Integrating the arts into clinical care

This paper explores the spiritual, intangible dimensions of the creative arts. Their value as a resource for enriching the human situation will also be discussed. The integration of the creative arts into therapeutic nursing will be specifically referred to as a means for the innovative, creative nurse to generate change and sever the bonds of conventional thought. It will be further argued that the primary nursing model of care allows an environment that inspires registered nurses to incorporate creative arts therapies into patient care.     

Integrating the principles of evidence-based practice into clinical practice

This series of articles illustrates many considerations relevant to the application of clinical practice guidelines (CPGs). This particular column describes the actions of a nurse practitioner (NP) striving to understand the foundations of recommendations that are based largely on expert opinion. Although application of CPGs does not generally require this degree of investigation, it is essential that providers understand the processes used to interpret the basis of recommendations, including the application of the basic statistical concepts, when making decisions about how recommendations apply to individual patient scenarios. Utilizing evidence-based practice when providing patient care requires a range of skills that allows the NP to locate appropriate research evidence, to develop an understanding of the statistics used in interpreting and reporting research, and to evaluate the effects of interventions on patient outcomes. The application of the key concepts of evidenced-based practice within the primary care setting is explored through a hypothetical patient scenario, which was created as the focal point for three articles that illustrate principles of evidence-based practice. The goal of this series of articles is to provide a basic understanding of evidence-based practice and its application in clinical practice. This article explores the use of interventions selected from CPGs and investigates the potential effects of recommended interventions on patient outcomes. Commonly encountered statistical concepts are reviewed, and examples of their application in interpreting and reporting research are demonstrated. The principles of relative risk, relative risk reduction, absolute risk reduction, and numbers needed to treat are described. This review provides the NP with some basic skills to determine both the quality and usefulness of research.     

Integrating outcomes measurement into clinical practice improvement across the continuum of care: a disease-specific episode of care model

This article describes a model for incorporating outcomes measurement into a comprehensive, continuum-wide clinical practice improvement program developed at Lovelace Health Systems (Albuquerque, N.M.). Created in 1993, the Lovelace Episode of Care Program currently includes nine disease-specific multidisciplinary teams that are working to improve care by addressing such issues as severity, appropriateness, efficiency, continuous quality improvement indicators, practice guidelines, care maps, and outcomes. Key features and advantages of the model are discussed, as well as implementation issues, successes, lessons learned, program restructuring and improvement, and applicability of the framework across diseases and health organizations.     

Integrating palliative care into daily practice: a nursing perspective

Education of health care providers has historically been based on the traditional model of curative care. In this model, the curative care focus suddenly ends, substituted by a palliative approach to care, too often only in the last hours of life. Patient goals and wishes may never be clearly established, leaving family and care providers to guess at what the patient's wishes were. If we are to provide quality palliative care, we must equate it with health care providers establishing, acknowledging, and honoring patient and family goals. A major facilitator in accomplishing palliative care goals can arise from the nursing assessment. This article reviews the elements of a comprehensive nursing palliative care assessment (PCA). Although this article focuses on nurses, it has application for all health care professionals. Completion of the PCA provides an opportunity for reflection and evaluation of personal practices that support integrating palliative care into the care of all patients diagnosed with a life-threatening illness, beginning at the time of diagnosis and accelerating in intensity as the disease progresses.     

Integrating research into practice

Active involvement of students in research projects during implementation of the nursing role emphasizes regular implementation of this component in practice. Several examples of undergraduate research activities are described that developed out of the university based home health care agency and the faculty member's clinical practice. Some of these experiences not only met the educational goals related to research but also became the foundation for quality programs for clients in a variety of areas.     

Integrating genomics into clinical practice: standards and regulatory challenges

Bridging between the worlds of healthcare and life sciences is crucial to realizing the personalized healthcare vision. Initiatives regarding legislation and regulation in this interdisciplinary field, along with significant advancement in the development of data standards for genotype-phenotype associations, give rise to a banking paradigm in the form of both biobanks and independent health record banks (IHRBs). These data banks are the information technology infrastructures that are expected to enable the implementation of personalized healthcare. As opposed to the regional strategy currently piloted in the US, IHRBs offer an alternative constellation to achieving a nationwide health information network and the bills introduced in the US Congress relating to these data banks have stimulated public discussion on how best to personalize the care process.     

Integrating practice issues in managed care into the curriculum: a Delphi survey

PURPOSE: This project evolved from a partnership between an advanced practice nurse (APN) graduate program and a care management insurer. The purpose of this Delphi survey was to identify (a) role components germane to the practice of APNs in managed care and (b) topics reflecting these components in the curriculum. DATA SOURCES: Data were gathered from two expert panels, clinician preceptors and faculty members. Each panel had 11 members: 11.3% and 100%, respectively, of the target populations of clinicians and faculty in the partnering agencies. CONCLUSIONS: There was considerable congruence between the panels on the survey. IMPLICATIONS FOR PRACTICE: Case vignettes could be used as a vehicle for discussion of the broader issues of population approaches to specific problems. Faculty could partner with clinicians to develop cases for discussion of evidence-based practice. Faculty and clinicians could create preceptorships focused on business management, postgraduate fellowships within managed care systems, and regular opportunities to dialogue about curriculum and essential attributes of APN graduates.     

Integrating evidence into clinical practice: an alternative to evidence-based approaches

Evidence-based medicine (EBM) has thus far failed to adequately account for the appropriate incorporation of other potential warrants for medical decision making into clinical practice. In particular, EBM has struggled with the value and integration of other kinds of medical knowledge, such as those derived from clinical experience or based on pathophysiologic rationale. The general priority given to empirical evidence derived from clinical research in all EBM approaches is not epistemically tenable. A casuistic alternative to EBM approaches recognizes that five distinct topics, 1) empirical evidence, 2) experiential evidence, 3) pathophysiologic rationale, 4) patient goals and values, and 5) system features are potentially relevant to any clinical decision. No single topic has a general priority over any other and the relative importance of a topic will depend upon the circumstances of the particular case. The skilled clinician must weigh these potentially conflicting evidentiary and non-evidentiary warrants for action, employing both practical and theoretical reasoning, in order to arrive at the best choice for an individual patient.     

Integrating physician assistants into the practice setting

The role of anaesthetic practitioner was established in England using the National Anaesthesia Practitioner Curriculum Framework (Department of Health 2005) and is now being adopted in Scotland. This article reports part of a 29-month evaluation of the first two cohorts of physician assistant (anaesthesia) students as they progressed through their education programme, and discusses the management of integrating this role in clinical practice.