美国杜克大学临床型护理博士项目介绍

美国杜克大学临床型护理博士项目在全美护理院校中名列前茅,旨在培养多学科合作医疗团队中的护理领导者、促进护理实践变革和为患者提供高质量护理的高级护理专家。以在线学习为主、面授学习为辅的教学形式,为有知识提升需求的临床护理人员的继续教育提供了契机。该项目遴选具有丰富的高级护理实践、科研和教学经验的临床护理专家、护理领导者和研究者作为导师团队指导学生以保证学业质量。该文介绍该项目的开展情况,分析经验与现存问题,以期为我国护理学博士专业学位教育的开展提供借鉴和思考。     

Doctor of nursing practice students' perceptions of professional change through the DNP program

BackgroundThis thematic analysis study examined how post master's Doctor of Nursing Practice (DNP) students described personal and professional growth in their views of self, healthcare, and clinical practice that evolved as a result of the curriculum and experiences in the DNP program.PurposeThe purpose of this thematic analysis was to describe and discuss perceptions of graduating post master's DNP students regarding personal and professional development that occurred during the DNP program to identify how DNP graduates saw themselves change and grow during the course of the DNP program.MethodA thematic analysis method was used to code, categorize, and summarize data from 42 reflection papers of post master's DNP students into a thematic framework based on the eight DNP Essentials which are the framework upon which DNP programs build their curriculum and design student experiences. The authors systematically analyzed the statements from each student paper and drew interpretation of the students' statements into themes that were congruent with the eight DNP Essentials and one stand-alone category.ResultsData analysis yielded 15 themes that were aligned within eight categories of the DNP Essentials and one stand-alone category.ConclusionsThe eight DNP Essentials provided a framework for the themes which reflected professional growth attributed to the journey through the DNP program. A ninth category entitled Personal Advancements described students' perceptions of their personal and professional development. These dimensions are proposed in the new DNP Essentials currently in development. Increasing understanding of the DNP students' journey serves to inform DNP curriculum development and program experiences, and informs faculty of the influence they have on molding students into a more robust professional role.     

The challenges of mental health care reform for contemporary mental health nursing practice: delivery of nursing care

This ethnographic account of mental health nursing in a 22-bed acute inpatient facility in New South Wales, Australia, uncovered cultural meaning and cultural realities associated with the delivery of nursing care within the context of current challenges, demands, and influences brought about by service reforms. The findings demonstrate that mental health nurses have been responsive to changes brought about by the reforms. The ability of nurses to readily identify service gaps in their everyday practice provides them with the opportunity to develop strategies to respond to workplace challenges. As such, findings of the study contribute to current discussions concerning acute inpatient mental health nursing practice.     

Integrated health practices: development of a graduate nursing program

This article describes pedagogical issues in the development of a graduate nursing program in Integrated Health Practices (IHP), reports early experiences in the program, and asserts the importance of a graduate program in the specialty. The experience is described, and unique pedagogical issues encountered are discussed. While noting the contributions made to health and health care by Western medicine and nursing practice, the authors elaborate on the benefits of integrating western health care with less technological, less invasive, and less expensive holistic approaches. Diverse populations often require attention to specific chronic conditions, rather than to acute conditions, and constitutional requirements for overall health may be influenced by diverse health philosophies and practices. These requirements may be grounded in cultural and religious beliefs that must be incorporated into culturally sensitive plans of care. Clinical nurse specialists in IHP can offer knowledge and leadership to nursing practice, which address these complex, yet subtle health care issues.     

Safe practice of population-focused nursing care: Development of a public health nursing concept

Patient safety, a cornerstone of quality nursing care in most healthcare organizations, has not received attention in the specialty of public health nursing, owing to the conceptual challenges of applying this individual level concept to populations. Public health nurses (PHNs), by definition, provide population-focused care. Safe practice of population-focused nursing care involves preventing errors that would affect the health of entire populations and communities. The purpose of this article is to conceptually develop the public health nursing concept of safe practice of population-focused care and calls for related research. Key literature on patient safety is reviewed. Concepts applying to population-focused care are organized based on Donabedian's Framework. Structural, operational and system failures and process errors of omission and commission can occur at the population level of practice and potentially influence outcomes for population-patients. Practice, research and policy implications are discussed. Safe PHN population-focused practice deserves attention.     

The role of reengineering in health care delivery

Health care reengineering is a powerful methodology that helps organizations reorder priorities, provide more cost-effective care, and increase value to customers. It should be driven by what the customer wants and what the market needs. Systemwide reengineering integrates three levels of activity: managing community and health plan partnerships; consolidating overlapping delivery system functions among participating providers and vendors; and redesigning administrative functions, clinical services, and caregiving programs to improve health status. Reengineering is not a panacea; it is a critical core competency and requisite skill for health care organizations if they are to succeed under managed care in the future.     

Unemployment and health: issues in a primary care nursing practice

A group of clinical nurse specialists in primary care examined unemployment through the frameworks of stress/coping and relative deprivation theories. The moderating effect of social support was also considered. The impact of unemployment on health was elicited from unemployed clients and records kept by the nurses providing care. Nursing diagnoses were found to fall into three major categories: subsistence problems, increased psychosocial stress, and lack of necessary health care. Nursing interventions included exploration and constructive mobilization of emotional responses and assistance with problem solving, including support of existing strengths and identification of alternative behaviors and resources. The need for advocacy on behalf of clients emerged as a continuing concern.     

Doctor of nursing practice students advocating for health care access, quality, and reform: from the virtual classroom to Capitol Hill

The potential for doctor of nursing practice students to inform and influence the national health care reform movement inspired faculty teaching an online Health and Social Policy course to create an assignment combining comparative effectiveness research with a trip to Capitol Hill to meet with congressional representatives. Preparing for and participating in such an assignment can present challenges for online doctoral students already busy with family and professional responsibilities. However, from both faculty and student perspectives, the lasting value and professional growth are immeasurable. Course details and the theoretical concepts of experiential education are presented, as well as trip logistics and evaluation.     

美国实践型护理博士项目对我国高级护理实践发展的启示

实践型护理博士项目的兴起,极大地加快了美国高级护理实践的发展,在培养大批护理人才的同时,也规范、提高了护理实践活动质量,使护理实践活动得到了广泛的认可和支持。我国的高级护理实践活动起步较晚,发展缓慢,且没有形成统一规范的标准,借鉴美国的实践型护理博士项目发展我国护理实践活动,不仅是培养专科护士的途径之一,也是我国护理研究生多元化教育的重要形式。