Research Topics: Nursing Practice

Research for Registered Nurses

Criticizing individual practitioners for their lack of research awareness or clinical managers for the low level of research utilization in their area belies a simplistic approach to the problem.   Introduction   Health care is continually changing in the way health care professionals like individual practitioners and clinical managers organize and deliver care to the patients. For this reason, health care knowledge must continuously grow and expand to keep health care approaches relevant, current and appropriate. Without new knowledge, health care professionals cannot improve techniques for therapies and even management.   One important source of knowledge is research. Research is viewed in most professional circles as necessary for the continuous development of the scientific body of knowledge, which is the hallmark of a profession. The essence of evidence-based practice is the provision of quality and cost-effective health care to the health consumer ( 2003).   Research provides a solid foundation on which health care professionals base their practice. The scientific knowledge base for professional health care practice is developed through scholarly inquiry of the research literature, use of existing research findings, and the actual conduct of research (2004).   The gap between research and its translation to practice in the healthcare arena became a focus for policy discussion in some healthcare organizations in the last decade. Studies have continued to reveal that the gap between research and practice seems to be most obvious in the nursing profession. It is disheartening, however, to note that regardless of the millions of dollars spent on funding clinical research, the integration of the findings into practice has been relatively slow among nurses ( 2003).   There have been previous attempts at improving research utilization among nurses worldwide. The disparity in the conduct of research and its integration into practice became an international nursing concern. Various groups are made in the attempts at reducing the research conduct and utilization gap.   Integrating the findings of research to improve clinical practice should be a vision for most health care professionals – the nurses, who form the largest proportion of care providers at the bedside. There is a need to search for the missing link between the dissemination and implementation of research findings for evidence-based practice among nurses (2003).   There are several studies focusing on the barriers to research utilization among nurses but few on attitudes toward research. Researchers noted that where ability was higher, attitudes toward research activities were more positive, and vice versa. Attitude and availability of research reports were related to research utilization.   Although interest in research-based practice seemed to be present among a majority of the health care professional population, the reality of the situation suggests that it is not occurring as frequently as desired. The statistical section of a research study could be intimidating to the beginning researcher.   In a nationwide study focusing on the state of research utilization in the United States, it revealed that the culture of healthcare institutions does not value research utilization. The study noted that nurses without a baccalaureate degree did not fully understand or value research, while some of the baccalaureate-prepared nurses who had classes on research in their program complained that the way in which nursing research was taught in the schools turned them off ( 2003).   These are just some examples that depict the increasing lack oaf awareness and utilization of may health care professionals. The purpose if this paper is to identify the main reasons why nurses do not utilize research in their practice; discuss three of these reasons and why they exist; and make evidenced based recommendations for future nursing practice to overcome each of these three barriers.   Body   Nursing has long been urged to base care on research findings rather than tradition and ritual. The rapid growth of doctorally prepared nurse researchers has enabled the scientific base for nursing practice to grow (2004)   There are, however, barriers to utilization of research in clinical settings. This includes individual practitioners for their lack of research awareness or clinical managers for the low level of research utilization. Barriers limit the potential of identifying clinical outcomes in nursing care (2004). However, recognizing and acknowledging the existence of these barriers enable to implement change in practice in a timelier manner.   The reasons why nurses do not utilize research evidence in their clinical practice are complex and multi-factorial. Studies focusing mainly on barriers to research utilization noted that the following reasons answer why most nurses so not utilize research: (a) characteristics of the nurse, which revolves around poor knowledge of research; (b) characteristics of the research presentation, with statistical terms beyond the level of the average nurse; and (c) characteristics of the organization settings in clinical areas constitute barriers.   In particular, barriers to research utilization revealed by studies include nurses’ lack of time and independence in the organization, together with lack of support from nurse managers. Organizational characteristics were noted to present one of the greatest barriers to nursing research utilization in the practice setting (1998). The conclusions of many previous studies revealed that, in addition to the limitations in the workplace settings, the resistance among more senior nursing staff and the research values and skills of the nurses were important in research utilization (2003).   Most of these studies, however, have been conducted with samples consisting of nurses working mostly in urban settings, but the more one ventures out of the large urban medical centers, the less one hears about research and its utilization. Studies on nurses working in rural areas is paramount, if we are to “leave no nurse behind” in our professional struggle for evidence-based practice (2003).   For this paper, three reasons why nurses lack utilization and awareness of research will be discussed. These are: (1) lack of support from administration to implement new practices and fund research, (2) lack of time to investigate research findings, and (3) lack of interest and knowledge on the part of the nurses themselves.   Nurses encounter these three major barriers: lack of time for investigating and implementing research, lack of knowledge on the nurses’ part, and lack of support by the administrators and other health care professionals. All these barriers have been documented in other studies.   