Nurse leaders as stewards at the point of service

Nurse leaders, including clinical nurse educators, who exercise stewardship at the point of service, may facilitate practising nurses' articulation of their shared value priorities, including respect for persons' dignity and self-determination, as well as equity and fairness. A steward preserves and promotes what is intrinsically valuable in an experience. Theories of virtue ethics and discourse ethics supply contexts for clinical nurse educators to clarify how they may facilitate nurses' articulation of their shared value priorities through particularism and universalism, as well as how they may safeguard nurses' self-interpretation and discursive reasoning. Together, clinical nurse educators and nurses may contribute to management decisions that affect the point of service, and thus the health care organization.     

Economic evaluation: what does a nurse manager need to know?

This paper considers how health economists can assist nurse managers, using the concepts and tools of economic evaluation. We aim to clarify these and also explode some of the myths about economic evaluation and its role in health care decision-making. Economic evaluation techniques compare alternative courses of action in terms of their costs and consequences. There are four principal methods; cost-minimization, cost-effectiveness, cost-utility and cost-benefit analysis, all of which synthesize costs and outcomes, at different levels of outcome. Economic evaluation is an intrinsic part of national decision-making about the efficient provision of effective treatments and services, and increasingly, organizational matters. In the UK, such technology evaluation is disseminated in guidelines from the National Institute for Clinical Effectiveness (NICE), having a top-down impact on the nurse manager. But economic evaluation is increasingly relevant to the nurse manager at local level, through newer techniques such as Programme Budgeting Marginal Analysis (PBMA), which facilitates explicit, transparent decisions, from the bottom-up. Nurse managers need to weigh up competing demands on resources and decide in ways which maximize health gain. Economic evaluation can help here because it presents evidence to challenge or support existing allocations, and provides a systematic framework to analyse health care decisions. In the current context of competition for scarce resources, we suggest that nurse managers need to embrace these techniques, or be marginalized from the resource allocation process.     

Neuropharmacology and mental health nurse prescribers

Aims and objectives. To outline the development and content of a ‘top‐up’ neuropharmacology module for mental health nurse prescribers and consider how much pharmacology training is required to ensure effective mental health prescribing practice. Background. Debate about the content of prescribing training courses has persisted within the United Kingdom since the mid‐1980s. In early 2003 supplementary prescribing was introduced and gave mental health nurses the opportunity to become prescribers. The challenge of the nurse prescribing curriculum for universities is that they have only a short time to provide nurses from a range of backgrounds with enough knowledge to ensure that they meet agreed levels of competency for safe prescribing. There is growing concern within mental health care that the prescribing of medication in mental health services falls short of what would be deemed good practice. Over the past two decades, nurse training has increasingly adopted a psychosocial approach to nursing care raising concerns that, although nurses attending prescribing training may be able to communicate effectively with service users, they may lack the basic knowledge of biology and pharmacology to make effective decisions about medication. Methods. Following the completion of a general nurse prescribing course, mental health nurses who attended were asked to identify their specific needs during the evaluation phase. Although they had covered basic pharmacological principles in their training, they stated that they needed more specific information about drugs used in mental health; particularly how to select appropriate drug treatments for mental health conditions. This paper describes how the nurses were involved in the design of a specific module which would enable them to transfer their theoretical leaning to practice and in so doing increase their confidence in their new roles. Results. The findings of this study suggest that the understanding and confidence of mental health nurse prescribers about the drugs they prescribe coupled with the information they provide to service users can be improved as a result of specific educational support. It would appear that adopting a prescribing dimension to one's role requires nurses to revisit a number of skills that are integral to the work of the mental health nurse, e.g. good communication, establishing empathy, listening to what clients say, responding to what is required and involving clients in their own care. Conclusion. Mental health nurses from one particular Trust in the West Midlands were provided with a ‘top‐up’ course in neuropharmacology and, although they found this challenging, ultimately they found this to be helpful. As nurse prescribing is ‘rolled out’ to other nursing specialities it is important that local Trusts and Workforce Development Directorates maintain a dialogue about nurse prescriber training to ensure that nurse prescribers receive the appropriate time and support for their ongoing Continued Professional Development. Relevance to clinical practice. As increasing numbers of nurses from different specialities qualify as nurse prescribers it is vital that they are supported by their employing organizations and given the opportunity to maintain their competency and confidence in their prescribing practice.     

