Experiences of the advanced nurse practitioner role in acute care.

The aim of the service evaluation presented in this article was to explore the multidisciplinary team's (MDT) experiences and perception of the advanced nurse practitioner (ANP) role on an acute health care of the older person ward. A qualitative case study was carried out comprising semi-structured interviews with members of the MDT, exploring their experiences of the ANP role. An overarching theme of 'Is it a nurse? Is it a doctor? No, it's an ANP' emerged from the data, with three subthemes: the missing link; facilitating and leading holistic care; and safe, high quality care. The ANP role is valued by the MDT working with them and provides a unique skill set that has the potential to enhance care of older patients living with frailty. While there are challenges to its introduction, it is a role worth introducing to older people's wards.

Orientation without walls: opening an acute care hospital.

Providing holistic orientation for all hospital personnel of a newly constructed acute care facility without patient presence proved challenging and rewarding to staff development educators. Early planning, multidisciplinary involvement of key stakeholders for hospital-wide and nursing orientation, and on-boarding of unit nursing educators shortly after unit nursing managers promoted success. Using an interdisciplinary approach to address hospital policies, procedures, and education ensured a quality healthcare facility in the community.

Care of acutely ill older patients in hospital: clinical decision-making.

AIMS AND OBJECTIVES: The aim of this study was to investigate the nursing care of older hospitalised patients and how the nurses providing care understood the clinical decision-making around this care. BACKGROUND: One of the challenges confronting nurses is how best to manage the care required by increasing numbers of older people with complex problems and illnesses being admitted to hospitals. DESIGN: This qualitative study used multiple methods of data collection that included observations, interviews and, where needed, review of the hospital records of older patients. METHOD: Twenty-seven registered nurses participated from across five hospital units. Data were analysed thematically to understand how nurses cared for older patients. RESULTS: The interpretative analysis yielded three major themes that emerged in relation to nursing care of older patients: knowing about care; optionalising care; and blaming. Participants were knowledgeable and potentially competent in providing care required by older patients in hospital. However, they admitted that they optionalised care by making decisions about which patients to care for and how much care should be provided. Participants rationalised these decisions through laying blame on the hospital organisation, needing social time with colleagues and preferring medically oriented technical interventions. CONCLUSION: Nurses experienced tension between professional and ethical nursing responsibilities and the lack of challenge and reward associated with the care of this group of patients. They attended to the more highly valued medical interventions and substituted time to care for older patients by socialisation with colleagues. RELEVANCE TO CLINICAL PRACTICE: This study draws attention to the discrepancy between stated and practice values in the care of hospitalised older patients. Clarification of disciplinary values and the professional role is required, including the adoption of models of care that refocus nursing care through the promotion of holistic practices.

Experiences of ward-based nurse prescribers in an acute ward setting.

A plethora of literature is written about non-medical prescribing, directed towards community nurses, specialist or advanced practice roles. There is a lack of literature, however, regarding the use of non-medical prescribing with the open formulary in the acute ward setting. The experiences of two nurses reveal that non-medical prescribing is a valuable addition to patient care within the acute cardiac ward setting. It ensures that patients receive timely access to medications. This article reveals that the development of non-medical prescribing develops through clinical experience and with it, professional and clinical competence. Non-medical prescribing has been an invaluable addition to ward-based holistic patient care. It has ensured safety is maintained, and supported multidisciplinary working for the benefit of patients. It also provides the opportunity to develop service provision further.

Praxis and the role development of the acute care nurse practitioner.

Acute care nurse practitioner roles have been introduced in many countries. The acute care nurse practitioner provides nursing and medical care to meet the complex needs of patients and their families using a holistic, health-centred approach. There are many pressures to adopt a performance framework and execute activities and tasks. Little time may be left to explore domains of advanced practice nursing and develop other forms of knowledge. The primary objective of praxis is to integrate theory, practice and art, and facilitate the recognition and valuing of different types of knowledge through reflection. With this framework, the acute care nurse practitioner assumes the role of clinician and researcher. Praxis can be used to develop the acute care nurse practitioner role as an advanced practice nursing role. A praxis framework permeates all aspects of the acute care nurse practitioner's practice. Praxis influences how relationships are structured with patients, families and colleagues in the work setting. Decision-makers at different levels need to recognize the contribution of praxis in the full development of the acute care nurse practitioner role. Different strategies can be used by educators to assist students and practitioners to develop a praxis framework.

A qualitative case study review of role transition in community nursing.

