Future directions for the Prostate Cancer Specialist Nurse in Australia

Prostate cancer is the most commonly diagnosed cancer in Australian men. A cancer diagnosis causes physical, social and psychological morbidity. The role of the specialist nurse in chronic illness care is well recognized both nationally and internationally; however, the role of the Prostate Cancer Specialist Nurse is not as developed or formalized in Australian health care delivery. Prostate Cancer Foundation of Australia (PCFA) aims to bridge this gap and has developed a model to pilot a number of Prostate Cancer Specialist Nurses in various locations throughout both metropolitan and regional Australia. This paper reports on the findings of a project commissioned by PCFA to define a model for a national Prostate Cancer Specialist Nursing service. The service model was developed following an extensive consultation process at a national level. A framework for practice and professional development for the Prostate Cancer Specialist Nurse has been developed which utilizes both the Australian Nursing and Midwifery Council Registered Nurse Competency Frameworks and the National Cancer Nursing Education Project Professional Development Framework. The pilot program will involve PCFA working in partnership with host health regions by providing funding for the recruitment of the nurses on a 3‐year trial basis. The nurses will be employed directly by the host health regions and will be professionally supported by PCFA. The program will also be formally evaluated.     

Stoma coloproctology nurse specialist: a case study

Aims and objectives. The aim of this paper is to provide insight into the role of a Stoma Coloproctology Nurse Specialist. This paper presents the findings of an in‐depth case study of a stoma coloproctology nurse specialist employed in one health board area in Northern Ireland. This case study was part of a larger study exploring innovative nursing and midwifery roles in Northern Ireland. Background. Specialist nursing roles have evolved and developed in response to changing health care needs, patient expectations, changes in professional regulation and government initiatives. Design. A case study approach was adopted. Method. Semi‐structured interviews with the post holder (PH), her line manager and the human resource manager were undertaken. Non‐participant observation of the PH's practice was also carried out. Analysis was undertaken on secondary data such as job specification, annual reports and other documentation relating to the post. Results. Findings illustrate the PH's function and the impact of the role on patient care. Examples of innovative practices relating to providing care, support and guidance for patients and their families were identified; however, limitations to her role were also identified. Conclusions. The PH provides an invaluable service to patients, demonstrating a positive impact on care. However, the findings suggest the importance of establishing clear role boundaries, which may lead to professional growth and practice development. Relevance to clinical practice. Although this study provides a valuable insight into the role of a Stoma Coloproctology Nurse Specialist a number of challenges exist, as the CNS role requires policy and appropriate educational preparation to practice at an advanced level. Further research investigating the development of the CNS role in the clinical setting and its relationship to members of the multi‐professional team would be beneficial.     

Clinical role clarification: using the Delphi method to establish similarities and differences between nurse practitioners and clinical nurse specialists

This article is based on the Department of Health's (England) funded pluralistic evaluation of Nurse Practitioner preparation, 'Realizing Specialist & Advanced Nursing Practice: establishing the parameters of and identifying competencies for "Nurse Practitioner" roles and evaluating programmes of preparation' (RSANP). During this 27-month project, which began in 1996, one of the research methods used, the Delphi study, was aimed at reaching a consensus of views amongst nurses in clinical practice, educators, purchasers, providers and representatives of statutory and professional bodies on the parameters and competencies desirable for the Nurse Practitioner role. The agreed competencies were then used as one measure of the appropriateness of various programmes used to prepare Nurse Practitioners. Of the competencies required for the role, the majority are 'nursing' competencies and are the same as those required for the Clinical Nurse Specialist role. However, for both Clinical Nurse Specialists and Nurse Practitioners, these are practised at a 'higher level'. Other competencies needed for the Nurse Practitioner role relate to the knowledge and skills required to assess, diagnose and determine nursing and medical management of a patient and to evaluate that management. Data indicated, however, that even these competencies were being used by some Clinical Nurse Specialists. Final analysis enabled the identification of the two roles with the use of a 'Typology of Named Clinical Nursing Roles'.     

