University Health Network framework for advanced nursing practice: development of a comprehensive conceptual framework describing the multidimensional contributions of advanced practice nurses

BACKGROUND: The global paradigm shift resulting from radical transformations in knowledge and technology is significantly changing the context of healthcare delivery. In this changing environment, the contributions of health professions are vital in ensuring that the healthcare system adapts to meet the needs of today's patient. Advanced practice nurses (APNs) are clinical scholars and leaders in creating innovative approaches to patient care and organizational and professional leadership. AIMS: To develop a comprehensive conceptual framework for advanced nursing practice at University Health Network that will enhance role clarity by describing the complexity of these nursing roles and the significant contributions they make to patients and the healthcare system. METHODS: A critical review of the literature and a consultative process were undertaken to build consensus and develop a comprehensive framework for advanced nursing practice. RESULTS: The development of the University Health Network Framework for Advanced Nursing Practice (UHN-FANP), which clearly articulates all dimensions of advanced nursing practice roles. CONCLUSION: As clinical leadership roles in nursing continue to evolve, utilization of a conceptual framework facilitates role clarity, role implementation and role evaluation.     

A Framework for Hospice Nursing

The paper presents a conceptual framework for hospice nursing. Nursing is viewed as assistance to the person whose self-care activities are insufficient to meet self-care needs. A literature review on needs of the hospice client is included toward developing a hospice nursing philosophy. The paper shows how guidelines for nursing practice in hospice can be structured around the client’s self-care needs. Such guidelines include common nursing diagnoses, standards, policies and procedures. A suggested nursing documentation system is built upon the nursing process and structured around the patient’s self-care needs.     

Enhancing cardiac rehabilitation nursing through aligning practice to theory: implications for nursing education

This article presents a case study that examined the work practice of nurses in a cardiac step-down unit (CSDU). The action research included interviews, participant observation, and a self-reporting questionnaire. Nurses in the unit used a conceptual framework that was inconsistent with the rehabilitation-oriented nursing necessary to enhance patient outcomes in a CSDU. The results of this study show that a need exists for greater alignment between the practice and the educational preparation of nurses who work in a CSDU. A framework such as Dorothea Orem's Self-Care Theory of Nursing (1995) offers a conduit for nurses to deliver care appropriate to CSDU patient needs. However, there is a need for continuing education for nursing staff to align the cardiac rehabilitation nursing philosophy and the theories that underpin it (such as the Self-Care Theory) with nursing practice. Practice development provides a mechanism through which to examine the congruence between patient needs and nurse perception of those needs.     

循证护理:理论与实践

长期以来 ,护理实践的特点就是按照工作程序提供护理服务 ,在用科学证据指导临床护理决策和行动方面存在局限性。在讲求证据的年代 ,护士应积极寻求现时的证据来更新知识结构 ,增强解决问题的能力 ,为病人提供高效优质的护理 ,以满足 2 1世纪循证的要求 ,迎接所面临的挑战。循证护理实践就是实现此目标的一个很好的方法。文章从认识循证医学的内涵及以科学证据为基础的实践对临床护理服务影响的角度出发 ,主要讨论证据的质量分级、循证护理实践的主要步骤及其与临床路径的相互关系、我国循证护理实践现状、护理人员实施循证护理面临的挑战。     

Disability, facilitated sex and the role of the nurse

AIM: The aim of this paper is to explore the role that nurses can play in acknowledging and facilitating the sexual needs of disabled patients within an holistic framework of nursing care. BACKGROUND: Contemporary nursing claims to offer patient care within an holistic framework; this framework should encompass the biopsychosocial needs of patients, as defined by patients themselves. In spite of the importance of sexuality and sexual expression to the psychosocial welfare of patients, sexuality is often excluded from nursing practice. METHOD: Literature is reviewed from nursing, disability studies, and a variety of social science disciplines. FINDINGS: The paper begins with a discussion of the concept of 'holistic care' and the ways in which this has been interpreted in the nursing literature. The biopsychosocial approach and the notion of 'whole person' holism seem particularly significant, although the lack of attention to patient sexuality is identified. Literature from the social sciences is used to explore the significance of sexuality to individual self-identity and psychosocial welfare. This literature also highlights the way in which the denial of sexual identity is a significant feature of power relations. The disability studies literature catalogues the way in which disabled people are generally infantilized by society and perceived as asexual. This literature also highlights the professional neglect of disabled sexual identities. Using a variety of literature, the concept of facilitated sex is explored as a continuum of activities and the role of nursing, within a holistic framework, is examined. CONCLUSION: The paper concludes by arguing that an holistic approach to nursing care should include an appreciation of patient sexuality. In particular, it suggests that nurses can play an important role along the continuum of facilitated sex.     

