Understanding genomics: no longer optional for gastroenterology nurses

National news was made in 2003 with an amazing accomplishment: the completion of the Human Genome Project. This landmark endeavor produced a human DNA blueprint that helps scientists identify disease-causing genes and DNA variations affecting health promotion, disease prevention, and treatment responses. In October 2007, the Society of Gastroenterology Nurses and Associates joined the American Nurses Association and 48 other nursing organizations endorsing the document Essential Nursing Competencies and Curricula Guidelines for Genetics and Genomics. This document describes the minimum essential genetic/genomic competencies for all registered nurses regardless of education, practice role, or specialty area. How do these two pivotal events--mapping the human genome and establishing genetic/genomic nursing competencies--interface with each other and with gastroenterology nursing practice? This article defines genetics and genomics; discusses associated terminology and technology; and relates information to hereditary, familial, and sporadic colon cancer. Two case studies highlight essential nursing competencies, the genetic concepts of hereditary colon cancer, and the genomic aspects of sporadic colon cancer. A genomics glossary and a Web site resource chart for nurses and clients are included. The author shows how genetics and genomics are relevant for today's gastroenterology nurse.     

Genetics and Genomics Nursing: Scope and Standards of Practice

Genetics and genomics nursing is a new and expanding specialty practice. The International Society of Nurses in Genetics (ISONG) is the leader in defining genetics nursing and establishing scope and standards of practice for genetics nurses. Through ISONGs efforts, in 1997 The American Nurses Association (ANA) established genetics nursing as an official nursing specialty. This was followed by publication of The Scope And Standards Of Clinical Genetics Nursing Practice by ISONG and ANA in 1998. The roles of nurses in genetics and genomics have evolved and expanded since publication of this landmark document. A committee within ISONG representing genetics nurses in diverse specialties and practice settings has drafted a new scope and standards document in collaboration with ANA entitled Genetics Nursing: Scope and Standards of Practice, which is expected to be published by American Nurses Publishing in 2006. The purpose of the new scope and standards document is to define the parameters of genetics and genomics nursing practice at the basic and advanced practice level, include-non-clinical roles such as education, research, and administration, address the broader focus of genomics, and be applicable to genetics nurses within and outside of the United States since ISONG as an international organization.     

Preparing the nursing profession for participation in a genetic paradigm in health care

It is critical that nurses be recognized for their ability to deliver genetic services in collaboration with medical geneticists, genetic counselors, physicians, and providers from other disciplines. The purpose of this special communication is to describe progress made by the International Society of Nurses in Genetics toward incorporating genetics into nursing education and practice.     

Innovations in United States genetics nursing: Practice and research

Aim: Clinical and research applications from human genome discoveries are growing and creating both opportunities and challenges to the integration of genetic concepts into practice and research. Nurses have a long history of caring for individuals, families, and groups with genetic conditions. In the past two decades, a small group of nurses in the USA have used a variety of strategies to further develop the field of genetics nursing. In this paper we identify innovative approaches to identifying genetics‐related nursing roles and opportunities, as well as successful collaborative efforts beyond nursing to address the emerging health and societal challenges related to human genetics discoveries. Methods: The information presented here comes from a variety of sources where the authors or genetics nurses directly participated, including: (i) a systematic literature review of genetics nursing; (ii) a comprehensive research study of models of delivering clinical genetics services and the roles of health professionals; and (iii) participation in numerous national research, planning, programmatic, and advisory groups involved with clinical genetics‐related health services, research, education, and public policy. Results: Genetics nurses in the US have developed innovative responses to genetics‐related challenges within and beyond the profession of nursing. These include: (i) establishing an organization for nurses in genetics and gaining formal recognition of genetics as a specialty of nursing; (ii) defining the scope of genetics nursing practice and developing a new genetics nursing credential; (iii) establishing a multiprofessional genetics education coalition and defining genetic competency for health‐care practice; (iv) creating new clinical practice roles for nurses that integrate emerging genetics concepts and skills into diverse clinical practice areas; (v) expanding nursing involvement in genetics‐related research; and (vi) participation in high‐level genetics advisory groups. Conclusions: The US experience shows that nurses have made substantial progress in expanding their involvement in genetic services through visionary leadership, innovative approaches to challenges, establishing support with nurse colleagues, and engaging in multiprofessional efforts. The most important first step is developing a supportive environment for nurse advancement. In the US, the genetics nurses’ organization known as the International Society of Nurses in Genetics (ISONG) has provided this base.     

