The nurse navigator: Broker,boundary spanner and problem solver

BackgroundThe Queensland Health nurse navigator service is an innovative model that has recently emerged as a way of bridging gaps in care and supporting care coordination for patients with highly complex care needs. The translation of key principles into practice, and how nurse navigators operationalise their role in the care of individual patients in a highly complex health system while engaging a diverse team of health care providers, requires further understanding.AimTo explore how nurse navigators in Queensland operationalise their novel roles.MethodsThis was a qualitative study involving in-depth interviews with three nurse navigators. To explore interprofessional relationships and modes of operation, an exploratory multiple-case study design was used to produce illustrative case examples of practice.FindingsThree main modes of operation were identified and illustrated: the boundary spanner, the problem solver, and the broker. These modes of operation offer important insight into the practices and experiences of nurse navigators.DiscussionThe ‘problem solver’ demonstrates capacity to instigate system improvements, using patient advocacy as a mechanism for broader systems initiatives. The ‘boundary spanner’ exemplifies how nurse navigators can transcend traditional health system boundaries and build networks across nonhealth settings. The ‘broker’ illustrates the nurse navigator's relational role in forging partnerships with patients, across stakeholders in patient care, and across settings (and beyond the health sector).ConclusionThese case examples are demonstrative of how nurse navigators operate across a continuum, delivering holistic and individualised care.     

Examining the hurdles in defining the practice of Nurse Navigators

BackgroundNurse navigators are an emerging workforce providing care to people with multiple chronic conditions. The role of the navigators is to identify patients requiring support in negotiating their health care.PurposeA critical discourse analysis was used to examine qualitative data collected from nurse navigators and consenting navigated patients to identify key indicators of how nurse navigators do their work and where the success of their work is most evident.DiscussionNurse navigators help patients who have lost trust in the health system to re-engage with their interdisciplinary health care team. This re-engagement is the final step in a journey of addressing unmet needs, essential to hospital avoidance.ConclusionNurse navigators provide a continuum of authentic and holistic care. To acknowledge the true value of nurse navigators, their performance indicators need to embrace the value-added care they provide.     

Occupational health nursing with Navajo workers. Providing culturally competent care.

1. Native Americans in the southwestern United States are considered a "vulnerable population." Native Americans have economic difficulties, poor health, and little access to health care. The Navajo nation is the largest Native American reservation in the United States. 2. Occupational health nurses who provide culturally competent care increase the likelihood for Navajo workers to obtain optimal benefits from workplace health services. 3. The nurse uses cultural assessment skills and critical thinking abilities to maximize therapeutic interactions and minimize barriers in communications with workers of other cultural backgrounds. 4. The nurse who is knowledgeable about the Navajo way can help achieve a balance between the traditional ways and Western ways of addressing serious health care issues facing the Navajo worker. This knowledge and cultural awareness also increases the effectiveness of health promotion and health education programs offered to workers, their families, and their communities.     

Gender, ethnicity, and cardiovascular disease

Although the influence of gender and ethnicity on cardiovascular disease has been understudied, cardiovascular nurse researchers have contributed significantly to the existing body of knowledge. This article distinguishes between the constructs of "gender versus sex' and "ethnicity versus race,' acknowledging that the terms are often used interchangeably in research. A sampling of the substantial contributions of cardiovascular nurse researchers related to gender and ethnicity in the areas of symptoms of cardiovascular disease; risk factors and prevention; delay in seeking care, diagnosis, and treatment; recovery and outcomes; and cardiac rehabilitation is highlighted. Recommendations for future research include publishing research data by gender and ethnicity subgroups even though statistical comparisons may not be feasible, and increasing cardiovascular disease research in minority populations such as Asian Americans, Pacific Islanders, Native Americans, and Hispanics. Finally, we challenge cardiovascular nurse researchers to shift from the documentation of disparities toward designing and testing of interventions to eliminate health disparities.     

