Educating nurses to impact change in nursing's image

The widely held view that nursing is not intellectually demanding or challenging is the result of media representation of nurses. The television producers of dramas with a health care focus or new medical dramas need a clear understanding of a nurse's function and the important tasks performed as essential members of the health care team. The expression of professional nursing practice publicly focuses on the nursing shortage, staffing ratios, and patient safety issues. This article provides an overview of the media's impact on nursing's image and offers a challenge to nurse educators and nurses to speak out and justify the existence of nursing.     

A Dialogue on the Future of Nursing Practice

PURPOSE: The challenges of health care; its safety, effectiveness, and efficiency; the quality of care; and the outcomes patients experience are issues central to nursing practice. This centrality needs to be affirmed as the profession shapes its practice over the next 50 years. The purpose of this article is to initiate a dialogue on the future of nursing practice. METHODS: The methods used are observation, reflection, dialogue, and proposed actions. FINDINGS: The results of this process are preliminary. They suggest that the establishment of nursing hospitals is a distinct possibility. CONCLUSIONS: This article concludes with a series of arguments for and against this position along with an invitation for your participation in this dialogue. NURSING IMPLICATIONS: The major implications of this article are not "nursing" implications per se but client and patient implications and the future contribution of nursing to improved health and patient care.     

Outcomes and effectiveness research: capacity building for nurse researchers at the Agency for Healthcare Research and Quality

Several of AHRQ's priority areas including disease prevention, health promotion, primary care, quality of care, service delivery, and patient safety are particularly relevant to nurse researchers. With much national attention focused on nursing-related issues such as staff shortages, training, mandatory overtime, working conditions, and autonomy, it is mandatory that nursing research be conducted to inform healthcare delivery and policy. Nurses also need to contribute to the health services literature so that an even balance of discipline perspective is represented. AHRQ's mandate is represented by the slogan "quality research for quality health care." Although our understanding has expanded of contributors to and determinants of evidence-based practice and the relationship between clinical care and improved outcomes, we have much to learn. Appreciating how and which components of nursing care influence patient outcomes represents an essential area of research in need of development. While clarifying nursing contributions to improved outcomes is not the sole purview of nurse researchers, it is plausible to assume that a clinical background in nursing combined with strong methodological skills can help policy makers and health system leaders understand how nurses can most effectively contribute to outcomes and quality improvement. AHRQ is clearly interested in capacity building of researchers from all relevant disciplines. Nurses, the largest provider of healthcare, need to build capacity and develop a much stronger presence in the health services research community of scholars.     

Consequences of not "knowing the patient"

"Knowing the patient" is an emerging concept in nursing that appears to be a central aspect of practice. "Knowing the patient" encompasses the complex process whereby the nurse acquires understanding of a specific patient as a unique individual, which subsequently enhances clinical decision-making, selection of optimal nursing interventions, and patient outcomes. Despite these heralded benefits, "knowing the patient" is severely undervalued in contemporary health care. Organizational arrangements, economic restraints, and efficiency of healthcare systems currently are of top priority. The potential effect on nursing practice is disconcerting; the effect on the discipline and the patient potentially devastating. This article explores the specific bureaucratic obstacles that impinge on "knowing the patient" within the context of nursing practice. It is hoped that illumination of the issues will beget viable alternative solutions, facilitating the transformation of awareness into action.     

The moral imperative of designating patient safety and quality care as a national nursing research priority

Since the early 1990s, research studies conducted respectively in the USA, UK and Australia have found that between 4 and 16.6 per cent of patients suffer from some kind of harm (including permanent disability and death) as a result of human errors and adverse events while in hospital. It has been further estimated that approximately 50 per cent of these human errors/adverse events resulting in harm could have been prevented. In response to the significant financial, social, and political implications of these figures, a range of processes have been put in place in an attempt to improve patient safety and quality care in Australia. Nonetheless, it is evident that more can be done to improve the status quo. One process that warrants consideration is that of peak health professional groups and organisations providing active leadership in the promotion of patient safety, such as by making a visible and recognisable commitment to patient safety as a strategic research priority area. In this paper it is contended that, given the moral importance of patient safety and quality care in nursing and related health care domains, the inseparable link between nursing practice and patient safety, and the central role that research has to play in driving safety improvements in these domains, it is morally imperative that the nursing profession gives sustained and focussed public attention to patient safety and quality care as a national research priority.     

