Clinical Nursing Expertise Research Articles

Clinical Faculty Orientation Practices in the United States: A Descriptive Study.

Due to the nursing faculty shortage, expert clinical nurses are working as novice clinical instructors (CIs). Orientation is needed to prepare these nurses to teach; however, lack of evidence-based guidelines for orientation programs can lead to variability among institutions. The purpose of this study was to describe clinical nursing faculty orientation practices in the United States. A descriptive convergent mixed methods design was used. One hundred thirteen CIs participated. Of these, 70.8% were not provided with a formal orientation to their role. Duration, modality, and content varied widely among orientations. Four themes were derived from the qualitative data: Administrative Requirements, Transition to Clinical Educator, Mentorship, and Resilience. Clinical faculty orientation practices vary widely in the United States. Evidence-based guidelines are needed to streamline orientations to provide CIs with the requisite knowledge and skills to support clinical students.

Nurse educators' experiences of providing education to patients and families

Nurse educators' experiences of providing education to patients and families

Clinical Scholar Preparation: An Approach That Works.

The Colorado Center for Nursing Excellence established a formal didactic course in 2005 to deliberately prepare clinical faculty using expert clinical nurses. Independently, the National League for Nursing, in 2018, established criteria for certification for clinical nurse educators. The content of this course content closely mirrors those competencies and provides preparation for the exam. As a result, Clinical Scholars have established themselves as important players in nursing education in Colorado.

Current perceptions of cancer nurses in France about their role and the evolution of nursing practices: Findings and perspectives

BackgroundFlorence Nightingale lamented that nurses were seen as merely obedient and devoted. Our two previous oncology studies demonstrated the continuum of strictly curative care and paternalistic care practices among healthcare professionals. At a time when France has just formalized the nursing sciences, this article seeks to shed light on the specifics of the nursing role in oncology and the evolution of standard nursing practices in a rapidly changing environment. MethodsWe performed a secondary qualitative analysis, on the same dataset, focusing only on the nursing population (n = 20), to answer a question not excavated through the two previous studies. The COREQ guidelines were used to ensure the rigorous reporting of this study. FindingsThe data analysis show that the inherent role and application of medical directives characterise the profession of nursing in oncology. The former is essentially an intermediary role, whereby the nurse directs the patient to a professional specialist for a problem identified through clinical nursing expertise. The latter is expressed through the application of various medical instructions. The results highlight a minor evolution in nursing practices, despite an evolving environment. Oncology nurses do not seem to authorise themselves to become agents of change. ConclusionVarious reforms and studies of the nursing profession, as well as public funding of programmes dedicated to nursing research were designed to facilitate the integration of Evidence Based Practice to encourage the autonomy of nurses in their practices. Education in research is fundamental to awakening critical thinking and considering scientific validity as vital. Continuing education and leadership by advanced practice nurses are two strong levers to acculturate registered nurses to gaining empowerment, improving their ability to question practices, helping them adapt to increasing the quality of care and making oncology nursing care more efficient. For cancer nurses in France, research education is the challenge to be met.

The Healthcare-associated infections (HAIs) and infection Control link nurse as a strategy to face them: review of literature

Healthcare-associated infections (HAIs) are the most common adverse event in hospitals and a major public health problem with a negative impact on morbidity, mortality and quality of life. Governmental and non-governmental organizations are developing and strengthening plans to improve Infection and Prevention Control (IPC) programmes. Adopting reliable, effective and integrated IPC programmes can prevent 50% of HAIs. Implementation of a Infection Control Link Nurse (ICLN) system at the health care facility level is one of these. To obtain from a literature review evidence-based recommendations and practical instruments for developing and implementing a training course for ICLN. A literature review was conducted by searching the Cochrane Library, PubMed, Cinahl without time limits, until July 2019. PICO methodology was adopted to build the research question and the Prisma Flow Diagram chosen for the selection of studies. Results The final review included 4 studies which dealt with the following main topics: selection of the personnel, profile, educational pathway, activities and factors that affects ICLN. Even though there is no accordance on duration and contents of LN training courses, its usefulness is well accepted. Using expert clinical nurses on prevention, control and management of HAIs for LN programmes is useful when they are capable of being opinion leaders and trainers among their teams, as well as a formal connection to management areas and administrators.

Nursing diagnoses of impaired memory and chronic confusion for older adults: diagnostic content validation.

