Current State of Pain Resource Nurse (PRN) Programs and Experiences of PRNs in China.

BACKGROUND: Since the 2010s, the Pain Resource Nurse (PRN) program and similar programs have been introduced in Chinese hospitals. However, the status of the PRN program and nurses' experiences in these programs remain unclear. AIMS: The aim of the study was to identify the factors related to PRN programs and explore PRNs' experiences being part of the program. DESIGN: A combination of descriptive cross-sectional and qualitative methods was used in the study. SETTINGS: Thirty-two hospitals in the eastern, central, and western regions of China. PARTICIPANTS/SUBJECTS: Twenty-four PRNs who had been PRNs for 6 months or more. METHODS: A purposive sample of 32 hospitals from eastern, central, and western regions of China carried out a PRN or similar program for more than 1 year with at least five bedside nurses from different nursing units were enrolled in the descriptive cross-sectional study. The questionnaire was designed by Brown's advanced nursing practice framework theory. A total of 24 PRNs who had been PRNs for 6 months or more participated in the interview by convenience and purposive sampling. RESULTS: The mean number of PRNs in a program was 30.12 ± 17.93 (range 5-74). The role of the PRN was broader compared with that of bedside nurses, and it included pain management, training, and education. The most common reason for hospitals to establish PRN programs was to improve the quality of pain management (n = 28, 87.5%). Administrative support (n = 28, 87.5%) was a major supportive factor for PRN programs and lack of physician support (n = 28, 87.5%) was a barrier. Although all hospitals provided training, those with knowledge assessments after training indicated a significant improvement in the desired PRN functions compared with those that did not (p < .05). Personal interviews revealed that the reasons for becoming a PRN varied and included considering PRN as a career opportunity, personal interest, passively accepting the designation, and being a PRN temporarily. The positive professional experiences of being a PRN included an increased sense of self-worth and accomplishment and growth in a specialty, whereas the negative experiences included frustration with the work environment and resignation because of extra workload. CONCLUSIONS: The hospital survey results indicated that the PRN program in China is still in the early development stage. The PRN interviews suggest that being a PRN involves both positive and negative experiences.

Evidence-based practice among epilepsy specialist nurses in the Republic of Ireland: Findings from the SENsE study.

AIM: To describe how epilepsy specialist nurses in Ireland enact the evidence-based practice dimension of their role. BACKGROUND: The importance of epilepsy specialist nurses (ESNs) delivering evidence-based care to people experiencing epilepsy is unquestionable, yet research into this aspect of the role is relatively sparse. METHODS: A qualitative design was used, involving 12 epilepsy specialist nurses working in five units in Ireland, 24 multidisciplinary team members working with them and 35 people with epilepsy and their family members. Data were collected using individual and focus group interviews, observation and documentary analysis. RESULTS: These ESNs were active in accumulating, translating, applying, generating and disseminating evidence. All were actively involved in, or leading audit and service evaluations, and used findings to improve practice. Their research activity mainly consisted of small-scale unfunded research projects. CONCLUSIONS: These ESNs acted as opinion leaders and role models in relation to evidence-based practice, including the generation of new knowledge through audit and research. IMPLICATIONS FOR NURSING MANAGEMENT: Organisations and managers need to support ESNs by ensuring that they have the necessary resources and competencies to accumulate, translate, apply, generate and disseminate relevant evidence. Future research should explore the impact of ESNs' evidence-based practice on patient outcomes.

Relationship of Wound, Ostomy, and Continence Certified Nurses and Healthcare-Acquired Conditions in Acute Care Hospitals.

