Search

Catherine is an advanced nurse practitioner working in a large general practice in the north of England. She works alongside her medical colleagues and receives and treats patients with undifferentiated complaints. Margaret, a 64 year-old woman, is presenting today with vague symptoms. She is reluctant to come and get help and is fearful of what the consequences might be., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Members of the sexual and gender minority (SGM) community face complex barriers to accessing quality healthcare. NPs have a responsibility to create welcoming care settings where patients can share a trusting provider-patient relationship to disclose their SGM status, an event shown to improve patient outcomes.

Globally, from America to Europe and beyond, the need for the expansion of the role of nurse practitioners has been recognized within the healthcare professions. However, little emphasis has been placed on assessing the views of clients, and within the addiction services, the voice of clients can be additionally marginalized as a result of treatment philosophies, stigma, and resource constraints. The aims of this study were to establish from clients their nursing needs and to use these findings alongside an objective measurement of clients' health, to inform the development of a nurse-led treatment model.A cross-sectional survey with open-ended questions on client nursing needs was conducted in 2017 within a representative sample of six clinics in Dublin, Ireland. A convenience sample of 131 clients were interviewed. Interviews were analyzed using thematic analysis.Findings were both as expected and surprising. Clients articulated the role of the nurse in their physical care; however, unexpectedly, clients identified nurses as an essential source of psychological support and expressed the wish for the role to be expanded in terms of managing methadone treatment and accessing additional services and resources.Results contributed to the formation of the nurse-led, client mental-health-focused, Healthy Addiction Treatment Recovery Model for addiction nursing services. In terms of national policies, findings provided new evidence articulated by service users on their desire for the expansion of nurse prescribing in addiction services and an expansion of the role to more adequately address client needs.

Purpose: In this study we identified the essential elements of adolescent-friendly care in school-based health centers (SBHCs) from the perspectives of the nurse practitioners (NPs) providing care to adolescents and the adolescents, as the consumers of these services., Design and Methods: Complex adaptive systems provided the philosophical and theoretical foundation for this study. An explanatory sequential mixed methods study was conducted. A Delphi technique (strand one) was conducted with an expert panel of NPs (N = 21) to identify the essential elements of adolescent-friendly care in SBHCs. The second strand, a focus group study with adolescents (N = 30), elaborated on the Delphi results. Data from the two strands were then mixed., Results: This study generated expert opinion regarding the essential elements of adolescent-friendly health care in SBHCs. After four Delphi rounds, consensus was reached on 98-items (49% of the original 200; consensus level of 0.75). The results clustered into 6 essential elements: Confidentiality/Privacy (n = 8; 8.2%), Accessibility, (n = 15; 15.3%), Clinician/Staff (n = 51; 52%), SBHC Clinical Services (n = 12; 12.2%), SBHC Environment (n = 4; 4.1%), and Relationship between the School and SBHC (n = 8; 8.2%). The adolescent focus groups confirmed the essential elements identified in the Delphi and added two overarching themes: Comfortable and Trusted Relationship., Conclusions: These findings contribute to a greater understanding of essential characteristics needed in adolescent friendly care., Practice Implications: SBHCs, as an important community resource for addressing the health care needs of adolescents, should incorporate these characteristics., (Copyright © 2019 Elsevier Inc. All rights reserved.)

This article reinforces the many health benefits associated with breastfeeding and exposes lactation barriers for mothers and healthcare practitioners. NPs can use various strategies outlined in this article to help patients overcome these barriers.

As a new nurse, I was aware of how judging or stereotyping someone based on religion, gender, culture, or other bias can inhibit a caring nurse-patient relationship. Expectations or preferences of my patients and their family members in certain caregiving scenarios influenced our interactions, and, as a male healthcare professional, I learned how cultural context, interactions with unrelated people of the opposite gender, modesty, and masculinity could become barriers if not addressed. My own experience, beginning as a nurse and progressing to a nurse practitioner, has offered opportunities for me to expand the horizons of myself and my patients.

