Pamela N. Clarke

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.

From Theory to Practice: Caring Science According to Watson and Brewer

Caring science is presented by Jean Watson and Barbara Brewer through an interview and dialogue format. Jean Watson presents caring science and its philosophy and evolution and the impact of her model on nursing and other disciplines. Barbara Brewer addresses the implementation of the model in a Magnet hospital setting and describes how her leadership facilitated implementation.

Roy’s Adaptation Model:

This column presents a dialogue with three Roy scholars. They discuss research, practice, administration, and education issues in nursing from a Roy perspective and present data on curriculum in schools across the United States in relation to the use of nursing theory and Roy’s model.

Quality of Nursing Worklife Conceptual Clarity for the Future

A critical appraisal of the construct of quality of nursing worklife is presented in an interview with Dr. Beth Brooks. Dr Brooks makes a strong case for better understanding of nursing worklife as essential to healthcare in the future.

The Impact of Dorothea E. Orem's Life and Work An Interview With Orem Scholars

This column serves as a tribute to Dorothea Orems work and focuses on her leadership in the development of nursing science and nursing theory. Nurse scholars give a picture of Orems contributions over her life and reflections about the future of nursing and healthcare.

Caring Some Reflections on the Impact of the Culture Care Theory by McFarland & Andrews and a Conversation With Leininger

This column is the first of two with a special focus on the construct of caring. In this dialogue, two Leininger scholars together address the questions related to the global impact on practice and the contribution of the model to scientific development in nursing. Then, in a special conversation, nurse theorist Madeleine Leininger offers her view of the impact of her work as well as some of her early experiences.

Evolution of Nursing Science Is Open Access the Answer

The open access movement where journal content is made freely available over the Internet is purported to increase scientific exchange, yet has pros and cons. There are issues related to quality that need to be examined in relation to evolution of nursing science.

Nursing Leadership Interprofessional Education and Practice

The column presents a scholarly dialogue about nursing’s role in interprofessional education, practice, and collaboration. Susan Hassmiller, PhD, RN, FAAN, is the Robert Wood Johnson Foundation (RWJF) senior adviser for nursing. In this role, she shapes and leads the foundation’s strategies to address nurse and nurse faculty shortages and ensures that RWJF’s commitments in nursing have a broad and lasting national impact. In partnership with AARP, Hassmiller directs the foundation’s Future of Nursing: Campaign for Action. This effort, active in 50 states plus the District of Columbia, strives to implement the recommendations of the Institute of Medicine’s 2011 report, The Future of Nursing: Leading Change, Advancing Health, for which Hassmiller served as the study director.

Nursing Leadership and Health Policy A Dialogue with Nurse Leaders

National public health policy influencing the entire population is particularly exciting when nurses serve as key players informing the process. The leaders in this dialogue participated in the process by sharing their disciplinary knowledge and experience. They were selected to work with bureaucrats to design healthcare for the future. This dialogue among two nurse leaders demonstrates a path to top leadership in the United States. Swider and Bigley here share their stories of how they moved beyond clinical practice to involvement in their communities and the nation. Through public health and policy initiatives, both nurse leaders have helped shape healthcare to provide better patient-centered care at all levels. This dialogue not only shares their successes, but also sets the stage for others in nursing to use policy to transform healthcare for the future.

Typology of High Users of Health Services Among a Rural Medicaid Population

OBJECTIVES To identify a typology for high system users among a rural Medicaid population that could assist policy makers and providers in better and more efficiently serving this population. DESIGN AND SAMPLE Exploratory secondary data analysis of a large integrated Medicaid database in a western state. Five hundred and thirty-nine Medicaid recipients receiving 2 or more state services and receiving 10 or more unique medications. MEASURES Data analysis examining health care use, medication use, and demographic characteristics using SAS to identify patterns of use of services in the population. Results were confirmed with a statewide sample of 2,287 Medicaid users. RESULTS 3 characteristics-(1) use of 36 or more health care services in a year; (2) no gap in health care service use over the entire year; and (3) use of >12 health care services in 1 month-describe high-risk groups of Medicaid users. CONCLUSIONS Public health nurses, particularly as case managers and program planners, can look at service use patterns through client histories and their own agency records, in order to identify high-risk groups who may benefit the most from programs that address their support, education, and coordination of health care needs.