Nurse consultation support to primary care practices to increase delivery of health behavior services

Tobacco use, lack of physical activity, poor diet, and alcohol use are the key preventable causes of death in the United States. This study tested the use of nurses as consultants to primary care practices to assist practice clinicians and staff in identifying and carrying out plans to help their adult patients improve these health behaviors. A pre–post chart audit was conducted, and 17 of 20 practices (85%, p = <.01) increased documentation of health behavior delivery a mean absolute increase of 5.5% after the intervention. Nurse consultation may be an effective strategy to increase health behavior delivery to patients in primary care.     

Health promotion in hospitals: the attitudes, beliefs and practices of hospital nurses

This research paper explores the attitudes, beliefs and health promotion practices of hospital nurses working on acute adult wards, as demonstrated through the use of semi-structured postal questionnaires Responses were compared with those from hospital-based occupational therapists, physiotherapists, dietitians and medical consultants, in order to examine issues of consistency and continuity between professional groups and their interaction with patients in relation to health promotion activity The nurses are considered both as a homogeneous group and also in relation to their seniority within the profession Results demonstrate the lack of a coherent health promotion strategy within acute care settings and highlight the differing educational needs of nurses according to their professional role within the hospital By addressing these issues, a strategy can be developed to enhance health promotion in hospital by building on the concerns and needs identified by the nurses themselves Research literature and analysis of this study demonstrate that whilst the current position of health promotion in hospital is generally poor, nurses are keen to integrate health promotion into their practice     

Ethics in independent nurse consulting: strategies for avoiding ethical quicksand

Changes in health care have created a variety of new roles and opportunities for nurses in advanced practice. One of these changes is the increasing number of advanced practice nurses carrying out independent consultation. Differences in goals between business and health care may create ethical dilemmas for nurse consultants. The purpose of this article is to describe possible ethical pitfalls that nurse consultants may encounter and strategies to prevent or solve these dilemmas. Three themes related to nursing codes of ethics will be discussed: the duty to uphold human rights, the duty to fulfill commitments, and the duty to practice the profession competently.     

Primary care nurse practitioners and the interface with secondary care: a qualitative study of referral practice

In the United Kingdom nurse practitioners are assuming responsibilities traditionally considered to be within the domain of general practitioners. Important amongst these is the referral of patients to medical consultants in secondary care, a responsibility commonly associated with the general practitioner's role as 'gatekeeper' to health care. This paper describes a study designed to identify issues raised by the challenge that a developing nursing role presents to interprofessional working at the interface between primary and secondary care. When invited to comment, study participants (nurse practitioners, nurse educators, medical consultants and general practice registrars) related nursing referrals to issues associated with professional boundary changes, namely: teamwork, regulation of practice, communication, professional conflict and professional relationships. This paper discusses the views of primary and secondary care practitioners about who should take responsibility for the referral of patients in the light of concerns raised about professional competence and accountability. Individual nurse practitioners and their colleagues have found pragmatic ways to manage their work however, although UK government policy supports development of advanced clinical nursing, there remains much work to be done to provide the professional and legal infrastructure to support the role.     

The role and scope of the clinical nurse consultant in Wentworth area health service, New South Wales, Australia

Aims  This paper reports phase one of a two-part study in a New South Wales area health service, which aimed to evaluate the grading system for clinical nurse consultants.
Background  Since its inception in 1986, the role and scope of practice of clinical nurse consultants in New South Wales has been viewed with differing expectations leading to role conflict from the nurse consultants themselves and others in health care including managers and other clinicians.
Method  A quantitative approach was used for this study. A survey comprising of open and closed questions was mailed to all clinical nurse consultants ( n  = 42) employed in the area.
Results  The data presented suggest that ambiguity continues about the role, the scope and the differences within the grading system of clinical nurse consultants.
Conclusions  Clinical nurse consultants need leadership training and support from their managers to fulfil their role. More work is required to clarify the role of clinical nurse consultants.     