Nursing roles and levels of practice: a framework for differentiating between elementary,specialist and advancing nursing practice

The recent profusion of new nursing roles in the UK has led to much confusion in the minds of health care consumers, employers, nursing practitioners and educationalists regarding the meaning, scope of practice, preparation for, and expectations of such roles. Titles such as Clinical Nurse Specialist (CNS), Nurse Practitioner (NP), Advanced Nurse Practitioner (ANP), Higher Level Practitioner (HLP) and more recently Nurse Consultant (NC) are being adopted in a variety of care settings with little understanding or consensus as to the nature of or differences between such roles. Further, the former United Kingdom Central Council for Nursing, Midwifery and Health Visiting (1992) initiative for extending the scope of professional practice allows for the prospect that nurses can adopt additional clinical tasks or alter the nature of service provision provided that they acquire the appropriate education or training, levels of competence and are prepared to be accountable for their new practices. Consequently, nursing practice is becoming more diverse than ever before and the boundaries of inter- and intraprofessional practices are becoming increasingly blurred. The UKCC (1999a) has recently contributed to an understanding of the levels of clinical practice undertaken at the specialist level but the situation at advanced or consultant levels remains unclear.     

Role transition from staff nurse to clinical nurse specialist: a case study

? Over the last decade, nursing in the United Kingdom has witnessed a major development and expansion in the number of Clinical Nurse Specialists. ? These nurses are considered to be experts in their own specialities, have in-depth knowledge and provide a service for patients, relatives and staff. ? There is, however, a paucity of literature relating to role transition from experienced Staff Nurse to Clinical Nurse Specialist. ? Using Nicholson's (1984) model of work-role transition and Wanous' (1992) four-stage model of organizational socialization, this study explores the transition of two nurses from experienced Staff Nurses to novice Clinical Nurse Specialists.     

Program development: role of the clinical nurse specialist in implementing a fast-track postanesthesia care unit

Advanced practice nurses are involved in many aspects of program development as part of their roles. This can involve such things as developing programs for staff and family education, organizing system-wide quality assurance programs, or implementing new care programs. One unique aspect of the advanced practice nurse's role is the ability to serve as a change agent and implement new models of care. Although all advanced practice nurses can be involved in program development, the role of the Clinical Nurse Specialist lends itself to devoting dedicated services for implementing programmatic change in the clinical setting. This article describes the role of the Clinical Nurse Specialist in implementing an evidence-based, fast-track postanesthesia care unit.     

Maternal-infant clinical nurse specialist performance assessment: development of an evaluation tool

The Maternal-Infant Clinical Nurse Specialist Performance Evaluation Tool was developed to assist students to enact certain role behaviors of the clinical nurse specialist (CNS) in maternal-infant nursing and to provide faculty with a measurement of such behaviors for the purpose of student clinical evaluation. Items for the behaviorally-anchored, criterion-referenced tool were derived from current standards of CNS practice, expected competencies of the CNS as reported in the literature, and program and course objectives. Initial use of the tool with graduate students in the maternal-infant specialty indicated a valid and reliable rationale for continued use. Since the categories of the tool represent common CNS roles, it should be applicable to other specialties.     

护理专业化发展过程中的角色区别

文章总结了作为高级实践护士的临床护理专家和开业护士以及作为其前身的专科护士之间的区别,分别从其起源、概念和角色职能、培养认证、工作场所及处方权方面进行了阐述,以帮助护理人员正确认识护理专业中的多种角色。     

Clinical nurse specialists in acute pain management.

Specialist practitioner and ward-based nursing roles should complement each other. Clinical nurse specialists have an important educational role in helping nurses to assess their own practice. Specialist services to manage acute pain should provide an integrated service to prevent the fragmentation of care.     

肿瘤护理专家认证OCNS在日本的发展

本文总结了日本肿瘤护理专家认证（OCNS：Oncology Certified Nurse Specialist）的发展过程,以及目前的护理教育趋势。自1995年护理专家认证授予系统实行以来,日本目前有两百多名肿瘤护理专家在临床服务。护理专家认证系统主要有3个组织维持运行,包括肿瘤护理专家认证审核委员会、大学护理协会以及肿瘤护理专家认证协会。三个组织共同协作,对维持高水平的肿瘤护理专家认证起着非常重要的作用。肿瘤护理专家认证的发展促进了临床护理效率,也促进了不同专业协作研究和发展。认证系统的不断成熟有利于发展中的肿瘤护理革新。     

Is heart failure nursing practice at the level of a clinical nurse specialist or advanced nurse practitioner? The Irish experience.

