A survey of moral distress in certified registered nurse anesthetists:A theoretical perspective for change in ethics education for advance practice nurses

Objective:The aim of this study was to examine the relationship between moral distress that may affect patient safety,and the clinical practice model,assessing ethical decision-making skills of certified registered nurse anesthetists(CRNAs).Methods:A survey using the Ethical Stress Scale(ESS)and the Ethical Assessment Skills Survey(EASS)was conducted with 134 CRNAs.Results:Results indicated no significant effect of practice model on level of moral distress or perceived ethical assessment skill knowledge[Wilks's lambda=0.952,F(6,256)=1.068,P=0.382,n^(2)=0.02].A statistically significant positive correlation existed between importance and skill(r=0.275,P=0.001).CRNAs felt skilled to manage the actions or activities they deemed important.Conclusion:CRNAs who perceived a higher skill level in addressing ethical issues experienced lower levels of moral distress.Findings indicate content-specific curricula for the CRNAs need to be evaluated for ethical decision-making skill assessment content.

Perceptions of the effectiveness of Advanced Practice Nurses on a neurosurgery unit in a Canadian Tertiary Care Centre:A pre-and-post implementation design

Objectives:A framework for the advanced practice nurse(APN)role was developed in our Canadian Tertiary Care Centre,delineating five domains of advanced nursing practice:clinical practice,consultation,research,education and leadership.The goal of this study was to evaluate perceptions of the effectiveness of the implementation of an innovative APN role on an in-patient Neurosurgery unit.Methods:A pre-and-post implementation design,incorporating both qualitative and quantitative data,was utilized.An innovative APN role was implemented within the Neurosurgery program focusing on the clinical domain and required the successful candidates to be NP prepared.This APN role was designed to improve patient flow,documentation,communication and patient and staff satisfaction.Three primary outcomes were measured:pre-implementation questionnaire(nurses),post-implementation questionnaire(nurses and residents)and number of pages to the on-call resident.Results:Survey scores by nurses and residents indicated improvement across all aspects studied.Average scores increased from 1.1 to 2.6,reflecting an overall statistically significant increase.The number of pages to the on-call resident also showed a decrease.Conclusion:Perceptions of patient care delivery and professional collaboration improved following implementation of the APN role.Responses indicated that APNs significantly impacted patient care and improved nurses and residents'job satisfaction.

Advanced practice nurses transitional care promotes anticoagulation therapy of warfarin in atrial fibrillation patients in South China

Background Advanced practice chronic conditions. However, nurse transitional care has been proofed to be important for older adults with such effectiveness has never been studied in the management of appropriate Warfarin use in clinical practice. Methods A total of 97 patients were randomly distributed into control group who received usual care, and interventional group who received transitional care provided by APNs. A 12-month observation of both groups were recorded by physicians and APNs and the impact of APNs on the managing of Warfarin therapy was also evaluated based on time in the therapeutic range （TTR）. Results APNs transitional care significantly （P 〈 0.01） improved patients＇ adherence, increased TTR and high TTR ratio compared with control group. Re-admission due to stroke was significantly （P 〈 0.01） reduced by APNs transitional care. Conclusion APNs transitional care improves patients＇ knowledge on AF and reduces stroke risk. The current research strongly suggest the necessity of APNs transitional interventional in managing anticoagulation therapy in AF patients in China.

Studying the Reinforcement Effect of a Seminar on Ethical Practices among Pediatric Nurses

Aim: This study aimed to examine the effect of a seminar to continuously reinforce ethical nursing practices among pediatric nurses. Methods: This seminar was based on a 24-point pediatric nursing care model (PNCM) that provided specific examples of basic ethical nursing practices for children undergoing medical procedures and their families. Participants’ knowledge level and application frequencies, regarding these practices, were assessed face-to-face in the first session and via email 2 and 5 months later, using the PNCM checklist and qualitative data about ethical practices. Results: Results revealed that 8 PNCM items about frequency remained the same as the first session after 5 months;however, 16 items reported increased application. The qualitative data collected 2 months later suggested that the nurses could have adapted better to implement ethical pediatric nursing;however, the one collected 5 months later confirmed the effect of the seminar on ethical nursing practices with children and their families. The continuous effect of the seminar became more evident from the responses received 5 months later than those received 2 months later. Conclusions: The findings confirmed a reinforced effect on ethical pediatric nursing practice with child patients and their parents after 5 months.

