Embracing the role of a nurse practitioner with a doctorate in nursing practice (DNP) requires taking on the additional challenge of acting as an effective change agent. A DNP’s primary role is to act as a bridge between research and the bedside nurse. A strong clinical background assists in translating research findings into realistic evidence-based practices that nurses can readily incorporate into their daily routines. Nurses needed to learn what resources were available to meet the specific needs of the dying and how to promote a peaceful death. The CARES tool attempts to give some sense of order and structure to the care of the dying. The CARES tool is based on the immense educational resources provided by experts from the End-of-Life National Education Consortium (ELNEC), the National Consensus Project for Quality Palliative Care, and from evidence-based literature reviews.
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This chapter focuses specifically on nursing research program vertical infrastructure. Vertical infrastructure refers to the pillars of the program: the foundation that provides the support to build other services. Three essential components are used to develop a solid nursing research program foundation that advances the scientific foundation of nursing practice and promotes integration of evidence-based practices. The three components are nurse researchers who coach or mentor clinical nurses in nursing research, intranet website resources, and a research departmental database. A successful nursing research program is contingent on having the right nurse researcher personnel who can move research from project inception to dissemination in peer-reviewed literature and translation into practice. Nurse leadership may benefit from educational programs or a business plan that includes the benefits of a nursing research program and information about how a specific nursing research program aligns with strategic goals.
This chapter provides examples of programs and services beyond the foundational elements and global resources that can be used to overcome traditional nursing research barriers. It is assumed that at least one doctorate-prepared nurse researcher is available to facilitate research opportunities and educate nurses about research and evidence-based practice. Many clinical nurses fully understand their clinical roles but are completely unaware of opportunities and resources in nursing research within their hospital. Since contributions of nursing research are vital to the science and art of nursing and provide foundation for evidence-based practices, it is important to overcome the traditional cluster of barriers that include problems with nursing research visibility/priority, time and money, and research education. Nurses need confirmation that nurse leaders support research; when it is visible, it is valued. Moreover, nurses need time, education, and resources to complete rigorous research that leads to discoveries and answers to important clinical problems.
Clinical Nurse Specialists (
CNS) play a critical role in ensuring the implementation of high-quality evidence based care, improved patient outcomes, and reduced health care delivery costs. Professional certification is one way we distinguish our unique contributions and advanced practice nursing expertise from other advanced practice roles. This first edition of the book represents a compilation of Clinical Nurse Specialist practice knowledge contributed by respected clinicians from across the nation for certification examination preparation. The book incorporates content from the American Association of Colleges of Nursing Adult-Gerontology Clinical Nurse Specialist ( AGCNS) Population Focused Competencies and the American Association of Critical Care Nurses Scope and Standards for CNSPractice. It begins with an introduction to the current AGCNSexamination options, test plans and processes, as well as test taking strategies for success. The remainder of the book organizes test plan subject matter according to the three spheres of impact of CNSpractice. The book includes twelve chapters presenting the overview, pathophysiology, etiology, assessment, diagnosis, treatment/management, and related pharmacology content according to each body system. It addresses the nurse and nursing practice sphere of impact. Relevant content includes age-related response to illness and adult-gerontology population specific practice standards for care and advocacy of the older adult. Emphasis is placed upon culturally competent care and safe care transitions. Nursing practice content includes consultation, collaboration, education, mentoring and communication skills. Nurse and nursing practice advocacy topics review public policy, professional practice issues, and ethical concerns. The book covers systems and systems leadership competencies of the CNS. Relevant content involves quality improvement principles, safety initiatives, financial stewardship, organizational level program development and systems change. Clinical inquiry subject matter covers evidence- based practice, research methodology, and skills for dissemination of CNSwork.
Research is a foundation of correctional nursing practice. Correctional nurses can apply general nursing research to the correctional patient population and environment to improve care outcomes. In addition, research specific to correctional nursing practice can provide a basis for nursing care delivery in the specialty setting. Evidence-based practice (EBP) expands upon research utilization to include clinical expertise and patient preference. EBP and best practice guidelines apply external sources of information to local clinical practice. By using research principles in practice, correctional nurses can have greater confidence when changing clinical practice to improve patient outcomes. Involvement in a clinical trial should be of benefit to the inmate and a possible treatment for a known condition. Common therapeutic clinical trial involvement includes treatments for cancer, human immunodeficiency virus (HIV), and Hepatitis C. Clinical issues specific to the specialty practice can be investigated to expand the knowledge base and improve patient outcomes.