Oncology nurse navigator

The purpose of this integrative review is to explore the presence of the oncology nurse as navigator on measurable patient outcomes. Eighteen primary nursing research studies were found using combinations of the following key words: advocate, cancer, case manager, coach, certification, guide, navigator, nurse, oncology, patient navigator, pivot nurse, and continuity of care. Nurse researchers identified nursing-sensitive patient outcomes related to the time to diagnosis and appropriate treatment, effect on mood states, satisfaction, support, continuity of care, and cost outcomes. Navigator roles are expanding globally, and nurses should continue to embrace opportunities to ensure the safe passage of patients with cancer along the entire trajectory of illness and to evaluate the implications for educational preparation, research, and practice of navigators of all kinds.     

Bridging the healthcare divide with patient navigation: development of a research program to address disparities

Americans who live in poverty as well as certain ethnic and racial groups have higher cancer death rates than other populations. Patient navigators have been identified as an important weapon against these disparities. Navigators can address insurance, financial, and logistical issues (e.g., transportation, appointment scheduling, child or elder care). They can provide understandable health education that may lessen fears of cancer diagnosis and treatment. This article describes the development and implementation of a multisite patient navigator program involving five cancer institutions in Western Pennsylvania. Navigator programs have great potential to enhance cancer care by reaching underserved populations and opening the door for future research.     

Nursing expertise in breast cancer care: a systematic review on the effectiveness of specialised nurse interventions

To date there are no services in hospitals of the German speaking parts of Switzerland that offer continuous and specialist nursing care in oncology. This systematic literature review aims at providing an overview of the effectiveness of such interventions by specialist nurses for women with breast cancer. It should also inform the conceptualisation of new specialist nurse interventions in practice as well as indicate future research areas in this domain. Drawing on a database search, the review includes fifteen studies among which studies in German could not be taken into account. The studies included in the investigation differ in terms of the underlying concept of specialist nurse interventions as well as at the level of measured outcome variables. Comparability is limited. Overall, the review indicates that specialist nurse interventions can contribute to improving physical and psycho-social well-being in women with breast cancer. However, the review identifies both the need for a uniform definition of specialist nurse education and intervention in breast cancer care as well as the need for rigorous and confirmatory studies to evaluate their effectiveness - in order to provide a more reliable basis for future health care strategies.     

Gaining Access to Native American Cultures by Non-Native American Nursing Researchers

The authors sought to identify the problems non-Native American nurse researchers might have in gaining access to Native American cultures. The authors' method was nursing ethnography; several different tribes were observed. Findings revealed five significant categories of barriers to health care: understanding of cultural differences, language barriers, differences in interpersonal communication, historical antipathy I fear of exploitation by Native Americans, and distrust of researcher motivation. The authors make several recommendations for researchers to prepare extensively if they plan to work with Native Americans.     

African American consumers: What should we know to meet their mental health needs?

National health care organizations have placed greater emphasis on meeting the mental care needs of minority clients in the United States. Disparities in mental health care use among various populations have been clearly demonstrated. This article discusses what is known about mental health care use among African Americans and the need for new knowledge to address current and future needs. Strategies for examining and addressing mental health disparities in this population are addressed, and implications for nurse clinicians and researchers are presented. (J Am Psychiatr Nurses Assoc [2002], 8, 188-93.)     

Health careers for Native American students: challenges and opportunities for enrichment program design

Native Americans are severely underrepresented among US health care professionals, medical researchers, and public health officials. This low representation presents a substantial challenge to addressing the urgent need to improve health care in Native communities. Increasing the number of Native American clinicians and scientists can help to improve the health of these communities through direct provision of health care and by driving a targeted research and policy agenda. Low enrollment of Native American students in medical school and other health-related degree tracks has numerous root causes, ranging from financial constraints to the lack of appropriate mentorship. Academic institutions can play a vital role in reaching out to provide the appropriate experiences and resources that will engage Native students and help them take the next step towards a career in health care. These programs should always be accompanied by an appropriate evaluation structure that ensures continued improvement and facilitation of particular student needs.     

