Listening as a method of addressing psychological distress

Aims  This paper discusses the values of therapeutic listening and ways that emotional difficulties can impact palliative nurses' abilities to provide psychological care.
Background  Recent literature indicates that providing psychological care can burden some healthcare professionals including nurses; who may lack the necessary competencies or organizational resources to carry out their roles.
Evaluation  References drawn from the databases: all EBM reviews, BRITISH NURSING INDEX, CINAHL, PSYCH INFO and MEDLINE and EMBASE are discussed.
Key issues  Psychological care is considered critical to providing holistic care. Yet the literature suggests engaging in such work makes emotional demands on the professionals attempting to carry it out and is associated with psychological difficulties including burnout.
Conclusion  Clinical supervision can help reduce the distress caused by emotionally charged situations. Thoughtful clinical supervision can also contribute to safe and effective health care.
Implications for Nursing Management  Nursing would benefit from understanding more about the effects on healthcare professionals of repeated exposure to emotionally charged situations and benefits that clinical supervision can offer to health care.     

Illuminating the clinical nurse specialist role of advanced practice nursing: a qualitative study

As the advanced practice nursing initiative in Canada gains momentum, effort is being directed towards clarifying and defining advanced practice roles. A qualitative study was undertaken to increase understanding of the clinical nurse specialist role of advanced practice. Sixteen nurses who worked in advanced practice roles, organizing and providing healthcare for children with complex health needs and their families across the continuum of care, participated in in-depth conversations about the nature of their practice, the knowledge that informs it and the factors that influence it. Findings suggest that clinical nurse specialists have a unique role in the organization and delivery of healthcare for specialized populations with complex health needs in their dual focus on the system level of healthcare and on population health needs. Initiatives directed to children and families within the study participants' specialties included program development, consultation and educational outreach and the development of clinical guidelines and policies. Although the nurses described their practice as focusing both on individual children and families and on the population of children and families within their specialty, it is at the population level that they see their greatest potential for contributing to the delivery of high-quality, cost-effective healthcare.     

The clinical nurse leader: a catalyst for improving quality and patient safety

Aim  The clinical nurse leader (CNL^®) is a new nursing role introduced by the American Association of Colleges of Nursing (AACN). This paper describes its potential impact in practice.
Background  Significant pressures are being placed on health care delivery systems to improve patient care outcomes and lower costs in an environment of diminishing resources.
Method  A naturalistic approach is used to evaluate the impact the CNL has had on outcomes of care. Case studies describe the CNL implementation experiences at three different practice settings within the same geographic region.
Results  Cost savings, including improvement on Centers for Medicare and Medicaid Services (CMS) core measures, are realized quickly in settings where the CNL role has been integrated into the care delivery model.
Conclusions  With the growing calls for improved outcomes and more cost-effective care, the CNL role provides an opportunity for nursing to lead innovation by maximizing health care quality while minimizing costs.
Implications for nursing management  Nursing is in a unique position to address problems that plague the nation's health system. The CNL represents an exciting and promising opportunity for nursing to take a leadership role, in collaboration with multiple practice partners, and implement quality improvement and patient safety initiatives across all health care settings.     

Non-attendance in chronic disease clinics: a matter of non-compliance?

paterson bl, charlton p & richard s (2010)    Journal of Nursing and Healthcare of Chronic Illness 2 , 63–74
Non-attendance in chronic disease clinics: a matter of non-compliance?
Aim.  To identify the personal, contextual and mediating factors that influence non-attendance in specialty chronic disease clinics.
Background.  Non-attendance in chronic disease clinics is an ongoing problem that can increase patients' vulnerability to serious complications, affect continuity of care, contribute to long wait times, engender negative patient–provider relationships, and increase costs to the health system.
Methods.  Literature for this review was obtained by an extensive search of health and social science computerised bibliographic databases using the search terms participation , attendance , non-attendance , attrition , dropout , missed appointment , no show with diabetes , chronic disease and chronic illness care .
Results.  Twenty-eight research studies met our criteria for inclusion in the review. Analyses revealed that non-attendance at chronic disease clinics is influenced by a myriad of factors encompassed as personal and clinical factors, and factors pertaining to the nature and operations of the clinic.
Conclusions.  The factors that influence attendance are complex and multifactoral. A range of strategies are needed to address the myriad of patient-related and health-system factors to increase attendance rates and ultimately improve health outcomes.
Relevance to clinical practice.  A critical analysis of factors that affect attendance is important to begin to develop a greater awareness and understanding among health providers of the implications and reasons for missed appointments. The results can help to improve patient–provider relationships and deliver services that better meet patients' needs and expectations.     

