Implementing family-centred care: an exploration of the beliefs and practices of paediatric nurses.

OBJECTIVE: This study explored paediatric nurses' perceptions of how they include and involve parents in the care of hospitalised children. DESIGN: This qualitative study used individual unstructured interviews to gather data, the data was analysed using thematic coding. SETTING: Paediatric wards within two regional area health services of New South Wales, Australia. SUBJECTS: Fourteen paediatric nurses were asked to describe their beliefs and practices regarding the clinical application of family-centred care. MAIN OUTCOME MEASURE: Paediatric nurses' beliefs and practices about family-centred care were explored in an effort to explain how the concept was implemented. RESULTS: The findings are presented as four interconnected themes. The first describes how participants either allocated tasks to parents or retained them, the second relates to the nurses' professional identity, the third theme identifies barriers and constraints to the implementation of family-centred care, while the fourth describes the nurses' beliefs about their responsibilities when delivering family-centred care. CONCLUSIONS: Together these findings suggest that while nurses endorse the concept of family-centred care, the implementation into practice is more problematic. While it is not possible to generalise these findings to other paediatric nurses, the authors believe the insight gained will resonate with paediatric nurses internationally. The findings from this study are being used as the basis for the development of clinical practice guidelines to assist paediatric nurses to more consistently apply the concepts of family-centred care to their practice.     

Teaching nurses to focus on the health needs of populations: a Master's Degree Program in Population Health Nursing

Responding to the mandate to prepare nurses for practice in population-based healthcare, the faculty at Cleveland State University (CSU) developed a unique Master of Science in Nursing program to prepare Population Health Nurse Experts. The program prepares nurses to examine the health status of populations and to design, implement, and evaluate nursing interventions accounting for the varied factors impacting on the health of a defined group. The speciality of population health nursing is practiced by nurses who can use population sciences (epidemiology, demography, population projections, and population behavioral theories) along with post-baccalaureate nursing competencies to work with defined populations across care environments. The authors discuss a curriculum that prepares nurses for this emerging speciality.     

Journal club in a critical care unit: an innovative design triggering learning through reading and dialogue

Journal club has been used for decades to incorporate reading clinical and research articles into professional practice of numerous health care providers to disseminate knowledge and to bridge the gap between research and clinical practice. In this article, the authors describe how such activity was implemented by and for the nursing team of an intensive care unit. This journal club was designed to trigger dialogue among the nurses related to cardiac surgery topics, while providing an organizational support for them aimed to facilitate the incorporation of reading in their professional habits. More specifically, the design of this journal club was intended to create an opportunity for these nurses to keep their practice updated, to review physiological or pathological processes related to the cardiac surgery population, and to explore if how and why the results described in those research reports should be implemented in their own intensive care unit. The authors describe the phases of this project: the co-development of the journal club, the implementation of the activity and its results. The authors detail how this journal club format incorporated additional teaching aids during each session and used narrative pedagogy as a conceptual framework.     

Using Implementation Science in Nursing Research

ObjectivesClinical research continues to build knowledge that can potentially improve clinical and health service outcomes; however, integrating evidence into routine care is challenging, resulting in a knowledge practice gap. The field of implementation science is a resource available for nurses to translate evidence into their practice. This article aims to provide nurses with an overview of implementation science, illustrate its value integrating evidence into practice, and show how it can be applied with high rigor in nursing research practice.Data SourcesA narrative synthesis of the implementation science literature was conducted. A series of case studies were purposively selected to demonstrate the application of commonly used implementation theories, models, and frameworks across health care settings relevant to nursing. These case studies demonstrate how the theoretical framework was applied and how the outcomes of the work reduced the knowledge practice gap.ConclusionImplementation science theoretical approaches have been used by nurses and multidisciplinary teams to better understand the gap between knowledge and practice for better informed implementation. These can be used to understand the processes involved, identify the determinants at play, and undertake an effective evaluation.Implications for Nursing PracticeBy using implementation science research practice, nurses can also build a strong foundation of evidence about nursing clinical practice. As an approach, implementation science is practical and can optimize the valuable nursing resource.     