The finding that the desire for research utilization among nurse administrators was affected by their lack of support and budget for research from administration, needs closer consideration. Making no budget allowance for research in the nursing division could be seen as reflective of the importance attached to research by the nurse leaders. It is pertinent, however, to note that qualitative comments by the nurses in this study who were utilizing research showed that support by the administrators was an encouraging facilitator in their use of scientific findings in their practice settings. This supports previous studies that revealed one of the most effective facilitators for research utilization was the increased support and encouragement from administrators (2003).   Under this barrier of lack of support is uncooperative physicians, which seems to be an international problem. This is unfortunate because nurses and physicians work together closely and, in some cases, nurses are dependent on physicians to implement research findings in the any health care setting ( 2004).   Lack of time to read research articles and to investigate and implement research findings in practice is the second barrier. This is congruent with findings of other studies. One researcher found that time was an important factor to improve research use in clinical practice.   Perioperative nurses in one study reported that heavy activity and workload gave them neither time nor energy to do research-related activities. The administrative requirement to improve efficiency and long waiting lists press the surgical team to treat more patients. This pressure, acute procedures, and lack of personal resources increase nurses’ workload. Perioperative nurses have no authority to administer their time at work, and the possibility of finding time for research activities in practice depends on nurse leaders. Only nurse leaders can organize the OR team so that perioperative nurses have on-duty time to perform research activities (2004).   Recommendations   Developing a favorable attitude among nurses that encourages the integration of research evidence into nursing practice at the health care setting needs the cooperation of nurse leaders and other health care professionals in the clinical areas.   It is time for nurses to stop projecting nursing research as an academic exercise and start perceiving it as a scientific base for evidence-based practice. There is a need to stress support for nursing research as one of the important means of providing scientific evidence for practice in every forum for nurse executives (, 2003).   It is interesting to note the enthusiasm with which research results are presented in nursing conferences locally, nationally, and internationally. However, it becomes very frustrating when the wide gap between the enthusiastically presented research findings and what actually occurs in clinical practice remains for many years after the dissemination of such evidence reports and clinical guidelines. The existence of the gap between research and practice should continuously be a concern for researchers/educators and nurse administrators (2003).   Educators and administrators in healthcare organizations need to create collaborative strategies that emphasize the importance of research in enhancing evidence-based practice in the clinical setting, especially in the rural areas. Whatever approach is taken, if we are to improve nursing practice through scientific evidence, it will take the commitment and collaboration of educators/researchers, clinicians, and administrators to see that no nurse is left behind in the march toward evidence-based practice (2003).   There are several reasons why nurses should implement research findings. Using research increases the quality of nursing care’ and provides increased efficiency in patient care, as well as personal and professional growth for nurses. Most nurses are required by individual governments to work in accordance with scientific knowledge. Patients and their relatives increasingly expect nurses to incorporate research findings into their everyday practice, and most nursing councils all over the world require that nursing practice be evidence based. The health care setting continues to become more technologically challenging, and nurses must combine use of new technology with knowledgeable and safe patient care so patients do not experience complications (2004).   It is recommended that nurses have to be given study days for the lack of time they have in research investigation and implementation. Competence in the research process, statistics, and research methodology can help nurses argue for use and evaluation of research findings. This may improve support and collaboration from the physicians and other health care administrators.               To determine whether research findings can be used as a basis for nursing practice, the nurse should consider the scientific worth of the study, the substantiating evidence provided in other studies, the similarity of the research setting to the nurse’s own clinical practice setting, the status of current nursing theory, and factors affecting feasibility of application.   Conclusion               The utilization and awareness of research in nursing profession is a basis for scholarly and professional decision making in clinical practice and is essential in providing competent, efficient, and state-of-the-art nursing care.               Advances in care through research are meaningless unless they reach nurses at the point of care. Nurses should utilize these research findings if they are to improve the quality of care that they offer to their clients. Nurses must therefore read publications like journals and textbooks and other source which contain research reports in nursing and other related fields in the provision of health care.               Unfortunately, there are many barriers that prevent the nurses from utilizing these research finding. Among these are the lack of time and interest on the part of the nurses to investigate and implement research findings, the lack of support from the health care administration and other health care professionals, and the lack of knowledge of the nurses on the significance of research findings and its implementation. These barriers have to be overcome by the nurses with the help of the administration and other health care professionals.               Nurses in all health care settings must continue to seek knowledge by taking time to review research and practice findings, critique research studies, and discuss with fellow nurses the implications of using and not using new knowledge in nursing practice.             Nursing research is important and it addresses issues that are important to the discipline of nursing. Nurses must therefore be aware and use research findings in there practice. Acquisition and application of new knowledge is very important in contributing to nursing practice and patient care.                       Credit:ivythesis.typepad.com

