APN Knowledge,Self‐Efficacy,and Practices in Providing Women's Healthcare Services to Women with Disabilities

Women with disabilities require the same gynecological and reproductive healthcare services as women without disabilities, yet they often experience difficulty obtaining them. Advanced practice nurses (APNs) increasingly provide primary care services that include women's health care, yet their influence on this population has not been systematically examined. This study examined the practices, environments, knowledge, and self‐efficacy of APNs in Texas regarding provision of women's health care to women with disabilities. The study's respondents are 744 women who replied to a mailed survey. The results reveal that while nurses do not lack knowledge, work environments do not support competent care of women with disabilities and practices do not always follow national guidelines. Predictors of self‐efficacy in provision of health care to women with disabilities were status as a women's health nurse practitioner, previous rehabilitation experience, high knowledge scores, and a working environment perceived as accessible. Until changes are made in APN education and environmental barriers are addressed, APNs may not be able to provide optimal women's healthcare services to women with disabilities.     

Healthcare professionals’ values about and experience with facilitating end-of-life care in the adult intensive care unit

ObjectivesTo evaluate values and experience with facilitating end-of-life care among intensive care professionals (registered nurses, medical practitioners and social workers) to determine perceived education and support needs.Research designUsing a cross-sectional study design, 96 professionals completed a survey on knowledge, preparedness, patient and family preferences, organisational culture, resources, palliative values, emotional support, and care planning in providing end-of-life care.SettingGeneral adult intensive care unit at a tertiary referral hospital.ResultsCompared to registered nurses, medical practitioners reported lower emotional and instrumental support after a death, including colleagues asking if OK (p = 0.02), lower availability of counselling services (p = 0.01), perceived insufficient time to spend with families (p = 0.01), less in-service education for end-of-life topics (p = 0.002) and symptom management (p = 0.02). Registered nurses reported lower scores related to knowing what to say to the family in end-of-life care scenarios (p = 0.01).ConclusionFindings inform strategies for practice development to prepare and support healthcare professionals to provide end-of-life care in the intensive care setting. Professionals reporting similar palliative care values and inclusion of patient and family preferences in care planning is an important foundation for planning interprofessional education and support with opportunities for professionals to share experiences and strengths.     

Do nurses feel stressed? A perspective from primary health care

This study describes nurses' experiences of stress in primary healthcare settings, and examines correlations between stress and personal factors. There were 187 nurses from 18 public primary care centers participating, drawn from one county of Lithuania. The Expanded Nursing Stress Scale was used to evaluate the study data. The study indicates that in primary healthcare centers, nurses working with adult patients experienced less stress than those working with younger patients. The most frequently reported stressors were those related to death and dying, and conflicts with physicians and patients and their families. In particular, older nurses more frequently experienced stress related to death and dying. The intensity of nurses' stress in conflict situations with physicians was related to age, however, the depth of work experience in the healthcare setting was more influential. Findings indicate that more detailed research is needed regarding stress experiences in primary health care, and especially the related impact of the social contexts involved in the setting.     

Exploring district nursing competencies in health promotion: the use of the Delphi technique

Aims and objectives. The research outlined in this paper aimed to establish a consensus view amongst primary healthcare professionals about the competencies that district nurses need in order to fulfil an effective role in health promotion. Background. In recent years there has been a growing emphasis on health promotion in primary care in the United Kingdom and health promotion is becoming increasingly important to nurses who work in the community. However, consideration of the role of the district nurse in health promotion is rather restricted and consequently district nurses have limited access to empirical evidence, from which they can develop their work in health promotion. Design and methods. The Delphi technique was used for this study. Seventy‐two primary healthcare professionals were mailed a series of three questionnaires, which achieved response rates of 86, 87.5 and 78.9%. Results. There was a consensus amongst the panellists that district nurses require a range of competencies to engage effectively in health promotion. These were categorized to produce a definitive list of eight knowledge‐, seven attitude‐ and eight skill‐related competencies. Conclusions. For the first time, this study achieves a consensus on the competencies needed by district nurses to engage in health promotion. Relevance to clinical practice. District nurses should feel encouraged to develop their health promotion role in light of the fact that many of the competencies that they require for this activity have been identified as essential for their day‐to‐day nursing practice. The research highlights the fact that new paradigm health promotion is a concept that has moved beyond the academic arena and is recognized as significant by practising health professionals.     

