Competencias en enfermeras Especialistas y en Enfermeras de Práctica Avanzada

ObjectiveTo analyse the distribution of advanced competences in specialist nurses and advanced practice nurses and to evaluate their association with some characteristics of their professional profile.MethodMulticentre analytical cross-sectional study. Nurses who worked as advanced practice nurses and specialist nurses were included. Their level of perceived advanced competences was measured, as well as sociodemographic and professional characterization variables.ResultsA total of 277 nurses participated (149 practised as advanced practice nurses and 128 as specialists), with an average of 13.88 (11.05) years as a specialist and 10.48 (5.32) years as an advanced practice nurse. In the sample, 28.8% had a master's or doctorate level qualification, 50.2% worked in Primary Care, 24.9% in hospitals and 22.7% in Mental Health. The self-perceived global level was high in the different competences, the lowest dimensions being research, evidence-based practice, quality and safety management and leadership and consulting. The advanced practice nurses obtained a higher level of competence globally and in the dimensions of leadership and consulting, interprofessional relations, care management, and health promotion. There were no differences based on experience or possession of a master's degree or doctorate. In the advanced practice nurses, the practice context did not influence competence levels, although in the specialist nurses it did, in favour of those practicing in Mental Health.ConclusionsSpecialist and advanced practice nurses have different competences that should be adequately managed for the development of advanced and specialist nursing services.     

The development of competency standards for specialist critical care nurses

In defining the contemporary role of the specialist nurse it is necessary to challenge the concept of nursing as merely a combination of skills and knowledge. Nursing must be demonstrated and defined in the context of client care and include the broader notions of professional development and competence. This qualitative study sought to identify the competency standards for nurse specialists in critical care and to articulate the differences between entry-to-practice standards and the advanced practice of specialist nurses. Over 800 hours of specialist critical care nursing practice were observed and grouped into 'domains' or major themes of specialist practice using a constant comparison qualitative technique. These domains were further refined to describe attributes of the registered nurses which resulted in effective and/or superior performance (competency standards) and to provide examples of performance (performance criteria) which met the defined standard. Constant comparison of the emerging domains, competency standards and performance criteria to observations of specialist critical care practice, ensured the results provided a true reflection of the specialist nursing role. Data analysis resulted in 20 competency standards grouped into six domains: professional practice, reflective practice, enabling, clinical problem solving, teamwork, and leadership. Each of these domains is comprised of between two and seven competency standards. Each standard is further divided into component parts or 'elements' and the elements are illustrated with performance criteria. The competency standards are currently being used in several Australian critical care educational programmes and are the foundation for an emerging critical care credentialling process. They have been viewed with interest by a variety of non-critical care specialty groups and may form a common precursor from which further specialist nursing practice assessment will evolve.     

Family nursing: walking the talk

This article discusses a study exploring the lived experience of family nursing for novice registered nurses. There has been an increased emphasis on including family content in Canadian nursing education curricula. Literature on family nursing is ambiguous about differentiating family nursing at the generalist and specialist level, and acknowledges that there is a blurring of lines between the two. The study utilized a phenomenological approach to examine how nurses with 2 years or less in practice experience family nursing in a variety of settings. Following ethical approval, invitations were sent to all nurses employed in two health authorities, who met the study criteria. Five nurses were interviewed using a semistructured interview. Participants shared how they practice family nursing in the current nursing situation of shortages and constraints. This study adds to our understanding of what happens at a beginning level of family nursing, how nurses understand and experience caring for families in the everyday enactment of their professional role, and barriers and facilitators to including family in nursing care. The findings provide important information for nurse educators in grounding the teaching of family nursing in the real world of nurses.     

Role development and effective practice in specialist and advanced practice roles in acute hospital settings: systematic review and meta-synthesis