Research for Registered Nurses

Criticizing individual practitioners for their lack of research awareness or clinical managers for the low level of research utilization ...

Professional Nursing – Journal Actical Annotation

Professional Nursing – Journal Article Annotation   Nurses face an endless variety of situations which involves clients, family members, health care staff, and peers. Each of the situations that nurses face pose new experiences and problems involving clients’ care, different approaches to resolving problems, and different results as to whether approaches were successful. Each clinical situation that nurses face everyday requires careful and thoughtful analysis for accurate and sound clinical decisions and plans to be developed for each client.             The article argues that critical thinking is indeed an essential part of the nursing profession. It is not enough that a nurse has abstract knowledge; he or she also has to develop the intellectual capacity to contextualize and to adjust what he/she knows in particular cases. The key ideas that the authors and  are trying to communicate in this article are the relationship of critical thinking and intuitive practice to the expertise in nursing. It is true that aside for developing this while still a student nurse, nurses also gain knowledge through their experiences. Every clinical experience becomes a lesson which will serve as a guide and information for the nurse. It is not only the authors that consider critical thinking and intuitive practice as important, but other authors in the nursing discipline as well. In every clinical situation, it is important for a nurse to think critically and make sound judgments so that clients ultimately receive the very best nursing care. Critical thinking is not a simple step-by-step, linear process that can be learned overnight. It is a process acquired only through hard work, commitment, and an active curiosity toward learning. Nurses are responsible for making accurate and appropriate clinical decisions. Critical thinking is very important as no two clients have the same needs. The nurse after assessment and diagnosis has to employ critical thinking skills for a client’s particular condition. Intuition is simply a result of common experiences and applied to new ones. After a nurse has been exposed to a certain situation and is exposed to another similar situation, the nurse uses her intuition along with her critical thinking skills to develop an approach for the client. Intuition in nursing thus develops as a nurse’s clinical experience increases. A nurse is always challenged to observe each of his or her clients closely, search for and examine ideas and judgments about the problems that the clients face. Additionally the nurse has to consider scientific principles that he/she have learned and relate this to the clients’ problem, recognize the problems, and develop the right approach to nursing care as appropriate to the situation and problem of the client. Intuition is thus considered by authors as a trigger which brings about in the nurse an analytical process that leads them in a search to acquire data that confirms what they have sensed in the client or in a particular situation. Intuition thus triggers the nurse to apply his/her critical thinking skills in a situation in order to come up with the right thing to do or the right answer to a problem being presented. Nurses must not make snap judgments just by their intuition alone. This could jeopardize the client’s situation and perhaps affect the nursing quality of care for the patient. As a student nurse, knowing and understanding what critical thinking is and its importance very important. The article points out that a student nurse has to develop this skill. Critical thinking begins for a student when the student seriously asks questions, and in continuing way attempts to answer questions like “what do I really know about this nursing care situation?” or “how do I know it?” This is actually a process which is developed within the student nurse with the aid of other individuals like the educators. Students in nursing must learn nursing by consciously practicing reasoning skills needed in nursing. Students in nursing must also critically reason their way through nursing principles, concepts and theories as much as possible so that appropriate and accurate application of knowledge occurs naturally in clinical practice. As stated in the article, the purpose of reflective, critical thinking is to ensure that the nurse has the depth of knowledge necessary to immediately comprehend the practice situation so that safe, effective, quality nursing care is provided to the clients. Intuitive practice and critical thinking can significantly affect the quality of care delivered by the nurses to their patients. It is important to remember that the quality of nursing practice depends on the nurse’s ability to use all types of cognitive and emotional cues associated with a situation to trigger critical thinking and then to select effective nursing interventions. A nurse cannot safely act on intuition alone that is why critical thinking and intuition both have to go together in order to achieve expertise in the nursing profession. Intuition requires critical thinking as much as critical thinking needs intuition.   Credit:ivythesis.typepad.com