Surgical Site Infection Prevention Practices and Associated Factors among Nurses Working in Government Hospitals of Harari Regional State and Dire Dawa City Administration, Eastern Ethiopia

Background:Surgical site infections are the most frequent type of preventable hospital acquired infections with a serious and undesirable outcome of surgery associated with increase morbidity,mortality rate,hospital stay,readmission and excess cost.Surgical site infection prevention is one of the most important challenge in delivering optimal nursing care.Studies suggest that the nurses’practices of surgical site infection prevention is not well addressed.Moreover,there is clearly paucity of information,in Africa including the study area.Objective:The aim of this study was to assess surgical site infection prevention practices and associated factors among nurses working in government hospitals of Harari Regional State and Dire Dawa City Administration,Eastern Ethiopia from March 01 to 28,2019.Method and Materials:An institutional based cross-sectional study design was employed for a total of 515 nurses.Simple random sampling method was used to select study participants.Data were collected using pretested structured self-administered questionnaire supplemented by observation.Data were checked,coded,entered and cleaned using Epi-data version 3.1 and exported to SPSS version 20 for analysis.Bivariate and multivariate analysis were undertaken and P values less than 0.05 at 95%confidence interval were considered as statistically significant.Result:The overall self-reported level of SSI prevention practice was found to be 40.8%(95%CI:36.9%,45.4%).Nurses with BSc and above[Adjusted odds ratio(AOR)=2.52,95%CI(1.14,5.54)],trained on infection prevention[AOR=2.22,95%CI(1.29,3.82)],good knowledge[AOR=2.21,95%CI(1.32,3.71)],good attitude[AOR=5.11,95%CI(3.05,8.57)],got supply of personal protective equipment[AOR=2.57,95%CI(1.46,4.49)],had management support[AOR=3.41,95%CI(1.90,6.12)],experience of 5 to 10 years[AOR=5.38,95%CI(2.82,10.27)]and≥11 years[AOR=3.48,95%CI(1.47,8.25)],were found to be statistically and positively associated with nurses SSI prevention practice.Conclusion:In this study,the level of surgical site infection prevention practice was poor.Being BSc and above,being knowledgeable and good attitude,got personal protective equipment,had management support,serving for≥5 years and trained on infection prevention were found to be significantly associated with surgical site infection prevention practice.Updating knowledge and practice of nurses through in-service education and training on latest evidence-based practice,regularly supplying of personal protective equipment,developing hospital policy and procedures for surgical site infection prevention practice is recommended.

Effect of Supportive Measures Guidelines on Nurses’ Practices during Labor

Objectives: To investigate the effect of supportive measures guidelines on nurses’ practices during labor. Methods: A quasi-experimental design (an interventional pre and post-test study). Setting: The study was conducted at obstetric wards and intrapartum units at Nasser Institute Hospital. Sample: All nurses provide guided direct care, there were 40 nurses included in the study. Tools: Three tools were used to collect data named self-administered questionnaire sheet, labor supportive measures’ observational checklists, and nurses’ satisfaction sheet. Results: There was a highly significant improvement in total knowledge and total practical skills among the studied sample pre-intervention compared to immediate post and follow-up intervention (p ≤ 0.01). Additionally, 95% of the studied sample was satisfied with the advanced knowledge included in the guidelines. Conclusion: The supportive measures guidelines had an efficient improving nurses’ knowledge and practices post-intervention. Also, the majority of the studied sample was satisfied with the implemented guidelines. Recommendations: Implementation of labor supportive measure guidelines in different childbirth units to improve nurses’ practice. Further research is required to investigate parturient woman’s satisfaction with the childbirth process after implementing labor supportive measures and the effect of labor supportive measures on childbirth process outcome.

