Advanced practice nurses as faculty.

This article details a program through which two child health faculty members who are advanced practice nurses (APNs) combined practice with teaching undergraduate students in a community-based clinical experience on nursing case management. A collaborative agreement between a university-based Children's Special Services Team (CSST) and school of nursing faculty was developed to extend services into the home communities of children with special healthcare needs. Senior students made visits to the homes of the team's clients, conducted assessments, interacted with families, and provided additional care. The team, which included physicians, nurses, a social worker, and therapists (occupational and physical) identified children and families who would benefit from home visits by students nurses who were directed by APNs. Both service and educational goals were accomplished by this community-based case-management experience. The children and their families received additional care from multiple healthcare providers. Students practiced components of community-based case management, and the CSST obtained vital information about their clients' living environments.     

Bridging Cultures for Latino Children: School Nurse and Advanced Practice Nurse Partnerships

TOPIC:  Barriers to use of mental health services by Latino families include stigma, service costs, and disparity of services with cultural values and traditions. School nurses are in key positions to recognize mental health needs of Latino children and form relationships that facilitate family connections with mental health services. Advanced practice psychiatric nurses may be contracted by school districts to provide consultation to school nurses or may be available to school nurses through connections with school-based health centers. Case examples are provided to illustrate the value of school nurse consultation with an advanced practice psychiatric nurse in promoting awareness of cultural influences on children's symptoms and behaviors and developing culturally sensitive approaches to engage Latino children and families in school and health services.
PURPOSE:  This paper aims to review literature on Latino mental health and present rationale for school nurse and advanced practice nurse partnerships to promote culturally sensitive approaches that facilitate Latino family access and utilization of health services.
SOURCES:  Published literature and case scenarios.
CONCLUSIONS:  With advanced practice nurse consultation, school nurses identify mental health needs of Latino children and develop culturally sensitive approaches that bridge Latino families' access to and utilization of health services.     

Advanced practice nursing role: clinical nurse specialist

The public continues to demand quality health care that focuses on the achievement of quality patient outcomes. The clinical nurse specialist is an advanced practice role that originated in the early 1900s as a result of similar public demand, and continues to evolve to meet quality health care needs. Advanced practice nurses have many opportunities to create expanded nursing roles. Orthopaedic nurses also continue to refine their practice roles, and the clinical nurse specialist is one such example.     

Expanding nurses' roles in telemedicine & genetics services

This article presents nursing roles in telemedicine and genetics services. Telemedicine offers a promising solution to delivering comprehensive genetics services to children and families when travel, distance, and shortage of genetics professionals interfere with access. Nurses are already using telemedicine to provide nursing and healthcare services but have become involved in the delivery of genetics services via telemedicine only recently. Involving nurses in the development of telemedicine systems for genetics services is essential as they serve as a vital link between the patient, the healthcare system, and the community. Some of the emerging nursing roles in telemedicine include genetic family-health risk assessment, evaluation and counseling at the advanced practice level and at the primary care level, referral, participation in genetic evaluation and counseling, and family- and community-based care coordination and management. The Genomics Nurse Case Coordinator role as described by is presented as a means of further expanding the maternal-child health nursing role in supporting women and families to manage their own genomic health. Telemedicine offers nurses an opportunity to assure and provide quality genetic healthcare tailored to the individual and family's specific needs within their own community.     

Advances in graduate nursing education: beyond the advanced practice nurse.

Historically, graduate education in nursing has been primarily concerned with the clinical role. In recent years it has been suggested that graduate education needs to consider alternate programs of study that prepare nurses for clinical leadership that are distinct from management and advanced practice roles. Graduate education is needed that focuses on the skills required to coordinate care and implement outcome-based practice and quality improvement strategies. Two models are currently being proposed that meet these objectives. The first is the population health nurse expert that functions on the macrosystems approach and the second is the clinical nurse leader which is based on a microsystems framework. The two models are compared and a combined model where the clinical nurse leader is based on the population health framework is proposed.     

A critical gap: Advanced practice nurses focused on the public's health

BackgroundThe COVID-19 pandemic has highlighted the need for nurse leaders who “embrace the interconnection” between medicine and public health. The inequitable impact of COVID-19 on people of color demonstrates the importance of applying expertise from nursing practice and public health systems to work with communities and other professions on complex health issues. Yet, despite a clear need for improved population health, educational programs designed to produce Advanced Public Health Nurses, with skills to address complex system changes, have become increasingly scarce.PurposeWe put forward the perspective that the nation needs more advanced practice nurses prepared for leadership roles focused on the health of whole populations, marginalized communities, and the systems and policies that promote their health.DiscussionWe argue that opportunities should be expanded for nurses to attain education for these roles through increased investments in the Doctor of Nursing Practice model to prepare nurses for advanced public health specialty practice.     

