Understanding how advanced practice registered nurses function as patient advocates.

Although patient advocacy experiences for registered nurses (RNs) have been researched over the past 40 years, very little is known about patient advocacy at the advanced practice registered nursing (APRN) level. The APRN role is distinct from the RN role, in that APRNs are focused on diagnosing, prescribing, and management of treatment of various medical conditions in the settings where APRNs are used. The purpose of this study was to explore the APRN's experience with patient advocacy using a phenomenology-based qualitative design. A total of seven Texas APRNs were randomly selected for participation in telephone interviews. Interview transcripts were analyzed by the research team for repetitive statements and four themes emerged from the data: (a) patients with APRN advocacy is providing resources, information, and protection; (b) outcomes of patient with APRN advocacy: positive and negative; (c) patient advocacy mostly experientially learned at APRN level; and (d) increased medical knowledge increases advocacy ability. This pilot study provides important preliminary exploratory results regarding APRN advocacy and differentiates it from RN level advocacy. In addition, this study provides significant insight into APRN educational preparation for the APRN advocate role, thus serving as a foundation for improving educational approaches to advocacy.

Increasing Psychiatric Mental Health Nursing HESI Grade Allocation Percentage in a Psychiatric Nursing Course.

BACKGROUND: Scant evidence is found in the literature regarding the unit-level Health Education Systems, Inc. (HESI) examinations. This study aims to (a) compare student Psych HESI examination scores between cohorts after increasing grade allocation from 5% to 15%, and (b) examine student perceptions of the impact of increasing the percentage of course grade allocation. METHOD: An ex post facto research design analyzed differences in Psych HESI examination scores. HESI examination mean score differences between groups were analyzed using ANOVA. Narrative responses were analyzed using content analysis. RESULTS: Psych HESI examination means increased from 836 in spring 2015 (5% of course grade) to 905 in fall 2015 (15% of course grade). Narrative response themes included (a) Validated Learning; (b) Compelled Participants to Study More; (c) Incongruent With Class Content and Preparation Books; and (d) Stress-Producing. CONCLUSION: HESI examination scores improved with increasing course grade percentage allocated to the HESI score. Students indicated positive and negative perceptions of the increased grade allocation. [J Nurs Educ. 2018;57(10):604-608.].

The Texas Gulf Coast Graduate Nurse Education Demonstration: Collaboration in Action.

Advance Practice Registered Nurses (APRNs) are increasing in number and their value is becoming more evident as Texas and the region face a severe shortage of primary care physicians. APRNs can assist in meeting the needs of a growing and complex healthcare system. Increasing the pool of APRNs will allow healthcare providers to improve access to care and deliver quality outcomes. Hospitals and other healthcare providers have been limited in the number of APRN students they could accept for clinical training due to cost. The Graduate Nurse Education (GNE) Demonstration project was mandated by Section 5509 of the 2010 Affordable Care Act. The primary goal of this demonstration is to increase the number of APRNs who will provide primary care, preventive care, transitional care, chronic care management, and other services for Medicare beneficiaries. To meet this demand, it is necessary to increase the number of qualified clinical training sites. As part of a collaborative effort, Memorial Hermann-Texas Medical Center was one of five healthcare systems that participated in the $200 million funded Demonstration, which offsets the reasonable cost of clinical training for APRNs. Memorial Hermann partnered with four schools of nursing - Prairie View A&M University, Texas Women's University, University of Texas Medical Branch, and University of Texas Health Science Center at Houston - as well as area hospitals and non-hospital community based centers to provide APRNs clinical training. This article describes the collaborative efforts of the Texas Gulf Coast GNE Demonstration as well as the implementation plan, results, and benefits of all participating partners and schools of nursing.

Patient Advocacy at the APRN Level: A Direction for the Future.

Patient advocacy is seen as a critical role for the nursing profession. Although there is an existing body of literature surrounding the registered nurse level of patient advocacy, little is known about the advanced practice registered nurse (APRN) and patient advocacy. This article examines the existing patient advocacy research literature and existing APRN competencies to provide direction for further research.

Hemostasis, coagulation abnormalities, and liver disease.

