Current Issue : July - September Volume : 2013 Issue Number : 3 Articles : 6 Articles
Background: At the time of this study (2009) the role of the nurse practitioner was new to the province of British\r\nColumbia. The provincial government gave the responsibility for implementing the role to health authorities.\r\nManagers of health authorities, many of whom were unfamiliar with the role, were responsible for identifying the\r\nneed for the NP role, determining how the NP would function, and gaining team members� acceptance for the\r\nnew role.\r\nMethod: The purpose of the study was to explain the process of nurse practitioner role implementation as it was\r\noccurring and to identify factors that could enhance the implementation process. An explanatory, single case study\r\nwith embedded units of analysis was used. The technique of explanation building was used in data analysis. Three\r\nprimary health care settings in one health authority in British Columbia were purposively selected. Data sources\r\nincluded semi-structured interviews with participants (n=16) and key documents.\r\nResults: The results demonstrate the complexity of implementing a new role in settings unfamiliar with it. The\r\nfindings suggest that early in the implementation process and after the nurse practitioner was hired, team\r\nmembers needed to clarify intentions for the role and they looked to senior health authority managers for\r\nassistance. Acceptance of the nurse practitioner was facilitated by team members� prior knowledge of either the\r\nrole or the individual nurse practitioner. Community health care providers needed to be involved in the\r\nimplementation process and their acceptance developed as they gained knowledge and understanding of the role.\r\nConclusion: The findings suggest that the interconnectedness of the concepts of intention, involvement and\r\nacceptance influences the implementation process and how the nurse practitioner is able to function in the setting.\r\nWithout any one of the three concepts not only is implementation difficult, but it is also challenging for the nurse\r\npractitioner to fulfill role expectations. Implications for research, policy, practice and education are discussed....
Healthcare is a complex adaptive system, and efforts to improve through the implementation of best practice are well served\r\nby various interacting disciplines within the system. As a transdisciplinary model is new to clinicians, an infrastructure that\r\ncreates academic-practice partnerships and builds capacity for scientific collaboration is necessary to test, spread, and implement\r\nimprovement strategies. This paper describes the adoption of best practices from the science of team science in a healthcare\r\nimprovement research network and the impact on conducting a large-scale network study. Key components of the research network\r\ninfrastructure were mapped to a team science framework and evaluated in terms of their effectiveness and impact on a national\r\nstudy of nursing operations. Results fromthis study revealed an effective integration of the teamscience principles which facilitated\r\nthe rapid collection of a large dataset. Implications of this study support a collaborative model for improvement research and stress\r\na need for future research and funding to further evaluate the impact on dissemination and implementation....
Background: Spiritual needs of cancer patients should be assessed and discussed by healthcare professionals.\r\nNeurosurgical nurses need to be able to assess and support neuro-oncology patients with their spiritual needs from\r\ndiagnosis and throughout their hospital stay.\r\nMethods: Data were collected through questionnaires using a Critical Incident Technique (CIT) from neurosurgical\r\nnurses, findings were analysed using thematic analysis.\r\nResults: Nurses reported some awareness of their patients� spiritual needs during their stay on neurosurgical units\r\nalthough some used expressions approximating what could be described as spiritual needs. Patients� spiritual needs\r\nwere identified as: need to talk about spiritual concerns, showing sensitivity to patients� emotions, responding to\r\nreligious needs; and relatives� spiritual needs included: supporting them with end of life decisions, supporting them\r\nwhen feeling being lost and unbalanced, encouraging exploration of meaning of life, and providing space, time\r\nand privacy to talk. Participants appeared largely to be in tune with their patients� spiritual needs and reported that\r\nthey recognised effective strategies to meet their patients� and relatives� spiritual needs. However, the findings also\r\nsuggest that they don�t always feel prepared to offer spiritual support for neuro-oncology patients.\r\nConclusions: There is a need for healthcare professionals to provide spiritual care for neuro-oncology patients and\r\ntheir relatives. Although strategies were identified that nurses can use to support patients with spiritual needs\r\nfurther research is required to explore how effective nurses are at delivering spiritual care and if nurses are the most\r\nappropriate professionals to support neuro-oncology patients with spiritual care....