Practice nursing in rural Australia

Rural Australia faces unique issues in workforce management and health care delivery. This paper provides an integrated review of the existing literature describing the work of practice nurses in rural Australia and the perceptions of consumers. Distinct differences are evident in the role of the practice nurse between rural and metropolitan practices. A key difference is that the rural practice nurse is known within the community and plays an important role in care coordination. Findings from two studies of consumer perceptions of the role of PN in rural areas suggest that the more remotely located the consumer, the greater is their perception that the nurse works under the direct supervision of the doctor. Currently, remotely located residents do not support an expanded autonomous role for the nurse. Greater research is required to develop the role of the practice nurse in rural Australia.     

Clinical nurse specialists: state of the profession and challenges ahead

Clinical nurse specialists (CNSs) are enjoying a rebirth. As health science and healthcare increase in complexity, it is critical that nurse experts provide leadership to improve patient care, advance nursing practice, and strengthen healthcare delivery systems. CNSs with specialty expertise combined with competencies in patient care, nursing practice, and healthcare delivery systems are essential to translating the products of our vast research enterprise into policies and practices that serve the patient. Many challenges loom. New diseases have emerged; treatments change constantly. We are newly aware of the gravity of the perils posed by natural and man-made disasters. Patients use complimentary and alternative health practices but we do not understand the power and risks of these approaches. Information technology makes possible new approaches to educating nurses and patients and tracking clinical outcomes. CNSs are vital to building a healthcare system that is evidence based, patient centered, outcome effective, safe, ethical, interdisciplinary, and cost-effective.     

E-cigarettes: A Practical,Evidence-based Guide for Advanced Practice Nurses

E-cigarettes are gaining popularity as nicotine delivery devices, yet many health care providers lack the confidence to discuss these devices with their patients and families. Many myths exist about e-cigarettes and their effectiveness as a tobacco-cessation method. This article aims to educate nurse practitioners and other advanced practice nurses about e-cigarettes and the implications for patient care, including how to screen for e-cigarette use, identify misconceptions, and counsel patients and families about United States Food and Drug Administration (FDA)‒approved tobacco-cessation methods.     

Autonomy and the developing role of the clinical nurse specialist

The role of the clinical nurse specialist has developed in response to social, technological and political changes that have impacted upon the delivery of health care. Nursing has traditionally been associated with femininity and in a paternalistic health structure the concept of nursing care can be devalued because autonomous nurses may threaten the balance of power. Autonomy is a multi-faceted concept and yet, if nurses have the courage to embrace both the traditional values of nursing and the expertise that their caring role brings to health care, they will be able to develop their own competence and autonomous practice. Nurses may not need autonomy in order to enhance their roles but they do need to concentrate on the concept of care as a team phenomenon. This notion is included in the UKCC's higher level of practice initiative which may direct specialist practice in the future. A negative element to nurse specialization is that nursing care can become fragmented, thus compromising the continuity and accountability of patient care.     

Primary care nurse practitioners and the interface with secondary care: a qualitative study of referral practice

In the United Kingdom nurse practitioners are assuming responsibilities traditionally considered to be within the domain of general practitioners. Important amongst these is the referral of patients to medical consultants in secondary care, a responsibility commonly associated with the general practitioner's role as 'gatekeeper' to health care. This paper describes a study designed to identify issues raised by the challenge that a developing nursing role presents to interprofessional working at the interface between primary and secondary care. When invited to comment, study participants (nurse practitioners, nurse educators, medical consultants and general practice registrars) related nursing referrals to issues associated with professional boundary changes, namely: teamwork, regulation of practice, communication, professional conflict and professional relationships. This paper discusses the views of primary and secondary care practitioners about who should take responsibility for the referral of patients in the light of concerns raised about professional competence and accountability. Individual nurse practitioners and their colleagues have found pragmatic ways to manage their work however, although UK government policy supports development of advanced clinical nursing, there remains much work to be done to provide the professional and legal infrastructure to support the role.     

