Health Care Reform: Current Updates and Future Initiatives for Ambulatory Care Nursing

Executive Summary: While the signing of the Patient Protection and Affordable Care Act was a historical event marking the beginning of health care reform in the United States, it signaled the start of a golden age for ambulatory care nursing. Ambulatory care RNs are well-positioned to fully participate in health care reform initiatives. RNs are well-positioned to lead, facilitate, and/or participate in all patient care medical homes\u27 and accountable care organizations\u27quality and safety initiatives through enhanced use of major ambulatory care RN role dimensions such as advocacy, telehealth, patient education, care coordination and transitional care, and community outreach. RNs are also well-positioned to provide patient-centered care, coordinate care, and manage transitions across ambulatory care settings. For the golden age of ambulatory care nursing to become a reality, initiatives surround competencies, education modules, and leadership must be addressed immediately

Access to quality care: Links between evidence, nursing language, and informatics

Despite evidence on nursing’s contribution to the quality of care, much of what nurses “do” remains essentially invisible. It is vital to recognize the need for a paradigm shift in nursing that utilizes new informatics tools required for optimum use of evidence related to the delivery of quality nursing care. Embedding nursing language within informatics structures is essential to make the work of nurses visible, and articulate evidence about the quality and value of nursing in the care of patients, groups, and populations

Linking nursing workload and performance indicators in ambulatory care

More and more ambulatory care organizations are using nursing report cards to monitor and evaluate the quality and effectiveness of nursing care in the ambulatory setting. Nurse staffing levels is usually one of the items included in a nursing report card and the one most scrutinized by ambulatory care administrators. One strategy employed by the nursing leadership at the South Texas Veterans Healthcare System to justify nurse staffing levels is linking administrative staffing monitors with nurse-sensitive outcomes via workload and performance indicators. Through this approach, nurse leaders are able to justify nurse staffing level changes, needed technology changes, process improvements, and/or workflow needs to administrators with positive results and support

Penn Macy initiative to advance academic nursing practice

Academic nursing practice holds great promise for the future of the nursing discipline. The successful and intentional integration of the tripartite mission of research, education, and clinical practice can facilitate both the evolution of the science and implementation of evidence-based practice, while imbuing practitioners in the making with the world of the possible. Although many schools of nursing have been involved in some aspects of academic practice, the lack of common focus and direction has hampered concerted movement. The Penn Macy Initiative was conceived as a vehicle to help build and coalesce the critical mass needed to bridge this gap. The Penn Macy Initiative, its implementation and experience in the first 3 years, and how its alumni fellows, an annual conference, and Web-based consultation will continue to provide impetus, leadership, and resources for academic nursing practice in the years to come are described

Ambulatory Care Registered Nurse Performance Measurement

Executive Summary: On March 1-2, 2010, a state-of-the-science invitational conference titled Ambulatory Care Registered Nurse Performance Measurement was held to focus on measuring quality at the RN provider level in ambulatory care. The conference was devoted to ambulatory care RN performance measurement and quality of health care. The specific emphasis was on formulating a research agenda and developing a strategy to study the testable components of the RN role related to care coordination and care transitions, improving patient outcomes, decreasing health care costs, and promoting sustainable system change

Global partnerships to strengthen the evidence base for nursing

There is a growing emphasis on building the evidence base as governments, health systems, practitioners, and consumers, nationally and globally, search for ways to improve health care outcomes and enhance the efficiency and effectiveness of health services. Nurses and midwives constitute the largest group of health service providers in the majority of health systems around the globe. The WHO Global Advisory Group on Nursing and Midwifery recommended that WHO should form strategic alliances with partners to identify uniform core indicators and build a solid body of evidence to inform national health policies, particularly in the area of cost-effective nursing and midwifery services such as HIV/AIDS, tuberculosis, and malaria. Creating an international digital library has the potential to make a significant impact on global health

Knowledge, attitudes, and practice behaviors of oncology advanced practice nurses regarding advanced care planning for patients with cancer.

Purpose/Objectives: To establish initial reliability and validity of a Web-based survey focused on oncology advanced practice nurses\u27 (APNs\u27) knowledge, attitudes, and practice behaviors regarding advanced care planning, and to obtain preliminary understanding of APNs\u27 knowledge, attitudes, and practice behaviors and perceived barriers to advanced care planning. Design: Descriptive, cross-sectional, pilot survey study. Setting: The eastern United States.Sample: 300 oncology APNs.Methods: Guided by the Theory of Planned Behavior, a knowledge, attitudes, and practice behaviors survey was developed and reviewed for content validity. The survey was distributed to 300 APNs via e-mail and sent again to the 89 APNs who responded to the initial survey. Exploratory factor analysis was used to examine the construct validity and test-retest reliability of the survey\u27s attitudinal and practice behavior portions. Main Research Variables: Respondents\u27 demographics, knowledge, attitudes, practice behaviors, and perceived barriers to advanced care planning practice. Findings: Exploratory factor analysis yielded a five-factor solution from the survey\u27s attitudes and practice behavior portions with internal consistency using Cronbach alpha. Respondents achieved an average of 67% correct answers in the 12-item knowledge section and scored positively in attitudes toward advanced care planning. Their practice behavior scores were marginally positive. The most common reported barriers were from patients\u27 and families\u27 as well as physicians\u27 reluctance to discuss advanced care planning. Conclusions: The attitudinal and practice behaviors portions of the survey demonstrated preliminary construct validity and test-retest reliability. Regarding advanced care planning, respondents were moderately knowledgeable, but their advanced care planning practice was not routine.Implications for Nursing: Validly assessing oncology APNs\u27 knowledge, attitudes, and practice behaviors regarding advanced care planning will enable more tailored approaches to improve end-of-life care outcomes

Developing a Business Case for the Care Coordination and Transition Management Model: Need, Metrics, and Measures

In this descriptive qualitative study, nurse and healthcare leaders\u27 experiences, perceptions of care coordination and transition management (CCTM®), and insights as to how to foster adoption of the CCTM RN role in nursing education, practice across the continuum, and policy were explored. Twenty-five barriers to recognition and adoption of CCTM RN practice across the continuum were identified and categorized. Implications of these findings, recommendations for adoption of CCTM RN practice across the care continuum, and strategies for reimbursement policies are discussed

Factors Influencing the Implementation of a Point-of-Care Screening Tool for Delirium

Given the ample evidence delirium in hospitalized older adults is under diagnosed and not recognized by nurses up to 85% of the time, interventions are needed at the point of care to assist nurses in recognizing delirium. In this qualitative study, factors that might influence the implementation of a point-of-care screening tool for delirium were examined

Implementing an MSN Nursing Program at a Distance Through an Urban-Rural Partnership

Recruiting, retaining, and educating advanced practice nurses is essential to meet the growing need for advanced practice nurses in rural and urban communities. Through the support of Health Resources and Services Administration funding, the urban school of nursing expanded its MSN program and implemented the graduate curriculum on its rural campus by utilizing emerging online and distance education technologies. The purpose of this manuscript is to provide an overview of expanding an existing MSN program offered in an urban, traditional classroom setting to rural graduate nursing students via an online synchronous format. In addition, the article will describe the rural growth of the existing neonatal nurse practitioner program as an exemplar and the different methodologies that are being used in each program to engage the rural nurse practitioner students in clinical courses. In addition, strategies to address barriers related to rural nurse practitioner student recruitment and retention will be discussed