The study objective was to develop and evaluate a template for evidence-informed symptom protocols for use by nurses over the\ntelephone for the assessment, triage, and management of patients experiencing cancer treatment-related symptoms. Guided by the\nCAN-IMPLEMENT�© methodology, symptom protocols were developed by, conducting a systematic review of the literature to\nidentify clinical practice guidelines and systematic reviews, appraising their quality, reaching consensus on the protocol template,\nand evaluating the two symptomprotocols for acceptability and usability. After excluding one guideline due to poor overall quality,\nthe symptom protocols were developed using 12 clinical practice guidelines (8 for diarrhea and 4 for fever). AGREE Instrument\n(Appraisal of Guidelines for Research and Evaluation) rigour domain subscale ratings ranged from 8% to 86% (median 60.1\ndiarrhea; 40.5 fever). Included guidelines were used to informthe protocols along with the Edmonton SymptomAssessment System\nquestionnaire to assess symptomseverity. Acceptability and usability testing of the symptom populated template with 12 practicing\noncology nurses revealed high readability (?? = 12), just the right amount of information (?? = 10), appropriate terms (?? = 10),\nfit with clinical work flow (?? = 8), and being self-evident for how to complete (?? = 5). Five nurses made suggestions and 11\nrated patient self-management strategies the highest for usefulness. This new template for symptom protocols can be populated\nwith symptom-specific evidence that nurses can use when assessing, triaging, documenting, and guiding patients to manage theircancer\ntreatment-related symptoms....
The aim of the study was to illuminate the meaning of older personsââ?¬â?¢ independent decision making concerning their daily care.\r\nAutonomy when in care is highly valued in the western world. However, research shows that autonomy can give rise to problematic\r\nissues. The complexity of independence and dependence for older people when living at home with help has also been highlighted.\r\nIn Sweden, older people are increasingly expected to live at home with help frommunicipal home care services, and study into this\r\naspect of care is limited. This study is a part of an ongoing project and has a qualitative life world perspective. Audiotaped narrative\r\ninterviews were conducted and analysed using a phenomenological hermeneutic method. Findings revealed a main theme: ââ?¬Å?living\r\nwith uncertainty as to how to relate oneââ?¬â?¢s own independence and dependence with regard to oneself, and others.ââ?¬ÂThis involves a\r\nconstant process of relating to oneââ?¬â?¢s independence controlled by others or oneself, and adjusting oneââ?¬â?¢s independence and dependence\r\nwith regard to oneself and others. The conclusion is that professional carers need to acknowledge the changing vulnerability of\r\ndependent older persons over time. The implication is a relational approach to autonomy beyond the traditional individualistic\r\napproach....
The purpose of this study was to describe nurses� experiences of their collaboration and relationships with family members in\r\ninstitutional respite care for the elderly. The family has a particularly important role in respite care, which is an extension of care\r\nprovided at home.However no published studies were found on this subject. The data were collected through qualitative interviews\r\n(?? = 22). Content analysis of the nurses� descriptions of their collaboration with family members yielded four main categories as\r\nfollows: (1) conscious ignoring, (2) attempting to understand the family�s situation, (3) hinting at private family matters, and (4)\r\nbeing a friend. The results lend support to earlier findings which emphasize the complexity of relationships between nurses and\r\nfamily carers. A novel finding here is that these relationships may also develop into friendships. Greater emphasis must be placed\r\non primary nursing so that the nurse and informal carer can build up a genuine relationship of trust. If periods of respite care are to\r\nhelp older people and their families to manage independently, it is imperative that nurses have the opportunity to visit their patients\r\nat home....
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