The human papilloma virus (HPV) causes approximately 30,700 annual cancer cases of the cervix, vulva, vagina, penis, oral cavity, and anus. Nurse practitioners can use their unique relationships with patients to advocate for the HPV vaccine. The purpose of this article is to update NPs on current knowledge regarding the HPV vaccine while providing appropriate information necessary for counseling patients and parents.

In cases of child sexual abuse (CSA), NPs are faced with a variety of options dictated by community, agency, and individual resources. This article looks at victim-centered care from current guidelines and offers resources for clinical practice decision making when responding to CSA disclosure.

Military families are often faced with unique stressors that civilian families do not have to deal with, such as deployment, geographic separation, and frequent relocation. When an NP is providing care for a military family, it is important that these unique stressors are discussed and understood. NPs can employ the Causal Uncertainty Model to encourage effortful cognition and support family attributes to ameliorate the negative effects of the stressors these families may face.

Power in practice reveals itself in many ways. There are many definitions of power but in nursing care it could be said that the power is within the patient. Nurses facilitate patients power by engaging them in dialogical engagements. This helps patients to decide how to utilize the power of living their quality., (© The Author(s) 2016.)

The purpose of this research study was to determine if satisfaction and communication between the patient and the nurse practitioner are affected by allowing patients to view their electronic health records during the history portion of the primary care office visit compared with patients who do not view their records. A cross-sectional, experimental design was utilized for this study. The intervention group was shown several components of the electronic health record during the history portion of the nurse practitioner assessment. This group's scores on a patient satisfaction survey were compared with those of the control group, who were not shown the electronic health record. The study findings suggest that the introduction of the electronic health record does not affect patients' satisfaction related to the office visit by the nurse practitioner.

To reduce health disparities, nurses are expected to provide compassionate and high quality care to all patients regardless of socioeconomic and insurance status. In the United States (US) nurse practitioner (NP) educators need to expose students to clinical practice settings, such as free clinics, where the vulnerable populations like the non-documented immigrants and uninsured receive care. The purpose of this mixed method study was to provide an immersion experience for (NP) students at free clinics. Then researchers evaluated the impact of a clinical immersion experience on NP students' attitudes, perceptions, and beliefs about the uninsured and determine whether the clinical experience impacted their willingness to consider working with vulnerable populations in the future. Qualitative and quantitative data suggests students challenged their own beliefs and attitudes regarding the vulnerable populations, gained insight into care provided at these free clinics, and expressed their intent to volunteer at these settings. In the era of health care reform both nationally and internationally and the need to improve primary care access globally, educational initiatives are needed to expose NP students to economically vulnerable populations. Future research needs to replicate and extend the findings of this study, focusing on teaching-learning experiences for nurse practitioners and other advanced practice nursing students., (Published by Elsevier Ltd.)

This study presents an integrative review of the literature assessing the relationships among a patient's style in coping with a long-term health condition, the patient-practitioner therapeutic alliance, and treatment adherence among chronically ill adults. Evidence-based recommendations to improve nurse practitioner-patient therapeutic alliance and treatment adherence are suggested.