AIMS: This paper reports a study whose aim was to identify and synthesize qualitative research studies reporting barriers or facilitators to role development and/or effective practice in specialist and advanced nursing roles in acute hospital settings. BACKGROUND: The number of clinical nurse specialist, nurse practitioner, advanced nurse practitioner and consultant nurse roles has grown substantially in recent years. Research has shown that nurses working in innovative roles encounter a range of barriers and facilitators to effective practice. METHODS: Systematic literature searches were undertaken, and relevant studies identified using specific inclusion and exclusion criteria. The selected studies were appraised, and their findings synthesized using Ritchie and Spencer's 'Framework' approach. RESULTS: Fourteen relevant studies were identified, mostly from the UK. They described a range of barriers and facilitators affecting specialist and advanced nursing practice. These related to the practitioner's personal characteristics and previous experience, professional and educational issues, managerial and organizational issues, relationships with other health care professionals, and resources. The factors most widely identified as important were relationships with other key personnel, and role definitions and expectations. CONCLUSIONS: Relationships with other staff groups and role ambiguity are the most important factors which hinder or facilitate the implementation of specialist and advanced nursing roles. These factors seem interlinked, and the associated problems do not appear to resolve spontaneously when staff become familiar with the new roles. In order to reduce role ambiguity and the consequent likelihood of negative responses we recommend that, when specialist and advanced nursing roles are introduced, clear role definitions and objectives are developed and communicated to relevant staff groups; these definitions and objectives should be updated as necessary.     

美国医院伤口造口失禁护理专科护士的培养与使用

为了解美国伤口造口失禁护理专科护士的教育培训、使用与管理,以借鉴其经验,指导我国专科临床护理工作,赴美国8家医院进修伤口造口失禁护理,并参加了Emory大学培训中心的伤口造口失禁护理培训课程及美国中东部地区伤口造口失禁护理大会,了解了美国伤口造口失禁护理专科护士的培养模式、使用和组织管理架构、团队合作工作模式、工作内容及其方式和继续教育等现状。美国伤口造口失禁护理专科护士从选拔、培训、工作模式和内容、时间管理到继续教育再注册等环节均有明确规定,专科护士爱岗敬业、队伍稳定,对我国的专科护士培训和使用有一定的借鉴作用。     

Delineating advanced practice nursing in New Zealand: a national survey

Background

A variety of advanced practice nursing roles and titles have proliferated in response to the changing demands of a population characterized by increasing age and chronic illness. Whilst similarly identified as advanced practice roles, they do not share a common practice profile, educational requirements or legislative direction. The lack of clarity limits comparative research that can inform policy and health service planning.

Aims

To identify advanced practice roles within nursing titles employed in New Zealand and practice differences between advanced practice and other roles.

Method

Replicating recent Australian research, 3255 registered nurses/nurse practitioners in New Zealand completed the amended Advanced Practice Delineation survey tool. The mean domain scores of the predominant advanced practice position were compared with those of other positions. Differences between groups were explored using one‐way ANOVA and post hoc between group comparisons.

Results

Four nursing position bands were identified: nurse practitioner, clinical nurse specialist, domain‐specific and registered nurse. Significant differences between the bands were found on many domain scores. The nurse practitioner and clinical nurse specialist bands had the most similar practice profiles, nurse practitioners being more involved in direct care and professional leadership.

Conclusions

Similar to the position of clinical nurse consultant in Australia, those practicing as clinical nurse specialists were deemed to reflect the threshold for advanced practice nursing. The results identified different practice patterns for the identified bands and distinguish the advanced practice nursing roles.

Implications for nursing policy

By replicating the Australian study of Gardener et al. (2016), this NZ paper extends the international data available to support more evidence‐based nursing workforce planning and policy development.     

合理使用糖尿病专科护士提升医院专项护理水平的做法与体会

目的探讨合理使用糖尿病专科护士提升医院专项护理水平的做法与体会。方法成立以糖尿病专科护士为核心的糖尿病护理小组并进行培训,定期组织糖尿病专项护理质量检查、开展护理会诊、开设专科护理门诊和组建全市糖尿病健康教育者网络。结果非内分泌专科糖尿病患者对健康教育总体满意度由56.00%上升到92.00%;非专科病区糖尿病专项护理质量检查均分由(71.25±3.64)分上升为(92.18±1.52)分;2010年糖尿病专科护士完成健康教育门诊328人次、院内疑难护理会诊59次、院外护理会诊3次;全市二级以上医院内分泌科病房常规开展集体小讲座由4所增加到8所;2010年底糖尿病专科护士申报的护理科研项目获得基金资助。结论糖尿病专科护士在提升医院专项护理水平中具有重要作用,应重视专科护士的正确使用,从而拓展护理服务内涵。     

Development and validation of a learning needs assessment scale: a continuing professional education tool for multiple sclerosis specialist nurses