Essential Professional Nursing Practices in mental health: A cross‐sectional study of hospital inpatient care

Quality organizational structures and nursing practices are key to positive patient outcomes. Whereas structures have been largely studied over the past few decades, less is known of the nursing practices that account for patient outcomes, such as patient satisfaction. This is especially true in psychiatric, mental health care settings. The aim of the present study is to determine the relative importance of eight Essential Professional Nursing Practices (EPNPs) on the satisfaction of hospitalized patients on mental health care units. A cross‐sectional design was selected; 226 point‐of‐care mental health nurses completed the online EPNP questionnaire in Spring 2015. Statistical analyses included MANOVAs and a 2‐step linear regression. A significant relationship was found between university preparation and scores on two EPNP subscales: autonomous decision‐making and practicing with competent nurses. Scores on patient advocacy and control over practice subscales were significantly related to nurse‐rated patient satisfaction. The findings reinforce the positive link between university education and the work of nurses and highlight the power dynamics that are salient in mental health care. The pertinence of EPNPs in psychiatric settings is brought to the fore, with practices of patient advocacy and nurse control over care examined in relation to empowerment. Implications for clinical and administrative leaders are addressed, with a focus on strategies for empowering patients and nurses.     

Public health nurses perception of clinical leadership in Ireland: narrative descriptions

Aim  The aim of the study was to identify how clinical leadership skills are perceived by Public Health Nurses' in the course of their everyday work and the effectiveness and consequences of such skills in primary care delivery.
Background  Public health nurses deliver primary care to children and adults as part of small teams or in individual situations. Leadership skills are needed to fulfil their many roles.
Method  Rigorous analysis of narrative interviews with public health nurses working in primary care environments in Ireland was undertaken. Narrative information was obtained by having conversations with 20 public health nurses relating to their perceptions on what clinical leadership meant to them and how their leadership skills influenced effective primary care delivery.
Results  Analysis of conversations identified the tensions existing between the various roles and responsibilities of the public health nurse and other primary care workers. This tension was perceived by the nurses as being the main barrier to effective primary care delivery from their perspective.
Conclusions  Clinical leadership is viewed narrowly by public health nurses as management skills rather than leadership skills were mainly identified. Education for the role was identified as a critical success factor.
Relevance to nurse managers  Public health nurses are well placed to shape and influence health service culture through effective clinical leadership.     

Regional neonatal oral feeding protocol: changing the ethos of feeding preterm infants

The Calgary Health Region Neonatal Oral Feeding Protocol is the culminating work of a broad range of healthcare professionals, including staff nurses, nurse practitioners, nurse educators, nurse managers, dietitians, lactation consultants, clinical nurse specialists, and occupational therapists. The protocol represents a synthesis of research evidence and expert opinion pertaining to the introduction and management of oral milk feedings for high-risk infants in the neonatal intensive care unit. This evidence-based neonatal oral feeding protocol is presented to share knowledge and skill required to create positive feeding experiences while assisting high-risk infants to achieve full oral feedings. Goals of this project include promoting consistent neonatal nursing feeding practices and changing the ethos in relation to feeding interactions between caregiver and infant in the neonatal intensive care unit. This culture change will assist nurses to identify what is unique about their professional practice, which is of particular importance given the skill mix resulting from hospital understaffing and a growing nursing workforce shortage.     

Use of Physician Consultation by Nurse Practitioners in Community Health and Ambulatory Clinic Settings

Little information is available concerning factors that influence pediatric nurse practitioners' (PNPs) use of physician (MD) consultation in their delivery of child health care. A study of 112 graduates of a major midwestern university PNP program was conducted to evaluate their practice roles; of the 70 PNPs employed as primary care providers, 52 (83%) responded to questions regarding their clinical practice and use of MD consultation. Differences in responses between practice settings related to MD availability at the site and to the level of wellness of the patients seen. The majority of PNPs managed patients without consultation when patients came for routine care or common problems and sought consultation if patients had acute or chronic illnesses. Most PNPs were satisfied with the amount and type of MD consultation; however, over 30% were dissatisfied primarily because consultants were not readily accessible. PNPs in community health settings had significantly less on-site availability and satisfaction with MD consultation when compared to PNPs in ambulatory clinic settings. PNPs in community health settings referred patients and used protocols more often to manage patients than PNPs in ambulatory or institutional settings. PNPs in all settings were more satisfied with a model of consultation where MDs are readily available and where collaboration could develop. These findings are useful in planning for more satisfactory practice arrangements and for improved mutual understanding of the use of MD consultants by PNPs, MDs, and administrators.