People with Chronic Obstructive Pulmonary Disease (COPD) are at heightened risk of developing lung cancer. Recent research has suggested that in people who have the disease, the time between symptom onset and consultation can be long enough to significantly affect prognosis. The regular and routine clinical encounters that people with COPD engage in provide an opportunity for them to highlight new symptoms of concern, and for clinicians to be watchful for new symptomatic indicators. We present a micro-analysis of naturalistic data from a corpus of such encounters with the aim of exploring the interactional factors within these routine consultations which influence when and how new symptoms of concern are raised. Our hypothesis is that although the underlying aim of the review consultation is the same in both settings, the different consultation structures oriented to by nurses and GPs have a tangible effect on how new and concerning symptomatic information is introduced. Conversation analysis (CA) was used to examine 39 naturalistic review consultation recordings in two clinical settings; GP led (n = 16), and practice nurse led (n = 23). We describe three interactional formats by which patients chose to present new symptomatic concerns; 'direct', 'embedded', and 'oblique'. Both settings provided interactional 'slots' for patients to offer new and concerning symptomatic information. However, the structure of nurse led encounters tended to limit opportunities for patients to develop extended symptom narratives which in turn facilitated 'oblique' formats. We suggest that the attenuation of the 'oblique' format in this particular clinical setting has implications relating to the psycho-social idiosyncrasies of lung cancer and the maintenance of interactional conditions that encourage patients to disclose new symptomatic concerns., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The aim of this study is to explore how nurses perceive patient participations of patients over 75 years old undergoing hemodialysis treatment in dialysis units, and of their next of kin. Ten nurses told stories about what happened in the dialysis units. These stories were analyzed with critical discourse analysis. Three discursive practices are found: (1) the nurses' power and control; (2) sharing power with the patient; and (3) transferring power to the next of kin. The first and the predominant discursive practice can be explained with an ideology of paternalism, in which the nurses used biomedical explanations and the ethical principle of benefice to justify their actions. The second can be explained with an ideology of participation, in which the nurses used ethical narratives as a way to let the patients participate in the treatment. The third seemed to involve autonomous decision-making and the ethical principle of autonomy for the next of kin in the difficult end-of-life decisions.

Breaking negative news to patients is a common occurrence for nurse practitioners. This difficult task requires patience and refined communication skills, and must be approached with empathy for all parties involved. There are several ways to deliver bad news to patients successfully using patient-centered communication techniques and methods.

This article discusses the multiple challenges faced by a seasoned pediatric nurse practitioner as she struggled to manage the medical complexities of a 13-year-old boy in crisis while pushing the limits of her own professional boundaries-within the setting of an urban school-based health center (SBHC).

A nurse practitioner persists in caring for a patient with overwhelming problems. With God's help and against all odds, the patient's life eventually changes.

Purpose: Despite the recognized importance of patient involvement in primary care interactions, little information describing women's needs and expectations for these interactions is available. This participatory action study was based in Critical Action Theory and designed to describe any emancipatory interests that surfaced when eight ethnically diverse women examined their interactions with primary care nurse practitioners (PCNPs) over the course of five successive focus group meetings., Data Sources: Focus group meeting transcripts, field notes, interaction notations, seating maps, and first impression summaries., Conclusions: Participants wanted to learn how to "stand up" for themselves in primary care interactions. They believed this could be accomplished by developing a positive sense of self-esteem. Ultimately, they identified the right way to "talk back" to clinicians and created a method for regaining control of their own health care and maintaining equality in interactions with primary care clinicians., Implications for Practice: Nurse practitioners working in the primary setting are especially well situated to support self-management and foster patient participation by women as they live with chronic disease, engage in health promotion activities, and deal with common symptomatic problems for themselves and their families., (©2010 The Author Journal compilation ©2010 American Academy of Nurse Practitioners.)

Aim: This paper is a report of a study exploring nurse radiographers' experiences of examining patients who do not speak the native language., Background: The increased number of immigrant patients in Western countries poses a challenge to healthcare staff, as mutual understanding is needed in encounters with patients who do not speak the language of the host country. In particular, little is known about the quality of communication in the setting of radiological examinations, i.e. short encounters with demanding technical and caring components., Methods: Three focus group interviews with experienced nurse radiographers (n = 11) were carried out in 2007. The interviews were audiotaped and transcribed. A qualitative content analysis method was applied to analyse the interview texts., Findings: Four main categories emerged in the analysis: modes, needs, quality and improvements of interpreting. The need for an interpreter is strongly associated with the type of examination. For interventional procedures and contrast-enhanced examinations, a professional interpreter is required to inform the patient and to identify and handle side effects and complications. Friends, relatives, particularly children, and staff as interpreters were not considered ideal as an alternative. Shortage of time and lack of specific knowledge about radiological procedures were identified as problems with professional interpreters. Interpreter training and checklists specific for radiology department routines were suggested, as well as improved nurse radiographers' education on intercultural communication., Conclusion: The need for an interpreter, and the native tongue of the patient, should be clearly stated on the radiology request form, to allow timely scheduling of an interpreter. Intercultural communication in nurse radiographers' education should be enhanced.

