How nurse practitioners make decisions regarding coronary heart disease risk: a social judgment analysis

PURPOSE: Understanding how nurse practitioners use clinical decision skills in practice has the potential to guide education programs to ensure safe, competent, and high quality advanced nursing practice. This study used the lens of social judgment theory to examine the clinical decision making of 60 nurse practitioners. METHODS: A three‐group pretest–posttest comparison design was used to evaluate how much insight nurse practitioners had into their clinical decision‐making process. FINDINGS: Nurse practitioners had modest insight into their clinical decision‐making process. CONCLUSION: Self‐insight has implications for enhancing nurses' decision making, improving education, and fostering agreement among advanced practice nurses. IMPLICATIONS FOR NURSING PRACTICE: Self‐insight has implications for developing professional decision making and promoting appropriate educational opportunities for advanced practice nurses.     

Nurse prescribing as an aspect of future role expansion: the views of Irish clinical nurse specialists

Aim Nurses and midwives are expanding the scope of their professional practice, assuming additional responsibilities including the management and prescribing of medications. The aim of the study was to discover the attitudes of clinical nurse specialists (CNSs) in Ireland to nurse prescribing and to examine perceived barriers to engaging in this aspect of future role expansion. Background The expansion of the nursing role in relation to nurse prescribing is an ongoing process and is subject to incremental iterations of legislation and professional policy. Nurse prescribing as an expanded role function has become a reality in many countries. Ireland has addressed the matter in a formal and systematic way through legislation. Method A questionnaire was administered to a sample of 283 CNSs practising in a variety of care settings in Ireland. Attitudes were measured using Likert‐type attitudinal scales, designed specifically for the study. Results and conclusions Findings indicate that the majority of clinical nurse specialists were positively disposed toward nurse prescribing as a future role expansion. The fear of litigation was identified as the most significant barrier to nurse prescribing. The majority of respondents equated nurse prescribing with increased autonomy and holistic care. The findings indicate that there is a need for further examination of the educational requirements of the CNS in relation to nurse prescribing. The legislative implications for nurse prescribing and fear of legal consequences need to be considered prior to any implementation of nurse prescribing. Implications for nursing management While senior clinicians are willing to embrace future role expansion in the area of nurse prescribing, their Nurse Managers should recognize that facilitation of nurse prescribing needs to address the legal and educational requirements for such activity. Failure to address these requirements can represent a barrier to role expansion. This paper offers new understandings on the views of senior clinicians concerning nurse prescribing at a time of ongoing professional policy iteration and practice change in the area.     

Knowledge gaps in prostate cancer treatment between physicians and clinical nurse specialists

Delphi consultations, a method of gaining consensus by gathering expert opinion, were conducted in order to understand the role of degarelix as a treatment option for advanced hormone‐dependent prostate cancer. During the Delphi consultations, differences were identified between physicians and clinical nurse specialists in terms of their knowledge of therapeutic developments. We argue that disparities in knowledge between physicians and nurse specialists could limit the effectiveness of multi‐disciplinary teams in providing optimal patient care. When such situations arise, communication between patients and nurse specialists, often the patient's primary point of contact, may conflict with information they have received from the physician. This could lead to confusion and uncertainty among patients about whether they are receiving the best possible care. Time and resources should be provided to address the continuing educational needs of nurses, which will ultimately result in the improved care and experience of patients.     

Nurses' attitudes to and perceptions of knowledge and skills regarding evidence-based practice

The study evaluated the effect of an evidence-based practice (EBP) educational programme on attitudes and perceptions of knowledge and skills, of registered nurses, towards EBP. The study was conducted using a quasiexperimental interrupted time series design. Participants were clinical nurses in educational and leadership roles within a Health Service District in south-east Queensland. The data were collected using a self-administered questionnaire at three points. Nurses' belief in the value of EBP for practice was high prior to the programme and did not change subsequently. There was an improvement following the intervention in nurses' attitudes to organizational support for EBP and their perceptions of their knowledge and skills in locating and evaluating research reports. Providing educational courses in a clinical setting is useful in improving clinicians' attitudes to and perceptions of knowledge and skills related to EBP.     