PURPOSE: The purpose of this study was to describe the (a) number and types of employed WOC certified nurses in acute care hospitals, (b) rates of hospital-acquired pressure injury (HAPI) and catheter-associated urinary tract infection (CAUTI), and (c) effectiveness of WOC certified nurses with respect to lowering HAPI and CAUTI occurrences. DESIGN: Retrospective analysis of data from National Database of Nursing Quality Indicators. SUBJECTS AND SETTINGS: The sample comprised 928 National Database of Nursing Quality Indicators (NDNQI) hospitals that participated in the 2012 NDNQI RN Survey (source of specialty certification data) and collected HAPI, CAUTI, and nurse staffing data during the years 2012 to 2013. METHODS: We analyzed years 2012 to 2013 data from the NDNQI. Descriptive statistics summarized the number and types of employed WOC certified nurses, the rate of HAPI and CAUTI, and HAPI risk assessment and prevention intervention rates. Chi-square analyses were used to compare the characteristics of hospitals that do and do not employ WOC certified nurses. Analysis-of-covariance models were used to test the association between WOC certified nurses and HAPI and CAUTI occurrences. RESULTS: Just more than one-third of the study hospitals (36.6%) employed WOC certified nurses. Certified continence care nurses (CCCNs) were employed in fewest number. Hospitals employing wound care specialty certified nurses (CWOCN, CWCN, and CWON) had lower HAPI rates and better pressure injury risk assessment and prevention practices. Stage 3 and 4 HAPI occurrences among hospitals employing CWOCNs, CWCNs, and CWONs (0.27%) were nearly half the rate of hospitals not employing these nurses (0.51%). There were no significant relationships between nurses with specialty certification in continence care (CWOCN, CCCN) or ostomy care (CWOCN, COCN) and CAUTI rates. CONCLUSIONS: CWOCNs, CWCNs, and CWONs are an important factor in achieving better HAPI outcomes in acute care settings. The role of CWOCNs, CCCNs, and COCNs in CAUTI prevention warrants further investigation.

Reversing deterioration in continence services.

Despite the growing prevalence of incontinence and the recognition that it is a significant factor in admissions to hospitals and residential care, continence care is receiving less funding. This article compares the findings of a continence care survey undertaken in 2007 with one published in 2013. The survey shows there has been a reduction in numbers of specialist continence staff, particularly senior posts, an increased number of patients seeking help, a decrease in funding, fewer continence products being supplied and growing waiting lists.

Burnout in ICU caregivers: a multicenter study of factors associated to centers.

RATIONALE: The stressful work environment of ICUs can lead to burnout. Burnout can impact on the welfare and performance of caregivers, and may lead them to resign their job. The shortage of ICU caregivers is becoming a real threat for health care leaders. OBJECTIVES: To investigate the factors associated with burnout on a national level in order to determine potential important factors. METHODS: Prospective, multicenter, observational survey of all caregivers from 74 of the 92 Swiss ICUs, measuring the prevalence of burnout among the caregivers and the pre-specified center-, patient- and caregiver-related factors influencing its prevalence. MEASUREMENTS AND MAIN RESULTS: Out of the 4322 questionnaires distributed from March 2006 to April 2007, 3052 (71%) were returned, with a response rate of 72% by center, 69% from nurse-assistants, 73% from nurses and 69% from physicians. A high proportion of female nurses among the team was associated with a decreased individual risk of high burnout (OR 0.98, 95% CI:0.97-0.99 for every %). The caregiver-related factors associated with a high risk of burnout were being a nurse-assistant, being a male, having no children and being under 40 years old. CONCLUSIONS: The findings of this study seem to open a new frontier concerning burnout in ICUs, highlighting the importance of team composition. Our results should be confirmed in a prospective multicenter, multinational study. Whether our results can be exported to other medical settings where team-working is pivotal remains to be investigated.

Assessing nurses' continuing education preferences in rural community and urban academic settings.

Continuing education programs that increase nursing knowledge and collaboration are needed across urban and rural settings. A survey was distributed to determine interest in nursing grand rounds and preferred educational modalities at two unaffiliated hospitals. Results revealed that nurses from the urban and rural hospitals were interested in nursing grand rounds as a recorded online offering, thus providing valuable information used to develop a nursing grand rounds program.

A student evaluation workshop with rural nursing preceptors.

