Judy A. Beal

Academic-Service Partnerships in Nursing: An Integrative Review

This integrative review summarizes currently available evidence on academic-service partnerships in the profession of nursing. More than 300 articles, published primarily in refereed journals, were accessed. Articles (110) were included in this review as they presented detailed and substantive information about any aspect of a nursing academic-service partnership. The majority were anecdotal in nature. Topics clustered around the following categories: pre-requisites for successful partnerships, benefits of partnerships, types of partnerships, and workforce development with its themes of academic-practice progression and educational re-design. Many examples of partnerships between academic and service settings were thoroughly described and best practices suggested, most often, however, without formal evaluation of outcomes. Nursing leaders in both settings have a long tradition of partnering with very little replicable evidence to support their efforts. It is critical that future initiatives evaluate the effectiveness of these partnerships, not only to ensure quality of patient outcomes but also to maximize efforts at building capacity for tomorrows workforce.

Role of self-efficacy in birth choice.

The incidence of vaginal birth after cesarean section is relatively low, although the procedure is of minimal risk to the mother and fetus. The article reports a pilot study designed to investigate whether a relationship exists between the concept of self-efficacy and delivery choice. The Childbirth Self-Efficacy Inventory, a self-administered questionnaire, was completed by 74 pregnant women. The study found that women choosing elective repeat cesarean delivery had lower self-efficacy scores on the instrument. The results suggest the need for further research using assessment of preoutcome, postoutcome, and self-efficacy expectancy scores with specifically designed classes for women who have had a previous cesarean birth.

Academic Practice Partnerships: A National Dialogue

Academic-practice partnerships are an important mechanism to strengthen nursing practice and help nurses become well positioned to lead change and advance health. Through implementing such partnerships, both academic institutions and practice settings will formally address the recommendations of the Institute of Medicine Future of Nursing Committee. Effective partnerships will create systems for nurses to achieve educational and career advancement, prepare nurses of the future to practice and lead, provide mechanisms for lifelong learning, and provide a structure for nurse residency programs. This paper details the work of the American Association of Colleges of Nursing-American Organization of Nurse Executives Task Force on Academic-Practice Partnerships that has identified hallmarks of successful partnership and produced tools and shared exemplars to assist nursing leaders in developing and sustaining partnerships for the future.

The nurse practitioner role in the NICU as perceived by parents.

Purpose The aim of this study was to understand and describe the nature of nurse practitioner care delivery in the newborn intensive care unit (NICU) as perceived by parents of critically ill neonates. Design This qualitative study used a phenomenologic approach to answer the research question: “What is the lived experience of parents whose babies were cared for by a nurse practitioner in the NICU? Methods Consistent with phenomenologic methods, eight parents were asked: “What was it like for you to have a nurse practitioner care for you and your baby?” Parents whose babies had within the last 8 months spent at least 2 weeks in the NICU and had been discharged to home were asked to participate by letter. Consent of interested parents was obtained and interviews were conducted in the parents’ homes. All interviews were audiotaped and transcribed. Results In addition to being able to effectively manage the medical care of the complex neonate, nurse practitioners were consistently perceived as: “being positive and reassuring,” “being present,” “caring,” “translating information,” and “making parents feel at ease.” Implications Nurse practitioners working in the NICU can feel validated by the fact that they are clearly appreciated by parents. Inclusion of NPs in the NICU care team enhances the care provided to infants and their families.

Evidence for best practices in the neonatal period.

The purpose of this article is to provide a review of current nursing research that supports best practices during the newborn period. The literature review of peer-reviewed research articles published between January 2000 and October 2004 was conducted via keyword searches using the databases of the Cochrane Library, CINAHL, and MEDLINE. Key words included neonatal nursing, newborn, neonate, premature infant, preterm infant, and low birthweight. Content analysis revealed the following primary categories of studies that provide solid evidence for nursing practice: developmentally focused nursing care, neonatal skin care, feeding, skin-to-skin care, and pain management. Neonatal nurse researchers have made many important contributions to the research literature. Future research should expand the findings to date on the effective use of pain scales, the outcomes of skin-to-skin care and infant massage as standard practice for all neonates, and the effectiveness of nursing interventions to support the developmental sequelae of prematurity. Neonatal nurses should become familiar with and implement those findings from nursing research that strongly support evidence-based nursing practice.