Children's nurses and nurse prescribing: a case study identifying issues for developing training programmes in the UK

Aims and objectives. (1) To develop an insight into the opportunities and barriers to nurse prescribing for a case study of children's nurses. (2) To consider the implications of independent nurse prescribing for children's nurses and the potential for nurse prescribing to be developed in acute children's care settings. (3) To use research data to develop a training strategy. Background. Nurse prescribing in the UK is evolving and current initiatives aim to extend the range and scope of prescribing. Children's nursing presents interesting challenges because of off‐license drugs. Successful nurse prescribing lies in practice area preparation, local policy and practice development and identifying precourse training needs. Design. Case study. Research questions. (1) What opportunities do children's nurses identify as being appropriate for nurse prescribing? (2) Can children's nurses identify the benefits of patient group directives and the different levels of nurse prescribing? (3) What preparation do children's nurses need for nurse prescribing? Methods. Focus group of health visitors/district nurses to inform a survey of 500 nurses working in acute and specialist care settings in a large Children's Hospital. Results. Focus group main themes – training, supervision and the development of confidence, record keeping, benefits of nurse prescribing, autonomous practice, the formulary and its use in practice. Response rate was 27%. Senior nurses and specialists identified potential benefits for their practice. Course content needed to focus on children, i.e. children's physiology and pharmokinetics. Children's nurses frequently advise junior medical colleagues on prescribing issues. Patient group directives are a useful alternative to prescribing. Conclusions. The results provide an insight into the training needs of children's nurses and specialist nurses which may be used to develop nurse prescribing training and practice. Training may need to be targeted at senior nurses/specialist nurses initially to develop a critical mass to change organizational culture. Relevance to clinical practice. Pertinent for senior nurses responsible for developing children's nursing practice and services for children in acute settings.     

Clinical nurse specialists as entrepreneurs: constrained or liberated

Aims. This qualitative study explored the experiences of two groups of clinical nurse specialists – continence advisors and tissue viability nurses – working in primary care in the UK. In particular, the study focused on how clinical nurse specialists’ relationships with other health‐care professionals had an impact on their role. Background. Clinical nurse specialists are recognized worldwide as having expertise in a given field, which they use to develop the practice of others. Additionally, clinical nurse specialists share many of the characteristics of entrepreneurs, which they use to develop services related to their speciality. However, little research has been conducted in relation to clinical nurse specialists’ experiences as they attempt to diversify nursing practice. Design/methods. An ethnographic approach was adopted comprising many elements of Glaserian grounded theory. Data were collected via participant observation and face‐to‐face interviews with 22 clinical nurse specialists. Findings. Services provided by clinical nurse specialists were not static, clinical nurse specialists being the main drivers for service developments. However, clinical nurse specialists encountered difficulties when introducing new ideas. Given their role as advisors, clinical nurse specialists lacked authority to bring about change and were dependent on a number of mechanisms to bring about change, including ‘cultivating relationships’ with more powerful others, most notably the speciality consultant. Conclusions. The UK government has pledged to ‘liberate the talents of nurses’ so that their skills can be used to progress patient services. This study highlights the fact that a lack of collaborative working practices between health‐care professionals led to clinical nurse specialists being constrained. Relevance to clinical practice. Health‐care organizations need to provide an environment in which the entrepreneurial skills of clinical nurse specialists may be capitalized on. In the absence of an outlet for their ideas regarding service developments, clinical nurse specialists may remain dependent on the mechanisms witnessed in this study for some time.     

Research utilization and clinical nurse educators: A systematic review

Background Clinical nurse educators and other linking agents such as clinical nurse specialists, advanced nurse practitioners, and nurses working in research leadership positions are an important link in the facilitation of evidence‐based practice in health care organizations. Aim The purpose of this paper is to report the findings of a systematic review of the literature regarding clinical nurse educators and research utilization, using the Promoting Action on Research Implementation in Health Services framework as a backdrop for the analysis. Findings There is a positive relationship between research utilization and attitude toward research, higher levels of education, and reading professional nursing journals among clinical nurse educators. The authors suggest that not all clinical nurse educators have the necessary critical appraisal skills and research knowledge to use research effectively in practice. Conclusions Few studies have examined clinical nurse educators and the determinants of their research utilization behaviour in clinical practice. Future research on clinical nurse educators needs to focus on the outcomes of research utilization, including the effectiveness of their role as facilitators and the contexts in which they practice.     