Encounters between children's nurses and culturally diverse parents in primary health care

The objective of this study was to analyze the healthcare encounters between nurses and parents of different cultural backgrounds in primary health care. An ethnographic study was carried out using participant observations in health centers and interviews with nurses. Data were analyzed using thematic content analysis and constant comparative method. Four main themes were identified when nurses met parents of other cultural backgrounds: lack of mutual understanding, electronic records hamper the interaction, lack of professionals' cultural awareness and skills, and nurses establish superficial or distant relationships. The concepts of ethnocentrism and cultural imposition are behind these findings, hampering the provision of culturally competent care in primary health services. There were difficulties in obtaining and registering culturally related aspects that influence children's health and development. This was due to e‐records, language barriers, and the lack of cultural awareness and skills in health professionals making the encounters difficult for both nurses and parents. These findings show that there is a clear threat for health equity and safety in primary care if encounters between nurses and parents do not improve to enable nursing care to be tailored to any individual family needs.     

Genomic health care: Is the future now?

Abstract   In some areas of health care, genomics is having a steadily increasing impact on clinical practice. Yet, in other areas, genomic developments are considered to be at the periphery of care. Health-care professionals from such areas might feel that the potential of genomics is exaggerated. To explore this issue, genetic nurse specialists were invited to submit case studies and to identify barriers and facilitators in incorporating genomics into mainstream nursing practice. Twenty-five cases were submitted and a total of 10 barriers and seven facilitators were identified. These cases were presented as a basis for debate in a session conducted at the 2006 Annual Conference of the International Society of Nurses in Genetics . The majority of delegates agreed that genomics would have a profound effect on health care and nursing within the next 5 years, particularly in oncology. That nurses do not see genomics as being relevant to their practice was identified as the greatest barrier, by a narrow majority. Specialist nurses in any field have a role in acting as agents of change, educators, and consultants to non-specialists. It is clear that genetics nurse specialists still have a considerable challenge in raising awareness about the relevance of genomics to mainstream nursing practice.     

Healthcare professionals’ knowledge,skills, and role in offering and facilitating memory making during end-of-life care in the adult intensive care unit

BackgroundAn activity to provide a tangible keepsake following the death of a loved one is termed ‘memory making’. However, limited evidence is available related to professionals' education and support to provide memory making opportunities in the adult intensive care unit (ICU). Having a greater understanding of healthcare professionals’ experiences can inform future patient/family care and support for professionals in end-of-life care.ObjectiveThe objective of this study was to describe what participants perceive memory making to be, if they have facilitated memory making activities as part of their practice, if they perceive it as part of their role, and if they have the necessary skills to do so.MethodsSeventy-five registered nurses (75% response rate), 19 medical doctors (76% response rate), and two social workers (66.7% response rate) completed a survey at a single tertiary referral centre in an adult ICU.ResultsParticipants reported memory making to include the creation of tangible keepsakes as well as nontangible activities. Overall, participants reported high agreement scores that the responsibility for initiating memory making predominately belonged to the nurse. Participants reported skills most needed involved the ability to interact with the family, being open to the concept, and integrating memory making into their standard of care. Having developed a rapport with families was considered an enabler, whereas lack of knowledge and clinical workload were reported as inhibitors to offering memory making.ConclusionsOverall, participants in this study reported positive experiences with offering memory making to families during end-of-life care in the adult ICU. Nurses are more likely to perceive professional responsibility for offering memory making, likely due to their increased time at the bedside and higher prominence and leadership in other end-of-life practices. To support professionals, education should include conceptual knowledge, procedural knowledge of keepsake creations, communication techniques using reflective practices, and organisational support to facilitate time requirements.     