To validate the defining characteristics of the nursing diagnoses, impaired memory and chronic confusion for older adults, by testing diagnostic concept definitions among expert nurses. We used a Diagnostic content validation using an online survey of expert clinical nurses. 195 expert nurses performed the diagnostic validations. Findings provided validity of impaired memory with 11 major defining characteristics and chronic confusion, with 11 major and one minor defining characteristics. In both diagnoses, content validity index was 0.85. Factor analysis provided four and five supported factors for impaired memory and chronic confusion, respectively. The study provided evidence of validity of the two diagnoses and made them clearer. Using these updated nursing diagnoses, nurses have the potential to improve accuracy and quality of care for elderly patients, contributing to more accurate nursing gerontological care.

The Nurse-Family Partnership in Colorado: Supporting High-Quality Programming With Implementation Science.

The purpose of this article is to describe how the Nurse-Family Partnership (NFP) has been scaled up and supported in Colorado. As an intermediary, Invest in Kids (IIK) provides implementation support for the NFP in Colorado using a generalizable implementation framework, the Active Implementation Frameworks (AIF). An overlay of the AIF and the clinical nursing-informed implementation support that IIK offers to NFP providers across Colorado is explored, and relevant examples are highlighted. Without the use of the AIF in combination with clinical nursing expertise to support high fidelity use of the NFP throughout Colorado, promised NFP program outcomes may likely not be realized and sustained. Further understanding of how to utilize implementation frameworks to support evidence-based clinical nursing programs and interventions may allow for results found in research studies to be more widely attained and maintained across practice settings.

Compassion: A Critical Link in Extraordinary Care for Patients and Families.

Delivering clinical nursing expertise enveloped with compassion should be the expectation for care. Ensuring this level of excellence happens when a critically ill patient is transferred from one hospital to another is challenging yet imperative to the patient's and family's experience. The DAISY Foundation recognizes nurses who provide compassionate and extraordinary nursing care, as demonstrated in the stories of 2 nurses, from different organizations, who cared for the same patient and family and were honored with The DAISY Award.

Designing and Psychometric Evaluation of the Competency Inventory for Postgraduate Students of Intensive Care Nursing

Background: Today, the role of expert clinical nurses is highlighted because their presence is necessary for guaranteeing the quality of nursing care provided for the patients. However, there are no proper instruments for measuring the clinical competence of postgraduate students in intensive care nursing. Objectives: The present study aimed at development and psychometric evaluation of the clinical-competence inventory for postgraduate students of intensive care nursing. Patients and Methods: A methodological study was conducted at state nursing schools of Iran. The participants were postgraduate students of intensive care nursing, who were being trained at 16 nursing schools throughout Iran, during year 2014. After examining some relevant texts, the first draft of the inventory was designed with 60 items. In order to confirm its face and content validity, a panel of experts and students examined the inventory. The final draft, which contained 44 items, was distributed among postgraduate students of intensive care nursing, and 217 students answered the inventory. The construct validity was verified using exploratory factor analysis. The reliability of the inventory was verified using consistency tests. Results: Firstly an instrument with 60 items was developed. Next, the face and content validity of the instrument was assessed by 15 students and 11 experts. Overall, 16 items were removed through validity assessment and 44 items remained in the final draft. The content validity index of the final draft was 0.90. Moreover, the content validity ration of 44 items ranged between 0.75 and 1. The Cronbach’s alpha coefficient of the inventory was 0.95 and the intraclass correlation coefficient (ICC) of the test-retest results was 0.96. To examine the construct validity of the final draft, it was administered for 217 postgraduate students of intensive care nursing and five factors, with Eigenvalues above one and loading level equal to or above 0.4, were extracted through exploratory factor analysis. Conclusions: The inventory developed in this study is a suitable index for evaluating the efficacy of postgraduate students in the field of intensive care nursing.

Walking alongside: a qualitative study of the experiences and perceptions of academic nurse mentors supporting early career nurse academics

Purpose: This study explores the experiences and perceptions of academic nurse mentors supporting early career nurse academics (ECNAs). Methods: Interviews were undertaken with mentors following a mentoring partnership with ECNAs. Data were transcribed verbatim and analysed using a process of thematic analysis. Findings: Four themes emerged from the data, namely; motivation for mentoring; constructing the relationship; establishing safe boundaries and managing expectations. Conclusions: This study provides a unique insight into the experiences of mentoring within the context of an academic leadership programme for nurses. Such insights highlight the issues facing academics from professional disciplines and can inform strategies to support their career development. Clinical relevance: A sustainable academic nursing workforce is crucial to ensure that effective preparation of future generations of expert clinical nurses. Therefore, it is important to consider strategies that could strengthen the academic nursing workforce.

