Practice Nurses Research Articles

Content validation study on the Advanced Practice Role Delineation Tool.

Role understanding and practice standards become extremely important in countries that are developing and assessing nursing and advanced practice nursing (APN) roles. To describe the process and findings of a content validation study conducted on the Advanced Practice Role Delineation (APRD) tool in a Finnish context. A tool content validation study. Between September and October 2019, three rounds of surveys (n = 9, n = 8, n = 5) were conducted to assess the content validity of the APRD tool. Furthermore, a thorough literature review was conducted in December 2020 to examine how the tool has been used and validated between January 2000 and December 2020. A 45-item amendment of the APRD tool was created. The Scale Content Validity Index Average of 0.97 reflects excellent content validity. A literature review of 15 studies revealed that the tool has been used by many researchers, yet there is limited research on its content and construct. The steps taken in this study were effective and may be replicated in other countries. Further studies are needed to validate the content and structure of the developed 45-item modification of the APRD tool.

Ethical and Legal Challenges in Caring for Older Adults with Multimorbidities: Best Practices for Nurses.

This study explores the ethical and legal challenges faced by nurses in caring for older adults with multimorbidities, focusing on issues related to patient autonomy, polypharmacy, and end-of-life care. Through semi-structured interviews with 15 nurses in Riyadh, Saudi Arabia, the research highlights the complexities of obtaining informed consent from patients with cognitive impairments and the ethical dilemmas of balancing autonomy and safety. The management of polypharmacy emerged as a significant concern, with nurses emphasizing the importance of thorough documentation and coordination among healthcare providers to prevent adverse drug interactions. End-of-life care and advance directives posed further challenges, particularly when family members disagreed with patients' documented wishes. The study underscores the need for comprehensive strategies, including ongoing education, clear communication, and supportive institutional policies, to address these issues effectively. The findings suggest that enhancing nurses' understanding of ethical principles and legal requirements is crucial for improving patient care and ensuring compliance with regulatory standards. Future research should aim to develop evidence-based guidelines to support nursing practice in managing these ethical and legal challenges.

Knowledge and practices of neonatal intensive care unit nurses concerning hypothermia in preterm infants: Adescriptive cross-sectional study.

To investigate the knowledge level and clinical practice of neonatal intensive care unit nurses on the whole process of hypothermia prevention in preterm infants. A polycentric descriptive cross-sectional study was conducted in 23 hospitals in Shandong province involving 254 neonatal intensive care unit nurses. An evidence-based knowledge and clinical practice questionnaire on hypothermia prevention in preterm infants and a general information questionnaire were used to collect data. SPSS and EXCEL 24.0 database were used for data statistics and analysis. Nearly one-third of nurses were unclear about the definition of mild hypothermia and heat preservation measures during labour management and resuscitation. Knowledge about the correct rate of amniotic fluid evaporation was low. The higher the hospital level and nurses' education level, professional title, work experience, and position, the higher the knowledge level. The clinical practice of nurses differed in terms of body temperature assessment tools, measurement sites, and measurement frequency for premature infants. Nurses in neonatal intensive care units need to apply evidence-based knowledge and carry out practice interventions to ensure preterm infants' safe transition from the delivery room to the neonatal intensive care unit. There have been few studies evaluating neonatal nurses' knowledge and practices with regards to the preventing hypothermia of premature infants from delivery room to neonatal intensive care unit. The study identifies the deficiencies and problems in temperature management that can be attributed to the knowledge level of nurses. The findings will help improve the current curriculum, teaching strategies, and the nurses' knowledge levels, preventing premature hypothermia in infants. This study adhered to the STROBE statement for observational studies and obtained approval (KYLL-2023LW045) from the ethics committee of The Second Hospital of Shandong University. The other 22 third- and second-level hospitals, as our alliance members, recognized our chairperson status within the alliance and were willing to join our academic activities. Mutual responsibility for ethical filing between alliance units. 254 nurses were recruited from 23 tertiary and secondary public hospitals in Shandong province. No public or patient involvement. Members of the research group used the Questionnaire Star platform to prepare the electronic questionnaire, including obtaining informed consent, taking precautions for questionnaire completion, and using the aforementioned measurement tools. The project research team contacted the head nurses of 23 neonatal intensive care units in Shandong Province. After obtaining consent from the head nurses, they were asked to send the requirements and link of the electronic questionnaire to their WeChat management group. The nurses go through each question and make a choice which has two options of 'agree' or 'disagree.' Based on their answers, nurses were evaluated as having 'mastered' or 'not mastered' each item. Each 'mastered' item (correct answer) was given a score of 4; an item 'not mastered' (incorrect answer) was given a score of 0. The total score ranged from 0 to 100.