Unilateral neglect: assessment in nursing practice

The North American Nursing Diagnosis Association has recognized unilateral neglect (UN) as a nursing diagnosis for more than 2 decades. Such a designation implies that nurses primarily are responsible for assessing, treating, and researching the disorder. However, nurses have made few documented contributions toward this responsibility. Although UN is a complex problem that requires attention from several specialties, there is room for nurses to substantially increase their role. Nurses are uniquely positioned to assess and treat UN by virtue of their interaction with patients in a variety of times, settings, and activities. Nurses need to develop quantifiable measures of clinical observation that are reliable and valid in nursing practice. This article reviews the literature to examine the impact of UN, existing assessment methods, and nursing involvement in assessment and treatment. Potential nursing contributions in practice and research are featured as well.     

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.     

Stigma, negative attitudes and discrimination towards mental illness within the nursing profession: a review of the literature

The aim of this paper was to review the existing literature pertaining to stigma, negative attitudes and discrimination towards mental illness, specifically as viewed through the lens of the nursing profession. The results of the literature review were synthesized and analysed, and the major themes drawn from this were found to correspond with Schulze's model identifying three positions that healthcare workers may assume in relation to stigma of mental illness: 'stigmatizers', 'stigmatized' and 'de-stigmatizers'. In this paper, the nursing profession is examined from the perspectives of the first two major themes: the 'stigmatizers' and 'stigmatized'. Their primary sub-themes are identified and discussed: (1) Nurses as 'the stigmatizers': (a) nurses' attitudes in general medical settings towards patients with psychiatric illness and (b) psychiatric nurses; (2) Nurses as 'the stigmatized': (a) nurses who have mental illness and (b) stigma within the profession against psychiatric nurses and/or psychiatry in general. The secondary and tertiary sub-themes are also identified and reviewed.     

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.     

Navigating the evidence-based practice maze

Aim  This article's purpose is to provide nurses with key points to consider in facilitating informed decision making while navigating the evidence-based practice (EBP) maze.
Background  EBP in nursing evolved from the medical model and continues developing within the holistic nursing paradigm. Inconsistent terminology, multiple applications, and lack of a unifying theory create challenges for nurses.
Key issues  Recognition that multiple knowledge sources to support clinical decision making have merit for facilitating 'best' patient outcomes; EBP must be an internalized value of professional nursing.
Conclusions  Multiple ways of knowing, or evidence, for informed clinical decision making must be considered based on situational context. No hierarchy fits all situations. Nurses must provide support and resources to facilitate nurse empowerment; nurses are accountable for using EBP to enhance patient outcomes.
Implications for nursing management  Effective EBP implementation relies on nurses being cognizant of what current nursing EBP trends are based on and where they are going. Nurses have a key role in facilitating consensus regarding evidence to be used in EBP, and ensuring availability of resources for empowering nurses to be accountable for outcome-oriented patient care through utilizing EBP.     

Reuse of single use medical devices

During the ten years that I have worked at the Canadian Nurses Protective Society, we have had numerous calls from Operating Room nurses questioning the practice of re-using single use medical devices in their facilities and voicing their concerns about possible harm to patients, themselves and potential liability exposure. Interest in this topic has been rekindled by the recent Saskatchewan case involving the death of a patient from variant Creutzfeld-Jakob Disease (vCJD) and possible transmission of vCJD to 71 patients who may have been exposed to the same endoscope as the deceased while in hospital. In this article, I propose to address some of the concerns related to the reuse of single use medical devices by focusing on the prevalence of this practice, the legal risks involved, regulation of this practice, and risk management.     

Nurses' perspective on interprofessional communication on an intensive care unit

The aim of this qualitative study was to explore experience in nurses' interdisciplinary/interprofessional communication on an intensive care unit. The structure of communication and influencing factors were shown and interpreted from the perspective of the nurses. Nurses working on an internal medical intensive care unit at a teaching facility in central Germany were questioned by means of semi-structured interviews. One main result was that for nurses the culture of communication in the investigation unit was characterized primarily by hierarchical structures imposed by the physicians. This dominance was identified in all nursing activities resulting in a considerable adverse effect on the flow of information concerning the patient between nurses and physicians. Especially within the context of daily rounds nurses were confronted with barriers to participate actively with their knowledge and professional competence in the process of decision-making. The problems described are well known in everyday nursing practice and have been dealt with in the English research literature. However, this study's aim is to present and summarize the gained insights and to transfer them in a practice-oriented way into a selected field of work. Possible solutions for the problems of inter-professional communication are suggested in subsequent work steps in order to optimize patient care.     