Understanding the concept of health literacy: A strategy to improve nursing practice

Health literacy(HL)is an effective approach for improved health status and measures the capacity of individuals to engage in health promotion and disease prevention activities as low HL constitutes a global problem in health-care delivery.Nurses play a significant role in providing adequate information to the client and as such it becomes imperative for them to understand the concept of HL.Clinical approach of HL refers to ability to utilize literacy skills in relation to appointments,prescriptions,and instructions for self-management.Public health approach presents HL as means of empowering individuals to take control of their health and factors that influences health.HL is a hierarchy of skills that can be assessed and managed through health education and effective communication.Nurses’understanding of the concept of HL and strategies to reduce HL demands is crucial to delivery of effective nursing practice.This review will provide a clear understanding of the concept of HL which is essential for nurses to effectively educate patients and provide holistic care.More so,nurses will be able to assess literacy level of the patients,plan and develop better educational program tailored to patients’level of literacy.This could invariably improve patients’comprehension and adherence to treatment plans and overall health outcomes.

Experiences of Practical Nurses in Promoting the Rehabilitation of the Elderly and Their Education - A Secondary Publication

The significance of rehabilitation-promoting nursing care is emphasized in aging Finland. According to studies, rehabilitation-promoting nursing care enhances the functional capacity of the elderly. The Elderly Services Act obliges municipalities to create a plan to support the elderly population, emphasizing home care and rehabilitation measures. A large portion of graduated practical nurses will be working with the elderly, so the education of practical nurses must meet the needs of the workforce. The study aimed to produce new information on the implementation of rehabilitation- promoting nursing care in the elderly service system and on the education of rehabilitation-promoting nursing care for the elderly in vocational institutions. The research data was collected in the autumn of 2020 through individual thematic interviews with practical nurse students (n = 8). The data was analyzed using inductive content analysis. Practical nurse students’ experiences of rehabilitation-promoting nursing care for the elderly were related to nurses’ time management, organizational practices, nursing competence, nurses’ attitudes, nurses’ practices, organizational development, implementation and development of practical education, factors affecting the use of aids, and technological aspects of aids in the future. In conclusion, it can be stated that the content of education and practical work life do not align. It is essential to increase competence in rehabilitation-promoting nursing care and to develop organizational practices.

Examining advanced nursing practice in Hong Kong and Guangzhou

Objective:There were studies evaluating advanced nursing practice independently in the mainland and Hong Kong Special Administrative Region of China,but there was no attempt to make a comparison of practice between them.This study employed a case study method to examine and compare advanced nursing practice in Hong Kong and Guangzhou.Method:Purposive sampling method was used to recruit 24 advanced practice nurses(APN)who came from the specialty of medical,surgical and pediatric in Hong Kong and Guangzhou.A questionnaire survey and semi-structured interview were conducted to solicit quantitative and qualitative data for exploring the structure-process-outcome of advanced nursing practice.The structure component explored the factors influencing advanced nursing practice.The process part examined APN role components and illustrations of exemplary advanced nursing practice.The outcomes described outcome indicators that best reflected advanced nursing practice.Findings:Findings revealed that in the structure domain,APN education and career development,team approach in healthcare,and support from management,physicians and professional associations were important contextual factors for APN development in both cities.For the process domain,participants had at least 80%of their time practicing independently/interdependently and were engaged in APN activities including direct/indirect patient care,research/project work,initiation of staff and patient protocols.All participants demonstrated competencies with impacts on patient,service and profession in their description of exemplary practice.Participants from both cities ranked patient-related outcomes as top indicators for their advanced nursing practice.Conclusion:This study has revealed that APNs in Guangzhou and Hong Kong shared similar work involvement and impacts and their demonstrated competencies were on par with international counterparts.Continued efforts need to be put in establishing formal APN education,clear clinical career pathway and title protection to empower nurses to provide optimal care to the fullest extent that they are prepared for.