Increasingly, clinicians and faculty members are motivated to provide students quality preceptorship placements in rural areas, particularly in light of the potential for recruitment of new graduates to underserved areas. Invariably, student performance evaluation is an onerous task for many preceptors and one in which they often feel ill-prepared. Rural preceptors may face additional challenges given the lesser availability of educational resources and professional development. In this article, the authors detail the development, pilot testing, and evaluation of a workshop on student evaluation that was created in collaboration with rural nurse preceptors.

Research priorities for nursing professional development: a modified e-Delphi study.

In 2010, the National Nursing Staff Development Organization Research Committee identified the need to delineate research priorities for nursing professional development (NPD). A Delphi study with 13 experts in NPD resulted in the identification of 24 priorities for the next 5 years. These priorities provide the future direction for NPD research and funding.

Assessing confidence in triage decision making: evaluation of an inventory in a sample of navy and civilian nurses.

Triage decision making and prioritizing nursing care are essential nursing skills in all clinical settings. The purpose of this study was to evaluate the psychometric properties of the Triage Decision Making Inventory in a sample of Navy and civilian nurses with diverse clinical specialties and years of clinical experience. Establishing reliability and validity allows staff development educators to evaluate training strategies that promote confidence in decision making among nurses of all specialty practices.

Healthcare personnel resource burden related to in-clinic follow-up of cardiovascular implantable electronic devices: a European Heart Rhythm Association and Eucomed joint survey.

AIMS: A pilot European survey was conducted to assess the cumulative time spent by healthcare personnel for in-office follow-up of cardiac implantable electrical devices (CIEDs), including cardiac pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy (CRT) devices. METHODS AND RESULTS: Resource use data were collected during a session of in-clinic follow-up. Among 407 visits, 93% were scheduled and 7% unscheduled. Visit duration (total cumulative time) lasted a mean of 27 min for scheduled visits, and was ∼30% longer for unscheduled visits. Independent determinants of visit duration were: unscheduled visit (+7.6 min, P = 0.01), the need for device reprogramming (+7.5 min, P < 0.001), and the type of device checked, with CRT devices needing 9.1 and 6.6 more minutes than single- (P < 0.001) and dual-chamber devices (P = 0.002), respectively. Most visits involved two different types of healthcare personnel (239 of 407, 59%), simultaneously. The most frequent combination was the involvement of both a cardiologist and a nurse (216 of 407 visits with both of them only, and 65 additional visits with also an internal technician, an external technician, or both). Overall, an external technician was involved in 18% of visits. CONCLUSIONS: In 'real-world' practice, the follow-up of CIEDs nowadays requires important resources in terms of time dedicated by specialized personnel, corresponding to cardiologists, nurses, internal technicians, and external, industry-employed technicians. These observations should be the basis for addressing clinical, organizational, financial, and policy initiatives targeted to optimize follow-up procedures in order to face the increase in the number of patients treated with CIEDs expected for the next years.

A survey evaluating the current role of the nurse practitioner in urology.

The role of the nurse practitioner (NP) continues to expand into the care of specialty populations. This article presents results of a survey that allowed NPs who self-identified as working specifically with people diagnosed with urologic conditions to describe their clinical role. The purpose of identifying NP-specific clinical tasks was to provide evidence to be used in revising the urology specialty certification examination for NPs.

An Exploration of New Graduate Nurses' Transition to Specialty Practice.

New graduates' adjustment to high-acuity specialty areas was evaluated using qualitative methods in a hospital system that uses the Versant New Graduate Residency Program. Subjects were interviewed at baseline in person, answered interview questions at 6 months via computer, and were interviewed at 12 months in person. Twelve themes emerged from the interviews, reflecting intrinsic and extrinsic factors affecting new graduate nurse adjustment. Study results were used to evaluate the program and improve the program implementation.

Pediatric nurse practitioners in the United States: current distribution and recent trends in training.

