Effects of the Educational Leadership of Nursing Unit Managers on Team Effectiveness: Mediating Effects of Organizational Communication

Purpose

This study identifies the effects of the educational leadership of nursing unit managers on team effectiveness and the mediating effects of organizational communication satisfaction; it highlights the importance of educational leadership and organizational communication and provides the data needed to enhance the education capacity of managers.

开展监护室专科护士临床实践对普通护士核心能力的影响

目的 通过开展监护室专科护士临床实践,比较实践前后监护室普通护士的核心能力得分情况,来了解监护室专科护士临床实践对普通护士核心能力产生的影响。方法 以整群抽样法选择上海中山医院外科监护室60名普通护士为实验组、肝外科监护室60名普通护士为对照组,在外科监护室中开展专科护士临床实践,于实践前后分别对两组进行核心能力测评,比较分析两组在实践前后核心能力的得分情况。结果 实践前,两组核心能力得分在各维度上差异无统计学意义(P>0.05)。实践后,实验组在核心能力各个维度的得分均有提升,且高于对照组,差异有统计学意义(P<0.05)。结论 开展监护室专科护士临床实践可以有效提高普通护士的核心能力。     

Factors influencing secondary care pharmacist and nurse independent prescribers’ clinical reasoning: An interprofessional analysis

In the United Kingdom, pharmacist and nurse independent prescribers are responsible for both the clinical assessment of and prescribing for patients. Prescribing is a complex skill that entails the application of knowledge, skills, and clinical reasoning to arrive at a clinically appropriate decision. Decision-making is influenced and informed by many factors. This study, the first of its kind, explores what factors influence pharmacist and nurse independent prescribers during the process of clinical reasoning. A think-aloud methodology immediately followed by a semi-structured interview was conducted with 11 active nurse and 10 pharmacist independent prescribers working in secondary care. Each participant was presented with validated clinical vignettes for the think-aloud stage. Participants chose the clinical therapeutic areas for the vignettes, based on their self-perceived competencies. Data were audio-recorded, transcribed verbatim, and a constant-comparative approach was used for analysis. Influences on clinical reasoning were broadly categorised into themes: social interaction, intrinsic, and contextual factors. These themes showed that intrinsic, sociocultural, and contextual aspects heavily influenced the clinical reasoning processes of prescribers. For example, prescribers were aware of treatment pathways, but chose to refer patient cases to avoid making the final prescribing decision. Exploration of this behaviour in the interviews revealed that previous experience and attitudes such as confidence and cautiousness associated with responsibility were strong influencers within the decision-making process. In addition, strengthening the professional identity of prescribers could be achieved through collaborative work with interprofessional healthcare teams to orient their professional practice from within the profession. Findings from this study can be used to inform the education, training, and practice of independent prescribers to improve healthcare services by improving their professional and interprofessional development.     

Perception of nurse prescribing among nurses and psychiatrists in a developing country: A cross‐sectional survey

Nurse prescribing has the potential to improve patients’ access to, and experiences of, treatment. The aim of the present study was to examine nurse and psychiatrist attitudes about this extended role in a developing country. We conducted a cross‐sectional survey using a previously‐used, 65‐item, seven subscale measure of attitudes to nurse prescribing in mental health. We achieved a 79% response rate. The majority of participants had trained in developing countries where nurse prescribing has yet to be implemented. Across five subscales (general beliefs, impact, uses, training, and supervision), both groups reported positive attitudes about nurse prescribing. Both groups scored the training subscale particularly highly. Compared with psychiatrists, nurses were more confident about the range of clinical settings where nurse prescribing could be applied (e.g. acute inpatient and substance use). Although both groups had less favourable attitudes on the two subscales relating to clinical and legal responsibility, compared to nurses, psychiatrists were more undesirable. Although, overall, clinician attitudes do not seem to represent a barrier towards the potential implementation of nurse prescribing in the study setting, clarity about clinical and legal responsibility needs to be addressed.     

Self-care in Heart Failure Hospital Discharge Instructions—Differences Between Nurse Practitioner and Physician Providers

Patients with heart failure (HF) are at risk for frequent readmission potentially due to self-care deficits. Medical doctors (MDs) and nurse practitioners (NPs) both provide discharge instructions. However, each type of provider may emphasize different elements of care. The aim of this study was to analyze and compare the content of the documentation of 50 discharge instructions of heart failure patients written by NPs and MDs. Compared with MDs, NPs placed greater emphasis on symptom identification, and were more likely to advise and schedule follow-up appointments with primary care and cardiology providers rather than advising an appointment was needed without scheduling one.     

A National Study of Australian Nurse Practitioners’ Organizational Practice Environment

The nurse practitioner (NP) workforce in Australia plays a vital role in helping the country meet the current demand for health care. Data from Australian NPs using the Nurse Practitioner Primary Care Organizational Climate Questionnaire demonstrated that one-seventh of the overall Australian NP population completed the study. The response was overwhelmingly positive in the area of practice; 71.6% of NPs had no restriction on their practice and felt valued by their organization. The results of this study enable a benchmark for ongoing national evaluations in addition to international comparative data.     

A New Approach for Solving an Old Problem in Nurse Practitioner Clinical Education

Increasing enrollment in nurse practitioner programs to meet the current demand for primary care providers is a major focus of schools of nursing across the United States. Competition with other schools for clinical sites and a labor-intensive 1:1 preceptor/student education model limit the number of sites available for educational experiences. This article explains some of the barriers to obtaining clinical sites and how 1 school changed clinical education.     

HIV Primary Care Curriculum Improves HIV Knowledge,Confidence and Attitudes

To meet the goals of the National HIV/AIDS Strategy and the need for a human immunodeficiency virus (HIV)-competent primary care workforce, education and training of nurse practitioners are critical. The University of California, San Francisco School of Nursing developed and implemented an HIV primary care curriculum and evaluated this curriculum for a graduating cohort of 55 students. Results show gains in students’ HIV knowledge and confidence in providing basic HIV care and improvements in attitudes toward people living with HIV. We have been able to show that HIV content can be successfully integrated into a nurse practitioner generalist curriculum.