Current status of clinical nursing specialists and the demands of osteoporosis specialized nurses in China's Mainland

The clinical nursing specialist(CNS)is an expert who applies an expanded range of practical,theoretical,and research-based competencies to the care of patients within in a specialty clinical area within the larger discipline of nursing.A large number of studies consistently conclude that the CNS is a valuable healthcare resource that provides highquality clinical and evidence-based nursing practice and improves patient outcome.The CNS has been involved in healthcare practices for many years,with an increasingly diverse role.However,the training for the CNS in China is only in a preliminary developmental stage.The aim of this article is to review the history and development of the CNS role.Furthermore,the epidemiologic status of osteoporosis,as well as the feasibility and necessity of developing training programs in China for the osteoporosis CNS,will be discussed.

A systematic review of the effectiveness of clinical nurse specialist interventions in patients with chronic obstructive pulmonary disease(COPD)

Objective： This review aimed to examine the effectiveness of clinical nurse specialist （CNS） interventions in patients with chronic obstructive pulmonary disease （COPD）. COPD significantly affects people＇s health worldwide. With the development in nursing, CNSs are playing increasingly important roles in different departments. However, the studies on the effectiveness of CNSs in COPD are not as well organized as the studies on the effectiveness of CNSs in bronchiectasis and asthma. Therefore, this review aims to find some updated evidence on the CNS interventions for patients with COPD and on whether these interventions are effective.Methods： A narrative analysis of the data was performed for the eligible studies. Four databases were chosen： CINAHL, MEDLINE, British Nursing Index, and Cochrane Library. Other websites such as the National Institute for Health and Clinical Excellence, National Health Service Evidence, Association of Respiratory Nurse Specialists, and National Association of Clinical Nurse Specialist were searched as well. Two reviewers performed study identification independently, and all the retrieved articles were stored using the EndNote X7 software. The risk of bias in the included studies was assessed using the Cochrane Collaboration＇s risk of bias tool. Results： A total of nine studies were included in this review. There were five current interventions by CNSs for patients with COPD. These interventions were home nursing support, CNS]s supported discharge, multidisciplinary cooperation programs, nurse-led care programs, and self-care management education. The effectiveness of these five interventions was evaluated individually. There is low- to moderate-quality evidence indicating that home nursing support interventions may have a positive effect on mortality and quality of life. No significant difference in quality of life has been found between the CNS-supported discharge intervention and the usual service. The multidisciplinary cooperation program probably had a positive effect on quality ot life in patients with COPD. Both nurse-led care and self-care management education intervention had a positive effect on mortality of patients with COPD.Conclusions： The findings of this review provide updated evidence on the effectiveness of CNS interventions for patients with COPD. Although nine trials were included and five types of interventions were identified, there is still lack of high-quality evidence.

A review of advanced practice nursing in the United States, Canada, Australia and Hong Kong Special Administrative Region (SAR), China

This paper provides an overview of Advanced Practice Nursing(APN)in the USA,Canada,Australia and Hong Kong.It is based upon documents presented to the China Medical Board(CMB)China Nursing Network(CNN)as background for discussions held by the CNN in Shanghai.It discusses the APN role in these countries and regions according to topics identified by the CNN.These are APN educational preparation;role legitimacy;capacity requirements;scope of practice,domains of activities and limited rights for prescription and referral;professional promotion ladder;accreditation system;and,perfor-mance evaluation system.Both Canada and Australia have adapted many aspects of the USA model of APN to fit their specific legislative requirements and local conditions.Hong Kong has taken a different path which may be of interest in the Chinese context.

Strategic directions and actions for advanced practice nursing in China

There is a need and opportunity for China to develop education and practice innovations given that advance practice nurses (APNs) improve health care and outcomes.The China Medical Board (CMB)China Nursing Network (CCNN) began planning for an Advanced Nursing Practice Program for education and career development that will facilitate CCNN's contributions to meeting national nursing policy priorities.This paper presents the discussion,recommendations and action plans developed at the inaugural planning meeting on June 26,2015 at Fudan University in Shanghai.The recommendations are:Develop standards for advanced nursing practice;Develop Master's level curricula based on the standards;Commence pilot projects across a number of University affiliated hospitals;and Prepare clinical tutors and faculty.The strategic directions and actions are: Develop a clinical career ladder system;Expand the nursing role from hospital to community;and Build a specialty nurse accreditation system.

