Nurse-managed primary care: outcomes of a faculty practice network

PURPOSE: To describe selected outcomes of nurse-managed primary care in a large faculty practice network (FPN) and to use guidelines proposed by the National Organization of Nurse Practitioner Faculties (NONPF) to evaluate those outcomes. DATA SOURCES: Mission and goals, nursing control, fiscal stability, health care outcomes, and faculty role integration were examined. CONCLUSIONS: Outcomes show that the FPN directly supports the mission and goals of the East Tennessee State University College of Nursing and is managed by nurse faculty members. The FPN uses earned revenue, grants, and contracts to maintain fiscal stability. Patients are highly satisfied with services, and external and internal audits find the quality of care to be excellent. Students are educated in the centers. Faculty members publish and present research and other scholarly work derived from the FPN. IMPLICATIONS FOR PRACTICE: This model demonstrates that faculty practice can work, can meet the evaluation components of guidelines of a major national organization, and can contribute to the improvement of health for vulnerable populations.     

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.     

Patient safety issues in advanced practice nursing students' care settings

The purpose of this project was to identify and characterize patient safety issues across advanced practice nursing (APN) care settings including ambulatory care visits. A total of 162 registered nurses enrolled in an APN education program completed an online survey. Respondents reported patient safety issues related to diagnosis or management and treatment in almost half of 489 encounters. The most common issues were clinician communication problems with patients, which occurred during 42.4% of encounters. Adoption of information technology may be a pathway for improving patient safety issues in APN practice settings.     

Genetic education in baccalaureate and associate degree nursing programs in Japan

Abstract The purpose of the present study was to ascertain the amount and type of genetic content in basic nursing education programs in Japan baccalaureate degree (BSN) and associate degree (ADN), and to describe the qualifications of faculty members teaching the genetics content. A questionnaire was used to examine these. The sample was derived from 66 basic nursing preparatory programs. Faculty members from 34 out of 75 (44.7%) of the BSN programs and 32 out of 52 (61.5%) of the ADN programs returned completed surveys, providing a total response rate of 52%. As a result of the analysis of the survey data, the researchers recommend increasing the amount of genetic content, related to nursing practice, in the curriculum of Japanese baccalaureate and associate degree nursing programs. In addition, the researchers recommend increasing the number of nursing faculty specialising in genetics. Japanese nursing education must incorporate genetic knowledge into the curricula to produce professionals who are prepared to practise in the current and future genetic health care arena.     

Nursing students' and faculty members' knowledge of, experience with, and attitudes toward complementary and alternative therapies

This study was designed to describe and compare the knowledge, experience, and attitudes of nursing faculty and students (undergraduate and graduate) regarding complementary and alternative therapies (CAT). A cross-sectional survey (N = 153) of undergraduate (n = 41) and graduate (n = 57) students and faculty (n = 55) was conducted in one school of nursing. Most participants were White (87%) and female (78%). More than 70% of the students and faculty agreed that clinical care should integrate the use of CAT. More than 85% desired more education about CAT, especially in undergraduate nursing curricula. More than 65% agreed that the clinical nurse specialist or nurse practitioner role should include the use of CAT in their practice, and more than 50% agreed that they had some knowledge of CAT, but only approximately 30% had some experience with CAT. Faculty and students expressed positive attitudes toward integrating CAT into the undergraduate nursing curriculum and nursing practice. Faculty development and nursing research are needed to facilitate curriculum change and integrate CAT into nursing programs at all levels.     

Integrating on campus problem based learning and practice based learning: issues and challenges in using computer mediated communication

The Faculty of Nursing, University of Newcastle, Australia, has been keen to initiate strategies that enhance student learning and nursing practice. Two strategies are problem based learning (PBL) and clinical practice. The Faculty has maintained a comparatively high proportion of the undergraduate hours in the clinical setting in times when financial constraints suggest that simulations and on campus laboratory experiences may be less expensive.Increasingly, computer based technologies are becoming sufficiently refined to support the exploration of nursing practice in a non-traditional lecture/tutorial environment. In 1998, a group of faculty members proposed that computer mediated instruction would provide an opportunity for partnership between students, academics and clinicians that would promote more positive outcomes for all and maintain the integrity of the PBL approach. This paper discusses the similarities between problem based and practice based learning and presents the findings of an evaluative study of the implementation of a practice based learning model that uses computer mediated communication to promote integration of practice experiences with the broader goals of the undergraduate curriculum.     