Genomics and Cardiovascular Disease

Purpose : To describe genetic knowledge and discovery in the area of cardiovascular disease (CVD) and to discuss how these new advances will influence the clinical care of affected people.
Organizing Framework : A selective review of the literature is presented on the disease mechanism of both the Mendelian and multifactorial genetic cardiovascular conditions. A case study approach is used to illustrate how the genetic paradigm affects the healthcare experience of a family affected with familial hypertrophic cardiomyopathy.
Findings : The current state of CVD treatment remains complex. An understanding of genomic concepts and a genome-based approach is necessary to determine: (a) the risk of CVD susceptibility beyond traditional risk factors; (b) early detection of illness; (c) response to treatment; and (d) molecular taxonomy of the disease.
Conclusions : The results of genetic research, education, and teaching will lead to a new understanding of genes and pathways, resulting in powerful new therapeutic approaches to CVD. The challenge is to translate genetic discoveries into clinical practice that ultimately leads to preventing CVD and reducing mortality.     

From Evidence-Based Practice to Knowledge Translation: What Is the Difference? What Are the Roles of Nurse Leaders?

ObjectivesNurses, as the largest healthcare workforce, are well-positioned to apply knowledge translation. The role of nursing leadership in facilitating evidence-based practice has been extensively discussed in the literature, but this is not the case for knowledge translation. The objective of this study was to examine the potential role of nurse leaders in applying knowledge translation across health settings.Data SourcesWe reviewed the existing literature for evidence-based practice as best practice in clinical care; examined how a complex systems approach to knowledge translation may extend beyond evidence-based practice, and considered nursing leadership approaches including transformational leadership.ConclusionIn this discursive article, we discuss the differences between evidence-based practice and knowledge translation, highlight the promise of transformational leadership in facilitating knowledge translation through a complex systems lens, and argue for the importance of nurse leaders in facilitating and supporting complex knowledge translation across healthcare settings.Implications for Nursing PracticeAlthough future research is needed to test our ideas, we argue that the advanced conceptual understanding generated in this article should inform a roadmap toward a future in which nurse leaders initiate, participate and advocate for complex knowledge translation across healthcare settings.     

Human factors and safe patient care

Aims  This paper aims to introduce the topic of human factors to nursing management and to identify areas where it can be applied to patient safety.
Background  Human factors is a discipline established in most safety critical industries and uses knowledge about human behaviour in the analysis and design of complex systems, yet it is relatively new to many in healthcare.
Evaluation  Most safety critical industries have developed tools and techniques to apply human factors to system design, and these have been reviewed together with those resources already available for use in healthcare.
Key issues  Models of human behaviour such as the nature and patterns of human error, information processing, decision-making and team work have clear applications to healthcare. Human factors focus on a system view of safety, and propose that safety should, where possible, be 'designed in'. Other interventions such as building defences, mitigating hazards and education and training should only be used where design solutions cannot be found.
Conclusions  Simple human factors principles such as: designing for standardization; the involvement of users and staff in designing services and procuring equipment; understanding how errors occur; and the workarounds that staff will inevitably take are vital considerations in improving patient safety.
Implications for nursing management  Opportunities for the application of human factors to healthcare and improved patient safety are discussed. Some existing tools and techniques for applying human factors in nursing management are also presented.     

Factors impeding nurses from reporting adverse events

moumtzoglou a . (2010) Journal of Nursing Management 18 , 542–547
Factors impeding nurses from reporting adverse events Aim To explore the reasons why Greek nurses are reluctant to report adverse events. Background This study provides an understanding of why nurses fail to report adverse events so that we can introduce systems and develop cultures, which make this easier. Methods An exploratory study using the Adverse Events Questionnaire, which was administered to 214 nurses in 14 major Athens hospitals, comprising university as well as tertiary hospitals. Results Five main reasons for not reporting were identified. They include the fear of the press, the licensing board, the difficulty in handling an adverse event, confidence about bringing up adverse events and the complaints by patients. Moreover, clustering variables into homogeneous sets, three latent variables were extracted. They include procedures, culture and dishonour, social control, workload and tradition. Conclusion Nurses’ impeding factors for bringing up adverse events may be projected not only by cultural aspects such as professional, national and organizational cultures but also by healthcare practice structural issues such as safety systems, rules and procedures, and relevant acts and regulations. Implications for nursing management Nursing management should change management rules and establish systems so that nurses work in a blame-free culture, which examines system factors as causes of error rather than individuals.     