Professional Nursing – Journal Actical Annotation

Professional Nursing – Journal Article Annotation Nurses face an endless variety of situations which involves clients, family members...

Fine Motor Skills Case Study

Paul, a 5 year-old rescued street child was admitted in the charity ward of the hospital you are working to. He is suffering from severe malnutrition and some wounds in his legs and arms are left untreated. Upon attending to the patient, you learned that he is from the nearby city with no parents alive. His relatives are not interested of taking care of him. Immediately, you asked his name. As a five year-old kid, he is somewhat shy to answer several of your questions. But to the vital information that you need are given by his short, soft and hesitant responses.             After the preliminary recording of personal data and whereabouts, you immediately order a colleague to check on the medical files of the child in the hospital records shelves or in the nearby hospitals whom he is possibly admitted before. The colleague found out that Paul was born in your hospital as Paul Del Mar on March 18, 2000. According to the facts listed on the records, his mother passed away upon giving birth. He belongs to a poor family when his parents are still living.             1.         Physical milestones               – As a street kid, Paul is too skinny and short. He definitely falls below the average weight and height of a normal five years old child. For some normal kids of his age, they are expected to be active and curious. They are generally playful and full of energy. It is believed that the first five years of a child is the most crucial and considered the formative years (‘How to Raise a Healthy Child’). In the same article, a healthy child is in a perfect state not only in body but in mind. A child learns how to play independently, dress and undress (Craig, Kermis & Digdon 2001), talk, run, stand on one leg even as early as the age of 3 (Jeannerod 1990). In relation to height and weight, a 5 year old child has the average of 109.0 cm and 18.2 kg. With the case of Paul, he is under the average height and weigh acceptable to his age.   2.         Gross motor skills               “Gross motor skills are larger movements involving the arm, leg, or feet muscles or the entire body — things like crawling, running, and jumping are gross motor skills” (Hames 2005).             – Paul is not as active as a normal five years old child. He can run but easily gets exhausted. When tired, he barely moves his arms and limbs due to his malnourished condition. Accordingly, he just sits on street or park benches and waits for alms from by-passers. During meals, he often eats leftovers from rubbish.   3.         Fine motor skills   According to Hames (2005), “Fine motor skills are those smaller actions like picking things up between the thumb and finger or using the toes to wriggle into sand or the lips and tongue to taste and feel objects.”             – Though Paul is physically weak, he is still capable of thinking and speaking in his age. He can comprehend to questions from the people who interview him. He can move his hands in coordination with his eyes. He has a develop senses.   4.         Language   Language as well as motor development is now at a level to give expression to imagination at the age of 4 to 5 (Ramsden 1999).  - Basing it to his age, Paul can speak well. However, he is shy and hesitant. He can pronounce works as a normal kid of his age but his soft shy voice is the only problem.   5.         Social development for the particular age group               Paul is shy. Hence, he lacks self-confidence and self-esteem. His emotional health is poor. He is aloof to people and seems worried. Since he is a street child and no relatives taking care of him, his sense of security is low. This makes him troubled and uncomfortable. Referral may be the action of choice when a health professional believes that a patient has a personal problem and needs counseling. When the problem appears to be primarily related to something beyond the current treatment situation, or when it seems to be complex, the health professional may feel inadequate to deal with it (Ramsden 1999). Nursing Suggestions             In developing gross motor skills, consider the long-term implications for development for its control, as well as fine motor coordination and eye-hand coordination basing it from the data taken in the environment of the patient.             Most importantly, healthy food should be given to Paul to make him as fit as a normal 5 years old kid. His wounds should be treated to alleviate the risk of infection. Exercise, sleep, and proper care and attention must be given to him. Further, as a street child, the responsibility of the nurses and/or doctors is to look for an institution that will cater to the needs of the child.             In social development, “Emotional relations established very early in life set the pattern of relations in later life” (‘How to Raise a Healthy Child’). Paul must develop his emotional health because it is the basis of the child’s development of a sense of security, confidence and the ability to cope well with other people and with the world at large.             Meanwhile, it is vital to bear in mind that progression through the stages is a function of chronologic age, physical and emotional maturation, and the social environment. Different cultural contexts place different demands and expectations on individuals. Those presented here reflect a post-industrial society, and would not necessarily apply to a tribal society or that of a developing country. Thus, change occurs in the individual in several different areas simultaneously at each psychosocial stage throughout life.   Credit:ivythesis.typepad.com