A Toolkit on Patient Centered Transgender Care for Nurse Practitioner Faculty and Clinicians

The purpose of the Patient Centered Transgender Health: A Toolkit for Nurse Practitioner Faculty and Clinicians is to improve clinical care and reduce health disparities by closing the gap in knowledge of nurse practitioner faculty and practicing clinicians by providing evidence-based information on caring for this population. Resources, vetted by practicing clinicians in the field of transgender care who are also nurse practitioner/certified nurse midwife faculty, are provided. Faculty and clinicians can use this multimedia information to create evidence-based learning modules for students or clinicians and modify clinical services to address the needs of transgender individuals and provide solutions to those needs.     

Management of Mild-to-Moderate Osteoarthritis: A Study of the Primary Care Perspective

Abstract

Objectives: Examine the knowledge, attitudes, and practice patterns of primary care clinicians regarding the management of mild-to-moderate osteoarthritis (OA). Design: Case vignette-based survey. Methods: A survey was distributed to 251 physicians, physician assistants (PAs), and nurse practitioners (NPs) in the primary care setting. The survey assessed practice patterns in the management of patients with mild-to-moderate OA, as well as attitudes toward guidelines and future educational topics that may be of benefit to the clinician. Results: We found that primary care clinicians are most likely to treat mild-to-moderate OA with an oral nonsteroidal anti-inflammatory drug regimen. Patients with initial or recurrent OA were “very likely” to be recommended to a physical therapy maintenance program. Two-thirds of respondents claimed to be unfamiliar with Osteoarthritis Research Society International guidelines for OA management. Conclusion: This study reflects the need for further education for primary care physicians, NPs, and PAs on the management of OA.     

A faculty practice plan for the acute care and critical care nurse

This article discusses faculty clinical practice and explains the steps that one group of nursing faculty used to develop a faculty practice plan at a private college of nursing in a small, faith-based university in a midwestern city. The goal of the faculty practice plan was to link faculty interests and advanced practice skills with targeted populations and community needs. This was done to provide healthcare services to schools, agencies, health and human services programs, and populations in need. Examples of faculty roles in the faculty practice domains of educator, researcher, and expert clinician in an acute care setting illustrate how nurses can individualize their participation in the faculty practice plan to support their professional career goals. Faculty practice plans can benefit not only nursing faculty but also the college of nursing, its students, and its community and populations of interest.     

Improving perceptions of patient care--a nursing education and nursing practice initiative.

In January 2005, the University of Texas Medical Branch (UTMB) School of Nursing and the UTMB Hospitals and Clinics launched the first phase of a project to improve perceptions of patient care on the part of nursing faculty and nursing clinicians. A finding on the UTMB annual employee satisfaction survey that nursing faculty and clinicians tended to rate quality of UTMB patient care lower than other UTMB employees provided the impetus for the initiative. When UTMB colleagues noticed the findings, various entities including human resources and the Faculty Senate called for explanations from the dean of the School of Nursing, the chief nursing officer, and the CEO for the hospitals and clinics. In the process of attempting to give reasons for the findings, each of us determined we would take definitive action to address the situation. This article describes our accomplishments for Phase 1 of the initiative. Beginning with a vision for a productive professional community characterized by a pedagogical partnership between nursing education and practice, we share the processes we followed to (1) achieve mutual understanding among task force members, (2) obtain input on perceptions from nursing colleagues, (3) identify the clinical and nursing education aspects of the perceptions, (4) reach consensus on target perceptions for Phase 2 of the project, and (5) outline the next steps for the project.     

Using a partnership between academic faculty and a physical therapist liaison to develop a framework for an evidence‐based journal club: a discussion

Evidence‐based practice (EBP) in rehabilitation is increasingly recognized as important. Despite the importance of EBP, physical therapists' knowledge of EBP varies. Journal clubs have been used to educate clinicians about EBP. This discussion paper describes the partnership between academic faculty members and a physical therapist at a community hospital, and the process used to develop a framework to implement an evidence‐based journal club. The partnership blended the expertise of academic faculty members and a physical therapist with knowledge of EBP who served as the liaison between members of the partnership team and the clinicians at the community hospital. The three‐step framework developed enabled the clinicians to learn about critical appraisal, participate in guided practice of critical appraisal with the liaison, and lead critical appraisal of a paper with the assistance of the liaison as needed. This process could be easily replicated by other partnerships between academic faculty members and clinicians. Developing partnerships like the one described enables academicians to provide service to the profession, may enhance physical therapists' knowledge of the principles of EBP and may encourage EBP. Copyright © 2009 John Wiley & Sons, Ltd.     