Implementing differentiated practice: the Sioux Valley Hospital experience

Historically, nurses with different levels of education have been used interchangeably in acute care hospitals. If nursing is going to be viewed as a preferred career choice and acute care hospitals are to retain staff, nurse administrators must provide a nursing practice model that differentiates scope of practice based on education. The authors discuss how they implemented a system of differentiated practice.     

Evidence-based practice: a practical approach to implementation

Organizations often do not have processes in place to support nurses through a systematic approach for developing and evaluating nursing interventions, protocols, critical pathways, and policies that are derived from scientific evidence. The development of a framework to guide inquiry will have a positive impact on patients. This process may foster a higher level of professional engagement by nurses that may, in the long-term, help improve nurse retention and recruitment. The authors discuss a nursing evidence-based practice model and guidelines that were developed by a team of hospital and academic nurse leaders and is practical and easy to use. This model has been successfully implemented across the department of nursing as a strategic initiative. Results of the implementation have shown that staff nurses can effectively use this model with the help of knowledgeable mentors.     

Interprofessional education: an essential strategy to accomplish the future of nursing goals

The Institute of Medicine's Future of Nursing report has called for broad changes in the nursing profession for the benefit of society. Interprofessional education is one strategy to improve nursing education and enhance the role of nurses as collaborative leaders in the health care system. These are important lessons that have been learned from recent interprofessional educational initiatives and some encouraging examples of successful initiatives that are breaking down barriers across professional schools. The ultimate beneficiary of these changes will be our patients, who will receive better care.     

Living with DRGs

Efforts to curb Medicare and health care costs have resulted in new systems of third-party reimbursements to hospitals. The authors examine how implementation of a new system in New Jersey is affecting nurses and nursing care in that state.     

Adherence to a Medication Safety Protocol: Current Practice for Labeling Medications and Solutions on the Sterile Field

Medication labeling omissions in the OR and the adverse events that result from them remain a challenge in health care facilities. Standardization of protocols based on guidance from the Joint Commission, AORN, the Institute for Safe Medication Practices, and other organizations is important to ensure that patients do not mistakenly receive the wrong medication. A clinical nurse specialist and a perioperative education coordinator at the Cleveland Clinic, Cleveland, Ohio, undertook a direct observation quality improvement project to assess the adherence of 21 nurses and 19 surgical technologists to a revised medication and solution labeling protocol implemented in February 2008. Results showed that overall, 70% of staff members adhered to the medication and solution labeling protocol but adherence varied among specialty areas. There was increased adherence to the protocol by junior staff members compared with more experienced staff members.     

Correctional Nursing Interventions for Incarcerated Persons with Mental Disorders: An Integrative Review

The authors explore the current state-of-the art of correctional nursing by summarizing the types of interventions employed by nurses, across studies, designed to assist this challenging group of patients. This examination of evidence-based interventions implemented and tested by correctional nurses provides a better understanding of their role and function. Correctional health is a nurse driven system, yet a minimal amount is known about the nurses who practice in these environments or about their contributions to the practice of mental health nursing in correctional environments. An integrative review utilizing PRISMA guidelines examined five databases (Medline/PubMed, PsycInfo, PsychArticles, Sage Criminology, and Academic Search) for peer-reviewed articles that fit selected criteria. Of 324 references identified, 16 studies met criteria. Following assessment of strength of evidence, only eight studies offered scientific proof of the effectiveness of nursing interventions. Nursing interventions implemented in correctional settings targeted incarcerated persons with behavioral and psychological symptoms. Interventions included psycho-education, environmental adaptations, and behavior therapies. The centrality of nurses in correctional health care emphasizes the significance of understanding their role and function in this setting. This integrative review revealed that correctional nurses are actively engaged in providing therapeutic, evidence-based interventions in the health care of incarcerated persons. Of interest, seven of the eight studies focused on incarcerated persons with mental health or substance use issues. Nurse led interventions such as CBT, labyrinth walking, and yoga aim to improve coping and adaptation of incarcerated persons.     