Putting nursing research findings into practice: research utilization as an aspect of the management of change

This paper discusses a number of different levels at which the implementation of nursing research findings needs to be addressed and identifies 10 areas of potential difficulty: the complexity of the change process, the genesis of research programmes, the formulation of research questions, differences in theoretical approaches, timescales and planning cycles, information overload, credibility, applicability, response to change and the management of change. An attempt is made to shift the nature of the discourse from the personal to the organizational and from a diffusionist perspective to that of change management. It is suggested that it is simplistic to regard the apparent lack of take-up of research-based practice findings as a failure on the part of individual nurses to respond rationally to the production of new information. The integration of research and practice has to be addressed at all levels within an organization; from policy statements to procedure manuals and from managers, educators and clinicians to support workers within the framework of the management of change. The potential of action research and quality circles in this context is touched on.     

A critical review of appropriate conceptual models for use by coronary care nurses

Background:  There is little evidence of the extent of conceptual model use within cardiovascular nursing. Concern exists within nursing that nursing theory and conceptual model use within practice is less than optimal. It is further suggested that there is little evidence of nursing theory occupying its true position as the central tenet of nursing practice and cardiovascular nurses have been challenged to reconsider this aspect of practice.
Aim:  The aim of this review is to explore the effectiveness of conceptual models used within cardiovascular nursing to further explore their potential benefit.
Methods:  Using key terms, a search was conducted using electronic databases CINAHL and PUBMED; yielding seven papers that fulfilled selection criteria.
Findings:  Few papers related to research studies in the area. However, of those identified significant examination and testing of concepts emerged within the studies. Rather than merely using concepts as an organizing framework or a component of the study, theories alluded to were scrutinized and consistently applied. Although studies identified mostly referred to specific testing and examination of aspects of conceptual models, the notion of self-care and support for clients emerges as a strong theme within the review. The relationship between nurse and client seemed to be pivotal in any noted improvements.
Conclusions:  The findings have limited application to practice. In the absence of large-scale longitudinal studies, only selected aspects of conceptual models or theory were scrutinized. Further research is required in this area to identify conceptual models of nursing that are most appropriate for cardiovascular nursing care.     

Imogene King's conceptual framework: a proposed model for continuing nursing education

This paper presents a proposed model for continuing nursing education based on Imogene King's conceptual framework. The rationale for using King's conceptual framework as the foundation underlying this proposed model is three-fold: the concepts–social systems, health, perception, and interpersonal relationships–are relevant in every nursing situation; the interacting levels of operation–individuals, groups, and society–depict a reciprocal relationship between human behaviour and the environment; and the triad of elements–continuity nursing education, nursing practice, and nursing research–are interrelated in the nursing profession. The authors contend that this approach to continuing nursing education is beneficial to participating nurses, the health care consumer, and to the advancement of the nursing profession.     

A presentation of a conceptual framework and its use in the definition of nursing development within a number of nursing development units

This paper provides a conceptual framework upon which action plans can be built to enable registered nurses to reflect upon their work and practice activities This conceptual framework has been used by the author in his work with various nursing development units within Yorkshire, England, in his role as their academic nurse advisor The framework has been useful in helping nurses not only to reflect upon current work and practice activities but also as a guideline for future development The paper provides examples of such nursing development activities and includes a personal view of how nursing development units can act as catalysts for change     

Application of the Salmon Model: A Tale of Two Cities

This report demonstrates the application of a recently developed conceptual model of public health nursing practice to a specific community problem. The nurse was able to assist one community group and lead another in identifying their needs, developing a plan to meet those needs, implementing the plan, and evaluating the results. The model provided a structure for the nurse to use in determining scope of practice, the importance of values, practice priorities and interventions, and the relevant determinants of health. This project also served to demonstrate faculty practice. Graduate students in community health nursing attended the nonsmokers' group meetings and city council hearings. They participated at various levels, but primarily they observed their instructor putting into practice the role of the public health nurse specialist as described in the classroom. Discussions regarding group dynamics and community action strategies often occurred in the classroom as a direct result of faculty and student involvement. The Salmon model for public health nursing practice has significant potential for application in numerous areas. It can serve as a unifying force in considering the many variables that influence community action. Being specifically designed for public health nursing, it holds great promise for optimizing the practice of the nurse in community settings.     