There is abundant evidence of the importance of sleep and sleep disorders in nursing practice. This chapter provides a perspective on future directions in nursing research, practice, and education relative to sleep promotion and prevention and treatment of sleep disorders. It also provides an opportunity to examine some of the exciting possibilities and challenges for advancing sleep science and the implementation of this evidence in the discipline of nursing. While the contributions of nurses to sleep science are growing, the application of science to practice and pedagogy lags behind scientific progress. The chapter presents an overview of opportunities and possible directions for nursing scholarship related to sleep, and also presents an overview of current trends that intersect with the need for evidence-based practice in sleep promotion, and suggest implications for nursing curricula. The effort will require creativity, dedication, strategic planning and successful interdisciplinary collaboration, as well as collaborations within nursing.
- Go to chapter: Using Evidence-Based Practice to Enhance Organizational Policies, Healthcare Quality, and Patient Outcomes
Using Evidence-Based Practice to Enhance Organizational Policies, Healthcare Quality, and Patient Outcomes
This chapter discusses the evidence-based practice (EBP) paradigm and how it can be used to guide and improve organizational policies, healthcare quality, and patient outcomes. EBP is a problem-solving approach to the delivery of healthcare that integrates the best evidence from well-designed studies with a clinician’s expertise and patients’ preferences and values. Important components of clinical expertise in the EBP paradigm include: data gathered from a thorough patient assessment, internal evidence generated from outcomes management, quality improvement initiatives, and EBP implementation projects, and the evaluation of and use of available resources necessary to achieve desired patient outcomes. The chapter describes the difference between external and internal evidence, with an emphasis on how both types of evidence are important for changing institutional policies. It highlights the outcomes management and types of data collection systems that can be used to inform organizational policies.
This chapter describes how simulation fits the needs for 21st-century nursing education. It covers the aspects include the changing needs for nursing education in a technologically complex environment, how to succeed when incorporating simulation, the importance of the faculty role in embedding simulation throughout the nursing curriculum, meeting the challenges of clinical placement, and specific challenges and benefits to integrating simulation into the curriculum with an evidence-based practice focus. Simulation provides the missing piece for nursing education through harnessing each student’s enthusiasm for technology into an interactive and valuable learning experience in which to engage in critical thinking (Radhakrishnan, Roche, & Cunningham, 2007). Simulation takes on a life of its own, thus becoming "real" to the students. In conclusion, this chapter has emphasized the importance of integrating a simulation-focused pedagogy throughout the curriculum to best meet the needs of our program.
Compassionate Person-Centered Care for the Dying:An Evidence-Based Palliative Care Guide for Nurses
Caring for the dying and their families can be one of the most emotionally fulfilling, personalized, and loving acts a nurse can provide. This book, about the CARES tool, attempts to convey essential information on how to effectively care for the dying in a condensed and readily applicable format for the bedside nurse. It is divided into seven parts. A general background and the establishment of the CARES tool are found in Part I. The second part presents a detailed breakdown of the CARES tool by sections (comfort, airway, restlessness and delirium, emotional and spiritual support, and self-care). Part III shares the theoretical foundation of the CARES tool, and emphasizes the need for patient advocacy and strong communication skills. It also explores what can be done to promote a peaceful death. The fourth part consists of two chapters which address the changes in our culture that must occur and the new role of the doctor of nursing practice (DNP) for translating the current literature into evidence-based practice. Part V examines how the use of the CARES tool can impact nursing care and encourage end-of-life care involvement by other health care providers, and how hope can be nurtured for the dying. The penultimate part of the book provides insight into CARES tool application strategies employed at Sunnybrook Health Sciences Centre in Toronto, Canada. The last part summarizes the example scenario of an individual final journey and the individualized care he and his family were given in an effort to provide a peaceful and loving death. It also provides some recommended websites, readings, and references to continue the reader’s education on evidence-based compassionate care of the dying.
Educators use simulation in seminar experiences to teach key concepts from lecture and reading assignments in order to encourage critical thinking among students in all phases of the nursing program. Some of their important focuses are evidence-based practice, standards of care, and patient safety. This chapter presents a scenario of acute management of a patient in pulmonary edema. Overall objectives of the scenario are for students to demonstrate critical thinking skills in the care of the complex patient. Students must be able to identify inconsistencies with hand-off communication, recognize symptoms, and establish treatment options for acute respiratory distress as a result of congestive heart failure or pulmonary edema. It is recommended that students have basic knowledge from lecture regarding congestive heart failure and pulmonary edema prior to the scenario. In addition, there should be a discussion regarding treatment of respiratory distress and medications most frequently used.