The Impact of the Theory of Nursing for the Whole Person on the Professional Practice of Nursing School Graduates.

The Theory of Nursing for the Whole Person (TNWP) is a wholistic theory that focuses on the integration of body, mind, spirit, individual, family, and community. A qualitative descriptive research study explored Oral Roberts University graduates' perceptions of their use of the TNWP in practice. Analysis revealed six major themes. Respondents felt that the TNWP was a necessary tool to truly care for patients.

Advancing Nursing Practice: Management of Neuropathic Pain With Capsaicin 8% Without Physician Supervision.

PURPOSE/AIMS: The purpose of this study was to examine the management of patient's neuropathic pain with capsaicin 8% in a nurse-led clinic when administered by 1 registered advanced nurse practitioner without physician supervision. DESIGN: A longitudinal, single-group, descriptive research design was used to assess pain scores and quality of life 3 times over 3 months after treatment. METHODS: Patients with a diagnosis of neuropathic pain were assessed and treated with capsaicin 8% by 1 advanced nurse practitioner with prescriptive authority in a nurse-led clinic. Pain scores were collected at baseline, and self-assessed pain, activity level, and quality of life were assessed at 1 week, 4 weeks, and 3 months after treatment. Twenty-four patients were recruited, and data were analyzed using Friedman's test. In post hoc analysis, Wilcoxon signed-rank test was used with Bonferroni correction. RESULTS: Pain scores differed from pretreatment to posttreatment at each of the 3 time points, at rest (χ3 = 20.54, P = .001) and on movement (χ3 = 23.644, P = .001), and remained significant after Bonferroni correction. Overall, 62.5% (n = 15) of patients achieved at least a 30% reduction in self-reported pain at rest from pretreatment to 3 months, and 54% (n = 13) achieved the same reduction in pain on movement. Most improvements in patient's quality of life occurred between 1 and 4 weeks. Patient satisfaction was high, with 83% stating that they would be happy to have the treatment repeated. CONCLUSION: Single-dose capsaicin 8% decreased neuropathic pain after being administered in an outpatient setting by an experienced registered advanced nurse practitioner. Further multicenter research led by advanced nurse practitioners is needed to support high-quality, safe treatment of neuropathic pain with high-concentration capsaicin in nurse-led chronic pain clinics.

An exploration of nurse-physician perceptions of collaborative behaviour.

Interprofessional collaboration is a key element in providing safe, holistic patient care in the acute care setting. Trended data at a community hospital indicated opportunities for improvement in collaboration on micro, meso, and macro levels. The aim of this survey study was to assess the current state of collaboration between frontline nurses and physicians at a non-academic acute care hospital. A convenience sample of participants was recruited with a final respondent sample of 355 nurses and 82 physicians. The results indicated that physicians generally perceived greater collaboration than nurses. Physician ratings did not vary by primary practice area, whereas nurse ratings varied by clinical practice area. Nurse ratings were the lowest in the operating room and the highest in the emergency department. Text-based responses to an open-ended question were analysed by role and coded by two independent research teams. Emergent themes emphasised the importance of rounding, roles, respect, and communication. Despite recognition of the need for improved collaboration and relational behaviours, strategies to improve collaborative practice must be fostered at the meso level by organisational leaders and customised to address micro-level values. At the study site, findings have been used to address and improve collaboration towards the goal of becoming a high reliability organisation.

Effects of introduction of an inflammatory bowel disease nurse position on the quality of delivered care.

BACKGROUND AND AIMS: Inflammatory bowel diseases (IBDs) are chronic gastrointestinal conditions requiring long-term outpatient follow-up, ideally by a dedicated, multidisciplinary team. In this team, the IBD nurse is the key point of access for education, advice, and support. We investigated the effect of the introduction of an IBD nurse on the quality of care delivered. METHODS: In September 2014, an IBD nurse position was instituted in our tertiary referral center. All contacts and outcomes were prospectively recorded over a 12-month period using a logbook kept by the nurse. RESULTS: Between September 2014 and August 2015, 1313 patient contacts were recorded (42% men, median age: 38 years, 72% Crohn's disease, 83% on immunosuppressive therapy). The contacts increased with time: Q1 (September-November 2014): 144, Q2: 322, Q3: 477, and Q4: 370. Most of the contacts were assigned to scheduling of follow-up (316/1420), start of new therapy (173/1420), therapy follow-up (313/1420), and providing disease information (227/1420). In addition, 134 patients contacted the IBD nurse for flare management and a smaller number for administrative support, psychosocial support, and questions about side effects. During the study period, 30 emergency room and 133 unscheduled outpatient visits could be avoided through the intervention of the IBD nurse. A faster access to procedures and other departments could be provided for 136 patients. CONCLUSION: The role of IBD nurses as the first point of contact and counseling is evident from a high volume of nurse-patient interactions. Avoidance of emergency room and unscheduled clinic visits are associated with these contacts.