Nurse–patient negotiation: assumption or reality?

The current socio-political philosophy in the United Kingdom promotes the belief that consumers of health care should exercise choice and express opinions about the care they receive. This view challenges the traditional paternalistic approach to health care which espoused that 'the professional knows best'. In association with general socio-political trends, nursing is undergoing radical reform. The nursing literature widely promotes the importance of a nurse–patient relationship which fosters the involvement of the patient in negotiation and decision-making regarding his care. Nurses who advocate individualized, holistic care must hold such an ideology as a central tenet to their philosophy. However, it is questionable whether this philosophy is widely expressed in the reality of clinical practice. There is also an absence of empirical evidence to support the assumption that patients wish to participate in decision-making. This paper critically reviews some of the debate centred around the concept of nurse–patient negotiation. It is suggested that the issues are complex and that there remains a need for further research which takes into account multiple factors, including the social and organization context of nursing care.     

"Towering genius disdains a beaten path" Abraham Lincoln

We see nursing leadership existing at all levels in nursing...all nurses leading. Nurse executives within academic health environments across Canada will be influencing health policy directions and dialogue within the profession nationally. They will be contributing to the development of a national agenda for nursing practice, education, research and leadership. These nurse executives will lead in a way that makes an invigorating impact on human service in health care environments and they will be dedicated to preparing the nursing leaders of tomorrow. The Academy of Canadian Executive Nurses will connect with the Office of Nursing Policy, Canadian Nurses Association, Canadian Association of University Schools of Nursing, Association of Canadian Academic Health Care Organizations and others to develop position papers regarding key issues such as patient safety, health human resource planning and leadership in the Canadian health care system. Our definition of professional nursing practice, fully integrated with education and research, will be advanced through these endeavours. The end result of a strong individual and collective voice will be improved patient outcomes supported by professional nursing practice in positive practice environments. This paper is intended to stimulate dialogue among nursing leaders in Canada, dislodge us from a long and traditional path, and place us firmly in a new millennium of leadership for the profession and practice of nursing, a style of leadership that is needed, wanted and supported by nurses and the clients we serve. It is the responsibility of those of us who lead in academic health science centres to be courageous for the students we support, the puactitioners we lead and the renewal of the profession. We are the testing ground for nursing research, and need to be the source of innovation for nursing practice. It is incumbent on us to leap forward to engage a new vision of the professional practice of nursing with a reconfigured work design and work environment compatible with the new economy, workplace and workforce.     

Methodological issues in the evaluation of the quality of public health nursing: a case study of the maternal and child health centres in Hong Kong

The demand for the evaluation of the quality of patient and client care has increased in public health nursing as in all disciplines of nursing. In Hong Kong this demand led to the development of a collaborative study with the Department of Health to evaluate the quality of public health nursing in the maternal and child health centres. A multiple case study design was developed to undertake the research using both qualitative and quantitative methods of data collection. The findings from the study demonstrated not only implications for clinical practice which have been reported elsewhere, but also methodological issues for the evaluation of care. These findings indicate three major issues for consideration. The first issue is that of the cultural context of care which includes perceptions of care such as demands on the service and expectations of care. The second issue is the use of health data, including both the methods of recording as well as the sources of data. The final issue is that of the method of data collection, in particular the implications of the use of language in data collection tools. The findings suggest that both the use of professional language and the need for translation have implications for data collection methods. Indeed in the author's view the development of methodologies for the evaluation of care must address culturally specific issues, particularly where English is not the first language of subjects in the study. In addition the use the use of language in the method of data collection highlights more general issues raised by the use of translation in the collection and analysis of qualitative data.     

Legislative connection: summary on the nursing shortage--March 6, 2002

The panel was very well received and very informative to the legislators. The nursing shortage crisis in Colorado was succinctly identified. No single solution will fix the nursing shortage. Replacement of registered nurses by unlicensed assistive personnel, or using licensed personnel with less education, will add to increased patient safety issues, provide fewer learning experiences for nursing students, and decrease job satisfaction for current nurses. If a practice that decreases quality of care is put into law as a "quick fix," that standard is very difficult to change. Legislators must listen to experienced nurses so that the decisions they make on health policy will positively influence the nursing shortage issues.     