PURPOSE: This paper aims to describe existing community nursing practices and to explore factors that are associated with the transition of clinical practice from acute care settings to community care settings. METHOD: This qualitative case study assessment described existing community nurse practices and explored factors that were associated with the transition to community practice from acute care settings. The 48 participants in this case study were registered nurses who were working in community care nursing during the interview process. CONCLUSIONS: The results of this investigation revealed themes derived from data collection, including autonomy, client and family, education, and community as nursing work. This study indicated that making the transition to community-based nursing includes conceptual as well as emotional adjustments. Community nursing practice was seen by the participants as nursing that captures a holistic approach incorporating multiple dimensions from psychological, sociological, economic, and physical to spiritual aspects that provides services in interaction between the community nurse, the client, and the family. The findings indicate a need for additional supportive preparation strategies incorporated into nursing orientation and continuing education programs. Future research investigating agency culture and socialization would provide a more definitive survey of perceptions and competencies needed for role.

The potential of the patient room to promote healing and well-being in patients and nurses: an integrative review of the research.

The purpose of this integrative review is to synthesize the existing research on the patient room in the acute care hospital as it pertains to the promotion, maintenance, or restoration of healing and well-being for patients. This review will describe 22 years of research in nursing, medicine, architecture, psychiatry, and environmental psychology that assesses the effectiveness of design features in the patient room used to promote healing. Research studies reviewed also include those that address the well-being in the nursing staff. Using strategies of integrative research review, 18 studies were reviewed.

5-20: a model of minimum nurse-to-patient ratios in Victoria, Australia.

AIM: This study presents a critique of a new model of minimum nurse-to-patient ratio and considers its utility alongside established Patient Dependency Systems. BACKGROUND: Since 2001 legislation mandating minimum nurse-to-patient ratios has been enacted throughout large public hospitals in the state of Victoria, Australia. The Victorian model mandates minimum staffing of five nurses to 20 patients in acute medical and surgical wards. In conjunction with this approach, Patient Dependency Systems are employed to anticipate short-term resource needs. KEY ISSUES: Although this legislation has been successful in attracting nurses back into the public sector workforce, no published empirical evidence exists to support specific ratios. In addition, neither ratio nor Patient Dependency Systems approaches account for the critical influence of skill mix on hospital, employee, or patient outcomes. CONCLUSION: There is an urgent need for further research that specifically examines relationships between models of staffing, skill mix and quality outcomes.

Clinical nurse specialist practice within the Acute Care for Elders interdisciplinary team model.

As the complexity of care increases for hospitalized older adults, the clinical nurse specialist is essential for ongoing development of nursing practice and care standards. This article describes the Acute Care of the Elderly (ACE) model for interdisciplinary management of older adults and clinical specialist responsibilities within this interdisciplinary team. Within the model, clinical care specialists utilize clinical expertise and consultation skills reflecting three spheres of practice related to care of high-risk community-dwelling older adults admitted an acute medical unit. The goal for this patient group is to achieve medical stability while preserving maximum functioning. The Acute Care of the Elderly team members include primary nurses (staff nurses), physicians, clinical care specialists, therapies, social workers, dietitians, pharmacists, and a discharge planner. Under the leadership of the primarily nurse, the team develops a comprehensive care and discharge plan, implemented across a care continuum. Using protocols and working together, the team delivers cost-effective, coordinated care that promotes process improvement resulting in practice that is in alignment with current standards of care.

Tobacco and its trendy alternatives: implications for pediatric nurses.

Although acute and critical care pediatric nurses may not rank tobacco prevention and cessation among their top patient-care priorities, the importance of providing health education, especially during vulnerable moments, cannot be overlooked. This article provides an overview of trendy tobacco alternatives, such as bidis, clove cigarettes, hookah pipes, and smokeless tobacco, that entice youth. The significant health consequences of these tobacco products and the implications for pediatric acute and critical care nursing practice are also discussed.

Canine visitation (pet) therapy: pilot data on decreases in child pain perception.

PURPOSE: To explore the effectiveness of canine visitation therapy (CVT) in pediatric pain management in a tertiary care children's hospital, a descriptive pilot study was conducted. METHOD: A convenience sample of 25 English-speaking children ages 5 to 18 years who underwent surgery and experienced acute postoperative pain participated in a standard, one-time CVT intervention. Each child completed a pre-post survey and a post intervention interview. FINDINGS: Quantitative pre-post findings indicate that CVT significantly reduced perceived pain. Qualitative findings suggest that one mechanism that makes CVT effective may be cognitive. That is, CVTdistracts children from pain-related cognition and possibly activates comforting thoughts regarding companionship or home. CONCLUSION: The study findings suggest that CVT may be a useful adjunct to traditional pain management for children. IMPLICATIONS: Nurses may better serve their patients when CVT is an option.

Roles of nurse aides and family members in acute patient care in Taiwan.

To improve the nursing care quality in acute care hospitals in Taiwan after the 2003 SARS epidemic, the Taipei City Government Department of Health has allocated about US dollars 6 million for nurse aides' salaries and costs for recruitment, training, and administration of this program. Yet, there have been no corresponding changes in payments for nursing services by the National Health Insurance system in Taiwan such as increasing nurse fees for inpatient services. This article examines the roles of nurse aides and family members in providing acute patient care in Taiwan and discusses issues of nursing care quality as related to nurse staffing in acute care hospitals.