Aim. To develop and validate a learning needs assessment scale. Background. Learning needs analysis is a central component of continuing professional development but there is a lack of psychometrically developed learning needs assessment tools. Self‐assessment questionnaires are emerging as a key method. The development of a learning needs analysis scale for multiple sclerosis specialist nurses is described. Design. A psychometric approach comprising the three phases of the development and testing of the scale are outlined. Method. Phase 1: Item identification using a literature review; postal survey of stakeholders (n = 320), 20 nurse interviews; four nurse focus groups; five telephone interviews with people with MS. Phase 2: Refinement of draft scale and establishing face and content validity testing using an expert panel. Phase 3: Testing of draft scale using data from a postal survey (n = 47 MS specialist nurses) to assess the feasibility and effectiveness of scale, internal consistency and construct validity. Test–retest reliability was assessed using data from 17 MS specialist nurse respondents to calculate intra‐class correlation coefficients. Results. The data from the different study phases informed scale refinement. The validity and reliability of the scale was confirmed through testing. Conclusion. The study provides an example of how a robust learning needs assessment scale may be developed for a specialist area of nursing practice to be used in conjunction with more subjective approaches. Relevance to clinical practice. High quality nursing care depends upon a competent nursing workforce that engages in continuing professional development. This study provides an example of a psychometrically developed learning needs assessment scale to inform continuing professional development needs of nurses working in a specialist area of practice.     

我院发展专科护理的方法与效果

目的 探讨发展专科护理的方法与效果.方法 成立专业护理小组,落实护理会诊制度、层级管理与管床责任制,开设专科护理门诊,设立专科护士岗位.结果 7个专业护理小组运作良好,全院年护理会诊数量逐年增多,日专科护理门诊量30～40例;护嘱制度得到进一步完善;护理差错及护理投诉逐年减少;护士离职率逐年下降;护士对专业护理小组、护理会诊和专科护理门诊等工作表示认可.结论 发展专科护理有利于提高护士专业水平与职业归属感,更好地为病人提供优质护理服务.     

Therapeutic relationships in specialist palliative care nursing practice

There has been limited research into the scope or standards of specialist palliative care nursing practice in an Australian context. This study sought to develop a competency framework that described the core domains of specialist palliative care nursing. This article explores one key domain of specialist palliative care nursing practice - therapeutic relationships - that was identified as underpinning other domains of practice. A mixed method was used, involving a literature review, a survey including practice exemplars and an interview of specialist palliative care nurses. Seventy-four registered nurses working in designated specialist palliative care nursing roles from each Australian state and mainland territory were involved. The nurses represented metropolitan, regional, rural and remote communities, various inpatient facilities and community practice settings. Five core domains of specialist palliative care nursing practice were identified: complex supportive care, collaborative practice, leadership, improving practice and therapeutic relationships. Therapeutic relationships were identified as the central domain of specialist palliative care nursing practice to which all other domains were inextricably linked.     

Postgraduate Medical Imaging Nursing Curriculum: Development and Indications for Nursing Practice

Medical Imaging (MI) nurses require advanced education to increase their ability to positively influence patient care, leading to improved patient outcomes. The MI nursing field has been a neglected specialty with regard to postgraduate tertiary education programs, where the eminent skills, knowledge, and expertise of other specialist nursing fields have been recognized and sought after, such as critical care environments. Postgraduate tertiary education incorporates the application of evidence-based theory to clinical practice and can address the theory-practice gap and improve the critical thinking, confidence, and competence of MI nurses. Postgraduate tertiary education can contribute to improved patient outcomes and reduced mortality. A postgraduate tertiary MI nursing program was developed to support the clinical practice and critical thinking of nurses in radiology departments.     

Does education level influence the practice profile of advanced practice nursing?

BackgroundAdvanced practice nursing is recognised globally as central to meeting this community need. Whilst there is increasing recognition that advanced practice nurses should be educated to at least a master degree level, there is scant evidence on the influence of higher education on the practice profile of advanced practice nursing.AimTo investigate the relationship between level of education and domain practice scores of nurses in advanced practice roles.MethodsThe validated Advanced Practice Nursing Role Delineation (APRD) tool was used to measure the practice profile of advanced practice nurses at different postgraduate education levels, across five domains of nursing practice activities. A cross-sectional electronic survey of nurses was used.FindingsAPNs with higher degrees performed at a higher level across all five domains of the APRD tool compared to those who did not hold a higher degree. This was highly significant for the domains of Research and Leadership, followed by the Optimising Health Systems and Education domains, but not significant for the Direct Care domain.DiscussionQuestions are often raised about the benefits of investing in nurses’ education, particularly the need for a higher degree for advanced practice nurses. APNs with higher degrees have a different emphasis in their role activities than those without a higher degree. This difference could be significant given current global health challenges.ConclusionHigher education changes the practice profile of APNs. Those with higher education are more likely to be involved in research and leadership with knowledge integration across all practice domains.     