The American College of Nurse-Midwives Clarity in Collaboration Project: Describing Midwifery Care in Interprofessional Collaborative Care Models.

In 2014, the American College of Nurse-Midwives (ACNM) launched a project called Clarity in Collaboration to develop data definitions related to midwifery and maternity care delivery processes. These definitions are needed to ensure midwifery care delivered in collaborative care models is accurately and consistently captured in clinical documentation systems, data registries, and systems being developed as part of health care restructuring and payment reform. The Clarity in Collaboration project builds on the efforts of the Women's Health Registry Alliance (WHRA), which was recently established by the American College of Obstetricians and Gynecologists. Clarity in Collaboration mirrored the process used by ReVITALize, WHRA's first maternity data standardization project, which focused on establishing standardized clinical data definitions for obstetrics. The ACNM Clarity in Collaboration project brought together maternity and midwifery care experts to complete a year-long consensus process, including a period of public comment, resulting in development of 20 concept definitions. These definitions can be used to describe midwifery care within the context of collaborative care models. This article provides a summary of the ACNM Clarity in Collaboration process with discussion of implications for maternity data collection.

Achieving Good Outcomes for Asthma Living (GOAL): mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma.

BACKGROUND: Despite being a core component of self-management, goal setting is rarely used in routine care. We piloted a primary care, nurse-led intervention called Achieving Good Outcomes for Asthma Living (GOAL) for adults with asthma. Patients were invited to identify and prioritise their goals in preparation for discussing and negotiating an action/coping plan with the nurse at a routine asthma review. METHODS: The 18-month mixed methods feasibility cluster pilot trial stratified and then randomised practices to deliver usual care (UC) or a goal-setting intervention (GOAL). Practice asthma nurses and adult patients with active asthma were invited to participate. The primary outcome was asthma-specific quality of life. Semi-structured interviews with a purposive patient sample (n = 14) and 10 participating nurses explored GOAL perception. The constructs of normalisation process theory (NPT) were used to analyse and interpret data. RESULTS: Ten practices participated (five in each arm), exceeding our target of eight. However, only 48 patients (target 80) were recruited (18 in GOAL practices). At 6 months post-intervention, the difference in mean asthma-related quality of life (mAQLQ) between intervention and control was 0.1 (GOAL 6.20: SD 0.76 (CI 5.76-6.65) versus UC 6.1: SD 0.81 (CI 5.63-6.57)), less than the minimal clinically important difference (MCID) of 0.5. However, change from baseline was stronger in the intervention group: at 6 months the change in the emotions sub-score was 0.8 for intervention versus 0.2 for control. Costs were higher in the intervention group by £22.17. Routine review with goal setting was considered more holistic, enhancing rapport and enabling patients to become active rather than passive participants in healthcare. However, time was a major barrier for nurses, who admitted to screening out patient goals they believed were unrelated to asthma. CONCLUSIONS: The difference in AQLQ score from baseline is larger in the intervention arm than the control, indicating the intervention may have impact if appropriately strengthened. The GOAL intervention changed the review dynamic and was well received by patients, but necessitated additional time, which was problematic in the confines of the traditional nurse appointment. Modification to recruitment methods and further development of the intervention are needed before proceeding to a definitive cluster randomised controlled trial. TRIAL REGISTRATION: ISRCTN18912042 . Registered on 26 June 2012.

How the past influences interprofessional collaboration between obstetricians and midwives in the Netherlands: Findings from a secondary analysis.

Collaborations between groups of professionals often have a long history, which can still influence contemporary practice. If problems in the collaboration occur, the search for effective interventions for these problems may be informed by analysing current practice as well as the historical development of the collaboration. The study focused on the collaboration between obstetricians and midwives in the Netherlands. We performed a secondary analysis of questionnaire data focusing on midwives evaluating the collaborative performance of obstetricians in the Netherlands. Template analysis was used to analyse the questionnaires. The initial template was based on a model for interprofessional collaboration. As a final step, we reflected on the results in light of the historical development of the collaboration. The midwives experienced a power imbalance and a lack of trust and mutual acquaintanceship in their collaboration with obstetricians. They also reported a need for interprofessional governance and formalization. Most of these reported problems in the collaboration have their origin in the historical development of both professions and in the development of the collaboration between both professional groups. Combining an exploration of contemporary interprofessional practice with a historical perspective on interprofessional collaboration is fruitful for understanding problems in collaboration between professional groups, and provides guidance for improving collaboration.

