Enfermería de práctica avanzada. desarrollo de un modelo emergente / Advanced nursing practice: development of an emerging model

Objetivo. Exponer la evolución histórica de la enfermería de práctica avanzada (EPA) en el ámbito internacional, así como describir las características y competencias de este perfil enfermero, con el propósito último de fomentar la reflexión sobre la implementación de este modelo de enfermería en el contexto español. Metodología. Se realizó una revisión bibliográfica en las bases de datos CINAHL, MEDLINE y CUIDEN. Además se consultaron varias páginas web. Resultados. A nivel internacional, se ha identificado el impacto que tiene la EPA en el sistema sanitario, reduciendo el número y la duración de las estancias hospitalarias así como consiguiendo una mayor satisfacción de los usuarios. Respecto al contexto nacional queda manifiesto el interés sobre esta temática, a pesar de que la implantación de este rol de práctica avanzada es una asignatura pendiente. Conclusiones. En España, la implementación de la EPA supone un desafío por los retos legislativos, educativos, organizacionales y políticos que conlleva la introducción oficial de esta nueva figura de enfermería(AU)

Aim: To describe the historical evolution of Advanced Practice Nursing (APN) in the international arena, and to describe the characteristics and competencies of this nursing role, with the ultimate aim of encouraging reflection on the implementation of this model of nursing in the Spanish context. Methods: A literature review in the databases CINAHL, MEDLINE and CUIDEN was conducted. In addition, several websites were reviewed. Results: At the international level, there is evidence on the impact of the APN in the healthcare system, reducing the number and length of hospital stays and showing greater user satisfaction. Regarding the national context, it is clear the interest on this issue, although the implementation of this advanced practice role is a pending matter. Conclusions: In Spain, the implementation of the APN is a challenge due to the legislative, educational, organizational and political factors that are involved in the official introduction of this new nursing model(AU)

Engagement y resultados académicos de los estudiantes de grado / Engagement and academics results of the grade students

El engagement académico es un estado de bienestar psicológico tridimensional (vigor, absorción y dedicación) de compromiso intrínseco hacia los estudios. El conocimiento de ese estado motivacional en los alumnos y poder compararlo con el rendimiento académico fue el principal objetivo a alcanzar. Para ello se ha realizado un estudio observacional, correlacional y transversal. La población objeto comprende los estudiantes de Grado en Enfermería que están cursando prácticas clínicas en la Universidad de Málaga. Nuestros datos arrojan las siguientes puntuaciones medias: vigor 3,46 sobre 6 (DT 1,05), dedicación 5,16, igualmente sobre 6 (DT 0,97). Y absorción, 3,59, también sobre 6 (DT 1,18). El nivel global de engagement de nuestros estudiantes de enfermería se sitúa en 4,1 sobre 6. Destacan los niveles en la dimensión dedicación, con valores medios que los sitúan entre las categorías casi siempre y siempre, lo que implica una altísima vocación hacia sus estudios. Las calificaciones del Practicum II-III han mostrado asociación con las dimensiones vigor (p<0,008) y absorción (p<0,036) del engagement. No lo han hecho las calificaciones del Practicum I (AU)

The academic engagement is a three-feature psychological welfare (determination, knowledge absorptive capability and dedication) as an intrinsic commitment towards the studies. The main aim of this study is to know the motivational status in students and to compare this with their academic performance. For the purpose of this paper, it was carried out an observational, correlational, cross-sectional study. The target population is the students carrying out the clinical training in the University of Malaga as part of the Nursing Degree. According to the data achieved, the mean score are the followings: determination 3.46 out of 6 (ST 1.05), dedication 5.16 out of 6 (ST 0.97) and knowledge absorptive capability 3.59 out of 6 (ST 1.18). The engagement global mean score of the nursing students enrolled in this University School of Nursing is 4.1 out of 6. It is worthy to mention the levels for dedication, ranging from almost always and always, which involves a remarkable vocation towards their profession. The marks on Practicum II-III have evidenced an association with the engagement determination (p<0.008), and knowledge absorption capability (p<0.036). Marks on Practicum I have not evidenced any association (AU)

Factores relacionados con la identidad profesional del enfermero: visión de los discentes / Factors related to nurses professional identity: overview of students