Effects of rural hospital closures on nurse staffing levels and health care utilization at nearby hospitals.

Our study examines the causal effect of rural hospital closures on nearby hospitals' nurse staffing levels and health care utilization. We use data from the 2014-2019 American Hospital AssociationSurvey on nurse staffing level outcomes including licensed practical or vocational nurses (LPNs), registered nurses (RNs), and advanced practice nurses (APNs); and health care utilization outcomes, including inpatient and outpatient surgical operations and emergency department (ED) visits. Using propensity score matchingand difference-in-differences (DID) methods, we find that rural hospital closures lead to an average increase of 37.3% in the number of nurses in nearby rural hospitals during the 4years following the closure. This increase is found across all categories of nurses, including LPNs, RNs, and APNs. We also find a substantial increase in the provision of inpatient and outpatient surgical operations but there is no change in ED visits. We do not find any effects for nearby urban hospitals. Our study suggests that a large proportion of the nursing workforce relocates to nearby hospitals after a rural hospital closure, which mitigates the negative consequences of such closures and allows these nearby hospitals to provide a larger volume of highly profitable services.

Determination of the effects of hand hygiene education given to nursing students in intensive care unit on hand microbiota

Purpose: This study is conducted with the purpose of comparing fourth-year nursing students' hand hygiene practices and beliefs with their hand flora. Additionally, we aim to assess the effectiveness of hand hygiene education in this context. Material and Methods: This research has been conducted using a pre-test, post-test, and control group quasi-experimental design. The Hand Hygiene Application Inventory and the Hand Hygiene Belief Scale administered as pre-tests. Students underwent tape stripping and swab methods to collect samples for their hand flora before any interventions. A post-test was conducted for the experimental group. Results: The hand hygiene beliefs and practices of both groups were similar before training. When the Hand Hygiene Application Inventory and Hand Hygiene Belief Scale scores before and after the training were examined, an increase was observed in the scale scores after the training. In this study, the microorganisms present in the general hand flora were identified simplistically, and the changes were observed after hand hygiene education. Furthermore, the study shed light on the structure of hand flora after education in terms of microbial load. Conclusion: It has been experimentally determined that there is a significant decrease in hand microbiota load and pathogenic groups with hand hygiene education.

Structure of Advance Care Planning Practice by Home Health Nurses for Multigenerational Families With Dependent Children and Terminally Ill Grandparents

The present study aimed to identify the structure of advance care planning (ACP) practices implemented by home health nurses (HHNs) for multigenerational families with dependent children and terminally ill grandparents. Interviews of 20 HHNs were conducted. The grounded theory approach was used to describe the interactions among families with dependent children, terminally ill grandparents, and HHNs. The results showed that the structure of ACP practices for multigenerational families with dependent children and terminally ill grandparents was composed of 2 levels. First, HHNs were providing the underlying foundational “Practice of supporting end-of-life care (EOL care) at home” for family members from 2 generations: sandwich generation caregivers (SGCs) and terminally ill grandparents. Second, they were providing “Practices that connect multiple generations,” “Practices that address the children,” and “Practices that involve hands-on experience and communication” for multigenerational families with dependent children and terminally ill grandparents. Practices based on providing stability among family members from 2 generations, SGCs and terminally ill grandparents, were the nursing practice structure that activated ACP for multigenerational families with dependent children and terminally ill grandparents.

The Effect of Educational Intervention on Knowledge, Attitude, and Practices Regarding Colorectal Cancer Screening Practices Among Nursing Students in Jordan.

