The value of a post-graduate clinical placement for nursing students.

The importance of a clinical placement in graduate nursing programs has been recognized in the academic literature and in the advanced nursing practice workforce environment as being beneficial. During a placement, post-graduate students have opportunities to familiarize themselves with the Advanced Practice Nurse (APN) role and competencies, build networks, advance their personal and professional development, and validate their motivation and desire to pursue a particular professional area of advanced nursing practice. This paper describes reflections on a post-graduate clinical placement in palliative care, exercising the Canadian Nursing Association's (2019) APN competencies. Exposure to such a placement helps novice APNs develop a strategic and grounded advanced nursing practice foundation.

Evaluating Advanced Practice Nurses' Burnout and Potential Helping Modalities.

Health care providers are experiencing increased stress during the coronavirus disease 2019 pandemic. While it is understood that increased stress leads to burnout, limited research has been conducted to evaluate advance practice nurse response to coronavirus disease 2019, and more specifically, self-identified modalities that may decrease stress in the workplace or at home. This pilot study evaluated advance practice nurse-perceived burnout and evaluated perceived needs and/or perception of modalities aimed at reducing stress and improving well-being, such as essential oils, quiet room, soothing music, art therapy, pet therapy, and mobile applications, that could be easily accessed in the workplace.

The role of Doctor of Nursing Practice-prepared nurses in practice settings.

BACKGROUND: The role of the Doctor of Nursing Practice-prepared nurse (DNP) outside of academic settings has not been clearly articulated or widely explored, and therefore the value DNP-prepared nurses bring to their practice settings is largely unknown. This study: (1) surveyed existing DNP programs to identify the nonacademic settings in which their DNP graduates were employed and (2) conducted semistructured interviews with employers to identify the role and value of the DNP-prepared nurse in nonacademic settings. METHOD: Data were collected from January 2016 to August 2016 in two parts: (1) an online survey of the DNP programs and (2) qualitative semistructured telephone interviews with employers. First, we conducted an online survey of program directors (or their equivalent) from 288 DNP programs across the United States to capture descriptive information about current DNP programs (e.g., location, modality, profit status), the types of nonacademic institutions that hire their graduates, percentage of graduates employed by each setting, and the contact information for these employers. Employers were identified either by DNP program directors through the online survey or by a convenience sampling method. Using semistructured telephone interviews, we asked questions to employers in different care settings about the role of the DNP in these settings and how the DNP compares to other nurse leaders and advanced practice nurses (APRN). Employers were asked to describe the role of the DNP-prepared nurse working in direct patient care roles such as APRNs or as leaders, administrators, and managers. FINDINGS: Descriptive thematic analyses were derived from the interviews, to identify the roles DNP-prepared nurses filled and how they compared to other nurse leaders and advanced practice nurses in these settings. A total of 130 DNP program directors responded to the online survey. Twenty-three employers participated in semistructured telephone interviews. The thematic analysis resulted in four main themes regarding the role of the DNP-prepared nurse in non-academic settings: "DNP-Prepared Nurse Positions and Roles," "Perceived Impact of the DNP-Prepared Nurse on Staff, Patient, and Organizational Outcomes," "Comparison of the DNP-Prepared Nurse to Other Nurses With Advanced Training," and "Challenges Experienced by Nurses With DNP Degrees. DISCUSSION: The role of the DNP-prepared nurse in nonacademic settings is unclear. These DNP-prepared nurses typically function as APRNs in clinical care or as health care system leaders. While there is a low number of DNPs in clinical practice settings, the number is expected to grow as more graduate and enter practice. Thus, knowledge of the roles, value, and outcomes of the DNP-prepared nurse can guide practice setting leaders on how to best use DNP-prepared nurses in their setting.

["Advanced practice is founded on strong generic nursing care"]. / « La pratique avancée est fondée sur des soins infirmiers génériques forts ¼.

In the wake of legislation regulating advanced nursing practice in France, the first intake of student nurses entered university last autumn. These student nurses have at least three years of professional experience and will undertake a further two years of studies to obtain the master's level diploma in advanced nursing practice. In this context, a study highlights the issues of which French nurses must be mindful with regard to the implementation of advanced practice. Interview.