Case Study: The Challenges of Self-Management of Exacerbation of Pulmonary Symptoms

PURPOSE.  This case study demonstrates the signs and symptoms of pulmonary exacerbation and the challenges of self-management for a female veteran.
DATA SOURCES.  Data were obtained through the author's clinical practice in primary care nursing and research literature sources.
DATA SYNTHESIS.  The appropriate nursing diagnosis, nursing interventions, and patient outcomes were identified through the use of NANDA-International, the Nursing Interventions Classification, and the Nursing Outcomes Classification.
CONCLUSIONS.  This case study illustrates the appropriate nursing diagnosis, interventions, and outcomes pertinent to an individual with pulmonary exacerbations. It provides a framework for nurses in primary care when caring for individuals with pulmonary exacerbations.
IMPLICATIONS FOR NURSING PRACTICE.  Employing the NANDA-International standardized nursing diagnoses, the Nursing Interventions Classification and the Nursing Outcomes Classification provided the needed constructs for improving care for a patient that had pulmonary issues in a primary care setting.     

Reflections on independence in nurse practitioner practice

Purpose: To examine factors that influence the ability of nurse practitioners (NPs) to practice as independent primary care providers.
Data sources: Extensive literature search on CINAHL, OVID, MEDLINE, Internet journal sources, and professional association Web sites.
Conclusions: The legal authority for NPs to practice independently is recognized; however, the ability to put that authority into practice is undermined by the historical failure of political, professional, and social entities to recognize NPs as providers capable of providing primary care autonomously. Nonrecognition is responsible for complex reimbursement policies (both federal and state) that economically and professionally restrain the NP role; hence, NPs remain in a financially dependent relationship despite 40 years of proven safe practice. NPs must articulate their independence as practitioners more vociferously in order to meet society's healthcare requirements, as well as to attain professional fulfillment and forge collegial relationships.
Implications for practice: NPs will never be seen as members of a profession by either themselves or others without the practicality of independence and autonomy. Although legal independence is a fact, real practice independence in the pragmatic sense is contingent upon reimbursement. Without fiscal sustainability, practice independence is an impossibility. And, without professional autonomy, NPs will have only an employee's voice in the dynamic healthcare system in which they are really key players in providing healthcare services to the poor and undeserved populations.     

University Health Network framework for advanced nursing practice: development of a comprehensive conceptual framework describing the multidimensional contributions of advanced practice nurses

BACKGROUND: The global paradigm shift resulting from radical transformations in knowledge and technology is significantly changing the context of healthcare delivery. In this changing environment, the contributions of health professions are vital in ensuring that the healthcare system adapts to meet the needs of today's patient. Advanced practice nurses (APNs) are clinical scholars and leaders in creating innovative approaches to patient care and organizational and professional leadership. AIMS: To develop a comprehensive conceptual framework for advanced nursing practice at University Health Network that will enhance role clarity by describing the complexity of these nursing roles and the significant contributions they make to patients and the healthcare system. METHODS: A critical review of the literature and a consultative process were undertaken to build consensus and develop a comprehensive framework for advanced nursing practice. RESULTS: The development of the University Health Network Framework for Advanced Nursing Practice (UHN-FANP), which clearly articulates all dimensions of advanced nursing practice roles. CONCLUSION: As clinical leadership roles in nursing continue to evolve, utilization of a conceptual framework facilitates role clarity, role implementation and role evaluation.     

