A Tool to Teach and Assess Clinical Nurse Specialist Student Prescribing Competency: A Pilot Study.

PURPOSE/AIMS: The purpose of this study was to assess the usefulness of a tool designed to develop and evaluate clinical nurse specialist (CNS) student competency and confidence in prescribing therapeutic agents. Specifically, the aims were to identify students' perceptions of the tool's (1) helpfulness in learning to prescribe, (2) impact on confidence as a prescriber, and (3) recommended use in CNS education. DESIGN: An exploratory design was used. METHODS: Students used the tool in patient care with a supervising mentor during clinical rotations. Students completed surveys after using the tool at 2 points in time. Data were analyzed using descriptive statistics. RESULTS: Of the 18 students, 5 students completed the survey at time 1 and 6 students at time 2. The aims were met in that students perceived the tool to be helpful during CNS prescribing activities, felt confident about prescribing after using the tool, and agreed the tool should be used in CNS education. CONCLUSION: Replication of the study with larger samples of CNS students and psychometric analyses of the tool is recommended by the study's findings to support its use in CNS education beyond the study site.

Leading the Next Generation of Clinical Nurse Specialists: NACNS Response to the 2022 CNS Census Survey.

Acting on the 2022 Clinical Nurse Specialist (CNS) census results, the National Association of Clinical Nurse Specialists (NACNS) launched a robust response. In this column, the President of NACNS highlights key survey findings and strategic initiatives to modernize the CNS scope of practice and lead the next generation of CNSs to strong impact on patient and nursing care outcomes.

Credentialed and Privileged Clinical Nurse Specialists.

PURPOSE/OBJECTIVES: The purpose of this article is to illustrate, using exemplars, the practice of clinical nurse specialists (CNSs) in Michigan who are credentialed and privileged as providers by hospital/healthcare agencies to practice in acute inpatient and ambulatory settings. DESCRIPTION: The CNS provides expert specialty direct patient care to improve patient outcomes. They hold a graduate degree as a CNS, are professionally certified as a CNS in a specialty practice population, and are licensed or otherwise recognized to practice as an advanced practice nurse by the state nursing practice regulatory agency. OUTCOME: The exemplars illustrate CNS practice as an independent provider within a health system. CONCLUSION: Hospital-based credentialing and privileging facilitates CNS practice within the full scope of practice authority that consists of education, certification, and licensure and is a valuable contribution to cost-effective, high-quality clinical care for specialty populations.

The Clinical Nurse Specialist.

These APRNs improve the workflow of nurses in health care systems.

Informing and Supporting the New Clinical Nurse Specialist Prescriber.

Advanced practice registered nurses (APRNs) in the United States are trained to diagnose and treat disease and illness, hence, to prescribe. Of the APRN roles, the clinical nurse specialist (CNS) is the least likely to prescribe. Prescribing is one of many advanced care interventions performed by CNSs, but the statutes regarding prescriptive authority are constantly changing. The purpose of this article is to inform and support the new CNS prescriber. The article reviews CNS prescribing, credentialing and privileging, safety strategies, and educational considerations that influence CNS prescribing and offers current recommendations for new CNS prescribers. Clinical nurse specialist prescribing can enhance the patient care experience and fill unmet prescriptive needs for patients. Overall, more reports on the outcomes of CNS prescribing are urgently needed, specifically, publications on CNS prescribing in acute care, where most CNSs practice.

The Transition From Spousal Caregiver to Widowhood: Quantitative Findings of a Mixed-Methods Study.

BACKGROUND: The number of persons diagnosed with dementia is projected to triple to 14 million by 2050. The significance of these projections is particularly relevant to older women (>65 years), who are more likely to provide dementia caregiving for a husband than vice versa. Research has identified consistent themes around the impact of caregiving during the caregiving experience, yet there is limited research exploring the ongoing impact during the transition to widowhood. Moreover, there is a paucity of research examining differences between rural and urban spousal dementia caregivers. AIMS: The aims were to compare differences between older rural and urban spousal caregivers on physical and mental health factors affecting the transition from caregiver to widow and to identify resources the women used during this transition over 12 months. METHOD: This mixed-methods longitudinal study recruited 13 urban and nine rural female spousal caregivers. Participants were interviewed three times over 12 months. The dependent variables were depression (measured using Center for Epidemiologic Studies Depression Scale), physical and mental functioning (measured using the 12-item Medical Outcomes Study-Short Form Health Survey Version 2). RESULTS: No statistically significant differences were detected between rural and urban female caregivers on the dependent variables. However, rural caregivers scored higher on depression and lower on both physical and mental functioning compared to their urban counterparts. CONCLUSIONS: The findings have clinical and research implications. Psychiatric nurses are well positioned to provide education related to dementia information deficits; implement interventions that facilitate bereavement, resilience, self-care, and identity; advocate for additional services; and conduct larger scale studies with a more diverse sample of female spousal caregivers.

Spousal Dementia Caregiving to Widowhood: Perceptions of Older Urban and Rural Widows.