一般病院における非がん疾患患者に対する熟練看護師のエンド・オブ・ライフケア実践

本研究は,一般病院における非がん疾患患者に対するエンド・オブ・ライフケア実践を熟練看護師の実践知から明らかにした.7 名の慢性疾患看護専門看護師の実践事例のインタビューから質的統合法（KJ 法）を用いて最終ラベルを抽出した.熟練看護師は,患者の生き方の意思決定を支える関わりと,患者家族の生き方に沿う関わりを,状態悪化の過程にある患者の自尊感情の回復,満足感,納得を指標に定めていた.一般病院では患者の苦痛対応策が不十分であることや,多職種とのケアの合意や他施設とのケア継続は困難を伴うが,熟練看護師は患者の意向を日々捉えながら,家族や地域ケア体制に患者の意向を浸透させる調整を行っていた.治療の場でのエンド・オブ・ライフケア実践では,家族,医療者も共に了解しながら患者を支え続けることができる支持的環境,診断初期より関わる医療者の意識向上と患者の意思決定を支える支援技術の向上が必要である.

A qualitative study on the roles and responsibilities of nurse consultants in Hong Kong

This study aims to explore the roles and responsibilities of seven newly appointed nurse consultants (NCs) in various clinical specialties in Hong Kong as a pioneer project. Qualitative approaches using direct observation and semi-structured interviews were adopted with two full-day observations on the seven NCs plus 56 semi-structured interviews of NCs, nurses, doctors and patients. Five major NCs' roles and responsibilities had been identified, namely providing expert practice, initiating service development, leading education, guiding continuous quality improvement (CQI) and conducting research and providing evidence-based practice. The seven NCs within this study have by and large achieved building professional excellence, respect and trust within their own spheres. It is strongly recommended that the NC post be formally established in the new Nurses Career Structure to enable expert clinical nurses to develop a clinical career to contribute to service and patient care to its maximum.

From the Bedside to the Glossy Pages: Coaching Direct Care Nurses in an Authoring Experience

From the Bedside to the Glossy Pages: Coaching Direct Care Nurses in an Authoring Experience

Success and failure in integrated models of nursing for long term conditions: Multiple case studies of whole systems

BackgroundCurrent projections indicate that the UK faces a 252% increase in people aged over 65 with one or more long term conditions (LTC) by 2050. Nurses, managing their own caseloads and clinics, working across sectors and organisational boundaries and as part of a wider multi-disciplinary team, are frequently seen as key to managing this growing demand. However, the evidence base informing the nursing role in managing LTC, the most effective configuration of the multi-disciplinary team and the policy evidence relating to the infrastructure required to support cross organisational working, remains weak. ObjectivesTo explore, identify and characterise the origins, processes and outcomes of effective chronic disease management models and the nursing contributions to such models. DesignCase study whole systems analysis using qualitative interview methods. SettingsTwo community matron services, two primary care (GP) practice nursing services, two hospital based specialist nursing services were purposefully sampled from across England and Wales. ParticipantsSelection criteria were derived using a consensus conference. The nurses in the service, all patients and carers on the caseload, members of the multi-disciplinary team and stakeholders were invited to participate. MethodsSemi-structured interviews with all participants, thematic analysis within a whole system framework. ResultsThe study found high levels of clinical nursing expertise which in the case of the community matrons was meeting the aim of reducing hospital admissions. Both the primary care and hospital nurse specialist indicate similar levels of clinical expertise which was highly valued by medical colleagues and patients. Patients continued to experience fragmented care determined by diagnostic categories rather than patient need and by the specific remit of the clinic or service the patient was using. Patient data systems are still organised around the impact on services and prevalence of disease at an individual level and not around the patient experience of disease. ConclusionNurses are making a major contribution to meeting the policy objectives for long term conditions. Primary care nurses and hospital nurse specialists do broadly similar roles. The scope of the nursing roles and services studied were idiosyncratic, opportunistic and reactive, rather than planned and commissioned on an analysis of local population need.

Loss of clinical nursing expertise: A discussion paper

There is evidence to suggest that there is a general decline in clinical expertise in nursing as a result of experienced clinicians leaving the profession. The expertise of clinical nursing practice is an important resource and needs to be captured and made available to others as loss of this knowledge and expertise has implications for clinical outcomes. This paper aims to discuss the current nursing workforce, loss of clinical expertise, the nature of expertise and the way it can be captured. Clarification and articulation of clinical knowledge of nursing experts provides the means for knowledge to be transferred to a less experienced workforce and be available in an accessible form in the workplace. Leverage of nursing expertise in this manner has the potential to benefit less experienced staff, hold clinical nursing expertise in the workplace and improve clinical outcomes and satisfaction with performance.