Since 2000 there has been a significant increase of Heart Failure Nursing positions in the Irish health service. The background to these positions has been based on the model established at St. Vincent's University Hospital, Dublin since 1998. Recognition of nursing practice in Ireland has also transformed with the introduction of Clinical Nurse Specialist and Advance Nurse Practitioner positions. To date Clinical Nurse Specialists coordinate and manage heart failure programmes, however it remains to be seen whether current practices are within the scope of practice of these nurses. Advanced Nurse Practitioner is a new position in Irish Nursing from examining guidelines and education this may be the way forward for Heart Failure Nursing in Ireland.     

Integrating gerontology competencies into graduate nursing programs.

Current demographic and health care utilization trends strongly indicate a rapidly increasing demand for nurses who are well qualified to care for older adults. Advanced practice nurses are positioned to assume leadership roles in geriatric nursing care; however, they must first acquire adequate preparatory education. This article describes two graduate nursing schools' curricular innovations that were funded by The John A. Hartford Foundation, in collaboration with the American Association of Colleges of Nursing (AACN), through the Geriatric Nursing Education Project: Enhancing Gerontological/Geriatric Nursing for Advanced Practice Nursing. These programs at University of North Carolina at Greensboro and Pennsylvania State University incorporated techniques to translate the Nurse Practitioner and Clinical Nurse Specialist Competencies for Older Adult Care [American Association of Colleges of Nursing. (2004). Nurse practitioner and clinical nurse specialist competencies for older adult care. Washington, DC: AACN] into an advanced practice curriculum and developed strategies to sustain curricular innovations. Finally, lessons learned from these two projects are discussed and recommendations are made for integrating geriatric nursing competencies into graduate programs.     

Strategies to promote positive behavior toward elderly patients

The role of the Gerontological Nurse Specialist, regardless of setting, may be impeded by negative attitudes and behavior of caregivers toward the elderly client. Awareness of the contributing variables can assist the Gerontological Nurse Specialist to identify the need for improved attitude awareness and interactions in the care of the elderly. This article, supported by current literature, reviews common variables associated with negative attitudes and behavior of caregivers toward elders. Strategies including exercises in self-awareness, clinical nursing rounds, attending behavior development, role modeling, consultation, and inservice are suggested for the Gerontological Nurse Specialist for initiating change.     

Advanced practice in pediatric nursing: blending roles

In the past, pediatric advanced practice nurse's roles were the Clinical Nurse Specialist (CNS) in the inpatient setting and the Nurse Practitioner (NP) in the outpatient setting. With health care system changes, such as the shifting and blurring boundaries between inpatient and outpatient care, changes were required in the graduate curricula to blend the CNS and NP roles into an advanced practice nurse (APN) role. This article describes the model at Rush University, the advantages of the CNS/NP blended role, the revised APN curriculum, and examples of blended-role APNs in action. The curriculum change to blend the CNS/NP roles addresses the need for the blended APN role in changing health care systems.     

The RWJ Executive Nurse Fellows Program, Part 1: Leading change

This article is the first of a 3-part series describing the RWJ Executive Nurse Fellows Program, an advanced leadership program for nurses in senior executive roles who aspire to help lead and shape the US healthcare system of the future. This article describes the RWJ Executive Nurse Fellows program, its core leadership competencies, and the primary program components. Part 2 (December 2005) will focus on the nontraditional mentor relationships developed by fellows as part of the fellowship experience and lessons learned regarding best practices. Part 3 (February 2006) will explain how fellows are required to create a business plan for their leadership project because it is so important for nurse leaders to offer a strong business case for proceeding with a new initiative, service, or program.     

Developing case managers for chronically ill children: Florida's registered nurse specialist program

This article describes the Florida Health and Rehabilitative Services/Children's Medical Services Nurse Specialist Program. This program is a statewide training and service delivery system designed to prepare selected nurses to provide comprehensive, family-centered case management services to children with special health care needs, within the home and community settings.     

Model for integration of CNS with nursing management and staff development

The contemporary health care environment is changing rapidly in response to complex economic factors and changes in patterns of care. Coupled with limited nursing resources, these changes challenge the nursing profession to critically evaluate the effectiveness and quality of care delivery, particularly that of advanced practitioners. This paper presents a model for the integration of Clinical Nurse Specialist (CNS) practice with that of the Clinical Nurse Manager (CNM) and Staff Development Instructor (SDI). The model demonstrates that, although the CNS, CNM, and SDI share the same role dimensions, the central focus of each role determines and differentiates its unique practice arena. The interelationship of dimensions within roles and the complementarity between roles result in significant, nonduplicative contributions to high-quality, cost-effective care by the CNS, as well as the CNM and SDI.