Light is the metaphor for wisdom; we seek and turn toward light as we seek and reach for wisdom, personally and professionally. The purpose of human life is, as Jung noted, kindling the light of meaning to illuminate the darkness. Nursing caring, focusing on the wholeness of persons regardless of life experiences, events, or circumstances, is intimately bound with wisdom, acquired both professionally and personally. In order to glean the wisdom reflected in current nursing research on caring, the author reviewed studies conducted from 2003 to 2008. Only a sampling of the 99 studies found are included here. Patients, students, nurse leaders, and administrators were asked what caring means and how it can be improved; ways to measure and evaluate caring were tested. This body of work can be used to enlighten nurses on the process of caring and how we teach our students to care.

Purpose: To present the Interaction Model of Client Health Behavior (IMCHB) as a model to guide nurse practitioners (NPs) in their practice., Data Sources: Selected research-based articles on Cox's IMCHB and selected text and writings on the NP movement and nursing practice models., Conclusions: Many NPs practice in a medical setting where the boundaries between medicine and nursing are blurred. The IMCHB offers a nursing model to guide NPs in their practice., Implications for Practice: A nursing model that examines the elements of client uniqueness and assesses the interaction between NP and client can achieve positive health outcomes.

Aim: The aim of this study was to explore nurse practitioner (NP) client encounters from the nurse's perspective using a resource exchange paradigm., Background: In health care interactions there is a need to examine what is reinforcing from the nurse's perspective., Design: An exploratory descriptive design was used to address the following research questions: Prior to a clinic visit with midlife female clients what are NPs expectations of resources provided? What resources are actually provided during the visit with the NP and the client? To what extent is there congruence between the NP's expectations and the resources actually provided during a clinic visit?, Methods: The participants included two expert NPs and eight midlife female clients. Data for the study were derived from an initial larger study which examined resource exchange from the client angle and consisted of audio-taped pre- and postencounter interviews with the NPs, audiotapes of the entire clinic visit and field notes recorded by the researcher of the client visits. Content analysis was conducted using ETHNOGRPAH software., Results: NPs anticipated that a broad range of resources would be provided. The most prominent resources provided across visits were information, services, time and affirmation (that included affirmation itself, reassurance, reinforcement of positive health behaviours, support and feedback). In the more established relationships nurse self-disclosure was evident., Conclusions: Resource exchange theoretical formulations can be applied to NP-client interactions to understand and explain the specific nature of resources NPs expect to provide and actually provide., Relevance to Clinical Practice: The nature of resources NPs provide, relationship development, types of exchange relationships in clinical practice were identified and posit a beginning typology for NPs to apply in their own clinical practice.

"Can caring be taught?" is a question that spurs an emotional debate among nurses and leads to further questions: Is nursing science overshadowed by caring in nursing practice? Is the scientific basis of the nursing profession overlooked as a result of the emphasis of caring in nursing? Is it a logical fallacy to assume a correlation between nursing science and caring? Can nursing science or caring alone provide the basis of nursing practice? Further investigation is necessary into the depth of caring and its impact on nursing science and practice.