Consent and confidentiality issues among school-age children and adolescents.

This article supports the moral viewpoint that minors with decision-making capacity, regardless of their age, should be involved in their health care decisions. When clinical care proceeds without attention to a child's emotional and developmental potential, the needs of a young person to be socialized to take care of his or her health care from an early age are not met. This is ethically irresponsible. Developing competence for informed consent decisions is associated with cognitive capacity. Explicit federal guidelines and laws exist for the inclusion of minors in research. By contrast, minors are often left out of participating in the health care decisions that may affect them for a lifetime in illness and wellness preservation. For day-to-day care, respect for children as increasingly autonomous individuals, members of families, and society is derived from the ethical principle of autonomy. The school nurse is often in a unique position to promote this professional behavior because most interactions are directly with the minor and without parental presence. In addition, the health office is a "safe" place where students can go for a variety of concerns. The school nurse must be concerned about ethical practice while staying within the limits of state and federal laws regarding minors' consent to treatment and confidentiality.     

Value-based formulas for purchasing. Does managed care offer value to society?

To assess whether managed care is, all things considered, a good investment for our society, we can measure its performance relative to five essential health care goals: promote efficiency; expand access; improve quality; preserve freedom of choice; and protect patient advocacy. These goals, which have shaped and continue to shape health care policy, define what is important to us in our health care system. Concerns about managed care's ability to advance these goals and thus to offer value are heightened if recently observed trends continue.     

Nurse scholars of the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program

BackgroundThe challenge to increase the diversity, inclusivity, and equity of nurse scientists is a critical issue to enhance nursing knowledge development, health care, health equity, and health outcomes in the United States.PurposeThe purpose of this paper is to highlight the current nurse scholars in the Robert Wood Johnson Foundation (RWJF) Harold Amos Medical Faculty Development Program (AMFDP).DiscussionProfiles and the programs of research and scholarship of the current AMFDP nurse scholars are described and discussed. Scholars share lessons learned, and how the AMFDP program has influenced their thinking and commitments to future action in service of nursing science, diversity efforts, legacy leadership, issues of health equity.ConclusionRWJF has a history of supporting the development of nursing scholars. AMFDP is an example of legacy leadership program that contributes to a culture of health and the development of next-generation nursing science scholars.     

新形势下健康管理中心护士素质与多元化角色

目的:探讨健康管理中心护士多元化角色在医院健康管理工作中心发挥的举足轻重的作用。方法:分析新形势下健康管理中护士多元化角色应具备的素质。结果:随着医学服务模式转变、服务的内涵和范围不断的延伸和扩大,健康管理中心护士崇高的职业道德、深厚的人文素养、良好的心理素质、扎实的理论基础、精湛的护理技术、良好的自我形象,已成为有别于医院传统科室封闭式临床护士的新型全科护理专业人员,其多元化角色的扮演,极大地提高了医院的健康管理水平和服务质量。结论:21世纪是知识经济时代,各种医疗改革正在逐步进行,护士只有充分认识时代的特点,不断地完善自身的知识结构和能力结构,转变思想观念、改变思维方式,建立全新的护理观念,将护理与健康、护理与人的生活方式、已有的知识与现代化手段相结合,在健康管理中心立足于角色的多元化,内强素质、外树形象,以促进医院健康管理工作顺利开展,使健康管理工作在医院和社会发挥更重要的作用。     

Positive and negative criticism: strategies for professional growth.

Criticism is a common experience in critical care for both the novice and experienced nurse. Assisting staff to react positively to criticism presents a challenge to the critical care nurse manager and an opportunity to turn what frequently is a negative situation into a phenomenon that builds morale and relationships. Whether criticism is being given or received, it is up to the nurse manager to facilitate positive relationships in the critical care environment.     

