Nurse perceptions of the impact of nursing care on patient outcomes: an exploratory study

The aim of this research was to explore registered nurses' perceptions of the relationship between nursing care and clinical outcomes. We conducted an exploratory survey using a convenience sample of nurses attending a 3 day nursing practice conference. Nurses with postgraduate degrees and those with a clinical main work role had higher mean scores for the impact of nursing care on patient outcomes. Nurses reported that pressure ulcers and surgical wound infection were most affected by nursing care. Falls, medication errors, pain management, and patient education were some of the clinical indicators suggested as additional appropriate measures of nursing care. Our results suggest that nurses' educational background and work role may influence their perception of the impact of nursing care on patient outcomes.     

Advanced practice nurses' role in the treatment of pain

In 2003, the Canadian Association of Advanced Practice Nurses (CAAPN), with an educational grant from Purdue Pharma Canada, conducted a web-based survey to examine the pain management practices of advanced practice nurses (APNs). The survey objectives were to explore the role of APNs with respect to the treatment of pain, to determine the extent of their influence over treatment outcomes of patients with pain and to ascertain their level of knowledge of controlled-release pain medication. One hundred and sixteen surveys were collected. Results of the survey showed that APNs from a variety of patient care areas are caring for patients seeking pain management. Other results support the current literature that identifies lack of knowledge, education and experience as barriers to pain management practice, influencing the decision to prescribe pain medication. APNs need the tools to develop and implement effective pain management plans for their patients.     

Nursing scope of practice: descriptions and challenges

The nursing workforce is faced with shortages of near crisis proportions, yet little is understood about the optimal utilization of various categories of nurses - Licensed Practical Nurses (LPNs), Registered Nurses (RNs) and Registered Psychiatric Nurses (RPNs). The primary purpose in this study was to elicit the perceptions of nurses (RNs, LPNs, and RPNs) of what "working to full scope of practice" meant to them. Participants included acute care nurses in three health regions in western Canada. A key finding from the study was the fact that nurses most often discussed scope of practice by reference to the tasks they perform, rather than the roles they play in healthcare delivery. Assessment and coordination of care were two components of nursing work that most differentiated the three nursing roles. Nonetheless, insufficient role differentiation among nurses and between nurses and other healthcare professionals leaves some nurses feeling devalued and not respected for their contribution to healthcare delivery.     

Physical assessment: implications for nurse educators and nursing practice

AIM: In New Zealand, the physical assessment of a patient has traditionally been the domain of the medical profession. As a country implementing advanced practice roles, with an expectation that both nurse practitioners and registered nurses will use physical assessment skills, the relevancy of physical assessment for each scope of practice has currency. The aim of this literature review was to discover what could be learnt from the experiences of Western countries that already incorporate physical assessment skills into nurses' health assessment. FINDINGS: Nurses in the USA, and more recently Canada and Australia, readily incorporate physical assessment skills into their nursing practice as a component of health assessment. The international literature identified that any change to the nurse's role in health assessment, to include physical assessment skills, requires strategies that involve the regulatory, educational and practice components of nursing. CONCLUSION: Nurses and other health professionals must perceive that this role expansion will improve health outcomes for the diverse populations accessing health care. Teaching physical assessment skills within a holistic health model will enable nurses to contribute a more comprehensive health assessment to the planning and monitoring of people's health care.     

Developing advanced rural nursing practice: a whole new scope of responsibility

Rural registered nurses’ experiences of advanced clinical nursing practice were explored whilst they were enrolled in an advanced primary care course of study. Thirty-two nurses employed in rural health services in Victoria, Australia, studied advanced practice nursing by distance education with a clinical component. At course conclusion, focus groups and a quantitative on-line survey were conducted to explore outcomes. Nurses reported positive self-perceptions of their educational preparation with scores of >7/10 for competence, confidence, preparedness for advanced practice and job satisfaction. Focus group discussions concurred with positive survey results. The course was valuable in developing skills and knowledge, enabling more holistic patient care. The main themes that emerged related to the advancement of the nurse as a professional, and enhancement of patient care. Within their scope of practice, nurses assessed, diagnosed and treated minor patient illness presentations either independently or collaboratively with medical advice. The context of rural health services dictated practice and levels of autonomy. Nurses perceived the new role reduced an overload of medical work, whilst increasing patients’ access to care. As a result of the course 24% of participants reported a change in their work role. Nurses employed in rural health services reported positive potential for advanced collaborative practice in rural health care, in association with medical professionals. Defined role boundaries, role responsibilities and dedicated advanced practice positions will be required to achieve implementation of the role.     