An interprofessional education programme for medical learners during a one-month palliative care rotation.

Interprofessional education in health care and in palliative care has been the focus of increasing attention in recent years. For health professionals to provide and deliver high-quality palliative care, collaboration and teamwork is required. Palliative care is the ideal service to introduce interprofessional teamwork to medical learners early on in their training. During a 1-month palliative care rotation in Ontario, Canada, medical learners completed a questionnaire seeking their feedback on the interprofessional team model. This article will highlight the results of the questionnaire, how the team promotes a culture of interprofessional collaborative practice, and the supportive structures that foster collaboration among professionals.

The role of a clinical nurse consultant in an Australian Health District: a quantitative survey.

BACKGROUND: This study replicates previous research undertaken in 2013 that explored the role of the Clinical Nurse Consultant in a metropolitan health district in Sydney, Australia. METHODS: A descriptive survey, using Likert scales, was used to collect data from Clinical Nurse Consultants. RESULTS: Clinical Nurse Consultants are well informed about the domains and functions of their role, as stipulated in the relevant award. They identified clinical service and consultancy as the area in which they predominantly practice. CONCLUSION: Despite the clarity of the domains and functions as outlined in the relevant legislated award, the activities undertaken by these clinical nurses are institutionally, individually and contextually constructed.

End of Life Outside of "Business Hours": A Retrospective Review Evaluating Time of Death and Provider Time at End of Life.

Introduction: Pediatric palliative care (PPC) benefits patients and families, while potentially creating emotional and resource-management burdens for providers. This study's purpose was to characterize the occurrence of deaths attended by PPC providers outside of "business hours." Methods:N = 786 PPC patients at a single center died between 2008 and 2015. Descriptive statistics were prepared for all variables (Wilcoxon rank-sum test for continuous; chi-square or Fisher's exact test for categorical). Results:N = 434 (55%) of deaths occurred outside of business hours; n = 332 (70%) were attended by PPC. Time spent attending a death was not significantly longer when other PPC providers were present but was when certain tasks were performed (coordination with medical examiner and memory making). Conclusion: The occurrence of the majority of deaths outside of business hours has significant implications for service delivery models, provider emotional health, and health care value.

A survey of moral distress in certified registered nurse anesthetists: A theoretical perspective for change in ethics education for advance practice nurses.

OBJECTIVE: The aim of this study was to examine the relationship between moral distress that may affect patient safety, and the clinical practice model, assessing ethical decision-making skills of certified registered nurse anesthetists (CRNAs). METHODS: A survey using the Ethical Stress Scale (ESS) and the Ethical Assessment Skills Survey (EASS) was conducted with 134 CRNAs. RESULTS: Results indicated no significant effect of practice model on level of moral distress or perceived ethical assessment skill knowledge [Wilks's lambda = 0.952, F (6, 256) = 1.068, P = 0.382, n 2  = 0.02]. A statistically significant positive correlation existed between importance and skill (r = 0.275, P = 0.001). CRNAs felt skilled to manage the actions or activities they deemed important. CONCLUSION: CRNAs who perceived a higher skill level in addressing ethical issues experienced lower levels of moral distress. Findings indicate content-specific curricula for the CRNAs need to be evaluated for ethical decision-making skill assessment content.

Quality Indicators of Primary Care Provider Engagement in Nursing Home Care.