Emergency department case management: the dyad team of nurse case manager and social worker improve discharge planning and patient and staff satisfaction while decreasing inappropriate admissions and costs: a literature review

A model of emergency department (ED) case management consisting of a social worker and a nurse case manager can prevent inappropriate admissions, improve discharge planning, decrease cost, and enhance patient satisfaction. The individual and combined roles of the dyad team of social worker and nurse case manager are discussed. A literature review includes how a case management dyad team of social worker and nurse case manager in the ED can decrease utilization of the ED for nonemergent visits, promote the use of community resources, and improve discharge planning to avoid excessive costs. The importance of the dyad team working with the interdisciplinary team in the ED, the primary care physician (PCP), and other community health care providers in order to provide a holistic approach to care is addressed. A discussion about the improvement of both patient and staff satisfaction demonstrates the results of case management strategies that support and advocate for patients to receive quality, cost-effective care across the health care continuum, while decreasing the use of the ED for nonemergent care.     

Emergency department case management: the dyad team of nurse case manager and social worker improve discharge planning and patient and staff satisfaction while decreasing inappropriate admissions and costs: a literature review

A model of emergency department (ED) case management consisting of a social worker and a nurse case manager can prevent inappropriate admissions, improve discharge planning, decrease cost, and enhance patient satisfaction.3 The individual and combined roles of the dyad team of social worker and nurse case manager are discussed. A literature review includes how a case management dyad team of social worker and nurse case manager in the ED can decrease utilization of the ED for nonemergent visits, promote the use of community resources, and improve discharge planning to avoid excessive costs. The importance of the dyad team working with the interdisciplinary team in the ED, the primary care physician (PCP), and other community health care providers in order to provide a holistic approach to care is addressed. A discussion about the improvement of both patient and staff satisfaction demonstrates the results of case management strategies that support and advocate for patients to receive quality, cost-effective care across the health care continuum, while decreasing the use of the ED for nonemergent care.     

The school nurse manager: a catalyst for innovation in school health programming.

The nurse manager can assess students' needs in a school system and devise programs that will eliminate duplication of effort and promote collaboration of health-related services. The nurse manager can also accurately evaluate job performance of the nursing staff with an eye toward risk reduction and improved program outcomes. The work of a school nurse manager can facilitate the provision of excellent health care services by school health programs in an era of high expectations and fiscal accountability. This article examines the role of the nurse manager in the school setting and urges school nurses to develop managerial skills to enhance the delivery of care in their schools.     

One from the heart for people with a learning disability

Health inequalities are a major concern of the UK government which provides a good opportunity to look at the equity of access to health services for people with learning disabilities. To investigate how the whole system of care can be improved, this article will focus on a common problem that spans both primary and secondary care: heart disease. It uses access to a potentially life-saving procedure, the coronary artery bypass graft, as an indicator of equity. Opportunities can arise for nurses to overcome inequality for their clients, e.g. through nursing involvement in commissioning by primary care groups.     

Catastrophic case management. A case study

For the best clinical outcomes, catastrophic case management begins within the critical/intensive care units. The critical care nurse can facilitate this process by (1) documenting clearly, concisely, and legibly the patient's status in a holistic manner, as much of this information will be used to translate complex medical verbiage to clinical outcomes for financial authorization; (2) providing a receptive environment for the rehabilitation nurse case manager; (3) supporting the role of the rehabilitation nurse case manager in communications with the patient and family; (4) providing professional courtesy and dialogue when interacting with the rehabilitation nurse case manager; (5) understanding that although roles are different, the rehabilitation nurse case manager provides the continuous coordination of services and resources for optimal outcomes, and (6) including the rehabilitation nurse case manager in team or patient conferences so problems can be identified, allowing rehabilitation goals to be modified or expanded. Frequently, the rehabilitation nurse case manager is aware of the limitations of the health plans or capitated financial limitations of the benefit plans. With an informed understanding of the patient's problems, planning will maximize resources to achieve the best possible outcomes. For example, some benefits have a maximum number of home care visits annually or do not include acute rehabilitation hospitalization within the benefit plans. By matching the patient's needs to the benefit services within the time frame, resources are maximized. Most people are not aware of their health care plan services until the need arises. A rehabilitation nurse case manager possesses the expertise to advocate, negotiate, and use the benefits fittingly.     