The power of partnership to shape the future of nursing: the evolution of the clinical nurse leader

Aim(s)  This article describes the evolution of the clinical nurse leader role and demonstrates the vital nature of partnerships between academia and practice in the design and implementation of this new role.
Background  The health care system as it exists in the United States may put patients at risk in terms of safety and quality of care. Nursing leadership from across the US recognized a need for nursing practice and academia to work in partnership to develop workable and effective solutions. The vision was of a nurse generalist who would be prepared to address the complexities that make the current systems dysfunctional.
Evaluation  Review, share experiences and discuss the benefits of engaging stakeholders with broad and diverse viewpoints.
Key issues  Engaging a group of stakeholders with diverse backgrounds, varied world views and experiences for the purpose of developing common mutually beneficial goals, creates synergy and greater commitment to the goals, which results in success.
Conclusion(s)  The power of partnership in the development and implementation of the CNL is evident. Old ways of trying to 'go it alone' are no longer viable in a complex health care environment.
Implications for nursing management  With continued collaboration, practice and academia can continue to confront challenges and develop effective solutions.     

Human error theory: relevance to nurse management

Aim  Describe, discuss and critically appraise human error theory and consider its relevance for nurse managers.
Background  Healthcare errors are a persistent threat to patient safety. Effective risk management and clinical governance depends on understanding the nature of error.
Evaluation  This paper draws upon a wide literature from published works, largely from the field of cognitive psychology and human factors. Although the content of this paper is pertinent to any healthcare professional; it is written primarily for nurse managers.
Key issues  Error is inevitable. Causation is often attributed to individuals, yet causation in complex environments such as healthcare is predominantly multi-factorial. Individual performance is affected by the tendency to develop prepacked solutions and attention deficits, which can in turn be related to local conditions and systems or latent failures. Blame is often inappropriate. Defences should be constructed in the light of these considerations and to promote error wisdom and organizational resilience.
Conclusion and implications  Managing and learning from error is seen as a priority in the British National Health Service (NHS), this can be better achieved with an understanding of the roots, nature and consequences of error. Such an understanding can provide a helpful framework for a range of risk management activities.     

Nurse practitioner-led multidisciplinary teams to improve chronic illness care: The unique strengths of nurse practitioners applied to shared medical appointments/group visits

Purpose: To describe the roles of nurse practitioners (NPs) in a novel model of healthcare delivery for patients with chronic disease: shared medical appointments (SMAs)/group visits based on the chronic care model (CCM). To map the specific skills of NPs to the six elements of the CCM: self-management, decision support, delivery system design, clinical information systems, community resources, and organizational support.
Data sources: Case studies of three disease-specific multidisciplinary SMAs (diabetes, heart failure, and hypertension) in which NPs played a leadership role.
Conclusions: NPs have multiple roles in development, implementation, and sustainability of SMAs as quality improvement interventions. Although the specific skills of NPs map out all six elements of the CCM, in our context, they had the greatest role in self-management, decision support, and delivery system design.
Implications for practice: With the increasing numbers of patients with chronic illnesses, healthcare systems are increasingly challenged to provide necessary care and empower patients to participate in that care. NPs can play a key role in helping to meet these challenges.     

Safeguarding patients: complexity science, high reliability organizations, and implications for team training in healthcare

Serious events within healthcare occur daily exposing the failure of the system to safeguard patient and providers. The complex nature of healthcare contributes to myriad ambiguities affecting quality nursing care and patient outcomes. Leaders in healthcare organizations are looking outside the industry for ways to improve care because of the slow rates of improvement in patient safety and insufficient application of evidenced-based research in practice. Military and aviation industry strategies are recognized by clinicians in high-risk care settings such as the operating room, emergency departments, and intensive care units as having great potential to create safe and effective systems of care. Complexity science forms the basis for high reliability teams to recognize even the most minor variances in expected outcomes and take strong action to prevent serious error from occurring. Cultural and system barriers to achieving high reliability performance within healthcare and implications for team training are discussed.     

Childhood and adolescent attention-deficit hyperactivity disorder: Diagnosis, clinical practice guidelines, and social implications

Purpose: To review the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD), present an overview of the effects that ADHD has on family dynamics, school performance, and substance abuse, and provide an overview of the American Academy of Pediatrics (AAP) clinical practice and treatment guidelines.
Data sources: An extensive health science literature review was carried out using PubMed and Cumulative Index to Nursing and Allied Health Literature. Other information was collected by searching reference lists of published reports.
Conclusions: The diagnostic criteria and guidelines are important to make an accurate clinical assessment and manage a child with ADHD. Early diagnosis and treatment of ADHD decreases academic failure, family conflict, social isolation, substance abuse, and occupational adversity in later years for these children.
Implications for practice: Often primary care nurse practitioners are the first healthcare provider a child with ADHD will see. Awareness of the diagnostic criteria and treatment for children with ADHD can assist with early identification and perhaps eliminate much impairment that accompanies this chronic disorder.     