Nephrology nursing: blurring the boundaries: the reality of expert practice

Background. Expertise in nursing has been widely studied; there have been no previous studies into what constitute expertise in nephrology (renal) nursing. This paper describes a ‘real‐world’ characteristic of expert nephrology nursing practice. Aims and objectives. This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the concept blurring the boundaries. Design. The study utilized grounded theory methodology and symbolic interactionism. Methods. The study took place in one renal unit in New South Wales. Sampling was purposive then theoretical; the sample consisting of six non‐expert and eleven expert nurses. Simultaneous data collection and analysis using participant observation, review of nursing documentation and semi‐structured interviews was undertaken. Results. The study revealed that only expert nephrology nurses ‘blurred the boundaries’ of professional nursing practice. They did this by moving intermittently and purposefully, for the benefit of particular patients, into medical domains in the areas of prescribing, dispensing and ordering of pathology tests. Non‐expert nurses did not cross these professional boundaries. Conclusions. Blurring the boundaries was a significant feature of expert nursing practice, and this study was the first to describe explicitly nursing boundaries as two distinct entities; that is, formal and informal. Relevance to clinical practice. There are some nephrology nurses who have sufficient knowledge and experience to prescribe some medications and to order certain investigations.     

Practice and clinical decision-making autonomy among Hellenic critical care nurses

BACKGROUND: Nursing autonomy has been associated with better patient-outcomes; therefore, it is a priority for critical care nursing management. Low authority has been a persistent complaint of Hellenic intensive care unit nurses; however, issues of nursing autonomy have not been previously addressed empirically in Hellas. PURPOSE: To investigate: (1) the perceived contribution to clinical decision-making, (2) the degree of autonomy in technical tasks, and (3) factors related to practice autonomy in critical care nurses in Hellas. Additionally, because of the lack of sufficient tools, this study also aimed to construct and to validate a new tool for assessing practice and clinical decision-making autonomy among Hellenic intensive care unit nurses. MATERIALS AND METHODS: A Hellenic intensive care nursing autonomy scale, focused on technical aspects of care, was developed through literature review, a panel of experts and a pilot study in a random sample of 120 respondents. Items were refined by factor analysis, which revealed three major conceptual categories of autonomy: (1) basic technical, (2) advanced technical, and (3) clinical decision. Hellenic intensive care nursing autonomy (Likert 4, range: 38-152), was distributed to all nurses employed in intensive care units in Hellas (n = 807; attrition: 27%). Comparisons, correlation and multivariate regression were employed. RESULTS: The Hellenic intensive care nursing autonomy scale exhibited appropriate reliability (Cronbach's alpha = 0.86) and validity properties. Autonomy scores were moderate (mean: 105.24 +/- 9.58). Highest autonomy was attributed to basic technical tasks, followed by advanced technical tasks and decision-making. Male gender and higher education were predictors of higher overall, advanced technical and decision-making autonomy (P = 0.01). Bachelor degree graduates scored higher in decisional autonomy (P = 0.03). Intensive care unit experience and type of intensive care unit were also important determinants of decisional autonomy (P = 0.02). CONCLUSIONS: The results revealed moderate autonomy in technical tasks and low decisional autonomy among Hellenic intensive care unit nurses. Factors related to the educational preparation of nurses, gender issues and institutional characteristics might hinder intensive care unit nurses' autonomy in Hellas.     

心血管疾病患者增长对专科护理发展的思考和建议

目前我国心血管疾病发病率持续增长,医疗技术水平亦不断提高,新技术、新业务广泛应用于临床,心血管疾病专科护理领域出现了疾病的复杂性提高、对护理服务的需求增加和护士护理教育、人力配备、专业化发展方面的问题。通过分析现阶段心血管疾病护理工作面临的机遇和挑战,提出合理配置护理人力资源、加强护十培训和探索心血管疾病专科护士培训方式等建议,以适应医学的快速发展,为患者提供安全优质的护理服务。     