Family physician/nurse practitioner: stories of collaboration

AIMS: This paper presents the experiences of nurse practitioners and family physicians working in collaborative practice at four Canadian rural primary care agencies. It focuses on the qualitative segment of a larger study examining the impact of an educational intervention on interprofessional practice. BACKGROUND: Growing awareness of the importance of health promotion and disease prevention, the increased complexity of community-based care, and the need to use scarce human healthcare resources, especially family physicians, far more efficiently and effectively, have resulted in increased emphasis on primary healthcare renewal in Canada. Key to primary healthcare renewal is care delivery through interdisciplinary teams that include nurse practitioners. METHODS: Narrative analysis, a form of interpretive analysis that respects the integrity of the stories told by participants, was chosen as the strategy to examine the narrative data gathered in two sets of interviews with the nurse practitioners and family physicians. The study was undertaken during 2000. RESULTS: Thirteen family physicians and five nurse practitioners with diverse educational backgrounds and varied experience with collaboration participated in the qualitative component of the study. A number of issues related to working in a shared practice were identified in nurse practitioner and family physician interviews across the research sites. The themes identified in participants' stories included issues related to the scope of practice, emphasizing the importance of role clarity and trust, the ideological difference regarding disease prevention and health promotion, differences in perceptions about the operation of collaborative practice, and the understanding that collaborative relationships evolve. CONCLUSIONS: The placement of nurse practitioners and family physicians in a common clinical practice without some form of orientation process does not produce collaborative practice. Educational strategies related to role expectations are necessary to facilitate the development of care delivery partnerships characterized by interdependent practice.     

Knowledge about patients' rights among professionals in public health care in Finland

Scand J Caring Sci; 2012; 26; 436–448 Knowledge about patients’ rights among professionals in public health care in Finland Background: The legal rights of patients include civil rights for patients and the duties of healthcare professionals. Knowledge of legislation and the ability to put juridical norms into practice are among the main aspects of professionals. Aim: The aim of the study was to describe the level of healthcare professionals’ knowledge about patients’ legal rights and to describe background variables associated with the knowledge. The legal rights are based on the Finnish Act on the Status and Rights of Patients. Method: The data were collected from healthcare professionals (nurses and physicians) in public health care in Finland (recruited N = 290, responded n = 191) with a questionnaire designed for the study. The response rate was 66%. The data were analysed statistically. Results: Healthcare professionals were partially familiar with patients’ legal rights. The right to good health care, treatment and access to care and right to self‐determination were the best‐known areas. The respondents lacked knowledge on the right to information and the right to use the services of patient ombudsman. Based on self‐evaluation, half of the respondents thought that they had weak knowledge of the legislation on patients’ rights. However, they perceived knowledge about patients’ rights as being important. There was no correlation between respondents’ self‐evaluated knowledge and actual scoring on the knowledge test. Conclusion: These results implicate a need for further education aimed at healthcare professionals and development of professional training about patients’ legal rights.     

The impact of economic recession on health‐care and the contribution by nurses to promote individuals' dignity

The health sector is facing many challenges, and there is a need to maintain the delivery of high‐quality health‐care. Issues related to equity and access to health‐care have emerged in a context of an economic recession in which the sustainability of the health system depends on everyone, including the actions and decisions of professionals. Therefore, nurses and their skills may be the answer to ethical, professional and community health management, but this recession could lead to major problems in the education of nurses in daily health‐care practice. Due to the limited availability of resources, nurses are increasingly taking leadership positions, continuing to develop their critical abilities and thinking skills, and considering sciences such as deontology and ethics. The main goals of this study were to reflect on the economic recession and its impact on health‐care and to demonstrate the contribution of nursing to the sustainability of health‐care and in the promotion of individuals' dignity. The authors conclude that health‐care depends on economic redistribution and, in this context, needs to be equitable and fair. Nurses have the responsibility to develop their profession according to the underlying sciences and can therefore strategically help the healthcare system.     