Fine Motor Skills Case Study

Paul, a 5 year-old rescued street child was admitted in the charity ward of the hospital you are working to. He is suffering from severe ...

NURSING

The paper discusses the issue on why nurses do not use more research in their practice. Nursing should be a research-based ( 1972) due to its technicalities and that research should underpin nursing practice, nursing education and management ( 1995). Research is important to be integrated in nursing practices to improve the quality of nursing care.             Despite of the importance of research in nursing, and the widely accepted research and recent findings, nurses do not use more research in their practice ( 1993). Nurses tend to base their practice on traditions and cultural issues, organizational factors, individual resistance to implementation and problems with the research itself are the four general issues that prevent nurses from using research in practice (, 1994).             There are some health organizations that are not characterized by a strong research culture and the organization appears to undervalue its importance (1994). When the entire organization itself does not promote awareness and use of research, then nurses within the organization follow that practice and ignore the use of research in their practices. Also, in a health environment, nurses tend to be more inclined with traditions rather than on new ways of doing things that are based on research.             In addition, there is a wide physical and philosophical gap between research and practice ( 1994). Much research is conducted in universities away from the practice setting and many researchers are able to assume only minimal clinical commitment ( 1995). This statement is observably true. In universities, nursing students follow theories based on research but in hospitals, nurses usually follow what more senior nurses do which is usually based on traditions and experience thus improvement in nursing care tend to be slow.             Long-standing organizational structure is also one of the underlying reasons why nurses fail to integrate research on their practice. First, implementation of new ideas based on research should be supported by the managers of a health organization and most managers failed to do so. Multiprofessional practice is also a factor. It can be observe that it is difficult for nurses to change practices involving other medical professionals (1995) such as physicians, surgeons and others. For example, if anaesthetic or surgical instructions indicate an all-night fast prior to surgery and nurses know that a six- hour fast would be more appropriate, it is extremely difficult to adopt the correct policy (1998). Moreover, some nurses personally resist the use of research in their practice due to personal beliefs. Some individuals needed confirmation from a research before they practice the research themselves while some have different belief from a research study that is why they can not put the research on their practices ( 1994). In addition to that, nurses can only make decisions about the relevance of research findings in practice if they are able to analyze critically the raw material (1994). Most nurses neither have the skills to search for the literature nor to interpret critically a research (1990; 1990). The practice of not putting research into practice can be changed by educating the nurses from the universities up to the sites of practice so that they can have enough skills to interpret research and put it into practice. Also, most health organization should be aware of this issue so that they can implement change within the organization. This issue is more of an organizational issue. Nurses are only a part of an organization and they can integrate research on their practices only up to a certain extent.   Credit:ivythesis.typepad.com

NURSING

The paper discusses the issue on why nurses do not use more research in their practice. Nursing should be a research-based ( 1...