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide. This study aimed to examine the impact of an educational intervention on nurses' knowledge, attitude, and practice regarding CRC screening in Jordan. The study was an experimental design conducted before and after the educational intervention. Participants attended four 30-minute sessions held weekly over one month. A paired t-test was used to determine the mean difference in participants' knowledge, attitude, and practice regarding CRC screening before and after the intervention. Statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 27.0 (IBM Corp., Armonk, NY). A total of 43 participants took part in the study, of whom 29 (67.4%) were female and 14 (32.6%) were male. The majority (30, 69.8%) were aged between 20 and 30 years. The results showed a significant mean increase in knowledge (mean difference [MD] = 3.09, P < 0.001), attitude (MD = 4.16, P < 0.001), and practice (MD = 2.67, P < 0.001) regarding CRC screening following the intervention. The implementation of health education about CRC screening for the study participants was successful based on the results. This strategy could provide a solid basis for organizing, implementing, and supervising CRC screening initiatives.

Primary care team member’s perceptions of credentialed and privileged clinic pharmacists and impact on clinic workload in a pediatric primary care network

BackgroundPharmacists provide increased access to care, vaccinations, and medication management for patients. Credentialing and privileging of pharmacists allow pharmacists to practice at the top of their licenses and elevate pharmacy practice. ObjectiveThe primary objective of this study was to assess the perception of health care team members of credentialed and privileged pharmacists working in a pediatric primary care network (PCN) before and after implementation of pharmacist privileges. The secondary objective was to determine team members’ perceptions on the amount of time spent refilling medications, resolving medication access issues, and ordering vaccines before and after implementation of pharmacist privileges. MethodsThis was a prospective pre-post study using surveys to capture health care team members’ perceptions of credentialed and privileged ambulatory care pharmacists. Surveyed participants included attending physicians, advanced practice nurses, registered nurses, licensed practical nurses, medical assistants, and patient care assistants. Summary statistics are reported as frequencies and percentages. Statistical analysis was conducted using SAS version 9.4. ResultsFifty-eight preprivileging and 56 postprivileging surveys were distributed. The return rate was 79.3% (n = 46) for preprivileging and 80.4% (n = 45) for postprivileging surveys. More than 90% of respondents had a favorable perception of credentialed and privileged pharmacists in the clinic. There was a significant difference in the perception of the amount of time spent on medication access issues after pharmacist privileges were implemented (P = 0.0296). ConclusionCredentialed and privileged pharmacists in a pediatric PCN are viewed favorably by clinic team members and can have a positive impact on clinic workload.

Dysphagia: causes, diagnosis and treatment – an update for practice nurses

The number of people with dysphagia is rising in line with population ageing. It is now thought to affect around 5.2 million people in the UK, one adult in 8 ( Boaden et. al, 2019 ). It becomes more common as people age and is associated with neurological problems, frailty and poor outcomes ( Patel et. al, 2018 : Cohen et. al, 2021 ). This article aims to update practice nurses on the clinical features of dysphagia, how to identify it, when to refer and how it is managed. As many as one adults in eight in the UK are affected by dysphagia. Linda Nazarko looks at what nurses need to know when managing this condition.

Effects of ketogenic diet on cognitive function of patients with Alzheimer's

George Winter provides an overview of recently published articles that may be of interest to practice nurses. Should you wish to look at any of the papers in more detail, a full reference is provided.

The role of the mental health nurse in pediatric hematology-oncology - Part 1: Developing an innovative practice.

Pediatric hematological and oncological illnesses present many coping challenges. Mental health issues can arise during and after treatment, in both patients and their families. The current model of care does not always seem to meet the needs identified by some young patients. In Quebec, nurses are allowed to assess and care for patients experiencing physical and mental health difficulties (Ordre des infirmières et infirmiers du Québec, 2016). Therefore, a mental health nurse clinician (MHNC) with experience in pediatric hematology/oncology could provide care that is complementary to that offered by psychologists, social workers, and other psychosocial professionals in the pediatric hematology/oncology unit in order to meet any needs that remain unmet. The MHNC project has three stages: (1) role development, (2) role implementation, and (3) role assessment one year after implementation. In this first article, we explain how the MHNC role was developed. We used the participatory, evidence-based, patient-focused process for advanced practice nursing (APN) role development, implementation, and evaluation (PEPPA Framework; Bryant-Lukosius & Dicenso, 2004) to develop this model. The first five steps in the PEPPA Framework were applied in the creation of the MHNC role to (1) select the target population, (2) identify the stakeholders to be involved, (3) ascertain needs, (4) determine and prioritize problems and set goals, and (5) define a new model of care. After multiple meetings involving numerous health professionals and managers, the MHNC role was developed with a versatile, transdisciplinary perspective to address better the needs of young cancer patients (especially those in their teens) and their families. The role was developed around four main areas of practice: (1) interventions offered to patient-family, (2) interventions offered to health professionals, (3) psychiatric consultation-liaison, and (4) education and research. The next steps are to use a strategic plan to implement the role and then to evaluate the impact of the role one year after implementation.