OBJECTIVE: To assess the current distribution and training patterns of pediatric nurse practitioners (PNPs). STUDY DESIGN: Secondary data analysis from the National Association of Pediatric Nurse Practitioners and the 2008 US Census Bureau were used to estimate the distribution of PNPs per 100,000 children. Data on nurse practitioner (NP) graduation and specialty education programs were obtained from the American Association of Colleges of Nursing. RESULTS: PNPs have the greatest concentration in the New England and mid-Atlantic regions and a narrow band of Midwestern states. States that allow PNPs to practice or prescribe independently do not consistently have a higher density of PNPs per child population. There has been a slight decrease in the proportion of programs that offer PNP training. In the last decade, the proportion of NP graduates pursuing family nurse practitioner education has increased, and the proportion pursuing PNP education has decreased. CONCLUSION: Workforce planning for the health care of children will require improved methods of assessment of the role of PNPs and the volume of care they provide. Increased use of PNPs in pediatrics will likely require greater effort at recruitment of NPs into the PNP specialty.

Predictors of depression screening rates of nurses receiving a personal digital assistant-based reminder to screen.

The purpose of this study was to determine if race/ethnicity, payer type, or nursing specialty affected depression screening rates in primary care settings in which nurses received a reminder to screen. The sample comprised 4,160 encounters in which nurses enrolled in advanced practice training were prompted to screen for depression using the Patient Health Questionnaire (PHQ)-2/PHQ-9 integrated into a personal digital assistant-based clinical decision support system for depression screening and management. Nurses chose to screen in response to 52.5% of reminders. Adjusted odds ratios showed that payer type and nurse specialty, but not race/ethnicity, significantly predicted proportion of patients screened.

Why some adults with intellectual disability consult their general practitioner more than others.

BACKGROUND: This research identifies factors affecting why some adults with intellectual disability (AWIDs) consult their general practitioner (GP) more than others. Little is known about these factors, despite AWIDs having higher health needs and reduced longevity. Current barriers to accessing health care need to be understood and overcome to achieve improved health outcomes. METHODS: A secondary analysis of data obtained from a stratified randomised sample of AWIDs participating in a cluster randomised trial of hand held health records. The number of GP consultations was obtained retrospectively for the year preceding initial health interviews from GP records. AWIDs and their carers were given separate health interviews using identical/adapted questions where possible. RESULTS: Two hundred and one AWIDs and or their carers from 40 practices participated (response rate 64.6%) with GP consultation data extracted for 187 AWIDs. Overall consulting levels were low, 3.2 per annum for women and 2.2 for men. Increased age, gender (women) and type of carer (paid) were all significantly associated with increased consultations. Carers reporting health problems, medications reported by AWIDs, medications recorded in GP records, and pain reported by AWIDs were also significant factors affecting consultations to GP practices after adjustment for age and type of carer. CONCLUSIONS: Overall consultation rates were lower than expected, and affected by age, gender and type of carer. Targeted interventions are needed to improve attendance and promote health.

[Nurses and nephrology in Italy]. / Infermieri e nefrologia in Italia.

An acceleration in the professionalization of Italian nurses has taken place in recent years. This pattern, together with the increasing prevalence of kidney diseases and the decreasing number of active nephrologists, makes a new collaborative structure between nurses and nephrologists both possible and welcome. This article describes the recent changes and future prospects of the Italian nursing profession. Observations about nephrology are based on interviews conducted with key opinion leaders of nursing in nephrology and dialysis. Italian nurses have recently acquired a status of professional autonomy. Nursing training is now fully integrated in the university system and nurses have obtained more responsibilities and a higher status within healthcare organizations. Future developments may be related to the internal articulation of the profession, supported by master courses and specialist training. Another possible evolution refers to the ongoing restructuring of the healthcare system with an emphasis on nursing activities and skills rather than medical specialties, which will lead to new and stronger managerial roles for nurses. The increase in the prevalence of kidney diseases and the declining number of nephrologists will result in a change in the distribution and utilization of nephrology services. The professionalization of nurses allows a new work division with a task shift from doctors to nurses. Italian nephrologists should seek a preferential relationship with the nursing profession, also considering the nursing shortage in several regions. Possible means to accomplish this preferential relationship could be, in addition to task shifting, nurses' involvement in research, and support for postgraduate training.

