Mary Brennan

Evaluation of the clinical hour requirement and attainment of core clinical competencies by nurse practitioner students

Purpose: The purpose of this study was to analyze the national practice of fulfilling 500 clinical hours as a requirement for graduation from nurse practitioner (NP) programs at the masters level and to compare this standard to a comprehensive approach of evaluating attainment of clinical competencies. Data sources: The National Organization of NP Faculties (NONPF) and specialty accreditation bodies publications were used for references to clinical hour and core competency requirements for graduation from NP programs. Data from one university from student documentation on a commercial electronic tracking system were also analyzed. Conclusions: Data analysis revealed that the 500 clinical hours correlated to populations, skills performed, required levels of decision making, and expected diagnoses. However, assurance that these clinical hour requirements translated to exposure to all core competencies for entry into practice could not be established. Implications for practice: A more comprehensive approach to the evaluation of student core competencies by implementing one or more performance‐based assessments, such as case‐based evaluations, simulations, or objective structured clinical examinations (OSCEs), as a strategic part of NP evaluation prior to graduation is proposed. This change is viewed as critical to the continued success of NP programs as masters level education transitions to direct BS to DNP educational preparation for advanced nursing practice.

Practice patterns and organizational commitment of inpatient nurse practitioners

Purpose Nurse practitioners (NPs) deliver a wide array of healthcare services in a variety of settings. The purpose of this study was to examine the practice patterns and organizational commitment of inpatient NPs. Methods A quantitative design was used with a convenience sample (n = 183) of NPs who attended the American Association of Nurse Practitioners (AANP) national conference. The NPs were asked to complete a demographic questionnaire, the Practice Patterns of Acute Nurse Practitioners tool and the Organizational Commitment Questionnaire. Conclusions Over 85% of inpatient practice time consists of direct and indirect patient care activities. The remaining nonclinical activities of education, research, and administration were less evident in the NPs workweek. This indicates that the major role of inpatient NPs continues to be management of acutely ill patients. Moderate commitment was noted in the Organizational Commitment Questionnaire. Implications for practice Supportive hospital/nursing leadership should acknowledge the value of the clinical and nonclinical roles of inpatient NPs as they can contribute to the operational effectiveness of their organization. By fostering the organizational commitment behaviors of identification, loyalty, and involvement, management can reap the benefits of these professionally dedicated providers.Purpose:Nurse practitioners (NPs) deliver a wide array of healthcare services in a variety of settings. The purpose of this study was to examine the practice patterns and organizational commitment of inpatient NPs. Methods:A quantitative design was used with a convenience sample (n = 183) of NPs who attended the American Association of Nurse Practitioners (AANP) national conference. The NPs were asked to complete a demographic questionnaire, the Practice Patterns of Acute Nurse Practitioners tool and the Organizational Commitment Questionnaire. Conclusions:Over 85% of inpatient practice time consists of direct and indirect patient care activities. The remaining nonclinical activities of education, research, and administration were less evident in the NPs workweek. This indicates that the major role of inpatient NPs continues to be management of acutely ill patients. Moderate commitment was noted in the Organizational Commitment Questionnaire. Implications for practice:Supportive hospital/nursing leadership should acknowledge the value of the clinical and nonclinical roles of inpatient NPs as they can contribute to the operational effectiveness of their organization. By fostering the organizational commitment behaviors of identification, loyalty, and involvement, management can reap the benefits of these professionally dedicated providers.

Evidence-based care for patients with acute coronary syndrome in New York City

This chapter describes an innovative model of emergency cardiac care, designed by an academic medical center for residents living in the high-disparity community of East Harlem in New York City. Due to the socioeconomic, racial, and ethnic disparities experienced by individuals living in this community, residents experience the second highest rate of premature death in New York. With a state-of-the-art cardiac catheterization center, cardiologists, partnering with nurse practitioners, collaborate to utilize the best available evidence to assess, diagnose, and treat patients with acute coronary syndrome. This innovative model has resulted in a dramatic reduction of mortality rates involving both nonemergency and emergency patients as well as an improved safety record that has surpassed other New York State Hospitals since reporting of data began in 1994.

Normal food at will and nil-by-mouth enteral feeding after major upper GI surgery did not differ for mortality or morbidity.

K Lassen Dr K Lassen, University Hospital Northern Norway, Tromso, Norway; lassen@unn.no Does allowing normal food at will increase morbidity compared with “nil-by-mouth” enteral tube feeding (ETF) after major upper gastrointestinal (GI) surgery? ### Design: randomised controlled trial (RCT). ### Allocation: concealed. ### Blinding: {unblinded}.* ### Follow-up period: 8 weeks. ### Setting: 5 referral centres in Norway. ### Patients: 453 patients (mean age 64 y, 59% men, based on 447 patients) who had major upper GI surgery. Exclusion criteria included severe extra-abdominal disease or trauma, life expectancy <3 months, or indications for parenteral nutrition. ### Interventions: normal food at will (n = 220) or ETF by needle-catheter jejunostomy (n = 227) after surgery. ETF consisted of nutrition, 20 ml/h on day 1, increasing by 20 ml/h/d (if tolerated) up …

Review: routine NG decompression after abdominal surgery delays return of bowel function and increases pulmonary complications.

R Nelson Prof R Nelson, Northern General Hospital, Sheffield, UK; rick.nelson@sth.nhs.uk; altohorn@btinternet.com Is routine nasogastric (NG) tube decompression after major abdominal surgery better than selective or no decompression? ### Data sources: MEDLINE, EMBASE/Excerpta Medica, and Cochrane Central Register of Controlled Trials (all to 2006); and reference lists of published studies and reviews. ### Study selection and assessment: randomised controlled trials (RCTs) that compared routine NG tube decompression with selective or no tube use (control) in patients >18 years of age having abdominal surgery. In the routine decompression group, tubes were inserted before or during surgery and kept in place after surgery until spontaneous passage of flatus. In the control group, tubes …