Can services marketing concepts be applied to health care?

Aim: To generate thought and discussion regarding the application of key features of generic services which may influence management and marketing decisions in health care. Background: Health care, as many other services provides benefits to the consumer, the quality of which is largely dependent on the interpersonal element of the service delivery. Services now dominate the UK economy, and consumer participation in service delivery is as important in health care as in services in the private sector.
Background: Health care, as many other services provides benefits to the consumer, the quality of which is largely dependent on the interpersonal element of the service delivery. Services now dominate the UK economy, and consumer participation in service delivery is as important in health care as in services in the private sector.
Origins of information : There is now an established body of research on the nature of services and the particular management and marketing challenges posed by service provision. The application of general management concepts and tools to the public services is an area of current debate.
Key issues: The paper firstly discusses key features of services and their application to health care contexts. Secondly, a discussion of strategic classifications of services seeks to identify common themes which exist across the diverse service sector.
Conclusions: Nursing and midwifery managers have much to gain from understanding the use of services management frameworks, and have scope for much creativity in adapting generic frameworks for their own areas of practice.     

Patient satisfaction with nursing care: a concept analysis within a nursing framework

Title.  Patient satisfaction with nursing care: a concept analysis within a nursing framework.
Background.  Patient satisfaction is an important indicator of quality of care, and healthcare facilities are interested in maintaining high levels of satisfaction in order to stay competitive in the healthcare market. Nursing care has a prominent role in patient satisfaction. Using a nursing model to measure patient satisfaction with nursing care helps define and clarify this concept.
Data sources.  Rodgers' evolutionary method of concept analysis provided the framework for this analysis. Data were retrieved from the Cumulative Index of Nursing and Allied Health Literature and MEDLINE databases and the ABI/INFORM global business database. The literature search used the keywords patient satisfaction, nursing care and hospital. The sample included 44 papers published in English, between 1998 and 2007.
Results.  Cox's Interaction Model of Client Health Behavior was used to analyse the concept of patient satisfaction with nursing care. The attributes leading to the health outcome of patient satisfaction with nursing care were categorized as affective support, health information, decisional control and professional/technical competencies. Antecedents embodied the uniqueness of the patient in terms of demographic data, social influence, previous healthcare experiences, environmental resources, intrinsic motivation, cognitive appraisal and affective response. Consequences of achieving patient satisfaction with nursing care included greater market share of healthcare finances, compliance with healthcare regimens and better health outcomes.
Conclusion.  The meaning of patient satisfaction continues to evolve. Using a nursing model to measure patient satisfaction with nursing care delineates the concept from other measures of patient satisfaction.     

Catching and correcting near misses: The collective vigilance and individual accountability trade-off

Despite the focus on patient safety and quality health care for the last two decades, there is still limited understanding of how interprofessional interactions at an organizational or work unit level influence how clinicians perceive and respond to safety events and errors. Within the rubric of safety events, there has been a growing interest in near misses as precursors to adverse events in health care. Given the interactive nature of the variety of professionals working together in the delivery of health care, understanding how the different clinicians experience and respond to near misses in practice is important. A constructivist grounded theory approach was employed for this study which included semi-structured interviews with 24 participants in a large teaching hospital in Canada. Findings from this study provide a deeper understanding into how different clinicians experience and respond to near misses in clinical practice. This understanding indicates that collective vigilance can potentially create risk by eroding individual professional accountability through reliance on other team members to catch and correct their errors. Further research is needed to explore in more depth the trade-offs between collective vigilance and individual accountability by relying on others to catch and correct the potentially harmful errors and avert negative outcomes.     

Evidence-based nursing care for patients with heart failure

There is a gap between the evidence that supports treatments used in heart failure and day-to-day patient care. Clinical practice guidelines are evidence-based and suggest best practices; however, healthcare providers, patient and system factors complicate the diagnosis and must be addressed. Performance measures specific to nursing can be derived from the guidelines to guide practice and increase high-quality care. Innovative practice improvement programs, clinical leaders, and system tools are needed to close the gap. Nurses can facilitate processes that advance care planning and promote effective care delivery as part of a multidisciplinary team of healthcare providers.