Using Data to Strengthen Ambulatory Oncology Nursing Practice.

BACKGROUND: Efforts to measure quality of care do not capture the unique aspects of ambulatory oncology settings. To retain nurses, ensure a safe practice environment, and encourage behaviors that support high-quality care, there is a need to identify factors associated with job satisfaction and turnover with measures that reflect the ambulatory setting. OBJECTIVE: The objective of this study was to examine the patterns and correlates of the work environment for nurses and nurse practitioners working in a National Cancer Institute-designated Comprehensive Cancer Center. METHODS: Web-based questionnaires were disseminated to employees with a registered nurse license in ambulatory settings and related support services and included 3 affiliated satellite locations. Participants completed the Practice Environment Scale of the Nursing Work Index, revised for ambulatory oncology settings, the Safety Organizing Scale, and items to assess job satisfaction, perceived quality of care, and intention to leave their current position. Logistic and linear regression models were used to examine factors associated with these outcomes. RESULTS: From 403 individuals, 319 (79.2%) participated. The majority of respondents endorsed excellent quality of care (57.7%), job satisfaction (69.3%), and intention to stay in current position (77.4%). Endorsement of favorable collegial nurse-physician relationships was significantly associated with all 3 outcomes and increased performance of safety organizing behaviors. Nurses reported variations in practice environments and safety organizing behaviors across units. CONCLUSIONS: Work environment assessments are useful to retain experienced nurses and support the delivery of high-quality patient care. IMPLICATIONS FOR PRACTICE: Routine assessment of the work environment for registered nurses and advanced practice nurses is feasible and informative.

[Expectations, requirements and limitations of future task sharing between the nursing profession and the medical profession: results from the Care-N Study M-V]. / Erwartungen, Wünsche und Grenzen der künftigen Aufgabenteilung von Pflege und Medizin - Ergebnisse der Care-N Study M-V.

BACKGROUND: The aging population causes a sustained increase in demand of medical and nursing care services. At the same time health care professionals are aging, too. This leads to a growing number of health care gaps. Therefore, the health care system needs to be reformed. This includes a reallocation of task between some of the health care professions. AIMS: This article addresses developments, potentials and limitations in the context of the future allocation of tasks between the nursing and the medical profession. Aim is to specify the future task sharing between nurses and physicians regarding expectations, requirements and limitations. METHODS: We conducted questionnaire based Delphi interviews with an interdisciplinary group of experts. (type aggregation of ideas). RESULTS: In the future, to expert's point of view, nurses will take over routine tasks in the medical and nursing health care supply. Task sharing by substitution is regarded with skepticism by experts. It requires a long time perspective and an early involvement of all stakeholders. CONCLUSIONS: Germany is at the beginning of the process of the future task sharing between nurses and physicians. The realization requires a comprehensive political support and further development of concepts including scientific implementation and evaluation.

[An evidence-based healthcare system and the role of the healthcare professions]. / Ein evidenzbasiertes Gesundheitssystem: die Rolle der Gesundheitsfachberufe.

An evidence-based healthcare system necessitates a new role allocation and new role definitions of the players. By means of professional delegation, physician-nurse substitution and adoption of new professional functions, which so far have not been part of their professional profiles, nurses, midwives and allied health professionals will adopt a broad spectrum of new responsibilities. At present, nurses, midwives and allied health professionals lack basic scientific competencies and opportunities to acquire skills in evidence-based practice. A reliable link between evidence-generating sciences in nursing, midwifery and allied health professions and clinical practice is missing. In the future, an increase of academically qualified health professionals and a new skills mix within each profession might promote active and effective participation in an evidence-based healthcare system. (As supplied by author).

Midwife-physician collaboration: a conceptual framework for interprofessional collaborative practice.

