Expansion of nurse anesthesia educational programs: where are the barriers?

CRNAs have been a major contributor to direct patient anesthesia care for more than 100 years. All indicators suggest a greater need for nurse anesthetist services in the future. Our ability to meet this increased demand will depend on wise decisions in accreditation and professional agendas and support of all CRNAs in this critical issue. As stated by AANA Past President Linda Williams, CRNA, JD, students represent only 10% of our membership but they represent 100% of our future. Let's unite all forces to secure a future in which CRNAs will be indispensable healthcare providers throughout the 21st century.     

Mental health nurse practitioner: Expanded or advanced?

The role of the nurse practitioner has been described as the apex of nursing practice. Such a statement has significant implications for the professional status of nursing in its own right. The aim of this paper is to discuss the nature of the nurse practitioner role in Australia and the importance of distinguishing between advanced and expanded practice. Evaluations of the nurse practitioner role suggest that specifically nursing contributions lead to a high level of consumer satisfaction. If nursing in general, and mental health nursing in particular, is to maintain and further develop their professional status, debate about the implications of the nurse practitioner role, and the terminology used to describe its scope, is crucial.     

Analgesia and public health: what are the challenges?

Pain is a common problem, but unfortunately, it is one that is still notoriously neglected and poorly managed. Although it usually is not rated highly in public health statistics, it forms a substantial proportion of the everyday work of health care professionals, and thus remains a major public health burden. The first challenge in successful pain management is overcoming the ineffective learning processes most health care practitioners use to update their procedures and therapies in response to the latest research. The ready availability of over-the-counter analgesics means that much of the pain in the community is now self-medicated, and it is vital that they also have ready access to the latest evidence-based recommendations. Second, better methods are needed to tailor treatment to individual patients because differences in comorbidities, drug metabolism, or the nature and severity of disease processes lead to different responses from individual patients. Such tailoring should also account for differences in side-effect profiles of the various treatment options available. Finally, even if health practitioners are aware of the latest in clinical evidence and recommended practices, they may not be able to implement the most appropriate treatment because of legal or financial barriers. This article will to review these three challenges to the management of pain and discuss practical ways in which they may be handled to help reduce the burden of pain care in society.     

Attitudes to falls and injury prevention: what are the barriers to implementing falls prevention strategies?

OBJECTIVES: To ascertain the reasons for not taking up a fall or injury prevention strategy among older people who have sustained a fall and attended an emergency department. SUBJECTS: As part of another trial, we identified 60 people who attended the emergency department of a public hospital with a fall. MAIN MEASURES: Participants were interviewed to ascertain the reasons for not taking up a falls prevention strategy, their falls-related health state, and the likelihood of them undertaking a falls and injury prevention strategy. RESULTS: A total of 31 (52%) of the participants had considered falls prevention after their fall. There were high levels of reluctance to undertake a strategy with 43 (72%) reluctant to take exercise classes, 10 (59%) reluctant to cease psychotropic medications, 26 (43%) reluctant to have a home safety assessment and 17 (28%) reluctant to take osteoporotic medication. When asked specifically about taking up a strategy to prevent a worsening health state, 19 (63%) of participants would take up exercise, 17 (57%) a home safety assessment, 4 of the 17 (59%) already taking implicated medications would stop and 56 (93%) would begin osteoporotic medication. These decisions did not alter when the goal for treatment was to improve a much worse health state. In participants with a lower starting health state, home safety assessments were viewed more favourably. CONCLUSIONS: There were significant obstacles to the implementation of most falls prevention guidelines examined. Treatment for osteoporosis was more acceptable to participants than exercise classes, cessation of psychotropic medication, and having a home safety assessment. Osteoporosis treatment, which had the least resistance, also had the least impact on the participants' lifestyle.     

A case study of nurse practitioner role implementation in primary care: what happens when new roles are introduced?

Background

At the time of this study (2009) the role of the nurse practitioner was new to the province of British Columbia. The provincial government gave the responsibility for implementing the role to health authorities. Managers of health authorities, many of whom were unfamiliar with the role, were responsible for identifying the need for the NP role, determining how the NP would function, and gaining team members’ acceptance for the new role.

Method

The purpose of the study was to explain the process of nurse practitioner role implementation as it was occurring and to identify factors that could enhance the implementation process. An explanatory, single case study with embedded units of analysis was used. The technique of explanation building was used in data analysis. Three primary health care settings in one health authority in British Columbia were purposively selected. Data sources included semi-structured interviews with participants (n=16) and key documents.

Results

The results demonstrate the complexity of implementing a new role in settings unfamiliar with it. The findings suggest that early in the implementation process and after the nurse practitioner was hired, team members needed to clarify intentions for the role and they looked to senior health authority managers for assistance. Acceptance of the nurse practitioner was facilitated by team members’ prior knowledge of either the role or the individual nurse practitioner. Community health care providers needed to be involved in the implementation process and their acceptance developed as they gained knowledge and understanding of the role.

Conclusion

The findings suggest that the interconnectedness of the concepts of intention, involvement and acceptance influences the implementation process and how the nurse practitioner is able to function in the setting. Without any one of the three concepts not only is implementation difficult, but it is also challenging for the nurse practitioner to fulfill role expectations. Implications for research, policy, practice and education are discussed.     

Counselling of patients with HIV-related diseases: what is the role of the nurse?

• ? The need for counselling of patients with HIV-related diseases has been clearly demonstrated in the literature.
• ? This study aimed to elicit nurses', perception of their role in such counselling.
• ? Nurses did not have a uniform understanding of the term ‘counselling’, viewing it mostly as ‘information-giving’, however listening skills and allowing the person to deal with their own problems and fears were also central issues.
• ? The doctor was seen as the most important health professional when it comes to counselling of AIDS patients. The nurse is viewed as a ‘number two’, surprisingly perceived as more important than priests, psychologists and social workers, despite being thought of as not being well trained and consequently not having the necessary skills for counselling interventions.
• ? As a result, there was a clear need and wish for more general education on AIDS and counselling issues.