Reflexiones acerca del uso y utilidad de los modelos y teorías de enfermería en la práctica asistencial

Theory is essential to explain and understand nursing practice. The theoretical framework helps to examine, organize, analyze and interpret patient data, supporting and facilitating decision-making. Likewise, the theoretical framework helps nurses to plan, predict and evaluate the results of nursing care. Therefore, the theoretical approach is a useful tool for reasoning and critical thinking and, moreover, helps nurses to use and manage all the information on a patient and to provide nursing care in a structured and effective manner.The use of Conceptual Models of Nursing in nursing care guarantees that all nurses share a common language and similar concepts with respect to the nursing paradigms, person, health, environment and care that characterize their professional role. The present article provides a reflection on an issue that continues to be of great importance - the dichotomy between nursing theory and practice.     

The importance of spiritual assessment: one clinician's journey

Assessing spiritual values of a patient causes the nurse to assess and or re-examine his or her own beliefs. Self- reflection makes one aware of how spirituality affects the individual's life and nursing practice. Those who find themselves uncomfortable with spiritual issues may have difficulty in delivering spiritual care to others. Nonetheless, the ability to seek appropriate assistance should be possible, but in-depth conversation regarding spirituality may need delivery by another caregiver.[8]Before assessing spirituality, examine your own beliefs to provide compassionate care related to meeting the patient's spiritual needs. Today, I regularly ask if the elder has a religious or faith-based belief he or she follows. If so, I probe further to determine how this belief system helps them with their health care concerns. I watch for symbols such as a Bible, inspirational readings, or religious items in the home or health care setting. A practice choice I have made is to offer prayers together with my patients and families. This is an individualized involvement that some believe crosses the boundaries of professionalism and political correctness. However, this level of involvement provides a positive opportunity to provide fulfillment in my nursing practice for my patient and myself. I will continue this added dimension of care.Spiritual assessment involves the evaluation of spiritual needs and the relationship to health care issues, whereas spiritual care involves compassion, presence, listening, and the encouragement of hope. It may or may not involve God or religion. To best serve the elderly patient, nurses should examine their own spirituality and how this may affect their own unique ability to assess or deliver spiritual care.     

Alternative treatment modalities: the need for a rational response by the nursing profession

During the last 2 decades, interest in and use of alternative modalities of health care has proliferated. As the public demand for such therapies increased, nursing has been among a few of the health professions to fill this need. Some of these therapies may prove to be valuable, others may be shown to be ineffective, and others may be harmful. Presently, many alternative methods have not been tested by using rigorous scientific methods. In addition, standardization in education and credentialing of practitioners of these modalities is lacking. As health care professionals, nurses have a responsibility to their patients and to their profession to validate the safety and efficacy of their practice. It is incumbent on the recognized bodies of the nursing profession to address these serious issues. The safety of patients and the reputation of the profession of nursing may depend on it.     

The current state of nursing performance measurement, public reporting, and value-based purchasing

Over the last decade, there has been a substantial investment in holding health care providers accountable for the quality of care provided in hospitals and other settings of care. This investment has been realized through the proliferation of national policies that address performance measurement, public reporting, and value-based purchasing. Although nurses represent the largest segment of the health care workforce and despite their acknowledged role in patient safety and health care outcomes, they have been largely absent from policy setting in these areas. This article provides an analysis of current nursing performance measurement and public reporting initiatives and presents a summary of emerging trends in value-based purchasing, with an emphasis on activities in the United States. The article synthesizes issues of relevance to advancing the current climate for nursing quality and concludes with key issues for future policy setting.     

Report cards: relevance for nursing and patient care safety

The emergence of health care report cards in the North American environment is outlined. While it is evident that substantial activity has emerged, the majority of these initiatives excluded nursing, or use a broad indicator for nursing that may not provide meaningful representations of the quality of nursing care provided in the system and the relevance of this care to patient care safety. Given that nurses are the primary care provider in health care settings, this represents a significant gap in health care report cards. The pioneering work of the American Nurses Association (ANA) Nursing Report Card in the development and validation of report card indicators for nursing is discussed. Challenges related to data availability and data quality are identified. Potential opportunities for linking nursing practice outcomes to patient care quality and patient safety through a report card process are outlined.     

