Mary E. Burman

RN to FNP: A Qualitative Study of Role Transition

Registered nurses who return to school in a nurse practitioner program undergo role transition throughout the educational process and into the postgraduate period. This study examined the role transition that occurs in family nurse practitioner (FNP) students. A descriptive, qualitative design was used with in-depth telephone interviews of 9 female FNPs who had recently graduated. A conceptual model was generated that described the role transition from RN to FNP. Two phases of role transition occurred and were depicted by the central categories that emerged: extrinsic obstacles, intrinsic obstacles, turbulence, positive extrinsic forces, positive intrinsic forces, and role development. Although the central categories were found to be the same in Phase I and Phase II, the defining characteristics differed. This study has implications for FNPs, students, and educators regarding role transition. It presents new findings not identified in prior research: personal commitments and sacrifices were identified as specific obstacles encountered during the educational process, and differences were found between inexperienced and experienced RNs in relation to the FNP role transition during the educational period.

Advanced practice nursing model for comprehensive care with chronic illness: model for promoting process engagement.

New models of providing care to chronically ill persons are needed that can facilitate a more integrative approach to patient care. The purposes of this article are to describe the utilization of a theory synthesis process for development of a client-focused approach for advanced practice nurse (APN) management of chronic illness and to present the Model for Promoting Process Engagement. The model was developed as a theory-driven intervention to address complexities of chronic illness care. This APN practice model is the direct result of the synthesis of a number of differing theoretical models developed by the authors in previous individual research endeavors.

A qualitative study of self-transcendence in caregivers of terminally ill patients

Despite changes in social and cultural structure, the family has remained a consistent provider of in-home care needs for the chronically and terminally ill. The experience of a terminal illness is not limited to the individual patient and creates a myriad of challenges for the family, including the struggle to adjust and respond to the demands of the situation. The purpose of this study was to assess the caregivers’ sense of emotional well being and their ability to transcend and find meaning in the caregiving experience. The participants in this study were all caregivers of a family member who had died six to 12 months prior to the interview. They were able to find meaning as a result of their caregiving experience within the context of supportive networks, caregiving actions, grief and loss, fatigue, financial burdens and multiple challenges. Finding meaning involved “being with” or “doing for” their loved one as death approached. Finding meaning had positive consequences for the caregivers. They described a new life view and were able to reach out to help others as a result of their caregiving.

How do NPs make clinical decisions

The authors conducted a study to explore the process primary care NPs use in making clinical decisions and the factors that influence the process. By delineating the process used by primary care NPs in therapeutic decision making, we can enhance clinical decision making in students and practicing NPs.

Reconceptualizing the core of nurse practitioner education and practice

PurposeThe movement to the doctor of nursing practice (DNP) is progressing rapidly with new programs emerging and curricular documents being developed. We argue that the implementation of the DNP is a good move for nursing, provided that we use the opportunity to reconceptualize the core of advanced practice nursing, especially nurse practitioner (NP) practice. Data sourcesTheory and research articles from nursing focused on advanced practice nursing, NPs, and doctoral education. ConclusionsThe foundation of NP education is currently based essentially on borrowed or shared content in assessment, pharmacology, and pathophysiology. We argue that the heart and soul of nursing is in health promotion, both in healthy persons and in those dealing with chronic illness. Current masters programs do not prepare NPs to assume high-level practice focused on health promotion and disease management using the latest theoretical developments in health behavior change, behavioral sciences, exercise physiology, nutrition, and medical anthropology. Although these are touched upon in most NP programs, they do not represent the core science of NP education and need to be a critical part of any DNP program. Implications for practiceUltimately, our vision is for NP care to be consistently “different,” yet just as essential as physician care, leading to positive outcomes in health promotion and disease management.

Informational needs of caregivers of terminal patients in a rural state

Home care of a terminally ill family member is stressful, especially in rural areas. This qualitative study sought to determine informational needs of rural caregivers and how that information is obtained. Although most caregivers stated satisfaction with available information, mostly obtained from physicians and nurses, their behavior belied their satisfaction. Assertive and self-reliant, they used informal communications rather than written information to meet most of their needs. Approaches home care nurses can use to help caregivers obtain important information are presented.

Role Transition During RN-to-FNP Education

This study examines the role transition that occurs during RN-to-family nurse practitioner (FNP) education, described in an earlier qualitative study that identified a role transition framework of influential positive forces and obstacles. The purposes of the study were to validate the educational phase of the original framework and explore other role transition issues. The study used a descriptive correlational design by asking all FNPs in two rural western states to participate by answering a questionnaire. Findings evidenced a stronger level of agreement with the positive forces than with the obstacles. In addition, two significant relationships were found between the positive forces and obstacles and personal life circumstances. These included personal support systems, which were significant for those who had to travel to class, and personal sacrifices, which were significant for those who had children at home. Further research will focus on testing across nurse practitioner specialties nationally.

Rural Nurse Practitioners: Perceptions of Ethical Dilemmas

&NA; The purposes of this study were to identify ethical dilemmas encountered by rural nurse practitioners in primary practice and to identify constraints or enhancers that influenced ethical decision making. Nine nurse practitioners from Wyoming and Colorado responded to in‐depth interviews. Six categories of ethical dilemmas and a list of constraints and enhancers were identified. One central concept, conflict between personal values and professional responsibility, emerged. Beneficence, nonmaleficence, justice, and patient autonomy, as core ethical principles, were related to this central conflict.

Linking evidence-based nursing practice and patient-centered care through patient preferences.

Calls for both patient-centered care and evidence-based practice (EBP) have increased dramatically over the last decade despite a tension between the two. Patient preferences, one of the cornerstones of EBP, can provide the link between the two. Although current research supports the added value of patient preferences in care, there is currently a “gap” between EBP and patient-centered care, with the two often viewed as opposing ideas. The purpose of this article is to provide an overview of patient preferences, summarize research on patient preferences, and discuss implications for nursing and nursing administration. Efforts to incorporate patient preferences into nursing care must be multifaceted, targeting multiple levels from individual nurses to organizations and systems. Four critical elements have been identified for integrating patient preferences into EBP: (1) health care redesign, (2) decision support, (3) empowered organizational culture, and (4) informed and empowered nurses.

Complementary and Alternative Medicine: Core Competencies for Family Nurse Practitioners

Recent surveys demonstrate substantial use of complementary and alternative medicine. This growth presents a challenge for family nurse practitioner programs that already have dense curricula due to the explosion of biomedical knowledge. Significant barriers exist to incorporating complementary and alternative medicine into educational programs, such as differing philosophies about health and lack of research on many complementary and alternative medicine therapies. This study used a mailed questionnaire in which family nurse practitioner program directors described the current status of complementary and alternative medicine teaching in family nurse practitioner programs and identified core competencies for family nurse practitioners. Most programs reported integrating some content on complementary and alternative medicine into advanced practice courses, such as health promotion. Competencies related to interviewing, critical thinking, evidence-based medicine, knowledge of laws, ethics, and spiritual and cultural beliefs were rated the highest. The findings are useful in helping family nurse practitioner faculty incorporate complementary and alternative medicine content into their curricula with the goal of preparing family nurse practitioners for safe practice.