INTRODUCTION: Since the passage of the Affordable Care Act, collaborative practice has been cited as one method of increasing access to care, decreasing costs, and improving efficiency. How and under what conditions might these goals be achieved? Midwives and physicians have built effective collaborative practice models over a period of 30 years. Empirical study of interprofessional collaboration between midwives and physicians could be useful in guiding professional education, regulation, and health policy in women's health and maternity care. METHODS: Construction of a conceptual framework for interprofessional collaboration between midwives and physicians was guided by a review of the literature. A theory derivation strategy was used to define dimensions, concepts, and statements of the framework. RESULTS: Midwife-physician interprofessional collaboration can be defined by 4 dimensions (organizational, procedural, relational, and contextual) and 12 concepts (trust, shared power, synergy, commitment, and respect, among others). The constructed framework provides the foundation for further empirical study of the interprofessional collaborative process. DISCUSSION: The experiences of midwife-physician collaborations provide solid support for a conceptual framework of the collaborative process. A conceptual framework provides a point from which further research can increase knowledge and understanding about how successful outcomes are achieved in collaborative health care practices. Construction of a measurement scale and validation of the model are important next steps.

Playing nice: improving the professional climate between physicians and midwives in the Calgary area.

BACKGROUND: Anecdotal reports in the Calgary area indicate a lack of integration of midwives into the mainstream obstetrical community and strained relationships between obstetrical care providers. Finding ways to cultivate positive working relationships is essential for ensuring excellent patient care standards. In this study we sought to identify barriers to an effective working relationship between physicians (both obstetricians and family physicians) and midwives, and to find ways to improve the quality of professional interactions and promote team-based pregnancy care. METHODS: We conducted a mail survey within the former Calgary Health Region that included questions about professional interaction, philosophy regarding childbirth, and relationships between obstetrical practitioners. Participants included family physicians (FPs), midwives (MWs), and obstetricians (OBs) who were identified from publicly available lists. RESULTS: The overall response rate was 80% (144/180). Eligible responses were received from 56 FPs (89% female, 45% in practice < 10 years), 25 MWs (100% female, 68% < 10 years), and 37 OBs (60% female, 49% < 10 years). Responses in agreement with selected survey statements were as follows: childbirth is a dangerous process (36% FPs, 1% MWs, 57% OBs); there are many unnecessary Caesarean sections performed (23% FPs, 76% MWs, 27% OBs); MWs are well-trained professionals (68% FPs, 100% MWs, 30% OBs); residents would benefit from learning from midwives (61% FPs, 100% MWs, 38% OBs); and working relationships could be improved (89% FPs, 100% MWs, 97% OBs). CONCLUSION: Relationships between physicians and midwives are sometimes strained. Potential solutions include increased integration in learning, joint attendance at meetings and rounds, and increased opportunities for collaboration.

Contexte : Des signalements empiriques issus de la région de Calgary indiquent un manque d'intégration des sages-femmes au sein de la communauté obstétricale générale et des relations tendues entre les fournisseurs de soins obstétricaux. Il s'avère essentiel de trouver des façons de cultiver des relations de travail positives pour assurer l'excellence des soins offerts aux patientes. Dans le cadre de cette étude, nous avons cherché à identifier les obstacles à la mise en œuvre d'une relation de travail efficace entre les médecins (tant les obstétriciens que les médecins de famille) et les sages-femmes, et à trouver des façons d'améliorer la qualité des interactions professionnelles et de promouvoir l'offre de soins de maternité en équipe. Méthodes : Nous avons mené, au sein de l'ancienne Calgary Health Region, une enquête postale qui comprenait des questions au sujet de l'interaction professionnelle, de la philosophie en matière d'accouchement et des relations entre les fournisseurs de soins obstétricaux. Parmi les participants, on trouvait des médecins de famille (MF), des sages-femmes (SF) et des obstétriciens (OB) ayant été identifiés à partir des listes publiquement disponibles. Résultats : Le taux de réponse global a été de 80 % (144/180). Des réponses admissibles ont été obtenues de la part de 56 MF (femmes : 89 %, pratique < 10 ans : 45 %), de 25 SF (femmes : 100 %, pratique < 10 ans : 68 %) et de 37 OB (femmes : 60 %, pratique < 10 ans : 49 %). Les réponses indiquant l'accord du répondant pour ce qui est de certaines des affirmations de l'enquête se déclinaient comme suit : « L'accouchement est un processus dangereux ¼ (36 % des MF, 1 % des SF, 57 % des OB); « De nombreuses césariennes sont menées inutilement ¼ (23 % des MF, 76 % des SF, 27 % des OB); « Les sages-femmes sont des professionnelles bien formées ¼ (68 % des MF, 100 % des SF, 30 % des OB); « Les résidents tireraient avantage d'une participation à une séance de formation menée par des sages-femmes ¼ (61 % des MF, 100 % des SF, 38 % des OB); et « Les relations de travail pourraient être améliorées ¼ (89 % des MF, 100 % des SF, 97 % des OB). Conclusion : Les relations entre les médecins et les sages-femmes sont parfois tendues. Parmi les solutions possibles, on trouve une intégration accrue dans le cadre de l'apprentissage, la participation à des réunions et à des rondes communes, et l'augmentation du nombre d'occasions de collaborer.