Nursing’s Role in Cancer Pain Management

Nurses have advanced practice, research, and education in the field of cancer pain management. This paper highlights the contributions nurses have made to pain science and practice through literature published in the past 3 years. Work accomplished by nurses is examined in the areas of pain assessment, pain management, intervention-based research, evidence-based practice, patient education, and palliative care. Nurses serve as advocates for empowering patients to engage in self-management of their pain, and offer education and support to patients and families at their most vulnerable times. Nurse researchers have been at the forefront of work to develop and test new instruments and approaches to measure pain, elucidate pain experiences through quantitative and qualitative methodologies, and gauge the quality of pain care for patients and its impact on their caregivers. This research has uncovered many patient, health care professional, and systemic barriers to effective pain control, and has offered feasible solutions to overcoming these barriers.     

Nurses' roles in discharge decision making in an adult high dependency unit.

An ethnographic approach was used to investigate the roles which nurses take in the discharge decision making process in an adult High Dependency Unit (HDU). Participant observation and unstructured interviews were the data collection methods used. Four themes were identified. The first theme encompassed the relationship of nurses with medical staff. Tension was felt between nursing and medical staff, although this was not demonstrated in direct communication between the two professions. Nurses took a submissive role in order to avoid conflict, but this also enabled them to manipulate doctors. Another theme was the unique value of the nurse which was defined as the 'holistic' view which nurses took towards patients which was different to that taken by other health care professionals. Nurses undertook an important administrative role. They had substantial responsibility for bed management and became more proactive in decision-making when there was pressure on HDU beds. Issues associated with decision making were highlighted, as although nurses wanted to contribute to discharge decision making, they were often uncomfortable with this role. There is scope for further investigation into the working relationship of nurses and medical staff, how administrative roles of nurses influence their ability to provide patient care and whether the opinions expressed with regard to decision making are widespread within the nursing community.     

The American Society of Pain Management Nurses practice analysis: role delineation study.

A role delineation study was carried out by the American Society of Pain Management Nurses (ASPMN) to determine the activities performed by nurses involved in pain management. Demographic characteristics of pain management nurses and differences in practice based on educational preparation and specialty affiliation were identified. The role delineation survey was developed based on Nursing Intervention Classifications. The survey consisted of 91 activity statements. Respondents rated the frequency of performing each activity and the importance of the activity. A Mean Activity Index score was calculated for each item. All members of the ASPMN, the nursing special interest group (SIG) of the American Pain Society, and the pain SIG of the Oncology Nursing Society, as well as random samples of members of the National Association of Orthopaedic Nurses, Hospice and Palliative Nurses Association, American Association of Nurse Anesthetists, American Association of Critical Care Nurses, and American Academy of Nurse Practitioners were surveyed. Seven hundred and sixty-one questionnaires were analyzed (24.8% response rate). Demographic characteristics of the sample mirrored those of nursing as a whole in the United States. The activities with the highest Mean Activity Index were primarily those involving assessment of pain. Nurses with diploma and Associate Degree preparation rated assessment and nonpharmacologic management higher and communication and collaboration lower than nurses with higher educational preparation. Activities varied somewhat as a reflection of respondents' nursing specialty. The results of the study will be used to refine standards of care, develop nursing education curricula, develop research priorities, and develop a blueprint for a certification examination in pain management nursing.     

Dancing to our own tune: understandings of advanced nursing practice in British Columbia

There has been ongoing confusion about the meaning of advanced nursing practice (ANP) and the nature of ANP roles in Canada and elsewhere. A broad range of roles and titles have been adopted throughout Canada in an attempt to delineate specialized and/or advanced roles within nursing. One key objective in a recent three-phase study of ANP in British Columbia was to clarify the role and understanding of advanced nursing practice and related roles within the larger healthcare system. Our intent in this paper is to describe the understandings of ANP that emerged in Phase I of this recent study and to compare registered nurses' understandings of ANP to the characteristics and competencies identified by the Canadian Nurses Association (2002) framework. (Note: The term "nurse," as used in this paper, refers to "registered nurse.") We conclude by identifying future directions for development of advanced practice roles.     