Teaching in crisis. Patient and family education in critical care

Although the critical care setting is not always a positive teaching environment, it is possible to achieve the goal of optimal patient and family education. The critical care nurse must understand the unique learning needs of patients and families who are experiencing a life crisis a recognize that there are substantial obstacles to overcome to educate in this setting. In addition, it takes experience and resources to develop the teaching skills of the bedside nurse, so that those teachable moments are easily recognized and suitably used to give patients and family members valuable information in small doses. The advanced practice nurse is an essential nursing resource who can spearhead the development of teaching skills for all members of the health care team. In addition, the advanced practice nurse is a clinical expert who can assess the educational needs of patients and their families and provide more detailed and individualized health information from a different perspective. Achieving good patient and family education outcomes is possible when patient care continuity is a priority and the advanced practice nurse is an active part of the nursing team. Exploring the use of new technologies and resources to meet patient and family education needs is absolutely necessary. As hospitals continue to evolve and react to the financial demands placed on them, nursing leadership and critical care nurses will need to articulate clearly all of the essential components of patient care, including patient and family education. In keeping with the rich nursing tradition of patient and family education, critical care nurses and advanced practice nurses have the opportunity to demonstrate their unique teaching skills and continue to promote health education as a priority of patient care.     

Toward an integration of competencies for advanced practice mental health nursing

As new models of health care delivery evolve, the work of advanced practice nurses is growing in importance. Graduate programs in nursing have traditionally prepared advanced practice nurses for separate roles as clinical nurse specialists or as nurse practitioners. However, there are increasing trends toward the blurring of boundaries between these two types of advanced practice roles. Hence, a future blended role is projected by many nurse educators. The merger of clinical nurse specialist and nurse practitioner roles, however, requires corresponding shifts in academic programs. The purposes of this article are to discuss the need for a blended clinical specialist-nurse practitioner role in mental health, to identify populations of clients who would be served by a blended role provider, to discuss the competencies associated with such a role, and to share an approach to the preparation of advanced practice mental health specialist/practitioners.     

The nurse as a social worker

In the early twentieth century the role of the public health nurse (PHN) was expanding to meet the needs of individuals, families, and communities. Among the ideas discussed in the early nursing literature was that of the social nurse. This role was conceptualized as a combined nurse and social worker. Much of the PHNs work was with people of the poorer classes who needed assistance with both the medical aspects of their disease, as well as help with social needs such as food, rent money, and bedding. In this reprint from The Visiting Nurse Quarterly (1911), Ellen La Motte, Nurse-in-Chief with the Tuberculosis Division of the Baltimore Health Department, argued for this combined role based on economic efficiency. As she pointed out, it was "economic waste" to have two sets of workers going into homes when the nurse was capable, with additional education, of carrying out both roles. Additionally, from La Motte's perspective the only way the nurse could move beyond her role as the "physician's handmaiden" was through "social training" that prepared her for a broader scope of practice than that received in the hospital-based nursing schools. In the end, however, she left it open to nurses as "reasonable beings" to determine the direction the profession would take on this issue. La Motte's words provide historical context for issues contemporary public health nursing leaders are addressing, such as inter-professional boundaries between nurses and public health workers, reductions in the public health workforce, and economic constraints faced by the healthcare system. The Institute of Medicine mandate for inter-professional practice within the healthcare system, however, presents opportunities for exploring new roles and practice models for nurses in conjunction with our partners in public health.     

Education for differentiated role development for NP and CNS practice: one nursing program''s approach

Development of nurse care providers who best meet the public's health care needs is imperative. Some nurses believe the functions of nurse practitioners and clinical nurse specialists should be combined. However, the experience of the authors' nursing program argues otherwise. Two graduate nursing tracks, family nurse practitioner and rural health specialist, were developed to meet the health care needs of rural populations. Although the two tracks share expected competencies and areas of expertise to some extent, differences in practice are apparent in identified domains of practice and terminal competencies. Family nurse practitioner practice focuses on assessment, diagnosis, and management of health and illness conditions of individuals and families across the life span. Clinical nurse specialist practice incorporates traditional roles of client assessment, monitoring and coordination of care, outcome assessment, and client, family, and community education, with a new focus on case management strategies. These differences are important to care delivery in the managed care era.     