Comparison of childbirth care models in public hospitals, Brazil.

OBJECTIVE: To compare collaborative and traditional childbirth care models. METHODS: Cross-sectional study with 655 primiparous women in four public health system hospitals in Belo Horizonte, MG, Southeastern Brazil, in 2011 (333 women for the collaborative model and 322 for the traditional model, including those with induced or premature labor). Data were collected using interviews and medical records. The Chi-square test was used to compare the outcomes and multivariate logistic regression to determine the association between the model and the interventions used. RESULTS: Paid work and schooling showed significant differences in distribution between the models. Oxytocin (50.2% collaborative model and 65.5% traditional model; p < 0.001), amniotomy (54.3% collaborative model and 65.9% traditional model; p = 0.012) and episiotomy (collaborative model 16.1% and traditional model 85.2%; p < 0.001) were less used in the collaborative model with increased application of non-pharmacological pain relief (85.0% collaborative model and 78.9% traditional model; p = 0.042). The association between the collaborative model and the reduction in the use of oxytocin, artificial rupture of membranes and episiotomy remained after adjustment for confounding. The care model was not associated with complications in newborns or mothers neither with the use of spinal or epidural analgesia. CONCLUSIONS: The results suggest that collaborative model may reduce interventions performed in labor care with similar perinatal outcomes.

Comparação de modelos de assistência ao parto em hospitais públicos / Comparison of childbirth care models in public hospitals, Brazil

OBJETIVO Comparar os modelos colaborativo e tradicional na assistência ao parto e nascimento. MÉTODOS Estudo transversal realizado com 655 primíparas em quatro hospitais do sistema único de saúde em Belo Horizonte, MG, em 2011 (333 mulheres do modelo colaborativo e 322 do modelo tradicional, incluindo aquelas com trabalho de parto induzido e prematuro). Os dados foram coletados em entrevistas e levantamento de prontuários. Foram aplicados os testes Qui-quadrado para comparação e regressão logística múltipla para determinar associação entre o modelo e os desfechos analisados. RESULTADOS Houve diferenças significativas entre os modelos em relação ao nível de escolaridade e trabalho remunerado. No modelo colaborativo houve menor utilização da ocitocina (50,2% no modelo colaborativo versus 65,5% no modelo tradicional; p < 0,001), da ruptura artificial das membranas (54,3% no modelo colaborativo versus 65,9% no modelo tradicional; p = 0,012) e da taxa de episiotomia (16,1% no modelo colaborativo versus 85,2% no modelo tradicional; p < 0,001), e maior utilização de métodos não farmacológicos para alívio da dor (85,0% no modelo colaborativo versus 78,9% no modelo tradicional; p = 0,042). A associação entre o modelo colaborativo e a redução no uso da ocitocina, da ruptura artificial das membranas e da episiotomia manteve-se após o ajuste para fatores de confundimento. O modelo assistencial não esteve associado a complicações neonatais ou maternas nem à utilização de analgesia de condução. CONCLUSÕES Os resultados sugerem que o modelo colaborativo poderá reduzir as intervenções na assistência ao trabalho de parto e parto com resultados perinatais semelhantes. .

OBJECTIVE To compare collaborative and traditional childbirth care models. METHODS Cross-sectional study with 655 primiparous women in four public health system hospitals in Belo Horizonte, MG, Southeastern Brazil, in 2011 (333 women for the collaborative model and 322 for the traditional model, including those with induced or premature labor). Data were collected using interviews and medical records. The Chi-square test was used to compare the outcomes and multivariate logistic regression to determine the association between the model and the interventions used. RESULTS Paid work and schooling showed significant differences in distribution between the models. Oxytocin (50.2% collaborative model and 65.5% traditional model; p < 0.001), amniotomy (54.3% collaborative model and 65.9% traditional model; p = 0.012) and episiotomy (collaborative model 16.1% and traditional model 85.2%; p < 0.001) were less used in the collaborative model with increased application of non-pharmacological pain relief (85.0% collaborative model and 78.9% traditional model; p = 0.042). The association between the collaborative model and the reduction in the use of oxytocin, artificial rupture of membranes and episiotomy remained after adjustment for confounding. The care model was not associated with complications in newborns or mothers neither with the use of spinal or epidural analgesia. CONCLUSIONS The results suggest that collaborative model may reduce interventions performed in labor care with similar perinatal outcomes. .