Filling the Knowledge Gap for Nurse Leaders: Next Steps Following COVID-19

The purpose of this article is to share gaps in knowledge and research related to pandemic management identified by nurse leaders during the COVID-19 pandemic. As part of a larger Delphi study, nurse leaders responded to an open-ended question about gaps in research they saw as important following the pandemic. Responses were analyzed using directed content analysis. Results are presented as 4 supercategories: Organizational leadership preparedness, adaptive leadership in crisis, innovations in care delivery, and health, well-being, and resilience.     

Preparing Nurse Practitioners to Provide Orthopedic Primary Care

Musculoskeletal disorders are among the most costly and debilitating chronic medical conditions, comprising up to 60% of outpatient office visits. Although access to orthopedic care is diminishing, studies reveal that primary care physicians are inadequately prepared to manage musculoskeletal problems. A recently piloted orthopedic fellowship program revealed that nurse practitioners also lack adequate preparation to manage musculoskeletal problems in primary care, but their skills and confidence improve with focused musculoskeletal training. More research is needed to assess knowledge gaps in the wider nurse practitioner population and to develop strategies for increasing musculoskeletal training at the graduate and postgraduate levels.     

Connecting Chronically Ill,Uninsured Patients Who Use the Emergency Department as a Medical Home: A Process Improvement Project

IntroductionThe use of the emergency department by uninsured patients with chronic health problems may adversely affect those patients’ health outcomes. Successful interventions have involved the use of patient navigators to connect the uninsured adult population with medical coverage and a medical home. The aim of this project was to use principles of patient navigation in a nurse-led process improvement intervention to connect uninsured patients to medical homes.MethodED nurses were trained to refer uninsured patients with chronic health problems to care coordinators when they were discharged from emergency departments. The care coordinator was provided by the Health Care District, a community-funded medical department. Patients were therefore connected to community-funded medical homes.ResultsED nurses improved their knowledge about the overuse of the emergency department and successfully referred uninsured patients who were discharged. The referred patients successfully made contact with members of the Health Care District by phone or by attending their appointments.ConclusionThe role of patient navigators is essential in the emergency department. They assist patients to navigate through the various health care resources available in their communities, which can help to reduce ED overuse.     

Role boundaries – research nurse or clinical nurse specialist? A literature review

This paper focuses on issues relating to the role components of clinical nurse specialists and clinical research nurses working in breast cancer care. Identified issues relate to the lack of agreement as to the role and definition of clinical nurse specialists. At the same time there has been an increase and emergence of clinical research nurses, both within the NHS and university departments. The review fails to reveal the relationship between these two specialist groups in terms of role overlap and role boundaries. The lack of knowledge in this area substantiates the need for further research to be carried out.     

Finnish nurse teachers' perceptions of their 'scientific thinking' and its development during Master's-level teacher education at university

There are very few studies on nurse teachers education, since the main interest has been on the demanding nature of a teacher's work. In Finland, the educational system of nursing care is developing rapidly and nurse teachers' education is changing as well. However, there is no research into academic nurse teacher education, even though this can be seen as important with regard to the educational system as well as to the nursing discipline. In this study, the objective was to describe 45 nurse teachers' perceptions of the development of their scientific thinking during Master's-level studies at the university. Open-ended questions were used in collecting the material with a questionnaire. The results of this phenomenographic research show that the need to increase one's scientific knowledge, as well as external demands, were the reasons for applying for admission to the university. Conceptions of the development of scientific thinking differed with regard to the processing of knowledge and to changes or developments in scientific thinking. The teachers' conceptions of the use of scientific nursing knowledge varied as well. The results challenge future teacher education and how it is arranged and developed. Further research, utilising different research methods, is needed into the development of scientific thinking.