El objeto de este estudio incluye la identidad profesional de las enfermeras en la visión de los estudiantes, definir el propósito de discutir los factores que contribuyeron a la formación de la identidad profesional de las enfermeras durante el período de formación. La investigación es un enfoque cualitativo, descriptivo / exploratorio. Los sujetos fueron 11 estudiantes de enfermería de la UFRN. Fue aprobado por el Comité de Ética en Investigación de la Universidad Federal do Rio Grande do Norte (UFRN) en el Dictamen N º 120/2010 y N º CAAE 0037.0.051.000-10. Los datos fueron analizados utilizando la técnica de análisis de contenido. Los estudiantes señalan que la postura de docentes motivados con la profesión es fundamental para la construcción de esta identidad. Por otra parte, las experiencias y prácticas en el servicio durante las etapas mostraron ser indispensable para aflorar la idea de lo que es realmente ser enfermera. A pesar de los sesgos que surgen durante el curso, los estudiantes vieron la importancia de la SAE como una forma de mejorar su trabajo y mejorar la atención al paciente. Sin embargo, el asunto debe ser abordado con mayor frecuencia en el transcurso la graduación como una manera de ayudar a construir esta visión por las futuras enfermeras (AU)

The objective of this study includes the professional identity of nurses in the view of students, defining the purpose of discussing the factors that contributed to the training of professional identity of the nurse over the period of training. The research is descriptive and exploratory, with a qualitative approach. Research subjects were 11 students studying nursing at the Universidade Federal do Rio Grande do Norte (UFRN). It was approved by the Ethics Committee of the UFRN by Opinion No. 120/2010 and No. CAAE 0037.0.051.000-10. The data was analyzed using the technique of content analysis. The students pointed out that the attitude of motivated teachers to the profession is fundamental to the construction of this identity. Moreover, the experiences and practices in services during the stages it proved indispensable to touch upon the idea of what is really being a nurse. Despite the biases that arise during the course, the students viewed the importance of SAE as a way to enhance their work and improve patient care. However, the matter should be discussed more often during training as a way to help build this vision for future nurses (AU)

Teorías y modelos en la práctica enfermera. ¿Un binomio imposible? / Theories and models in clinical nursing practice. An impossible relationship?

Introducción. En las últimas décadas la Enfermería española ha sufrido numerosos cambios que han contribuido en mayor o menor medida al desarrollo de la disciplina. No obstante sigue existiendo en la actualidad una barrera que dificulta y retrasa este desarrollo: la ecuación compuesta por teoría y práctica. Desarrollo del tema. Son diversos los factores que influyen en la retroalimentación entre estos dos elementos, y que repercuten en el crecimiento que experimenta la propia Enfermería. Estamos en la actualidad en un periodo de inflexión en el que es necesario imbricar de una forma efectiva estas dos vertientes, y todo ello con un doble objetivo: aplicar a la práctica diaria los modelos teóricos existentes y disponibles, y fundamentar las decisiones clínicas en evidencias científicas que respalden nuestras actuaciones. Con todo ello se pretende que la Enfermería utilice su corpus propio de conocimientos y sea capaz de nutrirse y de aprovecharlos para su desarrollo en todos sus ámbitos competenciales. Conclusiones: En estos momentos la Enfermería se halla inmersa en un complejo proceso de reconceptualización de la propia disciplina, y se abre un abanico de posibilidades que deberán ir acompañadas inevitablemente de la asunción de ciertos desafíos para los cuales será necesario estar correctamente formados (AU)

Introduction: In the last few decades, Spanish Nursing has suffered several changes that have contributed to a lesser or greater extent to the development of this discipline. However, today there is still a barrier that hinders and delays this development: the equation consisting of theory and practice. Development of the subject. There are several factors which influence the feedback between these two elements and have an impact on the growth that nursing itself undergoes. Nowadays, we are in a period of inflection in which it is necessary to combine both aspects with a dual objective: to put into daily practice the current theoretical models which are available and to base the clinical decisions on scientific evidence which can support our proceedings. Moreover, it is intended that nursing uses its own corpus of knowledge to learn and profit from it in order to develop in all its areas. Conclusions: Nowadays, nursing is immersed in a complex process of conceptualization of its own discipline. There is a wide range of possibilities which must inevitably be accompanied by the acceptance of certain challenges for which individuals must be trained (AU)

The patient's dignity from the nurse's perspective.