Evaluation of the impact of an integrated simulation model in basic life support training on knowledge and practice: A randomized control trial in Jordanian hospitals

This study aims to evaluate the effectiveness of simulation training (ST) in improving nurses' knowledge and practice, which is essential in the nursing field, particularly among nurses in Jordanian hospitals. ST has the potential to significantly enhance patient care outcomes. A Randomized Control Trial was conducted in five hospitals in Jordan, using three repeated measurement tests: a pre-test, an immediate post-test after the intervention, and a post-test three months later. The nonparametric Mann-Whitney statistical test showed that the control and experimental groups were similar, with no significant differences in the participants' demographic characteristics. The Independent T-test confirmed the similarity of the pre-test results in the control group's knowledge and practice and the intervention group's mean scores. The simulation intervention proved to be highly effective in enhancing Basic Life Support (BLS) knowledge and practice among nurses. It nearly doubled the knowledge pre-test percentage from 40% to 75.35% in the immediate post-test, improving the scores from poor in the pre-test to excellent in the post-test. This significant improvement highlights the importance of simulation training in enhancing nurses' knowledge and practice. Similarly, ST significantly increased the average practice score percentage from 47.5% to 70% after the intervention, demonstrating its substantial impact. In conclusion, BLS simulation is a highly efficient educational method that helps participants acquire knowledge and skills. Simulation training prepares learners to activate cardiopulmonary resuscitation (CPR) quickly and correctly in case of cardiopulmonary arrest. Therefore, simulation in training should be expanded in the nursing curriculum.

Nurses' knowledge, attitude and practice in preventing medical device-related pressure injuries and its influencing factors: a cross-sectional study

The purpose of this study was to explore the knowledge, attitude, and practice about preventing medical device-related pressure injuries among Chinese nurses. A cross-sectional survey was used to gather self-reported data from 2236 nursing staff, from 164 nursing units in a tertiary hospital of China by using MDRPI knowledge, attitude, and practice questionnaire. The median total score for nursing staff in preventing MDRPI is 151 (with a quartile range of 138-165) points, and the score rate is 79.40%，the median total score for the knowledge dimension is 54 (with a quartile range of 45-60), with a score rate of 70.67%, the median total score for the attitude dimension is 37 (with a quartile range of 36-44), with a score rate of 85.06%，the median total score for the practice dimension is 59 (with a quartile range of 55-68), with a score rate of 85.48%. Multiple linear regression analysis indicated that position and whether training or not are key factors influencing the total score of nursing staff in MDRPI prevention. The study found that while nurses' attitude and practice score in preventing MDRPI are high, there is room for improvement in their knowledge score. Factors such as nurse position and training were identified as promoting MDRPI prevention. To enhance patient safety and quality of care, it is recommended that medical institutions focus on training programs to improve nurses' knowledge and attitude towards preventing MDRPI.