Developing expert clinical nurses: grow them, hold them andlet them walk away

Spivak M., Smith A. & Logsdon M.C. (2011) Journal of Nursing Management 19, 92–97Developing expert clinical nurses: grow them, hold them and let them walk away Aim The aim of the present study was to describe three case studies that exemplify decision making by a nursing leader related to retention of expert clinical nurses in the Emergency Department. Background Further understanding of decision-making processes that help nursing leaders to retain (or let go of) expert clinical nurses is needed so that sufficient numbers of expert nurses are available in the workforce to provide high-quality and safe patient care. Evaluation Decision processes related to retention of expert clinical nurses are exemplified in three case studies. Key issues Orienting nurses to specialty areas is costly and retention of nurses is an important international issue. Conclusions Expert clinical nurses across the skill continuum need guidance from nursing leaders related to their work behaviours and best choice for employment. Implications for Nursing Management Nursing leaders who are well acquainted with the skills and motivations of their employees are in the best position to promote the health of individual nurses and of specialty nursing units.

Understanding clinical expertise: Nurse education, experience, and the hospital context

Clinical nursing expertise is central to quality patient care. Research on factors that contribute to expertise has focused largely on individual nurse characteristics to the exclusion of contextual factors. To address this, we examined effects of hospital contextual factors and individual nurse education and experience on clinical nursing expertise in a cross-sectional analysis of data from 8,611 registered nurses. In a generalized ordered logistic regression analysis, the composition of the hospital staff, particularly the proportion of nurses with at least a bachelor of science in nursing degree, was associated with significantly greater odds of a nurse reporting a more advanced expertise level. Our findings suggest that, controlling for individual characteristics, the hospital context significantly influences clinical nursing expertise.

Enhancing inpatient rehabilitation through the engagement of patients and nurses

This paper is a report of a study conducted to describe nurses' knowledge, experiences and perceptions of a rehabilitation nursing practice development project conducted in their workplace. Several studies over the past two decades have led to increasing clarity about the nursing role in rehabilitation. Practice development is a useful vehicle for using the findings of such studies to enhance person-centred practice in rehabilitation settings. This qualitative study, in which grounded theory informed data collection and analysis, involved interviews with 21 nurses working in an inpatient rehabilitation unit in Australia about their knowledge, experiences and perceptions of a rehabilitation nursing practice development project conducted in their workplace. The three rounds of interviews were conducted as follows: 1) December 2005-January 2006; 2) June-July 2006; and 3) October 2006. Practice development was an effective vehicle for developing rehabilitation nursing practice. While collaboration and leadership were critical to the effectiveness of the project, the use of a clinically credible practice development facilitator and a focus on the development of collective nursing practice also seem to have been important. Through the introduction of new activities, both patient and nurse engagement in rehabilitation was enhanced and, as a consequence, the nurses developed a deeper appreciation of their role in rehabilitation. Carefully and collaboratively designed and sensitively implemented work-based practice development initiatives can change the context and culture of inpatient care. The use of a facilitator with relevant clinical nursing expertise to engage staff individually and collectively with research findings and to reflect on their practice and skill development is worth exploring in similar initiatives.

The relationship of nurses' professional characteristics to levels of clinical nursing expertise

Many hospitals are searching for guidelines for professional practice models, which are a requirement for Magnet recognition. This study was undertaken to determine the professional nursing characteristics that may contribute to the development of clinical nursing expertise. Experience as an RN was found to be highly correlated with initial level of expertise. Educational preparation and certification were not correlated with expertise. This research suggests that nurses may require more on-the-job experience for the development of clinical nursing expertise than what has been reported in the literature.

Developing a qualitative approach to 360-degree feedback to aid understanding and development of clinical expertise

This paper presents one aspect of a 5-year multicentre action research study to develop an accreditation process for clinical nursing expertise. Part of the process consisted of the exploration, critique and refinement of qualitative 360-degree feedback as a tool for peer review. Three hundred and sixty-degree feedback is widely used as a personal and professional development strategy. This part of the overall study challenged assumptions about the necessity for anonymity and structured questionnaires to collect data. The study involved 32 experienced clinical nurses drawn from a range of clinical settings supported by 'critical companions' (colleagues from clinical practice, education, management and research, recruited to provide supervision and support). Study participants, facilitated by the project team (the authors), engaged in critiquing and refining 360-degree feedback as a process to help them examine and develop their practice. On the basis of our findings this approach to gathering 360-degree feedback facilitates the collection of evidence that aids professional development. There are indications that it may also contribute to improved working relationships.