The aim of this study was to understand how nurses experience patients' dignity in Swedish medical wards. A hermeneutic approach and Flanagan's critical incident technique were used for data collection. Twelve nurses took part in the study. The data were analysed using hermeneutic text interpretation. The findings show that the nurses who wanted to preserve patients' dignity by seeing them as fellow beings protected the patients by stopping other nurses from performing unethical acts. They regard patients as fellow human beings, friends, and unique persons with their own history, and have the courage to see when patients' dignity is violated, although this is something they do not wish to see because it makes them feel bad. Nurses do not have the right to deny patients their dignity or value as human beings. The new understanding arrived at by the hermeneutic interpretation is that care in professional nursing must be focused on taking responsibility for and protecting patients' dignity.

Da relação ética e tecnologia em discursos exemplares: o caso das práticas baseadas em evidências

O texto propõe uma reflexão sobre a relação ética e tecnologia a partir de uma problematização focada nas práticas/enfermagem baseada em evidências. Tal tecnologia é tomada como exemplar por considerá-la um discurso potente na sua capacidade de definir modos de ser profissional e de propor um projeto educacional ou de ampla socialização de futuros profissionais. Discursos e tecnologias representativos do atual e complexo cenário de integração educação-trabalho no campo da saúde, como o eleito neste texto, devem ser analisados do ponto de vista ético, uma vez que participam da constituição do sujeito trabalhador, mediando suas relações com o outro e consigo mesmo...

The text proposes a reflection on the relation between ethics and technology from a questioning focused on the evidence-based nursing/practices.Such technology is taken as exemplary because it considers these practices a powerful speech in its ability to define professional behaviors and to propose an educational project or comprehensive socialization for future practitioners. Speeches and technologies representative of the current and complex scenario of education/work integration in the health area, like the elected for this text, must be analyzed from an ethical point of view, since they take part on the construction of the employee, mediating their relations with others and themselves...

El texto propone una reflexión sobre la relación entre la ética y la tecnología desde un cuestionamiento centrado en la práctica/enfermería basada en evidencias. Esta tecnología se toma como ejemplar, teniendo en cuenta que considera estas prácticas un discurso potente en su capacidad para definir maneras de ser profesional y de proponer un proyecto educativo o la socialización integral de los futuros profesionales.Discursos y tecnologías representantes del actual y complejo escenario de integración educación-trabajo en de en el campo de la salud, como el elegido en el texto, deben ser analizados desde un punto de vista ético, ya que participan de la constitución del sujeto trabajador, mediando en sus relaciones con los demás y él mismo...

Thoughtful nursing practice: reflections on nurse delegation decision-making.

This article discusses delegation challenges and legal and regulatory oversight associated with delegation in the clinical practice setting. The authors address moral and legal attributes of the roles and responsibilities of health care providers regarding delegating health care interventions. The article also explores guiding principles and rules of delegation within professional standards, national practice guidelines, and state nurse practice acts. Nurse experts provide thoughtful reflection on nursing models and the role of delegation, emphasizing the critical role of delegation in extending the role of the health care professional in patient care services.

Licensed nurses' perceptions of ethical climates in skilled nursing facilities.

This study examines the presence of ethical climates in skilled nursing facilities and identifies their antecedents (work group, job position, tenure). A cross-sectional survey design was implemented. A total of 359 facilities were selected in the Midwestern United States. Responses were received from nurses representing 100 of those facilities (28%). A total of 656 usable questionnaires were returned of the 3060 distributed (21.4% response rate). Descriptive statistics, confirmatory factor analysis, and multivariate and univariate analyses of variance were used. The results confirmed the presence of five ethical climates. Significant differences between registered and licensed practical nurses with regard to egoistic and independence ethical climates were found. Furthermore, nurses in management and non-management positions differed significantly in their perceptions of caring and egoistic climates. The results suggest incongruence in value perceptions and imply that researchers and practitioners have to direct efforts towards preventing and identifying reasons behind this.

