Leadership and the Clinical Nurse Specialist: From Traditional to Contemporary

The role of the clinical nurse specialist (CNS) is multidimensional. Although clinical expertise is the central core of the CNS role, the aspect of leadership is pivotal to effecting change in practice. Recently, the National Association of Clinical Nurse Specialists has redefined the role by spheres of influence and core competencies. Still, clinical expertise is central. This article highlights challenges as well as rewards in the CNS role. In addition, an example of entrepreneurial endeavors for the CNS is presented.     

The Fetal Patient: Coordinated Care for Families

Complete and accurate knowledge is critical to parent decision making for families with complex and/or life-threatening fetal conditions. Comprehensive fetal centers are available to provide multidisciplinary specialized assessment, evaluation, diagnosis, and nondirectional counseling. Interventional option may include fetoscopic procedures, open fetal surgery, and ex utero intrapartum treatment. The nurse coordinator serves as the family and health care provider liaison for arrangement of services and communication of the plan of care.     

Palliative or Hospice Care? Understanding the Similarities and Differences

With advances in health care and medical technology, the focus of medical care has been on curing. As people live longer, the possibility of experiencing chronic and life‐limiting disease not only increases but also spurs the ethical question “Is length of life or quality of life most important?” Palliative care may be confused with hospice care, as both focus on symptom management and improved quality of life for those with chronic life‐limiting disease. A better understanding of each healthcare option is needed for appropriate and timely patient referral. The purpose of this article is to identify the similarities and differences between these two options, clarify when referral is appropriate for hospice or palliative care services, and discuss the nurse's role in caring for patients with chronic disease.