How can we maximize nursing students’ learning about research evidence and utilization in undergraduate,preregistration programmes? A discussion paper

Aim. This article presents a discussion on how to maximize nursing students’ learning about research for evidence‐based practice in undergraduate, preregistration programmes. Background. Evidence‐based practice may use information from many sources, including research. Research utilization concerns the translation of research findings into practice. Thus, while evidence‐base practice may not be solely research‐based and hence more than research utilization, research remains an important ingredient in ensuring quality and cost‐effective care and an academic requirement for nursing students undertaking a science degree‐level qualification. Nevertheless, how educators can best support research‐related learning and application remains uncertain and requires discussion. Data sources. MEDLINE, CINAHL, Social Science Citation Index, British Nursing Index, and Intute were searched for papers published 1980–2011 using the following search terms: research, research utilization, evidence‐based practice, learning, teaching, education, training, nursing, health, and social care. Discussion. Nursing students need to be able to value the relevance, authority, and utility of nursing research for patient care through embedding research learning in both academic and practice‐based settings. Students can be supported in learning how to access, understand, and appraise the authority of research through weaving these skills into enquiry‐based learning. Furthermore, encouraging students to undertake research‐based practice change projects can support research utilization and development skills. Conclusion. Research should be fully embedded throughout nursing curricula beyond the confines of ‘research classes’, integrating learning in academic and practice‐based settings. Although this requires synergistic and integrated support of student learning by nurse educators, managers, clinical practitioners, researchers and policymakers; nurse educators have a pivotal role.     

What is the relationship between nurses’ attitude to evidence based practice and the selection of wound care procedures?

Aim. To investigate qualified nurses’ attitudes to evidence‐based practice and whether this influenced their selection of wound care products. Background. The literature shows that previous studies on attitudes to evidence‐based practice tended to be part of a wider study. The general consensus was that there was a positive attitude to evidence‐based practice. However, there appeared to be no published studies specifically addressing nurses’ attitudes to evidence‐based wound care. Design. Survey design using a questionnaire completed by 156 qualified nurses working in three UK National Health Trusts. Results. A statistically significant difference was seen between those nurses with a tissue viability link nurse role (p = 0·002) and those without a link nurse role; those educated to first degree (p < 0·001) and those without a first degree; and those who had received formal tissue viability training (p < 0·001) and those with informal tissue viability training. There was also a highly statistically significant relationship between the clinical grade of staff and the overall attitude to evidence‐based practice (p < 0·001). Conclusions. Nurses who had attained a higher level academic qualification, had a tissue viability link nurse role and those who had received formal tissue viability training scored generally higher in the wound care knowledge tests and in attitude to evidence‐based practice. Relevance to clinical practice. The care received by patients in relation to wound care could be dependent upon factors that are related to the individual characteristics of the nurse providing the care and these factors, in turn, are related to education and training with respect to wound care. Better general education and better specific training in wound care could lead to better wound care.     

临床护理专家对高职护理教育的看法与建议

目的调查临床护理专家对高职护理教育的看法和建议,为构建基于岗位胜任力的高职护理课程体系提供依据。方法应用行为事件访谈法,对浙江省8所三级甲等医院的15名临床护理专家进行访谈。结果专家认为毕业1⁵年的低年资护士存在工作责任心不强、主动学习意识欠缺、专科护理知识缺乏等问题。与本科生相比,高职护理毕业生的优点是操作技能强、培养成本低,但理论知识不强、可持续发展能力不足。临床护理专家从师资队伍建设、教学内容、教学方法和考核方法等方面对护理教育提出了建议。结论临床护理专家对护理教育的意见和建议不仅为高职护理专业课程体系设置提供了依据,对护理教育教学改革也具有借鉴意义。     

Stroke unit Nurse Managers' views of individual and organizational factors liable to influence evidence‐based practice: A survey

The uptake of evidence into practice may be impeded or facilitated by individual and organizational factors within the local context. This study investigated Nurse Managers of New South Wales, Australia, stroke units (n = 19) in their views on: leadership ability (measured by the Leadership Practices Inventory), organizational learning (measured by the Organizational Learning Survey), attitudes and beliefs towards evidence‐based practice (EBP) and readiness for change. Overall Nurse Managers reported high‐level leadership skills and a culture of learning. Nurse Managers' attitude towards EBP was positive, although nursing colleague's attitudes were perceived as less positive. Nurse Managers agreed that implementing evidence in practice places additional demands on staff; and almost half (n = 9, 47%) reported that resources were not available for evidence implementation. The findings indicate that key persons responsible for evidence implementation are not allocated sufficient time to coordinate and implement guidelines into practice. The findings suggest that barriers to evidence uptake, including insufficient resources and time constraints, identified by Nurse Managers in this study are not likely to be unique to stroke units. Furthermore, Nurse Managers may be unable to address these organizational barriers (i.e. lack of resources) and thus provide all the components necessary to implement EBP.     