IMPLEMENTATION OF A NURSE PRACTITIONER ROLE IN THE STUDENT’S LOCAL ENVIRONMENT

A Business Case for the Implementation of a Nurse Practitioner Role in the Student’s Local Environment   Executive Summary The decision was made to explore a school-based clinic within the [name of the city] school district at the high school level. The Advance Practice Nurse (APN) is in a pivotal leadership position from which to serve as the key individual to plan, develop and administrate the facility while using her health care delivery skills caring for student/patients. A business case was developed which explores the roles and status of the APN in relation to school nursing, the need for school-based clinics run by Advance Practice Nurses along with budgetary considerations. A plan was proposed that would enable the clinic to become self-sustaining using Medicare reimbursement for services provided by the APN as allowed by Medicare policy, Federal and State grants and other funds, such as for special needs children and through private donations from community and corporate sources. This will enable the APN and facility to be of benefit to the students and staff without drawing on funds necessary to support in-class educational opportunities and become a model for other school-based clinics as part of a pilot program within the state. A series of evaluations is outlined, both pre-development and post-development to be used for audit purposes, to assess program efficacy and measure original goals and objectives against current measures of success.   Introduction As a result of the growing prevalence of chronic conditions and the related cost burden, health promotion and illness prevention are increasingly becoming a top priority for schools. Spotlight is therefore given to school nurses who are first in line in watching over the health of school children. Approximately 50,000 licensed professional school nurses provide health services to children and youth in the school setting (, 2004). School nursing is a specialized practice of professional nursing that facilitates the well-being, academic success, and lifelong achievement of students. School health services like school clinics have the goal of supporting educational success by enhancing the student’s health. Research tells us the school nurse must possess skills in more than theory and clinical knowledge, that skills in political awareness and activism, public relations and management are essential for today’s school nurse ( 2001). Competencies in “program planning, research and evaluation skills, management by objective techniques and statistical data collection and compilation” are additional skills required and are only found in the educational preparation and requirements consistent with the Advance Practice Nurse (APN) (, 2001). Let us first discuss what an Advance Practice Nurse is. The APN is generally the most independent functioning nurse (, 2004). APNs are usually nurses with a master’s degree in nursing (, 2005), advanced education in pharmacology and physical assessment (, 2004), and certification and expertise in a specialized area of practice (, 2004). The term APN is actually an umbrella term describing several nurses with different functions. It refers to advanced clinical nurses that include nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and nurse midwives. The APN functions as a clinician, educator, case manager, consultant, and researcher within his or her area of practice, to plan or improve the quality of nursing care for a specific population (, 2004). APNs are state regulated relative to the services they can legally provide. Based on the combination of state legislation and federal recognition of their skills, several funding sources are available both to provide for funding as well as offer additional rebates or reimbursement for school nursing endeavors.             Research also tells us that school-based clinics serve as a pivotal healthcare function for many students who would otherwise miss school due to health reasons while not seeking or being eligible for medical attention ( 2003). A bigger problem is the tightening budgets seen by school administrations that require shifting funds from healthcare programs to academics (“,” 2006; , 2005). Primarily in the large urban setting, APNs are in a pivotal position to develop effective school nursing programs. This business case presents a model of school-based healthcare developed with the APN in mind. Budgetary figures are provided, funding sources are explored and facility staffing, management and functionality are explored.   Background Changes in lifestyle and an increase in disease states common to school children such as asthma (, 2004) or mental health issues (, 2004), as well as the additional program potential that a school nurse can provide, indicate an advance practice nurse can be an essential addition to school-based healthcare programs. APNs are also in a unique position to assess families for child abuse or neglect estimated in excess of 900,000 children annually and provide programs through school districts to advance training for recognition of risk factors (, 2005). Additionally, APNs, by virtue of their training, would be in a position to develop other community outreach programs that further the goals of health education for students. APNs are empowered to both diagnose and treat many common acute and chronic disease and disorder states (, 2002). APNs are skilled in providing common diagnostic services such as taking a medical history, performing a physical assessment or ordering laboratory tests (, 2002). Additionally, APNs provide therapeutic management and health promotion activities with the authority to practice independently in 21 states as of 2002 (, 2002). In addition to patient care, APNs are highly skilled nursing professionals who have extensive training in developing and effectively administrating community health services and political activism, management and organizational strengths are required for developing a new model for effective school nursing (, 2001). Various federal and state programs are currently available to increase funding to school districts for school nursing and student health programs (, , June 2004; “,” 2006; “,” 2006; , 2005; , 2003; , 2005). Federal grant programs are also becoming commonplace for the development of school-based clinics (, 2005). Additional sources can be developed through effective community outreach activities that a highly skilled APN performs within the natural scope of professional practice. Finally, the option of utilizing the school health facility as a formalized outpatient clinic from which to charge Medicare and Medicaid for reimbursement for professional services rendered (, 2002) are optional sources of funding to offset the cost of the APN and the educational model proposed herein.   