Nurses at the forefront of innovation

BACKGROUND: This paper is based on a presentation given by the author at the 23rd Quadrennial ICN Congress and 7th International Regulation Congress in Taipei in May 2005. AIM: Nurses worldwide are engaged in innovative practice on a daily basis. In most health systems across the world, nurses provide up to 80% of primary health care and are therefore well positioned to provide critically needed innovative solutions to many global health challenges. The aim of this paper is to increase awareness of the importance and value of innovations in nursing; provide an improved understanding of the contribution nurses make to innovation in health care; and increase understanding of the importance of creating environments that inspire innovation and help shape practice in new and improved ways. DESIGN: This paper explores the concept of innovation, the inherent set of characteristics that need to be present in order for innovations to succeed, and the barriers that impede innovation from occurring. CONCLUSION: There are numerous examples of successful innovations worldwide that are developed and implemented by nurses, some of which are described in this paper. The paper concludes that organizations need to have a support climate that encourages creativity and innovation to occur.     

The nursing strategy officer: a new and evolving role

As health systems have become more expansive, strategic and operational planning processes have become more complex. Enterprise-wide strategic plans now address a broad set of considerations that have significant impact across the organization, particularly nursing and patient care programs. Synchronous implementation of organizational strategies can be very challenging. Organizational capacity is constantly challenged with competing agendas. To drive the successful implementation of organization-wide strategies and optimize success, Cleveland Clinic Foundation established a new role modeled after other industry sectors, the Associate Chief Nurse for Strategic Planning. This article describes the genesis and focus of this new, important role.     

From expert to tasks,expert nursing practice redefined?

Aim. The aim of this paper was to explore the concept of expertise in nursing from the perspective of how it relates to current driving forces in health care in which it discusses the potential barriers to acceptance of nursing expertise in a climate in which quantification of value and cost containment run high on agendas. Background. Expert nursing practice can be argued to be central to high quality, holistic, individualized patient care. However, changes in government policy which have led to the inception of comprehensive guidelines or protocols of care are in danger of relegating the ‘expert nurse’ to being an icon of the past. Indeed, it could be argued that expert nurses are an expensive commodity within the nursing workforce. Consequently, with this change to the use of clinical guidelines, it calls into question how expert nursing practice will develop within this framework of care. Method. The article critically reviews the evidence related to the role of the Expert Nurse in an attempt to identify the key concepts and ideas, and how the inception of care protocols has implications for their role. Conclusion. Nursing expertise which focuses on the provision of individualized, holistic care and is based largely on intuitive decision making cannot, should not be reduced to being articulated in positivist terms. However, the dominant power and decision‐making focus in health care means that nurses must be confident in articulating the value of a concept which may be outside the scope of knowledge of those with whom they are debating. Relevance to clinical practice. The principles of abduction or fuzzy logic may be useful in assisting nurses to explain in terms which others can comprehend, the value of nursing expertise.     

Nursing interventions for sexual dysfunction: An integrative review for the psychiatric nurse

Sexual dysfunctions are prevalent disorders in psychiatric patients that too often are not addressed by psychiatric-mental health nurses. An integrative review was conducted using PubMed, Joanna Briggs Institute, SCOPUS, PsycINFO and CINAHL databases to evaluate the evidence for independent, nursing interventions for sexual dysfunction across all nursing literature that could be implemented by psychiatric-mental health nurses. Out of 2448 articles, nine papers met inclusion criteria and were synthesized. Best available evidence was found for sexual teaching interventions for female sexual dysfunction. The implications for psychiatric-mental health nursing practice and recommendations for future research are discussed.     

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.     

Effect of state regulatory environments on advanced psychiatric nursing practice

The first key message in the landmark Future of Nursing report is that “Nurses should practice to the full extent of their education and training” (Institute of Medicine, 2011). Although there has been significant progress across states to remove or diminish barriers to the exercise of full scope of practice by advanced practice registered nurses (APRN), state regulations continue to unnecessarily restrict APRN practice in most of the United States. This article integrates data from studies that examine how state and local regulation affects psychiatric mental health APRN practice with the literature on how state scope of practice regulation affects the size and distribution of the broader APRN workforce, access to care, health care costs and prices, and innovation in health care service delivery. Common themes include confusion about regulatory requirements and mixed experiences of mandated physician supervision.