Marietta Stanton

INNOVATIVE PARTNERSHIPS: THE CLINICAL NURSE LEADER ROLE IN DIVERSE CLINICAL SETTINGS

The American Association of Colleges of Nursing in collaboration with leaders in the health care arena has developed a new role in nursing, the clinical nurse leader (CNL). The CNL is a masters-prepared advanced nurse generalist, accountable for providing high-quality, cost-effective care for a cohort of patients in a specific microsystem. Although initial implementation of the CNL has been predominantly in urban acute care settings, the skill set of the CNL role is equally applicable to diverse clinical settings, such as smaller rural hospitals, home-based home care providers, long-term care facilities, schools, Veterans Administration facilities, and public health settings. This article reports the strategies used and the progress made at The University of Alabama Capstone College of Nursing in the development of innovative partnerships to develop the role of the CNL in diverse clinical settings. With academia and practice working in partnership, the goal of transforming health care and improving patient outcomes can be achieved.

Case management evolution: from basic to advanced practice role.

This article provides an overview of nursing case management as an advanced practice role from a theoretical and practice basis. Not all case managers will, or need to, perform case management duties at the advanced level. However, it has become abundantly clear over the past several years that nurse case managers are performing more complex duties that appear to match the competencies of other advanced practice roles. In this article, the authors will explore the issue in depth and demonstrate the differences between basic and advanced practice nursing case management on the basis of clinical practice, educational level, and research responsibilities for both the basic and advanced levels of case management practice; advanced practice competencies; and examples of advanced practice case management from current practice. Just as there are differences between basic and advanced professional and clinical nursing practice, there is a difference between basic and advanced levels of case management practice.

Nursing case management: A rural practice model

Nursing case management is a blend of individual case- and/or disease-management activities used in urban hospitals or community health settings. The authors propose that in rural communities, a third form of case management is also used. Nursing case management in the rural community has a broader and more diverse scope of practice than nurse case managers practicing in urban settings.

Images and sensations of war: A common theme in the history of military nursing

We analyzed interviews with 22 military nurses who had served in wars or conflicts since World War II, up to and including Operation Desert Storm. Using a method of hermeneutic phenomenology, we found several common themes in the interviews. In this article, we report on the theme Images and Sensations of War. Within that theme, the subcategories sights, sounds, and other sensations (climate and weather, taste, smell, and comfort) were discovered. We categorized the images and sensations as pleasant, unpleasant, and horrible. The findings from this analysis may be useful to professionals who recruit military nurses, provide ongoing military training, help military nurses return to civilian life, and treat posttraumatic stress syndrome. Furthermore, the findings could be used as a basis for future quantitative studies to determine how widespread this theme is in larger groups of military nurses.

Patient education in the hospital health-care setting

The implementation of patient education within the hospital setting can be justified for a variety of reasons. The rationale for implementing patient education can be justified in terms of escalating emphasis on consumerism and informed participation on the part of the health-care recipient, the support of federal legislation, the support of hospital regulatory bodies, the support of third-party insurance carriers and private foundations, increased cooperation and compliance on the part of the patient, reduced stress levels for the hospitalized patient, and the improvement of staff-patient relationships. All of these serve as a database that justifies the integration of patient education within hospital care services. Patient education is the responsibility of the existing health-care system. In many instances, patient education is still not being approached in a serious manner. Therefore this paper attempts to provide a number of reasons health-care professionals functioning within the hospital setting should implement this process.

The clinical nurse leader: a comparative study of the American Association of Colleges of Nursing vision to role implementation.

The clinical nurse leader (CNL) is a new nursing role developed from a series of discussions held by the American Association of Colleges of Nursing (AACN) about revisions in nursing education that would prepare nurses with the competencies needed to work in the current and future health care system. The CNL is supposed to have a direct impact on clinical, functional, satisfaction, and cost outcomes. A number of health care organizations have adapted the role and integrated it into their unique clinical environment, but it remains unclear if the implementation is in line with the AACNs vision. This study investigated this question using the first cohort of graduates at a major university in the Southern United States. Of the 11 graduates, 8 responded to a questionnaire. Results support the idea that these new CNLs function largely in accord with the nine components of the CNL role outlined by the AACN. However, these results also show that different CNL role components are emphasized in different clinical settings. The results suggest that the CNL role as an advanced generalist role is a genuine innovation, rebutting some critiques. Implications and directions for future research are discussed.

Parent gender, victim gender, and family socioeconomic level influences on the potential reporting by nurses of physical child abuse.

In 1974, the Federal Child Abuse Prevention and Treatment Act required reporting of child abuse in all states. Although nurses have since this time been designated as mandated reporters of abuse, only recently have nurses begun to hold positions where they are directly responsible for abuse reporting. This study investigated whether the gender of the victim, the gender of the abusing parent, or the familys socioeconomic level influences the potential reporting of child abuse by nurses. Participants were shown three vignettes of children being admitted to an emergency room with symptoms of possible abuse. When asked if they would or would not report the incident as child abuse, participants indicated they were significantly less apt to report abuse when the victim was female rather than male, and when the family was perceived as being from a middle rather than a low or high socioeconomic background. The implication of this finding is that female children from middle-class backgrounds may be left less protected than others as nurses become more actively involved in child abuse reporting.