Coagulopathy-related bleeding events are a major concern in the management of acute and chronic liver disease. The liver attempts to maintain a balance between procoagulant and anticoagulant factors, and providers struggle with poor prognostic indicators to manage bleeding and critical complications. Subtle changes in patient presentation that may require extensive provider-directed interventions, such as blood transfusions, intravenous fluid management, mitigating possible sepsis, and evaluating appropriate pharmacologic treatment, are discussed.

The medical-surgical nurse perspective of advocate role.

UNLABELLED: Nursing advocacy for patients is viewed as a vital role for the nursing profession; however, there is little empirical research regarding nursing advocacy. PROBLEM: The medical-surgical nursing specialty is the largest specialty in acute care settings, but few advocacy studies have focused exclusively on this specialty population. METHODS: The purpose of this study was to explore the nurse advocacy actions and workplace support for advocacy using written narrative responses to a mailed survey using a medical-surgical nursing sample. FINDINGS: The responses help to illuminate the importance of the advocate role for this nursing specialty and provide preliminary information on the advocacy actions and workplace support as reported by the nurses. CONCLUSIONS: The resulting data provide a basis for examining the workplace environmental support for nursing advocacy, further delineate the actions of the nurse advocate, and clarify how nurse advocates follow patient desires regarding care. In addition, the results can be used in education, improving advocacy skills, and safety initiatives.

Development and testing of an instrument to measure protective nursing advocacy.

Patient advocacy is an important aspect of nursing care, yet there are few instruments to measure this essential function. This study was conducted to develop, determine the psychometric properties, and support validity of the Protective Nursing Advocacy Scale (PNAS), which measures nursing advocacy beliefs and actions from a protective perspective. The study used a descriptive correlational design with a systematically selected sample of 419 medical-surgical registered nurses. Analysis of the 43-item instrument was conducted using principal components analysis with promax rotation, which resulted in the items loading onto four components. The four subscales have sufficient internal consistency, as did the overall PNAS. Satisfactory evidence of construct, content, and convergent validity were determined. Implications for nursing practice include using the PNAS in conjunction with an educational program to enhance advocacy skills, which may help to improve patient outcomes.

The lived experience of nursing advocacy.

Nursing advocacy for patients is considered to be an essential component of nursing practice. This phenomenological qualitative pilot study explored registered nurses' lived experience of nursing advocacy with patients using a sample of three medical-surgical registered nurses. The guiding research questions were: (1) how do registered nurses practicing in the medical-surgical specialty area describe their experiences with nursing advocacy for their patients; and (2) what reflections on educational preparation for their professional roles do registered nurses identify as related to their practices of nursing advocacy with their patients? Data analysis procedures were based on Moustakas' data analysis method, and Lincoln and Guba's criteria were applied for rigor. The emergent themes were: speaking out and speaking for patients; being compelled to act on unmet needs of patients; fulfillment and frustration; the patient is changed; primarily learned on the job; and confidence gained through practice. The findings increase the body of knowledge surrounding nursing advocacy as practiced by nurses.

Barriers to nursing advocacy: a concept analysis.

Advocacy for clients is viewed as an essential function of nursing; however, to be effective advocates for patients, the nurse must often overcome barriers to being an effective advocate. This concept analysis of barriers to nursing advocacy uses the Walker and Avant method of concept analysis. By analyzing the barriers to effective nursing advocacy for clients, nursing can then find strategies to manage those barriers and maximize the nurse's advocacy efforts.

Sphere of Nursing Advocacy Model.

The Sphere of Nursing Advocacy (SNA) model explains and depicts nursing advocacy on behalf of a client. The SNA model views the client as continually protected from the external environment by a semipermeable sphere of nursing advocacy that allows clients to self advocate if the client is emotionally and physically able or to be advocated for by the nurse if the patient is unable to advocate for him- or herself. The SNA model can be used to guide research or it can provide the basis for instruction on the subject of nursing advocacy.

Induced abortion: an ethical conundrum for counselors.

Induced abortion is one of the most controversial moral issues in American culture, but counselor value struggles regarding abortion are seldom addressed in counseling literature. This article considers the conflictual nature of the the ethical principles of autonomy, fidelity, justice, beneficence, and nonmaleficence as they can occur within the context of the counseling relationship, particularly with clients considering abortion. In addition, the authors present strategies for counselor self-evaluation, offer recommendations, and provide questions to facilitate ethical decision making.