Knowledge and Practice of Psychiatric Nurses toward Side Effects of Clozapine Drug on Co-morbid Psychiatric Patients

Knowledge and Practice of Psychiatric Nurses toward Side Effects of Clozapine Drug on Co-morbid Psychiatric Patients

Effectiveness of an Educational Program on Improving Nursing Care for Thalassemia Patients Undergoing Blood Transfusion

Background: Thalassemia is a genetic disorder that disrupts hemoglobin production, leading to severe anemia. Beta-thalassemia major patients often require lifelong blood transfusions. Nurses play a crucial role in managing these transfusions, but gaps in knowledge and practice can lead to complications. This study assessed the impact of an educational program on nurses' knowledge and skills regarding thalassemia and blood transfusion protocols. Methods: A quasi-experimental study was conducted at the Jin Pediatric Hematology-Oncology Center in Duhok City, Iraqi Kurdistan. The sample included 20 nurses. The program consisted of four sessions (two theoretical and two practical). Data collection instruments included a socio-demographic sheet, a knowledge questionnaire, and a skills checklist. Pre- and post-intervention knowledge and practice scores were analyzed using paired t-tests and chi-square tests. Results: The educational program significantly improved nurses' knowledge of thalassemia (P &lt; 0.00) and transfusion protocols, with the mean knowledge score increasing from 5.2 ± 2.09 to 8.05 ± 1.82. Practice scores also showed statistically significant improvements (P &lt; 0.002). Correlations between total knowledge and practice scores, as well as with nurses' experience and educational level, were statistically significant. Conclusion: The study demonstrated that an educational program can enhance nurses' knowledge and practices in managing thalassemia patients undergoing blood transfusions. Continued education and targeted interventions are essential to improving the quality of care for these patients.

Challenges and Strategies of Developing Certified Anesthetist Nurse Practitioners in the Post-Pandemic Era in Taiwan

&lt;p&gt;臺灣的麻醉護理在專業定位、執業範圍、證照考試和標準化訓練制度等方面面臨著諸多挑戰，尤其2020 年衛生福利部雖將麻醉護理師正式納入專科護理師之制度內，但後續所推行之標準化課程也衍生出更多待解決之難題，如：未導入核心能力架構及評量機制、欠缺思考成人學習理論、龐大的訓練課程時數、麻醉專師之師資量能不足及欠缺系統性師資培育等窘境。本文提出二項教育改革的因應策略，首先是建構以勝任能力導向的麻醉專科護理教育架構並發展麻醉訓練專師之系統性評量工具，即「可信賴專業活動」，未來則需建立共創教學和共享資源文化，以促進教師之間的協作和知識分享，期能提高教學品質，並為教師和學員帶來更豐富、多元化的學習體驗。本文呼籲麻醉專師訓練應即刻進行課程再造，打破傳統以知識和時間為本的教學框架，改以混成授課、自主學習作為課程規劃與執行之原則，積極接軌「勝任能力導向教育」的全球發展趨勢，朝向共創、共享之目標邁進。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Anesthetist nurse practitioners in Taiwan encountered several challenges, particularly in terms of professional identity, scope of practice, certification, and standardized training programs. In 2020, the Ministry of Health and Welfare in Taiwan recognized anesthetist nurse practitioner as one of the advanced practice nurses and included them under the regulation of the nurse practitioner system. However, the implementation of the nationwide standardized training program had faced some unre-solved issues and challenges including that the lack of alignment with competency frameworks or pro-grammatic assessments, the extensive increase of training courses, neglects of adult learning theories, shortage of nurse anesthetists instructors, and lack of faculty development system for nurse anesthetist instructors. This article proposes two initiatives as responses to educational reform: 1. constructing a competency-based framework and developing programmatic assessments for training Student Reg-istered Nurse Anesthetist Nurse Practitioner (SRNANP) ; 2. establishing a culture of collaborative teaching and resource sharing. The new culture enhances teaching quality and provides a richer, more diverse learning experience for both trainers and trainees. The article emphasizes the need for im-mediate curriculum transformation in SRNANP training. It emphasizes on the removal of traditional knowledge-centric and time-centric teaching frameworks and focused on adopting blended learning and self-directed learning principles. By aligning with the global trend of competency-based educa-tion, we can actively move toward the goal of co-creation and resource sharing&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Timing of stroke survivors' hospital readmissions to guide APRNs in primary care.