Essential managerial attributes of the nowadays nursing service manager in the South African context

Nursing service managers need certain essential managerial attributes in taking the lead in effective management of the nowadays health care organisations in South Africa. Major changes in restructuring and human resources planning are taking place through transformation of health services and specific managerial attributes are needed in this scenario. Without nursing service managers with the necessary managerial attributes, change in the health care environment will be hampered and planning, organising, directing and control of the delivering of quality care will be negatively influenced. The research problem was addressed in the following question that guided the study: Which essential attributes/characteristics should a nursing service manager possess to run a health care service effectively? It was unclear what the opinions of all level of nurse managers were regarding the necessary managerial attributes the health services manager currently need to run the current health care services effectively. This study aimed at highlighting the necessary attributes of the nowadays nursing service manager in running a health care institution in the current health care environment of South Africa. Purposive sampling was done and forty-five functional, middle and top-level managers registered for a second year degree course in Health Services Management at a South African university participated in the study. The findings indicated important managerial and leadership attributes, which the current nursing service manager should possess. This article will only discuss the important managerial attributes needed. A conceptual framework came to the fore according to which an example of a self-evaluation instrument was compiled for nursing service managers for future use. The results of the data analysis indicated that the nursing service manager should promote good interpersonal relationships with colleagues, subordinates and patients through the attributes of openness, being inviting and empowering behavior. The purpose of this article is to make nursing service managers more aware of the necessary attributes they should possess and should develop to manage nursing services more effectively.     

The Nurse Practitioner's Role

Decisional incapacity is the inability to make decisions for oneself caused by mental or physical impairment. With technologic advances in health care and the growing proportion of elderly in American society, the problem of decisional incapacity occurs more frequently. In the past, medical decision making was based on the principle of beneficence, and the judgment of others was used to determine medical interventions. The current trend is to base decisions as much as possible on the principle of patient autonomy. Advance directives allow for the greater use of this principle.
The primary care nurse practitioner (NP) can take an active role in promoting patient autonomy by helping the adult patient plan for decisional incapacity. By including the value history as a routine part of the health history, the NP can help patients identify their beliefs, values, and attitudes about health care. This documented value history can then be used to provide evidence of a patient's wishes should he or she become decisionally incapacitated.     

The clinical nurse manager: a literature review

This paper is a literature review of the clinical nurse manager role The purpose is to identify, m today's health care environment, what expectations organizations in this role have, and therefore to determine the skills and characteristics required to be effective at this level An analysis of the literature revealed a consensus that human and leadership skills are taking the place of clinical skills It is suggested that within them decision-making is the key factor in responding to the changing and competitive health care environment     

Stigma and Developmental Disabilities in Nursing Practice and Education

Individuals with developmental disabilities (DD) experience stigma, discrimination, and barriers, including access to appropriate health care, that restrict their ability to be equal participants in society. In this study, underlying contexts, assumptions, and ways of acting are investigated that perpetuate inequalities and pejorative treatment toward those with disabilities. Several nurse researchers and educators suggest specific content for, or approaches to, education about DD. Critical pedagogy that employs cultural competency and a disability studies’ framework to guide curriculum and course development will allow assumptions underlying common health care practices that oppress and “other” people with disabilities to be exposed and changed.     

Informatics competencies for nurse managers and their staffs

Nurses have always dealt with data, information, and knowledge. Therefore, as automated information systems become increasingly important in health care, all nurses should have core competencies in computer skills and data and information management. These competencies differ according to the skill level of the nurse, from a beginning nurse to nursing manager, and on to those who specialize in nursing informatics.     

Ethical concerns in nurse migration.

International nurse migration is natural and to be expected. Recently, however, those who have fostered nurse migration believe that it will solve nursing shortages in developed countries and offer nurse migrants better working conditions and an improved quality of life. Whether natural or manipulated, migration flow patterns largely occur from developing to developed countries. In this article, nurse migration is examined using primary health care (PHC) as an ethical framework. The unmanaged flow of nurse migrants from developing to developed countries is inconsistent with "health for all" principles. Removing key health personnel from countries experiencing resource shortages is contrary to PHC equity. Often, nurse migrants are placed in vulnerable, inequitable work roles, and employing nurse migrants fails to address basic causes of nurse shortages in developed countries, such as dissatisfaction with work conditions and decreased funding for academic settings. Nurse migration policies and procedures can be developed to satisfy PHC ethics criteria if they (1) leave developing countries enhanced rather than depleted, (2) contribute to country health outcomes consistent with essential care for all people, (3) are based on community participation, (4) address common nursing labor issues, and (5) involve equitable and clear financial arrangements.