experience

Health care leaders, government agencies, and professional nursing associations all understand that rethinking existing delivery strategies is part of the strategic approach to workforce planning. In the United Kingdom, the demand for nurses is great and the supply inadequate. The potential for a public health crisis is challenging the way the United Kingdom educates and positions nurses within the health care industry. This article reviews past efforts and current strategies in workforce characteristics, age, educational mix, competencies, career goals, and future plans to ensure adequate nurses to care for the health needs of the people residing in the United Kingdom. The activities of the National Association of Theatre Nurses in promoting dialogue around this issue and fostering collaborative initiatives are presented in a framework of efforts designed to benefit all.     

Advancing practice by developing a primary care nursing programme

The discussion of advanced practice in nursing is ongoing, yet the need for practice to advance and develop across the health economy is called for in much of the current literature and government policy. This article considers an educational intervention that set out to advance primary care nursing. The programme aimed to facilitated nurses to understand clients, families and carers in the community setting, to offer a high standard of care, to support specialist practitioner team leaders to work across community nursing disciplines and to make their own career development choices. Advancing practice in this novel primary care nursing programme required change management, collaboration, partnership, leadership and involvement of the staff nurses themselves.     

Partners in care: investigating community nurses’ understanding of an interdisciplinary team‐based approach to primary care

Aim. This study investigated community nurses understanding of teamwork in primary care. Background. Internationally trends indicate a movement towards the development of primary care as a key element in health service delivery. This will have implications for the organisation of community nursing services by creating the need for more coherent integrated structures for service delivery. In this context, teamwork is associated with a range of positive outcomes including higher levels of quality care and job satisfaction. Design. A research study was undertaken to investigate community nurses’ understanding of an interdisciplinary team‐based approach to primary care using a qualitative research design. Focus groups were held with community nurses working in the areas of public health nursing, general nursing and practice nursing. Methods. Three focus groups were established. Twenty seven participants were recruited to form three groups comprising public health nurses (n = 10), general nurses (n = 10) and practice nurses (n = 7). A sequenced‐questioning framework guided the systematic process of data collection. Data analysis engaged a thematic content analysis framework. Results. The analysis of the data revealed the following themes: teamwork, promoting community services, promoting health, professional roles and skills and knowledge for primary care. Conclusion. Nurses can contribute significantly to the re‐orientation and development of primary care services. There must be greater efforts to encourage interdisciplinary approaches. The outcomes of this study can inform strategies for effective team working in primary care. Collective team efforts enhance patient care and effective teamwork requires a greater understanding of group processes and team development. Relevance to clinical practice. Nurses clearly articulated their contribution to primary care, but recognised that there are many challenges to overcome. An enhanced primary care team has the potential to allow the public access to both the individual and collective skills and knowledge of team members.     

社区护理干预对老年人健康行为的影响

目的评价社区护理干预对老年人健康行为的影响。方法对辖区老年人进行为期1年的社区护理干预,以访视和问卷相结合的方式向辖区60岁以上老年居民发放“老年人遵医行为调查表”、“老年人健康知识知晓率调查表”和“辖区老年人对社区护理工作满意度调查表”,收集干预前后资料进行对比分析。结果护理干预后老年人遵医行为、健康知识知晓率和对社区护理工作满意度均有提高(P<0.05或P<0.01)。结论社区护理干预有助于提高老年人的遵医行为、健康知识和满意度,从而有助于健康行为的建立。     

Perceived status of nurses compared to other health care professionals

The global shortage of nurses indicates that strategies must be in place to attract individuals to the profession. The purpose of this study was to explore the specific motivations/influences that encourage students to undertake a nursing career, their perceived status of nurses, their perceived goals as nurses and their future career pathways. The study involved a cross sectional approach using Ford's (1986) taxonomy of human goals as a theoretical framework. A questionnaire was administered to 126 nursing students enrolled in the first semester of a nursing degree and 80 students in the final semester. Results revealed the image of nurses continues to be influenced by the media. Findings also show how the perceived status of nurses, within a hospital and community setting differ compared to other health care workers. This result highlights the participants' lack of knowledge in regard to the role of professionals within the health care industry. Results have implications for nurse education (long and short term) in relation to the role of nurses.     

Babies and machines that go ‘beep’: First‐year nursing students’ preferred areas of future practice

Students of nursing enter their programmes of study with preconceived ideas of what a career in their chosen profession will entail. The literature suggests that images from the media and past experiences contribute to these perceptions. Although it is positive images of the profession that will usually attract an individual to a career in nursing, often more negative perceptions will direct students away from potentially rewarding areas of specialization. This paper describes career projections of nursing students enrolled in the first year of four preservice nursing programmes at the rural campus of one Australian university. Part of a larger study, the data reported here indicate that most respondents intend to practice in the areas of midwifery, paediatrics and emergency nursing. Oncology, community nursing, aged care and mental health nursing all ranked poorly across three rounds of surveys. These findings have implications for practicing nurses and nurse educators who seek to dispel inaccurate images of these important specializations.