Topic: Increasingly, students from various professional backgrounds are enrolling in Psychiatric Mental Health (PMH) Nursing graduate programs, especially at the post-master's level. Faculty must educate these students to provide increasingly complex care while socializing them as PMH advanced practitioners., Purpose: To present how one online program is addressing these issues by reasserting the centrality of the relationship and by assuring it has at least equal footing with the application of a burgeoning knowledge base of neurobiology of mental illness., Sources: Published literature from nursing and psychology., Conclusions: The PMH graduate faculty believes that they have developed strategies to meet this challenge and to help build a PMH workforce that will maintain the centrality of the relationship in PMH practice.

Purpose: The purpose of the pilot study was to determine the feasibility of investigating nurse practitioners' (NPs) use of clinical preventive services (CPS) in practice and the influence of provider-patient communication in achieving the CPS outcome. NP-patient communication styles were also explored., Data Sources: Five NPs were audio-taped each during one patient encounter. Using manifest content analysis, the transcripts were evaluated for the presence of CPS and communication styles., Conclusion: Because this was a pilot study and the sample size was small, no generalizations could be made. The presence of health promotion and disease prevention activities, as evaluated by the use of recommended CPS, was present in only one NP-patient encounter. NPs did use patient-centered communication style in all the encounters. No correlations could be made to link communication styles with CPS., Implications for Practice: Further study with a larger sample size needs to be done. NPs may not be using health promotion and disease prevention, as demonstrated by CPS, in actual practice. This may be an area that needs greater emphasis in education and practice.

Background: A well established "midlevel" of patient care, such as nurse practitioners and/or physician assistants, exits in many countries like the US, Canada, and Australia. In Germany, however there is only one kind of profession assisting the physician in practices, the practice nurse. Little is known about the present involvement of practice nurses in patients' care in Germany and about the attitudes of GPs, assistants and patients concerning an increased involvement. The aim of our study was to get qualitative information on the extent to which practice nurses are currently involved in the treatment of patients and about possibilities of increased involvement as well as on barriers of increased involvement., Methods: We performed qualitative, semi-structured interviews with 20 GPs, 20 practice nurses and 20 patients in the Heidelberg area. The interviews were digitally recorded, transcribed and content-analysed with ATLAS.ti., Results: Practice nurses are only marginally involved in the treatment of patients. GPs as well as patients were very sceptical about increased involvement in care. Patients were sceptical about nurses' professional background and feared a worsening of the patient doctor relationship. GPs also complained about the nurses' deficient education concerning medical knowledge. They feared a lack of time as well as a missing reimbursement for the efforts of an increased involvement. Practice nurses were mostly willing to be more involved, regarding it as an appreciation of their role. Important barriers were lack of time, overload with administrative work, and a lack of professional knowledge., Conclusion: Practice nurses were only little involved in patient care. GPs were more sceptical than patients regarding an increased involvement. One possible area, accepted by all interviewed groups, was patient education as for instance dietary counselling. New treatment approaches as the chronic care model will require a team approach which currently only marginally exists in the German health care system. Better medical education of practice nurses is indispensable, but GPs also have to accept that they cannot fulfil the requirement of future care alone.

Previously explored as separate phenomena, this phenomenological-hermeneutic study integrated caring and presence with the experience of caring presence described within the context of a shared nurse practitioner-patient relationship. The results suggest that caring presence is (1) mutual trust and sharing; (2) transcending connectedness; and (3) experience. Research related to caring presence within the nurse practitioner-patient relationship in the context of a managed care outpatient system provides another basis from which to develop nursing knowledge that guides practice within the boundaries of and barriers to care in the technologic world of healthcare.