Conceptual frameworks and the nursing curriculum

In this article the author discusses the meaning of a conceptual framework in the curriculum, the advantages of a conceptual framework, the relationship of curriculum design to the conceptual framework and some types of conceptual framework used in nursing curricula. The conceptual framework in the curriculum process and the relationship of nursing theory to the conceptual framework are also discussed. This article presents some results of a survey of Australian post-basic clinical nursing courses and a content analysis of curricula for these courses. Such curricula are often perceived as based on nursing theory but in reality most appear to be heavily orientated to the medical model.     

Putting nursing research findings into practice: research utilization as an aspect of the management of change. 1989

This paper discusses a number of different levels at which the implementation of nursing research findings needs to be addressed and identifies 10 areas of potential difficulty: the complexity of the change process, the genesis of research programmes, the formulation of research questions, differences in theoretical approaches, timescales and planning cycles, information overload, credibility, applicability, response to change and the management of change. An attempt is made to shift the nature of the discourse from the personal to the organizational and from a diffusionist perspective to that of change management. It is suggested that it is simplistic to regard the apparent lack of take‐up of research‐based practice findings as a failure on the part of individual nurses to respond rationally to the production of new information. The integration of research and practice has to be addressed at all levels within an organization; from policy statements to procedure manuals and from managers, educators and clinicians to support workers within the framework of the management of change. The potential of action research and quality circles in this context is touched on.     

Ineffective airway clearance and ineffective breathing patterns: theoretical and research base for nursing diagnosis

This article addresses the conceptual approach to nursing diagnosis in general and the theoretical and research base for these two nursing diagnoses. Pertinent issues concerning the use of nursing diagnoses in clinical practice are presented within the framework of the nursing process. This is followed by a review of mechanisms of airway clearance and normal breathing patterns which form the theoretical basis for the subsequent articles on alterations in airway clearance and breathing patterns.     

A stage planning programme model for health education/health promotion practice

AIM: To investigate the validity of a stage planning programme model for health education/health promotion practice in nursing settings and to develop a specific model for this purpose. Background/rationale. The last decade or so has seen a marked increase in the amount of health educational/health promotional activities that nurses are expected to undertake. This has followed concerted calls to make health promotion a familiar and recognized part of nursing practice. Despite this, however, current health-related practices are still unstructured, haphazard and under-evaluated. This state of affairs is further compounded by the lack of any generic and systematic nursing planning process model by which health education/health promotion programmes are applied in practice. This paper puts forward the case for such a model, develops it, and demonstrates its possible application in clinical settings. METHOD: A systematic literature review was conducted in order to develop a new theoretical perspective for health promotion/health education nursing practice. The proposed model has evolved from this new perspective. The process of developing this model has drawn on existing contemporary planning models--using them as a means to develop a conceptual framework. Consequently, the proposed model seeks to critique, adapt and adopt some of their components within a nursing context. CONCLUSION: If the current situation continues, in which planning process models are not adopted as a routine part of practice, then nursing may well remain a "bystander" in health promotion/health education.     

Achievement of group cohesion through the development of a psychiatric nursing seminar

The purpose of this paper is to describe the process by which group cohesion emerged around the task of developing a psychiatric nursing seminar at the Palo Alto (California) V.A. Medical Center. This paper will discuss how group cohesion evolved, describe the seminar, and offer suggestions to other nurses wanting to work together more collaboratively. As clinical nurse specialists (CNS) assigned to the inpatient psychiatric units of a Veterans Administration Medical Center, we were asked by nursing administration to develop an educational course. The purpose of the course was to provide registered nurses with a common knowledge base that would facilitate communication related to patient care. While we were aware that teaching discreet areas of content commensurate with our individual interests and expertise would get the job done rapidly, our combined experience taught us that this approach to learning did little to bring about a change in clinical practice. We viewed the selection of a conceptual framework to which we could all be committed as an essential step prior to the content development. What is significant about this experience was that the group process of achieving cohesiveness was so closely related to the conceptual framework that finally evolved. We chose a framework that reflected our own perspectives towards working with others and about psychiatric nursing. In turn, the major concepts of the chosen framework guided many of our interactions with each other.     