The place of knowledge and evidence in the context of Australian general practice nursing.

BACKGROUND: The purpose of the study was to ascertain the place of knowledge and evidence in the context of Australian general practice nursing. General practice nursing is a rapidly developing area of specialized nursing in Australia. The provision of primary care services in Australia rests largely with medical general practitioners who employ nurses in a small business model. METHODS: A statistical research design was used that included a validated instrument: the developing evidence-based practice questionnaire (Gerrish et al. 2007). A total of 1,800 Victorian practice nurses were surveyed with a return of 590 completed questionnaires, equaling a response rate of 33%. FINDINGS: Lack of time to access knowledge for practice was a barrier for participants in this study. In-service education and training opportunities were ranked as the number one source of knowledge for general practice nurses. Experiential learning and interactions with clients, peers, medical practitioners, and specialist nurses were also considered very important sources of knowledge. Research journals were ranked much lower than experiential learning and personal interactions. Participants assessed their own skills at sourcing and translating evidence into practice knowledge as low. Younger general practice nurses were more likely than older nurses to assess themselves as competent at using the library and Internet to locate evidence. DISCUSSION: The predominantly oral culture of nursing needs to be identified and incorporated into methods for disseminating evidence from research findings in order to increase the knowledge base of Australian general practice nurses. CONCLUSIONS: Findings from this study will be significant for policy makers and funders of Australian nursing in general practice. The establishment of a career structure for general practice nurses that includes salaried positions for clinical nurse specialists would assist in the translation of evidence into knowledge for utilization at the point of care.

Attitudes toward guidelines in Finnish primary care nursing: a questionnaire survey.

BACKGROUND: Evidence-based clinical guidelines have attracted international interest as tools for improving the quality of health care. Attitudes toward these guidelines are of great importance because attitudes are proven to be important predictors of guideline use. Attitudes are also believed to be shaped by perceptions of others, which makes the role of organizational implementation interventions interesting. AIMS: This article describes primary care nurses' attitudes toward guidelines among Finnish primary care nurses and the associations between attitudes, implementation interventions, and guideline use. METHODS: This study was a cross-sectional survey using postal questionnaires. Participants (N = 409) were primary care nurses working in outpatient services of primary health care centers in Finland. They were selected for the study from two groups of Finnish health centers representing contrasting implementation styles, for example, disseminator and implementer health centers (N = 32). RESULTS: Responses were received from 327 nurses. In general, nurses' attitudes toward guidelines were positive, especially those concerning the reliability and usefulness of guidelines. The utilization of any implementation intervention included in the questionnaire was associated with more positive attitudes. In addition, nurses working in health centers that used an active implementation strategy as opposed to a disseminator strategy also felt that others in their organization rated the guidelines more positively and that guidelines were more easily available. Further, nurses who were familiar or very familiar with the guidelines had more positive attitudes toward them. Attitudes were also associated with self-reported guideline use. CONCLUSIONS: The evidence-based guidelines were accepted as a reliable source of advice in patient care in Finnish primary care. It seems that implementation interventions improve attitudes toward guidelines and enhance guideline use. These interventions might also be important from another point of view; they presumably improve familiarity with guidelines, which was also associated with guideline use.

Reaching the top: career anchors and professional development in nursing.

This study, based on Shein's conceptual theory of career anchors, examined the relationship between career anchors, professional development and emerging career patterns for graduates of 12 consecutive two year second career programs in nursing (N=231) compared to graduates of concurrent four year academic programs (N=273). A 2-group comparison design was used and data collection tools included a demographic profile, a professional profile and a career anchor questionnaire. Statistically significant differences were found in regard to career anchors (p< 0.001) and career development (p< 0.001). Primary career anchors for the second career nurses were specialization and lifestyle where academic graduates chose management, autonomy and service. Academics displayed a statistically significant preference for administrative specialization (34%) compared to the second career tract (6.5%). Researchers propose that each group develops differently and contributes to the workplace and the importance of both certification and academic incentives to ensure recruitment.