The initiative described here aims to identify quality indicators (QIs) germane to the international practice of primary care providers (PCP) in post-acute and long-term care in order to demonstrate the added value of medical providers in nursing homes (NHs). A 7-member international team identified and adapted existing QIs to the AMDA competencies for medical providers. QI sources included the ACOVE 3 Quality Indicators (2007), NH Quality Indicators (2004), NH Residential Care Quality Indicators (2002), and AGS Choosing Wisely (2014). We recruited a technical expert panel (TEP) consisting of 11 panelists from the US, Canada, and the European Union, selected for their knowledge and leadership in post-acute and long-term care. The TEP, using a RAND Modified Delphi approach, provided pre-meeting ratings, discussed items in-person for clarification, and re-rated items following discussion. When panelists rated more than 1 option for a particular QI as valid and feasible, the most stringent option was selected for inclusion in the final candidate set of QIs. Panelists confidentially rated an initial 103 items on validity and feasibility of implementation. During the meeting, panelists added 18 QIs and modified 18. In post-meeting analysis, we eliminated 7 QIs rated not valid and 9 QIs for which a more stringent QI was rated valid and feasible. This resulted in a final set of 97 QIs rated valid and feasible and 8 rated valid but not feasible. This set of QIs for PCPs in the NH identified practices in which provider engagement adds value through expertise in geriatric syndromes, employing evidence-based practice, advocating for residents, delivering person-centered care, facilitating advance care planning, and communicating effectively to coordinate care. Next steps include pilot testing and evaluating the association between adherence to QIs, PCP staffing models, and better outcomes.

Partners in research: building academic-practice partnerships to educate and mentor advanced practice nurses.

RATIONALE: Clinical practice is the primary focus of advanced practice nursing (APN) roles. However, with unprecedented needs for health care reform and quality improvement (QI), health care administrators are seeking new ways to utilize all dimensions of APN expertise, especially related to research and evidence-based practice. International studies reveal research as the most underdeveloped and underutilized aspect of these roles. AIMS: To improve patient care by strengthening the capacity of advanced practice nurses to integrate research and evidence-based practice activities into their day-to-day practice. METHODS: An academic-practice partnership was created among hospital-based advanced practice nurses, nurse administrators, and APN researchers to create an innovative approach to educate and mentor advanced practice nurses in conducting point-of-care research, QI, or evidence-based practice projects to improve patient, provider, and/or system outcomes. A practice-based research course was delivered to 2 cohorts of advanced practice nurses using a range of teaching strategies including 1-to-1 academic mentorship. All participants completed self-report surveys before and after course delivery. RESULTS: Through participation in this initiative, advanced practice nurses enhanced their knowledge, skills, and confidence in the design, implementation, and/or evaluation of research, QI, and evidence-based practice activities. CONCLUSION: Evaluation of this initiative provides evidence of the acceptability and feasibility of academic-practice partnerships to educate and mentor point-of-care providers on how to lead, implement, and integrate research, QI and evidence-based activities into their practices.

Collaboration Between PNPs and School Nurses: Meeting the Complex Medical and Academic Needs of the Child With ADHD.

Pediatric nurse practitioners take a lead role in diagnosing and coordinating the care of children with attention deficit hyperactivity disorder (ADHD). School nurses offer rich insight into the child's health and social and academic functioning in the school setting. School nurses develop individualized health care plans, administer and monitor medications, provide valuable input on Individualized Education Plans and Section 504 Accommodation Plans, and serve as the point person in communicating with the medical provider. Pediatric nurse practitioners can enhance the collaboration with school nurses by establishing communication parameters, streamlining medication regimens, and facilitating development of educational curricula for school nurses regarding evidence-based ADHD management. Optimizing partnerships with school nurses will provide better surveillance of treatment efficacy and can facilitate improved health and academic and social outcomes for children with ADHD.

Essentials of noninvasive cardiac stress testing.

PURPOSE: To provide advanced practice nurses (APNs) with practice recommendations for noninvasive cardiac stress testing (NCST) to enhance diagnostic test selection and to improve the interpretation of the test results. DATA SOURCES: A review and synthesis of current scientific literature on noninvasive cardiac stress tests was conducted including a review of pertinent guidelines, indications, contraindications, procedures and findings of exercise, pharmacological, echocardiographic, and myocardial perfusion imaging studies. CONCLUSIONS: Noninvasive cardiac stress testing is an integral component in the care of men and women for the diagnosis, prognosis, and management of individuals at risk for cardiovascular conditions or with known histories of cardiovascular disorders. IMPLICATIONS FOR NPS: Cardiovascular disorders are common in our society. APNs care for a variety of individuals in the inpatient and outpatient settings that may require noninvasive cardiac stress tests for the evaluation of significant health histories and clinical presentations. An enhanced understanding of NCST improves test selection, preparation and education of patients, interpretation of test results, and implications for future patient care.