Older widows might experience poor health outcomes following their spousal dementia caregiving experience. Widows from rural areas with fewer resources may have worse health outcomes. Serial, qualitative interviews were conducted at baseline, 6-months and 12-months with 13 urban and nine rural older widows who cared for husbands with dementia. Perceptions of caregiving, widowhood, and resources were examined. Major themes were 24/7 Care, Watch the Man Go Down, Build a Network, Spiritual Support, No Regrets/Some Regrets, Time for Me Now, Loneliness, and Keep Reaching In. Compared to urban widows, rural widows had fewer emotional and tangible resources. All widows desired more support during spousal dementia caregiving and in their transition to widowhood. Nurses need to continue to support the transition from spousal dementia caregiving to widowhood and to test interventions unique to meeting the needs of urban and rural older women.

Students' Perceptions of a Poem to Evaluate Learning: A Qualitative Study.

BACKGROUND: How best to use poetry in nursing education remains uncertain. This study explored students' perceptions of incorporating a poem into a final examination to evaluate learning in an advanced physical assessment course. METHOD: Qualitative design and method were used to collect and analyze data retrieved from private interviews with seven graduate nursing students. RESULTS: The themes were Being There, Think More, and Feeling Rushed. Students recommended the strategy as a measure of learning because it simulated a real patient encounter and made them think at a deeper level than other traditional approaches used to evaluating learning. CONCLUSION: Poetry might engage nursing students in thinking critically and compassionately and be closer in touch with real-time nursing care than other traditionally used methods to evaluate nursing practice. More research is needed to validate poetry's best fit in nursing curricula. [J Nurs Educ. 2017;56(10):628-632.].

Clinical Nurse Specialist Perceptions' of Spiritual Care: Nurses Need Support, Care Falls Short.

The clinical nurse specialist (CNS) is positioned to influence spiritual care at three levels of practice: patient, nurse, and system. This study, the first to explore CNS spiritual care, reports on CNSs' perceptions in providing spiritual care. Four themes were extracted from interview data: 1) Providing direct spiritual support for patients, 2) Nurses need support in providing spiritual care, 3) Using existing resources, and 4) Spiritual care falls short. Not one CNS mentioned barriers to their direct provision of spiritual care. Results support that CNSs can improve spiritual care delivery.

Clinical Nurse Specialists' Perceptions of Care for Vulnerable Patients.

The vulnerable and underserved are populations that have higher risks in health care. A clinical nurse specialist is an advanced practice registered nurse who can help mitigate risks and provide holistic care for these patients. Researching clinical nurse specialists' perceptions of their role in caring for the vulnerable populations is important to ensuring quality care and filling in current practice weaknesses.

Hospital Admissions for Malnutrition and Dehydration in Patients With Dementia.

Dehydration and malnutrition are commonly experienced by patients with dementia and can result in hospitalizations and decreased quality of life. The purpose of this study was to explore and describe retrospectively, the incidence and correlations of variables that may precede hospitalizations for dehydration/malnutrition in the community-dwelling patient with dementia. Data from the Outcome and Assessment Information Set (OASIS) Start of Care (SOC) on 44 patients served by a Michigan home care agency were retrieved for analysis. This study did not reveal any single or collection of variables that would predict risk for hospitalization for dehydration/malnutrition. With the lack of specific predictors of hospitalization related to dehydration and malnutrition, clinicians need to place high priority on risk-lowering strategies and preventive education for patients, family, and caregivers.

Using Poetry Writing and Sharing to Promote Student Empathy and Caring.

A poetry writing activity revealed both empathy and caring among nursing students. Using course readings to identify a topic, students created and shared their poems in an online format. The poems and students' reactions concur with existing literature that poetry writing and sharing reveals empathy and caring. Suggestions for using a poetry writing activity in nursing education are included.

Clinical nurse specialists' perceptions of work patterns, outcomes, desires, and emerging trends.

OBJECTIVE: This study explored clinical nurse specialists' (CNSs') perceptions of work patterns, outcomes, desires, and emerging trends in practice. BACKGROUND: Clinical nurse specialists transform patient care toward high-quality, cost-effective outcomes, but the role includes multiple dimensions contributing to role confusion. METHODS: Using qualitative methods, 12 CNSs were interviewed for perceptions of their role in healthcare today. Data reduction and confirmability strategies were used in data analysis. RESULTS: Work patterns included office activities, patient rounds, working with nurses, attending meetings, and supporting quality improvement initiatives. Outcomes included safer patient care, getting patients the resources they need, transforming nurses, and meeting the quality metrics. An emerging trend was increased involvement in research. CONCLUSIONS: Clinical nurse specialists perceive the role to be important in driving change and transforming nursing care towards high-quality clinical outcomes.

Perspectives from family caregivers receiving home nursing support: findings from a qualitative study of home care patients with heart failure.

Many heart failure (HF) patients depend on a family caregiver and many families need additional home care nursing support. This qualitative study identified perspectives of being a HF caregiver for families receiving home care nursing. Eleven caregivers of homebound HF patients were interviewed on what helps them the most, their own health, obstacles in caregiving, and greatest needs overall. Eight themes emerged and will be discussed in this article. The findings articulate the positive influence nurses can have on HF families to guide future practice and research.