An instructional technology for patient education

A review of the literature on patient education disclosed a high degree of consistency regarding the necessary components of a patient-education program. These components fall into three broad categories: design, implementation, and evaluation. Using these components as criteria for effective patient education, a survey of hospitals was undertaken to determine how closely these criteria are adhered to. Of 200 hospitals sent the questionnaire, 120 responded. Results show that patient educators adhere to the design and implementation components with high to moderate frequency but do little with respect to the evaluation components.

Alabama Veterans Rural Health Initiative: A Pilot Study of Enhanced Community Outreach in Rural Areas

PURPOSE Access, enrollment, and engagement with primary and specialty health care services present significant challenges for rural populations worldwide. The Alabama Veterans Rural Health Initiative evaluated an innovative outreach intervention combining motivational interviewing, patient navigation, and health services education to promote utilization of the United States Veterans Administration Healthcare System (VA) by veterans who live in rural locations. METHODS Community outreach workers completed the intervention and assessment, enrolling veterans from 31 counties in a southern state. A total 203 participants were randomized to either an enhanced enrollment and engagement outreach condition (EEE, n = 101) or an administrative outreach (AO, n = 102) condition. FINDINGS EEE participants enrolled and attended VA appointments at higher rates and within fewer days than those who received AO. Eighty-seven percent of EEE veterans attended an appointment within 6 months, compared to 58% of AO veterans (P < .0001). The median time to first appointment was 12 days for the EEE group and 98 days for the AO group (P < .0001). Additionally, a race by outreach group interaction emerged: black and white individuals benefited equally from the EEE intervention; however, black individuals who received AO took significantly longer to attend appointments than their white counterparts. CONCLUSIONS Results provide needed empirical support for a specific outreach intervention that speeds enrollment and engagement for rural individuals in VA services. Planned interventions to improve service utilization should ameliorate ambivalence about accessing health care in addition to addressing traditional systems or environmental-level barriers.

Chief Nursing Officers' Perceptions of the Doctorate of Nursing Practice Degree

PROBLEM Nurse executives practice in a business environment, which requires a skill set that has traditionally not been included in advanced nursing curriculum. The Doctorate of Nursing Practice (DNP) essentials are designed to address this gap in education while maintaining the focus on advanced nursing practice and executive management competency. Current literature supports the appropriateness of the DNP with practice focus areas of advanced practice specialties and nursing leadership. Although certification and educational bodies, and some professional nursing organizations, have embraced the DNP as the terminal degree for non-research-focused nurses, there remains a gap in the literature in regards to the perceptions of validity of the DNP for nurse executives. METHOD The purpose of this capstone project was to investigate the perceptions of practicing chief nursing officers (CNOs) in the acute care setting regarding the application of the DNP degree for nurse leaders. Utilizing an online survey, specific perceptions investigated included application and appropriateness of the DNP in a business-based practice model and managing daily nursing operations. FINDINGS CNOs practicing in the acute care setting differed on their responses regarding whether the DNP should be the recommended or the required degree in CNO development programs. CNOs with tenure responded more positively to the perception that the DNP curricula contains advanced nursing knowledge content appropriate to nurse executive practice. CONCLUSIONS Practicing CNOs in the acute care setting do perceive the DNP as an appropriate degree option for nurse executive roles at aggregate, system, and organizational levels.Problem Nurse executives practice in a business environment, which requires a skill set that has traditionally not been included in advanced nursing curriculum. The Doctorate of Nursing Practice (DNP) essentials are designed to address this gap in education while maintaining the focus on advanced nursing practice and executive management competency. Current literature supports the appropriateness of the DNP with practice focus areas of advanced practice specialties and nursing leadership. Although certification and educational bodies, and some professional nursing organizations, have embraced the DNP as the terminal degree for non-research-focused nurses, there remains a gap in the literature in regards to the perceptions of validity of the DNP for nurse executives. Method The purpose of this capstone project was to investigate the perceptions of practicing chief nursing officers (CNOs) in the acute care setting regarding the application of the DNP degree for nurse leaders. Utilizing an online survey, specific perceptions investigated included application and appropriateness of the DNP in a business-based practice model and managing daily nursing operations. Findings CNOs practicing in the acute care setting differed on their responses regarding whether the DNP should be the recommended or the required degree in CNO development programs. CNOs with tenure responded more positively to the perception that the DNP curricula contains advanced nursing knowledge content appropriate to nurse executive practice. Conclusions Practicing CNOs in the acute care setting do perceive the DNP as an appropriate degree option for nurse executive roles at aggregate, system, and organizational levels.