A multidisciplinary approach to chronic pain

Chronic pain often is frustrating to nurses and patients, since many times it has not been responsive to traditional medical approaches. The purpose of this article is to discuss the chronic pain syndrome and the role of nursing within a multidisciplinary chronic pain rehabilitation program designed to return the patient to a functional lifestyle. The purpose and rationale for each treatment modality within the pain management program is described, although the treatment plans are individualized for every patient. Nurses play a crucial role, because they are the only professionals who are constantly available to the patient. Nurses collect data and continually assess the patient to develop comprehensive nursing care plans. In this intensive educational program, nurses also assist in teaching the patient positive health practices to control the pain. Further evaluations of these chronic pain rehabilitation programs are needed.     

Are Australian general practice nurses underutilised?: An examination of current roles and task satisfaction

BackgroundThe general practice nursing workforce in Australia has grown exponentially in the last fifteen years. To understand the contribution and issues relating to this workforce we need to explore the evolution of the nurses’ role and the nurses’ perceptions of the work that they undertake.AimTo describe trends in general practice nurse clinical activities, the extent to which GPNs use their knowledge and skills and their satisfaction with the general practice nurse role.MethodsWithin a larger mixed methods project, a national cross-sectional survey of Australian primary health care nurses was undertaken. This paper details the survey findings related to the role of nurses working in general practice, the extent to which they use their knowledge and skills and their satisfaction with their role. Data about nurse roles was compared with previous workforce data to elucidate changes over time.FindingsOf the 1166 primary health care nurses who responded to the survey, 950 reported being employed in general practice. Participants reported undertaking activities related to health promotion and chronic disease management more frequently now than previously. They identified a desire to spend the same or less time on administrative activities and more time on health promotion, patient education and patient assessment. Nearly half of participants reported that often they feel that they could do more, or most of the time they don’t use their skills to the full extent.ConclusionNurses working in general practice are increasingly undertaking activities related to health promotion and chronic disease management. However, these nurses remain underutilised. Having nurses working to their full scope of practice has the potential to increase job satisfaction and nurse retention, as well as improve patient health outcomes.     

The impact of health care restructuring and baccalaureate entry to practice on nurses in New Brunswick

Health care restructuring during the 1990s resulted in major changes in the way nurses' work is defined and implemented. The adoption of the baccalaureate degree as basic preparation for entry into nursing has further complicated the lives of nurses. The purpose of this qualitative study is to explore the impact of health care reforms and changing educational requirements on nurses in New Brunswick, Canada. Sixty-three nurses representing different practice settings were interviewed and three focus groups were held with the nurses that were interviewed. Study findings indicate that nurses' practice has changed as a result of the reforms. Nurses give less direct care to patients and have taken on a greater administrative role. The requirement of a baccalaureate degree for entry to practice has placed a strain on working relationships between older and younger nurses, accentuating differences in working knowledge and work ethic among these groups.     

The impact of role discrepancy on nurses' intention to quit their jobs

Aims and objective. The purpose of this study was to investigate the impact of role discrepancy on nurses’ intention to quit their jobs. Background. Nurses experience role discrepancy, which refers to incompatibility between the roles nurses desire and expect to take, and the roles they actually engage in at work. However, there is a paucity of information as to how this role discrepancy affects nurses’ intention to quit their jobs. Design. A correlational design was used to investigate the impact of role discrepancy on nurses’ intention to quit their jobs. Methods. A total of 346 Australian nurses participated in this study by completing questionnaires. The results were analysed by t‐test, polynomial regression and response surface analysis. Results. Nurses tended to experience role discrepancy, in particular, in decision making with hospital policies and provision of patient education. The overall results show that this role discrepancy contributes to nurses’ intention to quit their jobs. Nurses’ intention to quit their jobs also increased when they had a low desire to engage in nursing roles and when they only performed a few roles. When specific dimensions of nursing roles were examined, a role discrepancy in the use of nursing skills, such as participation in decision making and providing patient education and emotional support, had little impact on their turnover intention. On the contrary, a role discrepancy in task delegation practice showed a significant association with nurses’ intention to leave their jobs. Conclusions. Role discrepancy has been experienced by many nurses, and this discrepancy partially contributes to nurses’ intention to quit their jobs. Relevance to clinical practice. To reduce nursing turnover, it is important to create a work environment where nurses are inspired to engage in various nursing roles and their work desires are reinforced by existing work opportunities.     