Purpose: To explore how tobacco-dependent nurse practitioners (NPs) describe their experiences with health promotion and disease prevention practices with patients who smoke., Data Sources: Twelve NPs who completed a graduate level NP program of study participated in face-to-face interviews and/or online chat room interviews., Conclusions: Participants' responses revealed three themes relevant to their experience as tobacco-dependent clinicians with health promotion responsibilities. These themes centered around (a) living as an insider in the world of tobacco addiction, (b) having the outside-in view of living with a tobacco addiction, and (c) being caught in the middle of a tobacco addiction., Implications for Practice: All of the tobacco-dependent participants described limited smoking-cessation interventions with their patients. A barrier to implementation of more aggressive interventions, perhaps, is the provider's own tobacco addiction. With increasing evidence that tobacco-dependent health care professionals are not adequately intervening with tobacco-dependent patients, effective strategies are needed to assist and/or support not only tobacco-dependent patients but providers as well.

Culturally incompetent communication patterns with providers influence the health disparities of African Americans. Limited knowledge exists on cross-racial nurse practitioner nurse-patient relationships (NP-NPRs). The purpose of this paper is to describe how NPs and patients in cross-racial relationships developed primary care relationships in one nurse managed center (NMC). A qualitative design incorporated a social constructivist paradigm and the methodology of Interpretive Interactionism. Twenty cross-racial NP-patient dyads (White NPs and Black patients) participated in individual 1 to 3-hour audiotaped interviews regarding their ongoing relationships and the impact of the NMC. The analysis uncovered a rich description of the relationship processes from the initial meeting to its current state. Multiple themes for each phase, as well as, four typologies of primary care cross-racial NP-NPRs are described. Significant relationship work was needed by both partners to overcome communication misunderstandings, contextual aspects of cross-racial interactions and other overt and covert perceptions.

Purpose: To investigate nurse pratctitioners' (NPs') perceptions of their own caring behaviors and to examine NPs' demographics as a function of their caring behaviors., Data Sources: Responses to the Caring Behaviors Inventory(CBI) and a demographic inquiry from 348 NPs in Louisiana., Conclusions: CBI mean scores and subscale scores were high for all 348 NPs. No statistically significant difference was found between male NPs' and female NPs' total mean CBI scores or between urban or rural total mean CBI scores. The interaction between nurse gender and area o practice was not statistically significant., Implications for Practice: NPs often work in clinic situations where productivity is the most valued characteristic and where little time is afforded for identifying caring behaviors of the NP and/or establishing a caring relationship with the patient. NPs must be extremely conscious of the need not to "throw out the baby with the bathwater" and sacrifice characteristics that are inherent in nursing for those emphasized in primary care practice. As their responsibilities in the health care setting continue to expand, NPs must continually evaluate and validate their roles to ensure quality care that satisfies patients.

Purpose: To illuminate the nature of the lived experiences of nurse practitioners (NPs) interacting with patients, to discover the essential meanings of those lived experiences, and to articulate a structure gleaned from the essential meanings., Data Sources: Six NPs provided concrete descriptions of their experiences interacting with patients. Data were collected and analyzed using a descriptive, phenomenological method of inquiry., Conclusions: The data revealed eight essential meanings for interacting with patients: openness, connection, concern, respect, reciprocity, competence, time, and professional identity. The nature of NPs' lived experiences interacting with patients is an authentic attending to health-related concerns, originating and enduring within the context of an intersubjective relationship. Through the dialogues that evolve within the context of intersubjective relationships, both NPs and patients become more as persons, amenable to understanding the meanings each has assigned to his or her life-world situations, regardless of the outcomes of any health-related interventions., Implications for Practice: The NPs in this study valued the relationships that ensued from their interactions with patients. From these relationships they derived both personal and professional growth. Intersubjective relating is the "art of nursing" for the participants in this study.

Caring for older people and listening attentively to what they say about themselves and their varied health situations, especially in relation to quality of life and peace of mind, body, and soul, are important matters to nurses aligned with Watson's caring-healing theory. Assumptions and key concepts of Watson's framework are described with examples that illustrate how a nursing framework has shaped the author's advanced nursing practice. Some of the key concepts discussed include intersubjectivity, transpersonal caring, spirituality, and caring moments. Watson's framework of caring-healing is shown to inform practice, education, and research.