Past experiences enhance the future. Health care providers gaining expertise in creative thinking, traditional medicine, spirituality, and cultural sensitivity is an essential requirement for 21st century health care. We must stay mindful that poverty, isolation, and rural living may create new forms of social exclusion because of lack of communication and rapidly changing technology. Conversely, sensory overload resulting from a faster paced lifestyle and rapid enhancements in technology may cause increased tension and stress. This article reviews successes that may offer the reader ideas on coping with the provision of health care services in such a volatile changing environment, while honoring tradition and cultural competency.
The aim of this study was to test a new method for continuous monitoring of the Danish contact person concept and to evaluate the impact of the concept on the mothers' perception of nursing care and on their self-efficacy.
This is a descriptive study, carried out at a neonatal unit forming part of a department of paediatrics. Using an electronic questionnaire, the mothers were asked if they had been given a contact nurse and how they assessed the quality of the care and their own self-efficacy. The correlation between their experience of being given a contact person and having high scores of nursing care and of self-efficacy was analyzed by logistic regression.
A total of 300 (81%) of the mothers answered the questionnaire. Among the mothers who acknowledged having had a contact nurse compared with those who did not, odds ratios were > 1 in 10/11 questions concerning assessment of nursing care. Concerning the mothers' assessment of their self-efficacy, the odds ratios were > 1 in 7/11 questions. None of these were statistically significant.
The study showed a tendency towards a positive impact on nursing care when contact persons were allocated to the mothers who were admitted to a neonatal ward. The findings were statistically significant in 2/11 questions.
In spite of the long history of nurse practitioner practice in primary healthcare, less is known about nurse practitioners in hospital-based environments because until very recently, they have not been included in the extended class registration (nurse practitioner equivalent) with the College of Nurses of Ontario. Recent changes in the regulation of nurse practitioners in Ontario to include adult, paediatric and anaesthesia, indicates that a workforce review of practice profiles is needed to fully understand the depth and breadth of the role within hospital settings. Here, we present information obtained through a descriptive, self-reported survey of all nurse practitioners working in acute care settings who are not currently regulated in the extended class in Ontario. Results suggest wide acceptance of the role is concentrated around academic teaching hospitals. Continued barriers exist related to legislation and regulation as well as understanding and support for the multiple aspects of this role beyond clinical practice. This information may be used by nurse practitioners, nursing leaders and other administrators to position the role in hospital settings for greater impact on patient care. As well, understanding the need for regulatory and legislative changes to support the hospital-based Nurse Practitioner role will enable greater impact on health human resources and healthcare transformation.
The acute care nurse practitioner (ACNP) role was developed in Canada in the late 1980s to offset rapidly increasing physician workloads in acute care settings and to address the lack of continuity of care for seriously ill patients and increased complexity of care delivery. These challenges provided an opportunity to develop an advanced practice nursing role to care for critically ill patients with the intent of improving continuity of care and patient outcomes. For this paper, we drew on the ACNP-related findings of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing. The synthesis revealed that ACNPs are working in a range of clinical settings. While ACNPs are trained at the master's level, there is a gap in specialty education for ACNPs. Important barriers to the full integration of ACNP roles into the Canadian healthcare system include lack of full utilization of role components, limitations to scope of practice, inconsistent team acceptance and funding issues. Facilitators to ACNP role implementation include clear communication about the role, with messages tailored to the specific information needs of various stakeholder groups; supportive leadership of healthcare managers; and stable and predictable funding. The status of ACNP roles continues to evolve across Canada. Ongoing leadership and continuing research are required to enhance the integration of these roles into our healthcare system.
This paper is a report of a study to identify the patterns of prescribing by primary health care nurse practitioners for a cohort of older adults.
The older adult population is known to receive complex pharmacotherapy. Monitoring prescribing to older adults can inform quality improvement initiatives. In comparison to other countries, research examining nurse practitioner prescribing in Canada is limited. Nurse practitioner prescribing for older adults is relatively unexplored in the international literature. Although commonly used to study physician prescribing, few studies have used claims data from drug insurance programmes to investigate nurse practitioner prescribing.
Drug claims for prescriptions written by nurse practitioners from fiscal years 2004/05 to 2006/07 for beneficiaries of the Nova Scotia Seniors' Pharmacare programme were analysed. Data were retrieved and analysed in May 2008. Prescribing was described for each drug using the World Health Organization Anatomical Therapeutic Chemical code classification system by usage and costs for each fiscal year.
Antimicrobials and non-steroidal anti-inflammatory drugs consistently represented the top ranked groups for prescription volume and cost. Over the three fiscal years, antimicrobial prescription rates declined relative to rates of other groups of medications. Prescription volume per nurse doubled and cost per prescription increased by approximately 20%.
Prescription claims data can be used to characterize the prescribing trends of nurse practitioners. Research linking patient characteristics, including diagnoses, to prescriptions is needed to assess prescribing quality. Some potential areas of improvement were identified with antimicrobial and non-steroidal antiinflammatory selection.
To review the literature to ascertain best practices in the diagnosis and treatment of adult attention-deficit/hyperactivity disorder (ADHD) and to determine the current beliefs and practices of nurse practitioners (NPs) regarding adult ADHD.
Licensed NPs (n= 260) responded to a questionnaire that inquired about numbers of patients seen with ADHD and about current diagnostic and treatment methods. Diagnostic confidence and referral patterns were also surveyed. Best practices were identified through a review of current and classic nursing, medical, and psychological literature on ADHD.
The results of the survey showed that most NPs believe that adult ADHD exists, although the majority diagnose and treat this condition infrequently. Psychiatric NPs were an exception.
NPs are diagnosing and treating adult ADHD at levels far below expected based on population prevalence data. While those NPs who suspected ADHD were using appropriate diagnostic and treatment methods, more education is warranted to increase confidence for a greater number of nonpsychiatric NPs to improve targeted diagnosis and treatment for this condition.