Caring for patients after a neurovascular incident is common for advanced practice registered nurses (APRNs). Most neurological readmission studies focus on a small subset of neurovascular incident groups, but advanced practice nurses in primary care attend to a diverse neurovascular population and lack time to adequately search hospital records. The aim of this study was to determine readmission risk factors after a neurovascular incident to guide APRNs in the primary care setting. The study is a retrospective observational study that used a crude single predictor model to determine potential risks for readmission. A total of 876 neurovascular participants were studied. Of these, only 317 experienced at least one hospital readmission, with 703 readmissions within 1 year, indicating some were readmitted more than once. Risks for readmission varied across neurovascular events. The main reasons for readmission were because of neurological, cardiovascular, and musculoskeletal complications. Stroke readmission rates are high and require intervention by APRNs. To prevent readmission includes timely follow-up within 30 days and should also include longitudinal follow-up beyond 90 days to prevent hospital readmission. Future studies are needed to create guidelines for APRNs that implement rehabilitation strategies to decrease hospital readmission for the neurovascular population that focus on interdisciplinary communication.

A Caring Ethic in Advocacy Work: Advanced Practice Nurses’ Professionalism in Restrictive States

A Caring Ethic in Advocacy Work: Advanced Practice Nurses’ Professionalism in Restrictive States

Hospital nurse managers' perspectives of the Magnet Recognition Program using an importance-performance analysis: A quantitative cross-sectional study.

To explore the perspectives of nursing managers in Korean hospitals on the Magnet Recognition Program using importance-performance analysis. A descriptive quantitative cross-sectional design with a survey methodology was used to evaluate nursing managers' perceptions of the Magnet Recognition Program criteria. After the Magnet Recognition Program's content validity was confirmed, an online survey was administered to 150 nursing managers from 10 hospitals. The results were analysed using importance-performance analysis. The average importance of the questionnaire for the developed Magnet Recognition Program criteria was 3.19 ± 135 and the performance was 2.90 ± 222. Items corresponding to the areas 'Concentrate here', 'Keep up the good work', 'Possible overkill' and 'Low priority' were identified using two importance-performance analysis frames. The items corresponding to 'Concentrate here' included evidence-based nursing practice, the nursing professional practice model, nurses' participation in improving turnover rate and cases of innovation in nursing. This study highlights areas for improvement within the Magnet Recognition Program as perceived by Korean nursing managers, emphasizing evidence-based practice, professional models and nurses' involvement in turnover reduction and fostering innovation. To achieve Magnet recognition, hospitals must understand nursing managers' perspectives on the Magnet Recognition Program criteria. This study provides insights into enhancing the work environment for nurses in South Korean hospitals and lays the groundwork for developing effective Magnet certification programs. Introducing the Magnet program into South Korean hospitals may improve the overall nursing work environment and mitigate the serious problem of nursing staff turnover. The findings were reported using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.

Nursing Recommendations for Symptom-Specific Self-care of Low Anterior Resection Syndrome: A Systematic, Scoping Review of the Literature.

Low anterior resection syndrome (LARS) is a result of removing part or most of the rectum as a treatment for rectal cancer that negatively impacts quality of life. There is a lack of standardized nursing symptom-specific self-care recommendations for patients suffering from LARS. The aim of this study was to map the existing research regarding nursing guidelines and symptom-specific recommendations for LARS self-care. A systematic scoping review using 4 comprehensive databases (ProQuest, EMBASE, PubMed, and Web of Science) was completed using the PRISMA Extension for Scoping Reviews guidelines. Applying specified search terms, relevant articles were extracted using criteria and entered into an Excel database. Three publications met the study inclusion criteria: 1 randomized controlled pilot study; 1 nonrandomized, retrospective pilot study; and 1 retrospective, comparative, cross-sectional study. No professional nursing guidelines were found, but 3 nurse-led management programs were reviewed. Publications provided self-care nursing recommendations for all LARS symptoms except for repeated painful stools/tenesmus, soiling, or discrimination disorders/flatulence. Combination of nursing self-care recommendations included dietary/lifestyle modifications, fiber supplements/bulking agents, antidiarrheal and laxative over-the-counter medications, and pelvic floor muscle exercises. When mapping the literature, there appears to be nurse-led management programs and recommendations for self-care for patients with LARS for almost all symptoms. Yet, there are no standardized recommendations. Professional nursing practice guidelines for all symptoms are lacking. Nursing recommendations for self-care of LARS exist and need to be expanded and standardized to include all symptoms. Further research regarding comprehensive nursing self-care recommendations and management is warranted.