Complementary therapies in practice: the ethical issues

Summary

• ? This article explores some of the ethical issues associated with the use of complementary therapies in practice.
• ? The adopted terminology and related concepts are clarified. The term ‘complementary therapy’ is compared and contrasted with ‘alternative medicine’ and ‘non-conventional therapy’.
• ? The increasing emphasis on holistic nursing care is also discussed.
• ? Ethical issues of patient choice, informed consent and the principle of beneficence are examined in relation to complementary therapies.
• ? The article highlights the obligation of the nurse, midwife or health visitor to provide or facilitate holistic care including complementary therapies, such as massage or aromatherapy, for those clients who request such care, and where it can be demonstrated that there will be benefits for the patient.
• ? It is concluded that nurses should consider the possibility of incorporating or facilitating certain complementary therapies in their practice in order to benefit their patients. There is a corresponding need for an appropriate knowledge base, founded on nursing research, into the effectiveness and outcomes of complementary therapies. In addition, relevant educational courses should be developed.

     

Primary prevention of agricultural injuries. Use of standardized nursing diagnosis, interventions, and outcomes.

1. The use of standardized nursing language is important to the advancement of nursing knowledge and practice. The standardization of nursing diagnoses, interventions, and outcomes provides a means for collecting and analyzing large clinical databases. 2. The occupational health nurse has a clear role in developing health and safety programs. Standardized language using North American Nursing Diagnosis Association diagnoses, nursing outcomes classification, and nursing intervention classification can be incorporated into these programs. 3. The use of standardized taxonomies in the primary prevention of cumulative trauma disorders demonstrates how these systems are integrated into the documentation of the nursing process in a nursing care plan.     

Gender Binaries in Nursing: A Critical Shift to Postgenderism

Gender binaries refer to grouping systems that label individuals as male or female. Societal shifts in what defines gender have evolved over the past decade; however, nursing practice remains grounded in these traditional gender binaries. The negative impacts of these practices, specifically in reproductive care, are detrimental for individuals who do not identify within traditional gender binaries. Gender binaries and stereotypes persist because of the prevalence of attitudes; nursing education development; and biases within care areas—specifically, reproductive care—because of issues such as gendered theories and language. Nurses can play a role in enhancing inclusivity by encouraging reflective practice, implementing gender-informed concepts into curricula, and encouraging the use of a postgenderism lens in policy and practice. Improvements in these areas can help foster health care access and safety.     

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.     

The usefulness of nursing languages to communicate a clinical event

The purpose of this study was to explore nurses' perceptions of the strengths and limitations of standardized nursing languages in the electronic health record to communicate a clinical event. Limited examples of research exist exploring the effectiveness of the electronic health record with embedded standardized nursing languages as a communication system. Therefore, their effect of standardized nursing languages on nurse-to-nurse communication remains largely unknown. Data from a larger study were analyzed using qualitative content analysis. Fifty-seven thematic units represented nurses' perceptions of the electronic health record with NANDA, NIC, and NOC for documenting and retrieving patient information associated with a clinical event. These thematic units were further analyzed, and three categories emerged: language comprehension, inexactness of the languages, and language usefulness. Standardized nursing languages were perceived to support planning care but also posed semantic challenges and fostered inaccuracies in patient information. Standardized nursing languages may constrain nurse-to-nurse communication related to a clinical event. For languages to support nurse-to-nurse communication and avoid potential safety issues, facilities must deal with inaccuracies and semantic misunderstandings to provide safe patient care.     

Patient safety issues in advanced practice nursing students' care settings

The purpose of this project was to identify and characterize patient safety issues across advanced practice nursing (APN) care settings including ambulatory care visits. A total of 162 registered nurses enrolled in an APN education program completed an online survey. Respondents reported patient safety issues related to diagnosis or management and treatment in almost half of 489 encounters. The most common issues were clinician communication problems with patients, which occurred during 42.4% of encounters. Adoption of information technology may be a pathway for improving patient safety issues in APN practice settings.