护理人员循证护理知识、态度、行为、技能调查研究

目的；调查了解护理人员循证护理知识、态度、行为、技能状况，为临床开展护理人员的相关培训和循证护理教育的方向及管理灾践提供理论依据。方法：在参考国内外文献基础上自行设计调查问卷，对广州市5所医院的101名护理人员进行循证护理知识、态度、行为、技能状况调查。结果：63．7％的护理人员熟悉循证护理知识（人群集中在本科学历以上的护理人员），31．5％的护理人员对循证护理知识有一定的了解，只有4.8％的护理人员对循证护理一无所知；97．5％的护理人员对循证护理具有正向态度；护理人员的循证护理技能掌握较好的占18.4％，大部分人（58．3％）对检索知识、在实施循证护理过程与患者的沟通能力掌握较好，但在评价研究质量的优劣、决策能力技能方面能力不自信；20．80％的护理人员具有主动寻找解决问题的行为，而且集中在职称较高的人群；56．1％的护理人员会利用业余时间通过互联网获取需求知识，但有23．1％的护理人员墨守成规。结论：护理人员均对开展循证护理具有支持与正向的态度，但相当一部分护理人员对循证护理知识缺乏。     

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.     

安徽省急诊急救专科护士工作现状调查与思考

目的:了解安徽省急诊急救专科护士的工作现状,为完善专科护士培养制度,加强专科护士使用与管理提供参考依据。方法:采用自行设计的调查问卷,对经安徽省急诊急救专科护士培训基地培训并取得资格的92名急诊急救专科护士的工作现状进行调查。结果:①92名急诊急救专科护士中有6名已离开急救护理岗位,离岗率为5.71%。②22名(34.78%)专科护士担任护士长职务,其中有20名是培训后升为护士长职务的,角色改变率为21.74%。③专科护士在教学方面发挥了较多的作用,但在急救技能、抢救流程、转运模式、各种规范的修订与完善、院外急救知识培训等高级临床实践方面作用发挥得不明显。④护士缺编、护士未分层次使用、职责不明确是影响专科护士核心能力发挥的主要因素。⑤经培训后,专科护士查阅文献和科研能力提高。⑥100%专科护士认为需要得到管理层支持和经常参加学术会议以促进其核心能力持续养成。结论:发挥专科护士高级临床护理实践作用,科学地使用专科护士,加强专科护士岗位管理,进行资格再认证,真正使专科护士学有所用,是目前面临的亟待解决的问题。     

不同职称护士对临床护理专家认知比较

目的:了解三级甲等医院护士对临床护理专家的认知状况。方法:采用自设问卷对北京市4家三级甲等教学医院护士进行调查,内容包括临床护理专家的临床工作、管理、科研及教学4种基本能力。结果:被调查的2038名护士中,护士和护师注重基本技术操作能力、社会活动能力、协调能力和组织指挥能力;主管护师更注重解决问题的能力;不同职称护士对科研能力和教学能力认识无差异。结论:不同职称护士对临床护理专家的认识有差异。     

Conceptions of evidence, evidence-based medicine, evidence-based practice and their use in nursing: independent nurse prescribers' views

Aim. The purpose of this study was to explore nurses’ conceptions of evidence and evidence‐based practice, whether there are differences between evidence‐based practice and evidence‐based medicine and to identify the uptake of research evidence in the workplace. Background. The use and comprehension of the term ‘evidence‐based practice’ in relation to nursing shows remarkable variation. Numerous definitions are provided, some tend to be closely related to the concept ‘evidence‐based medicine’. Independent nurse prescribers need to be able to understand the concept of evidence‐based practice to utilize and apply this concept in order to provide adequate medication management of their patients. Method. Data were generated by focus group interview and open question questionnaire and analysed by analytical abstraction. Results. Nurses offered a variety of views on the use and uptake of evidence in the workplace. Some nurses acknowledged that they did not read research papers but were aware that they used a lot of evidence in their practice. Nurses had difficulty differentiating evidence‐based practice from evidence‐based medicine. Conclusions. Nurses were familiar with the research process but not the canons of evidenced‐based practice. The data generated indicate different levels of evidence are used by nurses. This may be a reflection of the level of intrigue of the nurses involved. Relevance to clinical practice. The education and training of independent nurse prescribers should include the exploration of evidence from randomized controlled trials and from naturalistic studies and their contribution to evidenced‐based practice and evidence‐based medicine. Both concepts need to be explored in relation to the medication management of patients.