Toward more clarity in terminology: frameworks, theories and models

Lack of precision in a person's choice of words, which perhaps indicates a lack of clarity and accuracy in ideas, may become a subtle form of negative teaching. It is suggested that such terms as "conceptual frame of reference" and "theoretical framework" should be used as broad terms for conceptions of reality, reserving "philosophy," "theory" and "conceptual model" as more restricted terms for conceptions of reality. Nurse authors do not agree that nursing theory exists, that nursing has its own body of knowledge, that nursing is a science or even a discipline. Yet nursing is fully equipped to justify its claim to such terms. Starting from a nursing perspective rather than from a borrowed one, nursing theory can be developed, nursing knowledge can be accumulated, and nursing science can be advanced, all in the interests of a worthwhile contribution to society's health.     

Madness in our methods: nursing research, scientific epistemology

This paper is a critique of some research methods evident in contemporary nursing literature. The arguments derive from critical-feminist, humanist and ethical perspectives. As a consequence of investigating specific aspects of scientific method, an approach to research that is congruent with values intrinsic to an holistic approach to nursing practice is articulated. Such methodologies also render problematic with status quo power relations between nurses and other health professionals, as well as between nurses and patients. The central themes in this paper are: the absence of overt conceptual frameworks; an avoidance of complex social contexts within which research subjects live; an apparent lack of empathy; and an apolitical articulation of research problems and data analyses. All four of these difficulties may be traced to scientific methodology by many researchers. Most nurse researchers may not actually adhere to this technique, but I propose that they have been informed by belief systems associated with scientific methodology and diat these have dire consequences for the discipline of nursing. A key argument is diat the apparent lack of conceptual frameworks in the majority of nursing research is due to the epistemology, which therefore provides a pre-existing, non-declared conceptual framework, that is incorporated into the research by drawing upon scientific mediodology. A further argument is diat scientific, or scientistic, ways of approaching situations are antithetical to nursing values and to constructive social change for the benefit of patients, nursing and nurses.     

Critical thinking: perceptions of newly graduated female baccalaureate nurses

Nursing education strives to develop critical thinking through emphasis on process, inquiry, and reasoning. Although North American nursing education programs have recommended integrating the critical thinking construct into the conceptual framework that supports undergraduate nursing programs, critical thinking is still ambiguously and inconsistently applied within the profession. The research described in this article explored the development of thinking in five newly graduated baccalaureate RNs by accompanying them on the conceptual, theoretical, and practical evolutionary journey of their first 6 months in nursing practice and explicating their knowledge development over time, offering insights into the role of undergraduate education in teaching, and fostering critical thinking as an approach to nursing practice.     

Creating a climate for the implementation of a nursing conceptual framework

Over the last decade, increasing numbers of service and educational institutions have initiated plans to implement a nursing conceptual framework to guide practice, education, administration, and research. Regardless of the conceptual framework being implemented, for effective change to occur, considerable attention must be paid to the nature of the learning process experienced by individual nurses. In this article, adult learning theory is discussed as it relates to the process of learning a nursing conceptual framework.     

Implementing interprofessional education and practice: Lessons from a resource-constrained university

ABSTRACT

Interprofessional education is seen as a vehicle to facilitate collaborative practice and, therefore, address the complex health needs of populations. A number of concerns have, however, been raised with the implementation of interprofessional education. The three core concerns raised in the literature and addressed in the article include the lack of an explicit framework, challenges operationalising interprofessional education and practice, and the lack of critical mass in terms of human resources to drive activities related to interprofessional education and practice. This article aims to present lessons learnt when attempting to overcome the main challenges and implementing interprofessional education activities in a resource-constrained higher education setting in South Africa. Boyer’s model of scholarship, which incorporates research, teaching integration, and application, was used to address the challenge of a lack of a framework in which to conceptualise the activities of interprofressional education. In addition, a scaffolding approach to teaching activities within a curriculum was used to operationalise interprofessional education and practice. Faculty development initiatives were additionally used to develop a critical mass that focused on driving interprofessional education. Lessons learnt highlighted that if a conceptual model is agreed upon by all, it allows for a more focused approach, and both human and financial resources may be channelled towards a common goal which may assist resource-constrained institutions in successfully implementing interprofessional activities.