Effects of the information–knowledge–attitude–practice nursing model combined with predictability intervention on patients with cerebrovascular disease

BACKGROUND Cerebrovascular disease(CVD)poses a serious threat to human health and safety.Thus,developing a reasonable exercise program plays an important role in the long-term recovery and prognosis for patients with CVD.Studies have shown that predictive nursing can improve the quality of care and that the information–knowledge–attitude–practice(IKAP)nursing model has a positive impact on patients who suffered a stroke.Few studies have combined these two nursing models to treat CVD.AIM To explore the effect of the IKAP nursing model combined with predictive nursing on the Fugl–Meyer motor function(FMA)score,Barthel index score,and disease knowledge mastery rate in patients with CVD.METHODS A total of 140 patients with CVD treated at our hospital between December 2019 and September 2021 were randomly divided into two groups,with 70 patients in each.The control group received routine nursing,while the observation group received the IKAP nursing model combined with predictive nursing.Both groups were observed for self-care ability,motor function,and disease knowledge mastery rate after one month of nursing.RESULTS There was no clear difference between the Barthel index and FMA scores of the two groups before nursing(P>0.05);however,their scores increased after nursing.This increase was more apparent in the observation group,and the difference was statistically significant(P<0.05).The rates of disease knowledge mastery,timely medication,appropriate exercise,and reasonable diet were significantly higher in the observation group than in the control group(P<0.05).The satisfaction rate in the observation group(97.14%)was significantly higher than that in the control group(81.43%;P<0.05).CONCLUSION The IKAP nursing model,combined with predictive nursing,is more effective than routine nursing in the care of patients with CVD,and it can significantly improve the Barthel index and FMA scores with better knowledge acquisition,as well as produce high satisfaction in patients.Moreover,they can be widely used in the clinical setting.

Advances in the application of action learning in nursing practice

In this paper, we elucidate the concept and characteristics of action learning as well as summarize the re？exivity, cooperativeness, and subjectivity of this approach. Furthermore, we describe the effects and limitations of action learning when applied in nursing management, nursing education, and clinical practice, among various ？elds.

Realities,scope,challenges,and facilitators for implementation of nurse practitioner's role in India:A review

India is in dire need of an alternative to general medical practitioners to overcome a severe shortage of doctors,especially in rural and underprivileged regions.Empowering nurses through nurse practitioner(NP)role is the superlative solution to provide quality health care in primary care setting.Based on conceptions and research findings of the NP's role,we analyzed and examined the realities,scope,and barriers for implementing the NP's role in India and propose future strategies to create a NP cadre.

Development of the Emerging Theory of Encountering Nursing in a Nurse-Nursed Dyadic Relationship (ThENNDyR)

Encounters are celebrated experiences between persons with connectedness in human situations as expectation. While being in a human dynamic and rhythmic interaction, nursing encounters are dyadic relationships illuminated as patterns of an interconnected relationship moving between the nurse and the nursed, and reflecting person-and-otherness events. The purpose of this paper is to describe the theory of Encountering Nursing in a Nurse-Nursed Dyadic Relationship (ThENNDyR) and to illuminate the four nursing practice processes on which the theory is founded: Knowing as appreciating relational moments;Reflecting as engaging moments;Realizing as patterns of living moments;and Transcending as celebrating moments. Nursing practice occurs in moments in which dyadic relationships transpire as nursing encounters. As fleeting as moments are, the four processes of nursing simultaneously take place as understanding conditions that the who and what of the person warrants persons. “Encountering nursing” is a momentary co-existence of persons in a person-and-otherness situation communicating connectedness-interconnectedness in distinct patterning. Interactions in nursing exist as persons remain wholes and complete in the moment.