Implementation of nurse-delivered vestibular rehabilitation in primary care: a qualitative study of nurses' views on involvement in an innovative service

Aim: To explore practice nurses’ perceptions of vestibular rehabilitation and its place in relation to their general role development. Background: Vestibular rehabilitation has been known for a long time to be effective for chronically dizzy patients in secondary care, but its use in primary care has been limited. A recent pragmatic trial of vestibular rehabilitation delivered by practice nurses in primary care has confirmed its utility in a community setting. This type of role is increasingly common for practice nurses, but few studies explore the nurses’ perspective. Methods: A qualitative study was undertaken; 19 nurses took part in focus group sessions. Participants discussed their views on vestibular rehabilitation and its potential for integration with their existing role. A thematic analysis of the data was undertaken. Findings: Four main themes were identified: creating a unique nursing role; the therapeutic role; responsibility and role boundaries; and time. Nurses were positive about developing extended roles, but sought ways to achieve this without eroding fundamental nursing skills. Vestibular rehabilitation was seen as fulfilling both the need for a distinct nursing identity and professional development. Concerns over responsibility for patient assessment and time management constraints are potential obstacles to overcome in the wider development of this therapy in primary care. Conclusions: Understanding the perspective of nurses will be vital in future development of chronic disease management within primary care. Whilst nurses may be positive about such role expansion, the implementation of services of this type will require clarity about nurses’ responsibilities and flexibility in managing workload. Relevance to clinical practice: Vestibular rehabilitation is simple, low‐tech and appropriate for widespread development in primary care. Nurses wishing to provide vestibular rehabilitation or similar chronic disease management activities will need to work with medical colleagues to define role boundaries.     

Nursing workforce utilization: an examination of facilitators and barriers on scope of practice

Several reports have highlighted the need to address underutilization of health human resources, but barriers to and facilitators of role optimization for nurses are poorly understood. The purpose in this study was to understand the perceptions of nurses - Licensed Practical Nurses (LPNs), Registered Nurses (RNs) and Registered Psychiatric Nurses (RPNs) - of the extent to which they can work to full scope of practice and identify barriers and facilitators in optimizing their roles. As part of a mixed-methods study, semi-structured interviews were conducted with 167 acute care nurses (RNs, LPNs, RPNs and nurse managers) in three western Canadian health regions. Approximately 48% of all nurses interviewed felt they were working to full scope, at least some of the time. Barriers to working to full scope included heavy workload, high patient acuity, lack of time, poor communication and ineffective teamwork. Identified facilitators were working as a team, management and leadership support and support for continuing education. Barriers need to be addressed in light of nursing shortages, as these are closely related to job satisfaction and directly affect the retention and recruitment of all groups of nurses. Policies and strategies based on these findings must be developed to ensure that nurses can work to their full scope of practice.     

Influences of patient behavior on clinical nurses' pain assessment: implications for continuing education

Pain management is an important consideration in the promotion of patients' comfort. However, research continues to indicate patients' pain management is poor. The nursing literature cites nurses' lack of knowledge as a significant determinant of poor pain management practices. The impetus for this study arose from poor attendance by nurses at inservice sessions discussing pain assessment and management. Knowledge of existing nursing practice and accompanying beliefs and attitudes in relation to pain management is paramount in the development of relevant continuing education for registered nurses. The aim of this investigation was to study nurses' intention to treat pain in different patients. A 10-page questionnaire with eight different patient scenarios was distributed to 886 nurses across all clinical divisions of an acute tertiary facility. Results indicate knowledge deficits regarding optimum pain relief for patients. This article highlights the need for innovative teaching strategies and approaches in the clinical context to heighten nurses' awareness of their lack of knowledge of pain assessment and management.