Health-illness beliefs and practices of Haitians with HIV disease living in Boston

The authors of this qualitative study explored the health-illness beliefs and practices of Haitians with HIV disease. The authors obtained a purposive sample of five Haitian men and four Haitian women with symptomatic HIV disease or AIDS living in Boston. Five themes were identified through content analysis of interviews and medical record review: (a) incorporation of traditional health-illness beliefs into beliefs about HIV disease; (b) A perceived need to hide HIV disease to avoid rejection, humiliation, and isolation; (c) use of spirituality to help cope with HIV disease; (d) history of limited contact with doctors prior to diagnosis of HIV disease; and (e) use of traditional healing practices for HIV disease. The findings have implications for improving cross-cultural communication between Haitians with HIV disease and their healthcare providers.

Essential elements of an optimal clinical practice environment.

Objective: This study describes essential elements for an optimal clinical practice environment wherein scholarly nursing practice flourishes. Background: Existing literature confirms that a healthy work environment that supports professional scholarly nursing practice is essential to retention and satisfaction of clinical nurses, enhanced patient safety, and improved patient/family outcomes. Methods: A subset of data from a larger qualitative study was analyzed using content analysis. Semistructured interviews were conducted at the workplaces of 36 experienced clinical nurses. Data on workplace facilitators and barriers to scholarly nursing practice are reported. Results: The major study finding is that the optimal practice environment embraces scholarly nursing practice and balances care giving with professional development. The 4 themes integral to this balance included the following: (1) the practice environment needs to openly value scholarly nursing practice, (2) seamless support is needed at every level of the organization, (3) even clinical scholars have professional development needs, and (4) it is a 2-way street. Conclusion: This study provides new insights into unique key elements essential for the development of scholarly nursing practice in hospital environments.

Responsibilities, roles & staffing patterns of nurse practitioners in the neonatal intensive care unit.

PURPOSE To describe the unique contribution of the NP in caring for critically ill infants through the study of NP responsibilities, roles, staffing patterns, and patient profiles. DESIGN This prospective descriptive study was conducted in conjunction with a regional multi-site outcomes study. METHODS Data were collected at five regional level II/III NICUs in Massachusetts and Rhode Island. Twenty-two NPs were surveyed. Existing data on outcomes of 2,146 very low birth weight infants were used to describe patient profiles. NP care was defined as assignment to an NP at admission. Illness severity was measured using the Score of Neonatal Acute Physiology (SNAP). RESULTS NP roles included all levels of NICU care as well as antepartal consultation, delivery room management, transport, and outpatient follow-up. NPs were equally involved with patients of all degrees of complexity and birthweights. Patient assignments were most often made by a rotational system with the resident/fellow or by complexity of infant with the NP in some NICUs caring for sicker smaller babies. CLINICAL IMPLICATIONS This study documents a blended model of NP MD care in the NICU with each provider bringing unique strengths to the team. Nurse practitioners working in the NICU provide an invaluable contribution in terms of parent support and teaching, post NICU follow-up care, and professional education and research. The NP role in the NICU should not be viewed as a substitution for resident physicians.

The role of the neonatal nurse practitioner in post NICU follow-up.

This descriptive correlational study explored the role of neonatal nurse practitioners (NNPs) in postneonatal intensive care unit follow-up. A random sample of 505 NNPs completed a researcher-developed instrument pretested for reliability and validity. There was overwhelming agreement (96%) that a role exists for NNPs in follow-up. In total, 52% felt qualified to provide follow-up and 22% were currently in the role. NNPs with previous primary care experience (P = 0.010) were more involved in follow-up. NNPs with additional certification (P = 0.016) or previous primary care experience (P = 0.003) felt more qualified to provide follow-up care. Facilitators and barriers to the role were identified by NNPs providing follow-up care.

Hallmarks of Best Practice in Academic–Service Partnerships in Nursing: Lessons Learned From San Antonio

UNLABELLED TOPIC INVESTIGATED: The objectives of this project were to (a) identify best practice in academic-practice partnerships; (b) identify the needs and/or desire for greater collaboration and partnership between the University of Texas Health Science Center San Antonio School of Nursing (SON) and key stakeholders in San Antonio, TX; and (c) guide the work of a national task force. METHODS One-on-one open-ended interviews were conducted with deans of nursing and vice presidents of patient care services at the six major health systems in San Antonio. Focus groups were also conducted with individuals who included chief nursing officers, vice presidents of a hospital, nurse managers, clinical educators, and clinical researchers. Data were analyzed using content analysis. RESULTS Seventy-two individuals participated, and all expressed a desire for greater partnership with the SON. All identified characteristics of best practice in academic-service partnerships and the value or benefits of such partnerships. All participants believed that partnerships between academic and service were critical to the advancement of quality patient care. CONCLUSIONS There has been limited research published to date that explicates the complexities of developing and sustaining partnerships between academia and practice. This article highlights preliminary findings on best practices in academic-service partnerships.