Advanced nursing practice: policy, education and role development

Aims and objectives. This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice. Background. The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required. Conclusion. The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community. Relevance to clinical practice. In a rapidly changing people‐centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research.     

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.     

Perceptions of the benefits and challenges of the role of advanced practice nurses in nurse‐led out‐of‐hours care in Hong Kong: a questionnaire study

Aims and objectives. The aim of the study was to identify the factors that nurses perceive may facilitate or hinder the development of advanced practice nurse roles in Hong Kong. Background. Advanced practice nurses are increasingly prominent in nurse‐led out‐of‐hours care in Hong Kong in response to changes to junior doctors’ hours of work. Setting. Three five‐day workshops for Hong Kong‐based advanced practice nurses were offered in partnership with UK clinicians. The aim of the workshops was to share UK experiences of implementation of the ‘Hospital at Night’ model of care delivery. The questionnaire study undertaken was not part of the workshop programme. However, the workshops gave the authors a unique opportunity to access relatively large numbers of Hong Kong‐based advanced practice nurses. Participants. The workshops were attended by experienced nurses who had been or were about to be appointed as advanced practice nurses. All nurses who attended one of the three workshops (n = 120) agreed to participate in the study. Methods. Responses to two open questions posed in the questionnaire were the subject of a content analysis. Results.  A prominent finding of the study was that respondents viewed the benefits of introducing advanced practice nurse roles in Hong Kong as outweighing any challenges. One of the main features of the perceived benefits relates to improving the quality and safety of patient care. The greatest challenges associated with the role related to acceptance of the role by other healthcare professionals, and difficulties associated with the general public’s traditional attitudes to healthcare provision in Hong Kong. Conclusions. Education of the public concerning the implementation of such roles is of crucial importance. Relevance to clinical practice. Findings from this study enhance understanding of the factors that hinder or facilitate advanced practice roles in out‐of‐hours care in Hong Kong.     

Cronicidad y complejidad: nuevos roles en Enfermería. Enfermeras de Práctica Avanzada y paciente crónico

The increase in chronic diseases and the progressive ageing of the population is a source of concern for the different agencies with responsibility for health care. This has led to the creation of many documents focused on the analysis of the current situation and care of chronic diseases, including the WHO recommendations intended to assist countries and health services design and implement strategies that will address the existing demand, control and prevention of chronic diseases.In addition, there is a need to respond to the demand generated by chronic diseases in every sense, and from the different systems it is becoming more difficult to get enough support from multidisciplinary teams where the nurse has a central importance. While chronic diseases are becoming a threat due to the costs they generate, it is also an opportunity for nursing to be at the forefront for advanced care requirements, performed by professionals with recognized advanced clinical skills and ability for case management while monitoring and controlling complex chronic patients. The different services of the National Health System have introduced nurses that play different roles (cases managers, liaison nurses, advanced practice nurses and so on). However, it could be argued that they are not being trained to a desirable development level.It is therefore time for health care authorities to determine the role of the advanced practice nurse in relation to functional positions, and allow them to make an advance in the development of unified skills for the whole National Health System. From our experience we have learned that the advanced practice nurse is a resource that helps in the sustainability of services, thanks to the efficiency shown in the results obtained from the care given to both chronic and complex chronic patients.     

Teaching family nursing: strategies and experiences

The traditional hospital-based approach to Australian nurse education curricula was primarily based on the medical model and directed towards the preparation of nurses who were able to give care to individual clients The major focus was on the needs of the individual A notable absence in curricula was any consideration of the role or importance of families to individual and family health This was despite the continuing involvement that nurses have in their practice with the families of their clients This paper describes the experiences of introducing a family nursing subject in an undergraduate, preregistration nursing programme which focuses on the family as a unit of care Educational strategies, clinical experiences, and evaluation of the unit of study are discussed     

Nurses of NESB working in a multicultural community

Ensuring that the cultural composition of the nursing population reflects the multicultural mix of the general population assumes that culturally appropriate care will occur when people of non-English background (NESB) are encountered in nursing practice. In a feminist praxis study involving twenty-six nurse participants, seven of whom were of NESB, the nurses discovered that the structure of the health care institution not only overlooked the cultural and linguistic needs of children and NESB families, but also created a dominant Anglo-Australian health culture that taught NESB nurses to ignore the traditions and practices of their NESB culture. This paper will explore the nurses' discovery of their own collusion in sustaining an Anglo-Australian health care culture.