Examining the language–place–healthcare intersection in the context of Canadian homecare nursing

Currently, much of the western world is experiencing a shift in the places where care is provided, namely from institutional settings like hospitals to diverse community settings such as the home. However, little is known about how language and the physical and social aspects of place interact to influence how health‐care is delivered and experienced in the home environment. Drawing on ethnographic participant observations of homecare nursing visits and semi‐structured interviews with Canadian family caregivers, care recipients and nurses, the intersection of language, place and health‐care was explored in this secondary analysis. Our findings reveal four themes: homecare nurses view themselves as ‘guests’; home environments facilitate the development of nurse–client relationships; nurses adapt healthcare language to each home environment; and storytelling and illness narratives largely prevail during medical interactions in the home. These findings demonstrate the spatiality of language and how the home environment informs decisions regarding language use. Furthermore, these findings exemplify how language and place mutually influence the experiences and delivery of home health‐care. We conclude by discussing the importance of considering the language–place–healthcare intersection in order to gain a better understanding of medical exchanges in places and the associated implications for optimizing best nursing practice.     

Nursing staff's understanding of oral health care for patients with cancer diagnoses: an intervention study

Aims and objectives. The aim of this study was to evaluate long‐lasting changes in the nursing staff's understanding of oral health care for cancer patients after an oral health care intervention. The study also assessed whether there were changes between registered nurses and auxiliary nurses. Background. The maintenance of good oral health care in cancer patients is essential for nutrition, recovery and wellbeing and requires the involvement of nursing staff. However, several studies reveal that the need to prioritize oral health care has not been made sufficiently clear. Methods. The nursing staff (registered nurses, n = 133 and auxiliary nurses, n = 109) on five wards at different hospitals providing cancer care took part in a four‐hour oral healthcare training session, including the use of an oral assessment guide and answered a questionnaire initially and after this intervention. The data were statistically analyzed. Results. Several aspects of implementation opportunities improved, but they did not include attitudes to oral health care. Knowledge of oral diseases decreased, more for auxiliary nurses than for registered nurses. Conclusions. A four‐hour oral health training session and subsequent activities improve the nursing staff's understanding of oral health care for patients with cancer diagnoses in some respects but not in terms of attitudes to oral health care or specific oral knowledge. Relevance to clinical practice. Oral healthcare education and training activities for nursing staff can produce some improvements in the understanding of oral health care for cancer patients but not in attitudes and specific oral knowledge. These areas must be covered during the basic education period or/and by a routine oral healthcare programme for nursing staff, probably including an oral healthcare standard.     

Nurse practitioners in Ontario primary healthcare: Referral patterns and collaboration with other healthcare professionals

The purpose of this study is to examine referrals of nurse practitioners providing primary healthcare (PHC NPs) to better understand how PHC NPs collaborate with other healthcare professionals and contribute to interprofessional care. The analysis is based on the data from a survey of 378 PHC NPs registered in Ontario, Canada in 2008. Overall, 69% of PHC NPs made referrals to family physicians (FPs) and 67% of PHC NPs received referrals from FPs. Almost 50% of PHC NPs had bidirectional referrals between them and FPs. Eighty-nine percent of PHC NPs made referrals to specialist physicians. Bidirectional referrals between PHC NPs and social workers and mental health workers were common in family health teams and community health centers. Patterns of referrals (bidirectional, unidirectional and no referrals) between PHC NPs and FPs, social workers, mental and allied health workers in various practice settings indicate development of collaborative relationships between PHC NPs and other healthcare professionals and reflect the influence of practice models on delivery of interprofessional care. These findings are discussed in light of the development of NPs' role and integration of PHC NPs in the Ontario healthcare system. Implications for policy changes and future research are also suggested.     

Canadian nursing in the genomic era: a call for leadership

With developments in genomics, there is an urgent need for Canadian nurses in all settings to be informed and involved in the incorporation of this new knowledge into healthcare. The purpose of this paper was to synthesize the literature on genetic nursing roles to provide a foundation for Canadian nursing leaders as they take on the challenges of nursing in the genomic era. A comprehensive review of 98 articles published between 1994 and 2004 revealed strong support for genetic nursing roles and recommendations for levels of genetic nursing practice. The few studies on genetic nursing roles suggested that nurses and other health professionals support the integration of genomics into nursing practice. Issues that need to be addressed related to nursing practice, education and research are offered to engage nursing leaders in advocating for the incorporation of genomics into nursing in Canada.     