Sources of knowledge in clinical practice in postgraduate medical students and faculty members: a conceptual map

OBJECTIVES: To determine the most important knowledge sources that can influence clinical practice and to cluster them in conceptual groups based on their relative importance. METHODS: Faculty members, fellows and residents of a large teaching tertiary care hospital were asked to rate the importance of different resources in their daily clinical practice and their understanding of some common terms from evidence-based medicine. The knowledge sources were distributed in a two-dimensional map using multidimensional scaling and hierarchical cluster analysis. RESULTS: A total of 250 of 320 recruited hospital staff returned the questionnaires. The most important resources in daily practice were English journals, text books and literature searching for faculty members, experience, text books and English journals for fellows and text books, experience and peers for residents. Regional journals were the least important resources for all study groups. About 62.7% of residents did not know the meaning of 'number needed to treat', 36.8%'confidence interval', 54.9%'confounding factor' and 44.6%'meta-analysis'. The percentages for faculty members were 41.3%, 37%, 42.2% and 39.1%. The knowledge sources were placed in four clusters in a point map derived from the multidimensional scaling process. CONCLUSION: The dominance of the traditional information resources and experience-based medicine debate which is the consequence of traditional approaches to medical education may be one of the considerable barriers to the dissemination of evidence-based medicine in developing countries. The evidence-based clinical practice guidelines could be used as a useful passive-predigested source for busy clinicians to make informed decisions. A considerable Western bias may undermine the local research in developing world.     

The process of curriculum redesign for the nursing baccalaureate program: an analysis of teacher actions

The purpose of this study is to define the teacher's actions in the process of developing a new curriculum for the Faculty of Nursing, in National Yang-Ming University. The authors defined three tasks of teachers developing the curriculum: Relocating, strategizing, and reflective practice. Relocating implied reflecting on the dilemmas of nursing education, world trends in nursing education, the experience of medical schools with problem-based learning, and the philosophy of the university. Strategizing meant developing guidelines that included humanistic education, faculty development, and course content of the new curriculum. Reflective practice included intersubject integration, dialogue teaching, and shifting the focus from hospital care to community and family care.     

Knowledge, perceptions, and attitudes of advanced practice nursing students regarding medical genetics

PURPOSE: To describe the current medical genetic knowledge and perceptions of graduate advanced practice nursing (advanced practice nurse [APN]/nurse practitioner and nurse anesthetist) students using survey data for future integration of genetic topics, principles, and healthcare issues into curriculum. DATA SOURCES: Survey data of APNs' perceived knowledge of genetics and a review of the literature from past research studies of students and current articles from professional journals and organizations. Web sites were those of the National Coalition of Health Professions for Education in Genetics and National Institutes of Health, Human Genome Research Institute; professional organizations; and the authors' professional, clinical, and educational experiences. CONCLUSIONS: Most APN students perceived they had minimum knowledge and prior training regarding medical genetics. There is a need to integrate genetic concepts, principles, and medical conditions into advanced practice nursing curriculum and to provide clinical experiences in genetic conditions across the life span and throughout the health and illness spectrum. APN students have positive attitudes toward integrating genetics into graduate curricula. Potential methods for program integration include readings, small group discussion, standardized patients, and role-play as measures to increase information. IMPLICATIONS FOR PRACTICE: The National Coalition for Health Profession Education in Genetics, the American Nursing Association, and the American College of Nursing Education have recommended integration of genetics knowledge and skills into routine health care to provide effective interventions for individuals and families. However, previous research and data from this study have revealed that many nurses have minimal training in genetics. Advanced practice nurses must be knowledgeable on genetic principles, topics, and the ethical, legal, and social implications related to medical genetics to increase the ability to diagnose, prevent, and treat diseases and to provide effective care for individuals and families.     

A qualitative assessment of systematic instructional design training by CLS faculty members.

OBJECTIVE: To determine the perceived value clinical laboratory science (CLS) faculty members gave to their participation in workshops on the use of a modified systematic instruction design (SID) model to develop curriculum and on-line courses. DESIGN: A survey assessing the perceived value of SID training was sent to 27 CLS faculty members. The survey asked the respondents to assess the value of the training that they received in developing their skills in Web-based, distance learning course development and teaching, and expanding their skills in traditional course development and teaching. The eight components of SID were listed and the respondents rated each component as to its value to them on a 5-point Likert scale of 5 = very valuable to 1 = not very valuable. In addition to rating the value of each SID component, the respondents were asked if they would like more training in any of the eight components. RESULTS: A majority of the 18 respondents (67%) reported that the training in SID was valuable to them. A strong majority of the respondents indicated that their training in goal and instructional analyses (96%), media selection (94%), and aligning objectives, assessments, and instructional strategies (94%) were valuable to their distance education programs and their traditional teaching skills. CONCLUSION: Faculty members who actively participated in SID training valued their new skills in developing distance education courses as well as improving their traditional teaching activities. Research is needed on the effect these new teaching skills have on student learning.