The international classification for nursing practice: a tool to support nursing practice?

Nurses have been slow to realise the uniqueness of their data and the importance of data management across the profession. This has resulted in nursing being neglected as a partner in healthcare because the data nurses collect cannot be easily retrieved from the patient record and is not widely used to support nursing practice. Nurses, as they should, have rejected language classification systems that are inadequate or inappropriate, but with the implementation of electronic health records, consensus on language classification must be achieved. One problem has been finding an appropriate terminology/s that represents the spectrum of nursing practice while making sense to both the user and computer. In 1989 the International Council of Nurses began work to achieve this and the International Classification for Nursing Practice (ICNP) was born. This paper provides an insight into language classification, explores the ICNP as a tool for nursing practice and discusses some of the projects undertaken thus far.     

Putting evidence into practice: prevention of infection

The prevention of infection is an important outcome to measure in patients with cancer because infectious complications are a significant cause of morbidity and mortality. Nurses play a vital role in the prevention of infection in patients with cancer through nursing practice, research, and patient education. However, many common nursing interventions to prevent infection are based on tradition or expert opinion and have not been subjected to scientific examination. The 2005 Oncology Nursing Society Prevention of Infection Outcomes Intervention Project Team reviewed, critiqued, and summarized the research evidence for nursing interventions to prevent infections in patients with cancer. Pharmacologic and nonpharmacologic interventions were included because many advanced practice nurses prescribe medications. This article is an evidence-based review of nursing interventions to prevent infection in patients with cancer.     

Supportive nursing: a critical review of the literature.

Nurses have long thought that providing support was a part, if not a central part, of their nursing practice. In the literature, nurses have described their ability to provide support and have discussed their inability as well as their reasons why they have been unable to give support. Support for nurses has at least three parameters: physical, social, and emotional. The emotional parameter has received the most attention by nurses. The meaning of support in nursing needs to be clearer and more precise. Although several nurses, either through theoretical discussions or exploratory research studies, have begun to further define support, this construct warrants more thought and investigation by nurses. Once an operational definition is determined and supportive behaviors identified, nurses can further investigate the influence of support to the promotion of health.     

Quality nephrology nursing care: beyond Kt/V.

Through a critical review of nursing and medical literature, this article argues that nephrology nurses have embraced Kt/V at the expense of other core elements of nephrology nursing care. The focus on quality care as technical expertise may dominate at the expense of interpersonal care. Nurses need to challenge the influence Kt/V has on other aspects of nephrology nursing care.     

Evidence-based practice guidelines and school nursing.

The use of evidence-based practice (EBP) has become the standard of health care practice. Nurses are expected to use best evidence on a wide range of topics, yet most nurses have limited time, resources, and/or skills to access and evaluate the quality of research and evidence needed to practice evidence-based nursing. EBP guidelines allow nurses and other health care workers to have research information collected, analyzed, and condensed into specific practice recommendations by experts. This article defines EBP guidelines and discusses the process of guideline development, including identification of topics, systematic literature searches, and evaluation and rating of research. Criteria for determining the quality of existing guidelines are reviewed. The steps needed to develop EBP guidelines specifically for school nursing are discussed.     

江苏省重症监护室护士专科护理实践行为的调查研究

目的调查江苏省重症监护室(intensive care unit,ICU)护士专科护理实践行为现状。方法2018年8月,便利抽样法选择江苏省6所医院的ICU护士作为研究对象,以自制的ICU护士专科护理实践行为问卷对其进行调查。结果共273名护士参与调查。ICU基础监护技术、检验标本采集/保存、仪器设备使用、检验指标判读等护理实践行为有较高的操作频率,分别为78.57%、77.78%、81.81%和100.00%。在护理实践技能的掌握方面,不同能级护士对护理实践行为的掌握有所差异,N0、N1护士掌握较好的是ICU基础监护技术和检验标本的采集/保存;N2、N3护士对大部分护理实践行为有着较好的掌握度,但仍对部分护理实践行为掌握较差。结论ICU不同能级的护士所掌握的专科护理实践行为有所差异,护理管理者在制定培训方案时应考虑不同能级护士的学习需求,同时为应对医疗技术的发展应定期培训和巩固操作频率较低的专科护理实践行为。