Nurses Perception of Advance Nurse Practitioners Roles in Public Hospitals: A Qualitative Study

Aim: To explore the nurses’ perceptions about the advanced nurses’ practitioner’s role in public hospitals in Saudi Arabia. Background: Advanced nurse practitioners are one of the leading professionals who contribute to health promotion, disease prevention, health counseling and patient education. However, misunderstandings of their roles may have an impact on the performances of the function that limits their access and the use of significant resources that can help patients to obtain treatment. Methods: This is a qualitative exploratory study conducted on nurses working in three public hospitals. Semi-structured interviews were conducted among fourteen nurses between October-January 2020. The three public hospitals were based in Eastern (1) and Central (2) Saudi Arabia regions. Data analysis was conducted through thematic analysis utilizing inductive and deductive coding. Results: The study found that the role of Advanced Practice Nurses will enhance, motivate, and sustain the status of nurses in Saudi Arabia. Findings indicated that advanced practitioners’ educational preparedness, organizational, and contextual factors are important factors that need to be addressed to promote their role and to improve nurse’s perception about the APN role in clinical practice. Conclusion: This research provided new evidence to support the need to raise understanding of the role of advanced nurse practitioners among nurse members, advanced nurses and clinical nurse specialists who wish to enhance quality healthcare delivery and job satisfaction in the Kingdom of Saudi Arabia. Recognizing the factors that comprise the function and status of APNs will assist health-care officials to make informed decisions when designing a national policy and a plan for the implementation and the development of the role of APNs.

Physical restraint using,autonomy,ethics among psychiatric patients in nursing practice in China

The application of physical restraint for patients represents ethical dilemmas for psychiatric nurses in terms of maintaining the safety of all(clients and staff)while at the same time curtailing the individual’s autonomy.This article aimed to provide a sound knowledge of ethical positions and strategies for psychiatric nurses to address ethical issues of physical restraint according to the ethical principles of autonomy,beneficence,nonmaleficence,and ethical theories.Given that nursing workforce was limited and workload among psychiatric nurses was heavy,physical restraint was one of the coercive interventions managing aggressive behavior.In relation to address ethical dilemmas,it was proposed to acquire informed consent of physical restraint from the individuals and provide person‑centered care.Effective communication and negotiation with patients could help to strike a balance between patients’autonomy and nurses’accountability when using physical restraint.In addition,guidelines and targeted intervention strategies need to be developed to regulate and reduce the implementation of restraint.Finally,a collaboration among nurses,psychiatrists,and families is essential to protect patients’autonomy concerning physical restraint use.

Nursing Practice in Recovery Room: A Case of Kibuye Hope Hospital and Mutoyi Hospital

Background: Nursing care in the recovery room is oriented to take into account the patient’s condition after surgery intervention with its main purpose of providing direct and continuous patient observation in emergence from general or regional anesthesia. In the absence of professional assistance, patients can develop complications that can lead them into shock or death. This study aims to understand the place of nurses in guiding nursing care in recovery room in two hospitals of Gitega Province by assessing the nurse’s knowledge and attitudes for the promotion of quality nursing care for post-operative patients. Methods: A cross sectional study design was used to assess the practice of nurses in managing nursing care in the recovery room in these two hospitals. A purposive sampling method was used to select the 82 nurses working in the recovery room for these two hospitals and Alain Bouchard’s formula was used to calculate the sample size. Data were collected using a self-report method involving questionnaire completion with five components addressing participants identifications, factors related to the work organization, factors related to the work environment, factors related to healthcare system, and nursing interventions in recovery room. Results: Findings revealed a significant lack of knowledge among the participants and their attitudes were slightly poor as for most of the variables of factors related to healthcare system as their score was less than 50% and their knowledge for nursing interventions was also poor as most of variable scores were less than 25%. Conclusions: The study findings were slightly poor as their scores were less than 50% in most of the variables;therefore, it was recommended that in-service training and workshops should be organized by these healthcare facilities for the purpose of empowering the nurse’s knowledge and practice. Moreover, these institutions should provide and encourage nurses to use nursing guidelines and protocols.