The meaning of technology in an intensive care unit--an interview study.

BACKGROUND: Previous research has suggested technology may dehumanise patient care and also that technology may restrict nurses' freedom of action. This raises questions about the relationship between technology, care and medicine in units where the patient's need for treatment is often an emergency. AIM: The aim of the study was to explore how staff members in an intensive care unit (ICU) make sense of technology in their everyday practice. METHOD: Twelve staff members from one ICU were interviewed about their understanding of technology in their everyday practice. RESULT: Three main findings emerged from the analysis: Technology seems to be considered decisive as it directs and controls medical treatment and results in the patients' well being; technology is seen as facilitating everyday practice because it makes treatment more secure and decreases workload; however technology can complicate the staff members' everyday practice as it is not completely trustworthy, is not easy to handle and can cause ethical dilemmas. CONCLUSION: Contrary to previous findings this study shows that technology seems to be embedded in care and medical treatment. Furthermore, the meaning of technology appears to be dependent on the different staff members' accounting practices.

Perceptions of conscience in relation to stress of conscience.

Every day situations arising in health care contain ethical issues influencing care providers' conscience. How and to what extent conscience is influenced may differ according to how conscience is perceived. This study aimed to explore the relationship between perceptions of conscience and stress of conscience among care providers working in municipal housing for elderly people. A total of 166 care providers were approached, of which 146 (50 registered nurses and 96 nurses' aides/enrolled nurses) completed a questionnaire containing the Perceptions of Conscience Questionnaire and the Stress of Conscience Questionnaire. A multivariate canonical correlation analysis was conducted. The first two functions emerging from the analysis themselves explained a noteworthy amount of the shared variance (25.6% and 17.8%). These two dimensions of the relationship were interpreted either as having to deaden one's conscience relating to external demands in order to be able to collaborate with coworkers, or as having to deaden one's conscience relating to internal demands in order to uphold one's identity as a 'good' health care professional.

Nurses' attitudes towards people with dementia: the semantic differential technique.

One important aspect of the nurse-patient relationship is nurses' attitudes towards their patients. Nurses' attitudes towards people with dementia have been studied from a wide range of approaches, but few authors have focused on the structure of these attitudes. This study aimed to identify a structure in licensed practical nurses' attitudes towards people with dementia. Twenty-one group dwelling units for people with dementia at 11 nursing homes participated in the study. A total of 1577 assessments of 178 patients were sent out to 181 respondents and 1237 answers were returned. The semantic differential technique was used. The scale had 57 bipolar pairs of adjectives that estimate an unknown number of dimensions of nurses' attitudes towards an identified patient. The assessments were analysed using entropy-based measures of association combined with structural plots. The analysis revealed four dimensions, which related to licensed practical nurses' opinions of the patients: an ethical and aesthetic dimension; an ability to understand; an ability to experience; and an ability for social interaction. The results of the study indicated that, on the positive to negative attitude continuum, the nurses' attitudes fell at the positive to neutral end. This is an important finding owing to the personhood perspective, from which it is reasonable to assume that, with a more positive attitude to people with dementia, the prerequisites for person-centred care will improve.

Meeting ethical challenges in acute care work as narrated by enrolled nurses.

Five enrolled nurses (ENs) were interviewed as part of a comprehensive investigation into the narratives of registered nurses, ENs and patients about their experiences in an acute care ward. The ward opened in 1997 and provides patient care for a period of up to three days, during which time a decision has to be made regarding further care elsewhere or a return home. The ENs were interviewed concerning their experience of being in ethically difficult care situations and of acute care work. The method of phenomenological-hermeneutic interpretation inspired by the French philosopher Paul Ricoeur was used. The most prominent feature was the focus on relationships, as expressed in concern for society's and administrators' responsibility for health care and the care of older people. Other themes focus on how nurse managers respond to the ENs' work as well as their relationships with fellow ENs, in both work situations and shared social and sports activities. Their reflections seem to show an expectation of care as expressed in their lived experiences and their desire for a particular level and quality of care for their own family members. A lack of time could lead to a bad conscience over the 'little bit extra' being omitted. This lack of time could also lead to tiredness and even burnout, but the system did not allow for more time.