Clinical decision‐making: predictors of patient participation in nursing care

Aim. To investigate predictors of patients’ preferences for participation in clinical decision‐making in inpatient nursing care. Background. Patient participation in decision‐making in nursing care is regarded as a prerequisite for good clinical practice regarding the person’s autonomy and integrity. Design. A cross‐sectional survey of 428 persons, newly discharged from inpatient care. Methods. The survey was conducted using the Control Preference Scale. Multiple logistic regression analysis was used for testing the association of patient characteristics with preferences for participation. Results. Patients, in general, preferred adopting a passive role. However, predictors for adopting an active participatory role were the patient’s gender (odds ratio = 1·8), education (odds ratio = 2·2), living condition (odds ratio = 1·8) and occupational status (odds ratio = 2·0). A probability of 53% was estimated, which female senior citizens with at least a high school degree and who lived alone would prefer an active role in clinical decision‐making. At the same time, a working cohabiting male with less than a high school degree had a probability of 8% for active participation in clinical decision‐making in nursing care. Conclusions. Patient preferences for participation differed considerably and are best elicited by assessment of the individual patient. Relevance to clinical practice. The nurses have a professional responsibility to act in such a way that patients can participate and make decisions according to their own values from an informed position. Access to knowledge of patients’ basic assumptions and preferences for participation is of great value for nurses in the care process. There is a need for nurses to use structured methods and tools for eliciting individual patient preferences regarding participation in clinical decision‐making.     

利益相关群体对护理硕士专业学位与专科护士并轨培养的认知调查研究

目的了解护理专业型硕士、专科护士、护理专家对护理硕士专业学位与专科护士并轨培养的认知及态度。方法在文献研究的基础上编制问卷,采用便利抽样,从全国东北、东、中、西部部分省市调查护理硕士专业学位研究生250名、专科护士250名和护理专家50名。结果专科护士和护理专家对护理硕士专业学位的了解程度不同,差异有统计学意义(P0.01)。护理专硕和护理专家对专科护士的了解程度相对较高。三组人群普遍对并轨相关政策不太了解。三组人群普遍认为护理硕士专业学位教育与专科护士培训并轨是可行的,且支持护理硕士专业学位教育与国家级专科护士培训并轨。从临床实践环节实施并轨是三组人群认可度最高的并轨方式。结论我国护理硕士专业学位与专科护士并轨培养是可行的,但护理专业型硕士与专科护士之间的了解不足。护理硕士专业学位教育可尝试与国家级专科护士培训并轨,从临床实践环节实现接轨。     

Predictors of recognition and practice of family nursing among healthcare professionals in Japan

Abstract Background. Although many nurses have become aware of the importance of family‐centered nursing, very little is known about the advanced knowledge and intervention skills of family nursing in Japan. Objectives. We examined the characteristics of their recognition of family nursing and factors related to the practice of family nursing. Methods. The subjects were nursing staff at a large hospital in Fukuoka, Japan (n = 596). A study using self‐administered questionnaires was conducted in October 2002. Factor analysis and multiple linear regression analysis were used to analyse the data. Results. Of 596 nurses, 376 returned questionnaires (63·6%). The study achieved the following findings. (1) The nurse's recognition of family nursing had four subscales: skills required to interview family members to construct a trusted relationship; assessment of family structure and family functioning; interventional skills of family nursing; and skills to collect information on family members. (2) The predictors of family nursing recognition were ‘gender’, ‘job position in hospital’, ‘individual experience of caring for their family members’, ‘length of clinical experience’ and ‘types of wards where they work’. (3) The predictors of practice of family nursing were ‘interventional skills of family nursing’, ‘skills to collect information on family members’ and the ‘total of four skills’. Conclusions. It is implied that the acquisition of knowledge and skills of family nursing in hospital settings are invaluable to consciousness‐raising and practice of family nursing. Relevance to clinical practice. As the factors related to practice or recognition of family nursing have been identified, the present findings are useful for hospital administrators who want to promote family nursing in their hospitals.     

Evaluating a community nursing service: listening to the voices of clients with an intellectual disability and/or their proxies

The aim of this study was to evaluate a specialist nursing service programme for people with an intellectual disability residing in the community. It is important to correct the imbalance in the literature that has neglected the voices of the clients themselves or denied expression by their proxies. The aim of the study was to gain a better understanding of matters of importance for clients and their families and to involve them in the evaluation of a service that directly affects their care. Only three clients were able to participate; however, 17 parents (next of kin) agreed to be interviewed. In-depth interviews were audio-taped, transcribed and analysed relating to the questions asked and were checked against the domains of the nursing practice in the disability area: continuity of care, advanced nursing practice, education and credentialling, personal and professional attributes, primary health care, and normalization. The findings confirm the high regard in which the programme is held. Service evaluation is crucial in providing evidence for programme funders. The favourable outcome of this evaluation meant that the programme gained funding for another few years.