Addressing the support needs of families during the acute hospitalization of a parent with mental illness: A narrative literature review

Hospitalisation of a parent with acute mental health problems impacts the consumer, their extended family/carers and children. Mental health nurses are at the forefront of promoting recovery for consumers in an acute inpatient setting. Recovery‐oriented care can include provision of family‐focused care which supports recovery of the parent‐consumer and their family members and contributes to prevention of intergenerational mental illness. The aim of this narrative literature review was to explore existing knowledge regarding the experiences, care and support needs of parent‐consumers, their family members/carers and children during the parent's acute mental health hospitalisation. It also aims to explore existing knowledge about the practices of mental health nurses providing care to this consumer group, to inform future healthcare practice and strengthen parent, child and family outcomes. Nineteen published studies addressed the review questions. In the context of hospitalisation, the majority of research regarding parenting with a mental illness is focused on mothers. Parents reported experiencing stigma during their hospitalisation. Separation from children was a concern for parents and their extended family, but admission provided an opportunity for the parent to receive treatment and for the family to receive support. Mental health nurses did not always identify parental status on admission. When parental status was identified, nurses reported issues regarding logistics and practicalities of using family rooms, children visiting the unit, and their own professional knowledge and organisational support regarding familyfocused care. Implications for practice are identified, highlighting how mental health nurses can develop their practice to support the recovery of parent‐consumers.     

Educating healthcare professionals to act on the physical health needs of people with serious mental illness: a systematic search for evidence

Healthcare professionals in primary and secondary care should monitor the physical health of people with serious mental illness, yet in practice this does not appear to be a routine intervention. Our objective is to develop evidence-based training for healthcare professionals to enable them all to offer better physical care to this population. We performed a systematic search with the aim of evaluating the current evidence of the efficacy of education interventions. Search terms covered Severe Mental Illness, Physical Health and Education. The search yielded 147 papers, of which none were eligible for inclusion. A number of studies were excluded from this review as although there was an implicit education package provided to healthcare professionals, no information was reported on the outcomes of this education with regard to healthcare professionals' knowledge, attitudes and behaviours. The only information that these studies provided was patient-specific outcomes. It is vital that researchers start to publish details of healthcare professional education and their outcomes in physical health and serious mental illness research.     

Advanced and specialist nursing practice: attitudes of nurses and physicians in Israel.

BACKGROUND: With the introduction of new and advanced nursing roles, the nursing profession is undergoing dynamic change. Realizing changes will be easier to accomplish if the nursing community and other healthcare professionals welcome the process. Recently the nursing staff mix in Israel has been undergoing a transformation: encouraging registered nurses to enhance their status by acquiring academic degrees and advanced professional training, and initiating the adoption of new nursing roles. OBJECTIVE: Our goal is to evaluate Israeli nurses' and physicians' attitudes to the introduction of new nursing roles and to expanding the scope of nursing practice. METHODS: Two hundred and fifteen nurses and 110 physicians from three large general hospitals and 15 community clinics filled in a questionnaire. FINDINGS: In general the majority of the nurses supported expansion of nursing practice, and such expansion did not cause significant opposition among physicians. However when the task affected patients' health, physicians were less willing to permit nurses to perform skills previously their responsibility alone. In addition, using multiple logistic regressions, support of the expansion of nursing practice was significantly higher among nurses in management or training positions, and among academically accredited nurses. Support for expanded roles was prominent among hospital physicians, graduates from Israeli schools of medicine, and less-tenured physicians. CONCLUSIONS: We suggest that confirmation by various groups of physicians and nurses of standardized definitions of the new boundaries in the scope of nursing practice roles could successfully promote development of new roles and facilitate integration of the Israeli healthcare system into the global context of change. CLINICAL RELEVANCE: Inter- and intra-professional collaboration, agreement, and understanding regarding advanced nursing practice roles and their introduction into the healthcare system might improve the relationship between healthcare professions and ultimately increase quality of care and patient satisfaction.