A new role for advanced practice nurses in Canada: bridging the gap in health services for rural older adults

This article is a report on the evaluation of a new nursing initiative in rural western Canada-the gerontological advanced practice nurse (GAPN) project. Using a qualitative approach in the i initial evaluative phase, the authors determined how the GAPN evolved, functioning primarily in a clinical nurse specialist role, and identified the successes and challenges of the project. The initial findings indicated health benefits to rural older adults. The project's success was attributed to strong support from key players, and attempts to address perceived gaps in rural health service. Challenges in developing the GAPN role included limited planning time, and lack of a clear definition about the role and responsibilities of the GAPN. The introduction of a GAPN, especially in underserved rural communities, has the potential to provide essential health care services to older adults, and to make major contributions to changing gerontology practice.     

Geropharmacology: a primer for advanced practice. Acute care and critical care nurses, part II

In the first part of this 2-part continuing education series, sources of medication errors were discussed. A predominant source of errors was the prescribing of potentially inappropriate medications for older adults. In this second part, drug classifications and drugs posing problems for older adults and cautions for advanced practice acute care and critical care nurses in their medication therapy management are highlighted. Cautions are advanced for anticholinergics, antihypertensives, analgesics, and psychotropics because of the severity of adverse reactions, including anticholinergic symptoms; mental status changes (especially confusion, sedation, delirium, and cognitive impairment); orthostatic hypotension; gastrointestinal tract problems (especially hemorrhage); depression; and neurobehavioral disturbances (agitation and aggressiveness). Risks of life-threatening outcomes associated with medications and adverse reactions are highlighted.     

Clinical education in managed care for advanced practice nurses: A case example

Managed care is a major component in the current practice environment of advanced practice nurses (APNs). Professional nursing organizations are incorporating managed care concepts into their requirements for nursing curriculum. Partnerships for Quality Education (PQE) was developed to foster partnerships designed to incorporate managed care skills into clinician education. This paper describes how one PQE-funded nurse practitioner project joined with a federally qualified community health center (FQCHC) to provide a foundation in managed care theory and practice to nursing students, clinicians, and other support staff.     

Educating advanced practice nurses for practice reality.

The complexity of the current health care environment ethically mandates advanced practice nursing (APN) educators to prepare graduates with a clear understanding of APN roles and professional and regulatory issues for them to make a reasonable transition to the marketplace. Integrating both clinical content needed for APN practice and APN role issues can be a difficult balance. This article describes critical role content needed in APN programs and offers a variety of teaching strategies. Recommendations regarding the timing and placement of role content in the graduate curriculum also are offered. Although there is no one right way to build APN role content into graduate coursework, some approaches are preferable to others.     

Complexity theory: a long-term care specialty practice exemplar for the education of advanced practice nurses

This clinical exemplar highlights how an academic clinical practice supported gerontological nursing students as they learned evidence-based approaches to managing complex geriatric syndromes in long-term care. Urinary incontinence (UI), which occurs in more than two thirds of nursing home residents, was the focus of the faculty practice. Advanced practice nursing skills developed by students included advanced physical assessment and diagnostic reasoning techniques, critical appraisal of the scientific evidence for UI management, and the ability to teach evidence-based approaches to UI care to bedside nursing staff. Outcomes of the practice for the facilities included improved detection of urinary retention, reduced wetness rates, and strengthened systems of care for UI. Student outcomes included an increased sense of self-efficacy in management of UI and other complex geriatric problems. Complexity theory guides a discussion of how curriculum design and research-based practices can be implemented to enhance both student and facility outcomes.     

Primary pulmonary hypertension: a review for advanced practice nurses.

Primary pulmonary hypertension (PPH) is a rare entity of unknown etiology, manifested as narrowing and obstruction of the pulmonary arteries leading to elevated pulmonary artery pressures. Left untreated, these high pressures can lead to right ventricular dilation, right heart failure, and death within 3 to 5 years. Over the last decade, advances have been made in the diagnosis and treatment of PPH. Advanced practice nurses and other expert nurses can use and interpret diagnostic and therapeutic medical regimens currently available to identify and treat this rare condition.     

Geropharmacology: a primer for advanced practice acute care and critical care nurses, part I

Advanced practice nurses' challenge in managing older adults' medication regimens from an evidence base is difficult because older adults are vulnerable to medication errors and adverse drug reactions related to a number of factors. Predicting patients' responses to drugs is compounded during critical illness, adding to the heterogeneity and unpredictability of drug effects that are prevalent premorbidly. In the first part of this 2-part continuing education series, sources of medication errors and older adults' vulnerability are discussed, including normal changes of aging affecting pharmacokinetics and pharmacodynamics, polypharmacy, self-medicating, patient-family noncompliance, and inappropriately prescribed medications. In the second part, drug classes and drugs posing particular problems for older adults and cautions for acute care and critical care nurses who manage the medications of older adults are highlighted.     

Clinical practice opportunities for advanced practice nurses

With approximately 132,000 practicing APNs and a continued need for APNs, the role will continue to expand. Many different business options and models for healthcare practice exist for the APN. Commonly thought of professional practice options for APNs include private practice, joint or collaborative practice, and group practice. Each model of professional practice brings with it different roles and responsibilities, rewards and challenges, and criteria for success. When evaluating different practice opportunities. APNs must be aware of each of these factors and evaluate each factor based on his or her chosen lifestyle. This article has presented an overview of common practice models and the roles and responsibilities, challenges and rewards, criteria for success, and lifestyle considerations inherent in each.     

The necessity and possibilities of playfulness in narrative care with older adults

For us, narrative care is grounded in pragmatist philosophy and focused on experience. Narrative care is not merely about acknowledging or listening to people's experiences, but draws attention to practical consequences. We conceptualize care itself as an intrinsically narrative endeavour. In this article, we build on Lugones' understanding of playfulness, particularly to her call to remain attentive to a sense of uncertainty, and an openness to surprise. Playfulness cultivates a generative sense of curiosity that relies on a close attentiveness not only to the other, but to who we each are within relational spaces. Generative curiosity is only possible if we remain playful as we engage and think with experiences and if we remain responsive to the other. Through playfulness, we resist dominant narratives and hold open relational spaces that create opportunities of retelling and reliving our experiences. Drawing on our work alongside older adults, as well as people who work in long‐term care, we show the possibilities of playfulness in the co‐composition of stories across time. By intentionally integrating playfulness, narrative care can be seen as an intervention, as well as a human activity, across diverse social contexts, places and times.