La prescripción enfermera. Historia de un eufemismo / Nursing prescription. The story of a euphemism

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Estándares de calidad asistencial para las consultas de enfermería en reumatología / Quality of care standards for nursing clinics in rheumatology

Introducción. Las consultas de enfermería en reumatología (CER) son modelos organizativos asistenciales en el ámbito de competencias de enfermería. Hay diversos modelos de CER, pero no existe una definición operacional. El objetivo del proyecto es elaborar estándares de calidad para definir y caracterizar una CER. Método. Estudio Delphi a 2 rondas. El panel estuvo constituido por 67 expertos: reumatólogos y enfermeras del Grupo de Trabajo de Enfermería de la Sociedad Española de Reumatología (SER). El cuestionario se elaboró tras revisión bibliográfica y experiencias de proyectos previos de la SER. El cuestionario consta de 7 apartados: consideraciones generales, estándares de estructura, de proceso, de tratamiento y seguimiento, educación sanitaria, formación e investigación y calidad asistencial. Cada ítem se puntuó de 1 (menos importante) a 9 (más importante) o mediante una cifra. El grado de acuerdo de los expertos se categorizó según el coeficiente de variación (CV) entre muy alto (CV ≤ 25%) y muy bajo (CV > 100%). Resultados. El cuestionario de la segunda ronda (182 ítems) fue respondido por 46 panelistas (34 reumatólogos y 12 enfermeras). Se obtuvo un grado de acuerdo muy importante en los estándares generales, de estructura, de proceso, de tratamiento y seguimiento, educación sanitaria y calidad asistencial. Se encontró menor acuerdo en los estándares relacionados con el tiempo para formación, el número de proyectos de investigación propios de enfermería y de publicaciones recomendables. Conclusión. Los estándares desarrollados en este estudio permitirían establecer mínimos deseables de calidad de estructura, proceso, labor asistencial, investigadora y docente que se pueden utilizar para desarrollar y evaluar las CER (AU)

Background. Nursing clinics in rheumatology (NCR) are organizational models in the field of nursing care. There are various NCR models, but there is no consensus on its operational definition. Our objective is to develop quality standards to define and characterize a NCR. Method. Two-round Delphi method. The panel consisted of 67 experts: rheumatologists and nurses of the nursing working group of the Spanish Society of Rheumatology (SSR). The Delphi questionnaire was developed after a literature and experience review from previous SSR projects. The questionnaire consists of 7 sections: general considerations, standards of structure, process, treatment and monitoring, health education, training and research and quality of care. Each item was scored from 1 (least important) to 9 (most important) or by assigning a number (e.g. waiting days). The degree of agreement among the experts was categorized according to the coefficient of variation (CoV) between very high (CoV≤25%) and very low (CoV>100%). Results. The second round questionnaire (182 items) was answered by 46 panelists (34 rheumatologists and 12 nurses). A very important agreement was reached on the general standards of structure, process, treatment and monitoring, health education and quality of care. Less agreement was observed on standards related to training time, number of recommended nurses’ research projects and publications. Conclusion. The standards developed in this study would be useful for establishing desirable quality standards of structure and process, and criteria for clinical work, research and teaching that can be used to develop and evaluate the NCRs (AU)

Can mental health nurses diagnose in Australia?

The naming of health related conditions has been the traditional province of the medical profession. Occasional concessions have been made in specific narrow domains, such as psychology or speech-related pathology, but diagnosis typically has been seen as medical practitioner business. "Ownership" of language is worthy of critical discussion. The answer to why the tradition has persisted, and nurses have invested lots of energy within the established rules of who can say what, may well be found through the lens of psycholinguistics. Nurses can name states of health and ill health using the currently accepted nomenclature. The authors argue that there is an unconditional "yes," to the question of can nurses diagnose, as long as they are not holding themselves out to be a medical practitioner by doing so. Additionally it is argued that advanced practice nurses must diagnose in order to fulfill their role as advanced practice clinicians.

Expanding nurses' scope of practice.

On April 9, 2009, the government of British Columbia announced that it was expanding the scope of practice of registered nurses, midwives and naturopathic physicians in the province. From now on, RNs will be able to independently provide a broader range of health services including suturing, tuberculosis screening and managing labour in hospital when the primary care provider is absent. Registered nurses working triage will now be able to immediately order diagnostic ultrasounds and X-rays. Additionally, registered nurses will be able to dispense or administer prescription medications in urgent situations including severe allergic reaction, drug overdose, post-partum bleeding and for communicable disease prevention and management. (British Columbia 2009) It is important to point out that it is RNs, not nurse practitioners, who will have these additional capacities.

The effectiveness of sexual assault nurse examiner (SANE) programs: a review of psychological, medical, legal, and community outcomes.

In sexual assault nurse examiner (SANE) programs, specially trained forensic nurses provide 24-hour-a-day, first-response medical care and crisis intervention to rape survivors in either hospitals or clinic settings. This article reviews the empirical literature regarding the effectiveness of SANE programs in five domains:(a) promoting the psychological recovery of survivors, (b) providing comprehensive and consistent post-rape medical care (e.g., emergency contraception, sexually transmitted disease [STD] prophylaxis), (c) documenting the forensic evidence of the crime completely and accurately, (d) improving the prosecution of sexual assault cases by providing better forensics and expert testimony, and (e) creating community change by bringing multiple service providers together to provide comprehensive care to rape survivors. Preliminary evidence suggests that SANE programs are effective in all domains, but such conclusions are tentative because most published studies have not included adequate methodological controls to rigorously test the effectiveness of SANE programs. Implications for practice and future research are discussed.

Telephone triage and consultation: an emerging role for nurses.

Telephone triage and consultation is increasingly being used to counsel patients about the appropriate level and timing of care. Nurses are becoming the most frequently used health care professionals providing this care. Although roles vary, consensus is emerging about role definition, scope of practice, and use of protocols. Professional associations and state boards of nursing are examining critical issues related to licensure and standards of practice. Nurses who practice telephone triage and consultation indicate that it is an exciting and demanding specialty with unique issues related to quality, documentation, amount of experience necessary, information resources, and supportive technology. The issues reported by practicing nurses are not necessarily those reported in the literature (e.g., liability, licensure, and practice standards). Developing or modifying current standards of practice needs immediate attention from professional nursing groups, as does the issue of licensure. Nursing educators need to be aware of this emerging role and prepare their students to function competently in this area. Finally, researchers have a rich and varied field of study around this new practice field and its impact on patient care and outcomes.

A review of the use of nursing diagnosis in U.S. nurse practice acts.

PURPOSE: To determine how many state nurse practice acts include the term or concept of "nursing diagnosis" and describe their similarities and differences. METHODS: Investigators independently divided the practice acts of the 50 states and the District of Columbia into those that did or did not include the term "nursing diagnosis" or the word "diagnosis" within a nursing context. To describe other differences, the investigators operationally defined and independently categorized each act as trendsetting, contemporary, or traditional. FINDINGS: Thirty-three of the 51 practice acts used the term "diagnosis" within nursing context. Of these 33, 13 were identified as trendsetters and 20 as contemporary. Seven trendsetting and 5 contemporary practice acts used the NANDA-based language or "response" when describing the "what" of nursing diagnosis. None of the trendsetting practice acts, but 8 of the contemporary acts, used the NANDA-based "individual, family or community" when describing the "who" of nursing diagnosis. CONCLUSIONS: The language of nursing is changing. The majority of practice acts now define the practice of professional nursing as including the diagnostic act, although the manner in which they use the term varies.