Organizational Aims and Objectives Organizational goals are relatively simple: to ensure that every student, in the community has access to qualified medical care. In an era of declining enrollment, when school districts are apportioned funds on a per student basis, based on the student meeting attendance requirements, it is in the best interests of the school administration to ensure their students have access to quality health care. The use of an APN to develop an effective school-based clinic model would provide the diversity and breadth of healthcare, administration and community health knowledge to effectively design, develop and administer such a program. APNs are skilled at community health issues, are skilled and knowledgeable in fund-raising and acting as a corporate liaison, are highly skilled at collaborating and establishing collaborative services with other health care facilities in the community, understanding budgetary planning and facilities management. Therefore, when matching the skills outlined with the requirements of the school-based clinic model and goals outlined above, the APN is in the unique position to deliver more than health care to the community; she is ready to design, develop and implement this model. Description of Services Required  (2005) documents the model for a school-based health clinic that mirrors a small doctor’s office in size and scope yet offers students the privacy needed to seek services without drawing the attention of other students.  (2005) states the school-based clinic must offer privacy “where the student can feel comfortable about counseling and sensitive medical treatments.” Too often school health centers are located in administrative areas that are high activity locations and counterproductive to providing confidentiality of student use (, 2005). The  (2005) model called for a 1,200 square foot clinic sectioned off to provide a waiting room, conference room, two exam rooms and a holding area that can be curtained off to maintain student/patient privacy as well as room for administrative and support staffing. A facility of this size is designed to handle a student population of approximately 1,000 students (, 2005). As a pilot-program for the community, it is suggested that this model be adopted for use, however, the design should provide for expansion should clinic use exceed expectations.             Current usage expectations are that 65% of the student population will utilize the clinic for any one of a variety of services offered by the APN or other staff members.   Description of Services Provided A school nurse develops programs that foster children’s growth, positive life skills for successful coping, and acquisition of knowledge and skills for self-care, and that reinforce positive health attitudes (, 2004). The services performed by the APN and nursing or on-call adjunct staff will be outlined in the succeeding paragraphs. It will include the following that are listed, but should not to be limited to those only. A rationale for providing such services will also be given. ·                                 Diagnosing and treating infections such as strep throat, ear, sinus or other illnesses (, 2005). Infections account for the majority of all childhood illnesses; respiratory infections are the most prevalent (, 2004). The common cold also remains the chief illness of childhood (, 2004). These are common illnesses that could affect school children and it is therefore a must for school clinics to have the right medical devices to diagnose and treat such common infections; ·                                 Performing laboratory screenings as required (, 2005). This is not a usual procedure of school clinics and is usually done only in extreme conditions requiring results. School age children are also significantly affected by cancer, birth defects, and heart disease (, 2004) and should be screened for these also; ·                                 Assisting in treating students with chronic health issues such as asthma or diabetes (, 2005); ·                                 Provide dental health awareness programs emphasizing the importance of oral hygiene in the totality of good health; ·                                 Performing sports and/or other routine physicals required for school participation (, 2005). It has become increasingly clear that children are becoming less active with the result being an increase in childhood obesity (, 2000). Schools can be an excellent facilitator of physical fitness and exercise (, 2002). Strategies such as offering sports and other physical activities incorporated early into a child’s daily routine could provide a foundation for lifetime commitment to good health and physical fitness (, 2004). ·                                 Be the first line of treatment for sports related injuries that take place on school property (, 2005); ·                                 Write prescriptions on a limited basis for the treatment of an illness, such as antibiotics for infection (, 2005); ·                                 Perform assessments for risk behavior, such as substance use or abuse, sexual practices and nutrition/dietary habits (, 2005). Certain groups of children are more prone to disease and disability, often as a result to different barriers (, 2004); ·                                 Administer immunizations to the student body and faculty1(, 2005); ·                                 Offer programs that promote healthy lifestyle habits, proper including nutrition. School age children should participate in educational programs that enable them to plan, select, and prepare healthy meals and snack; ·                                 Maintain comprehensive documentation compliant with HIPPA requirements; ·                                 File and follow-up on claims for Medicare reimbursement; ·                                 File and follow-up on documentation relating to reimbursements or rebates available from other Federal Education programs, such as the Individualized Education Program that pays for some healthcare services rendered to special needs children (, 2005); ·                                 Ensure that the school and its environment is one that could promote safety and good health in students; ·                                 It is important to note that although APNs can be skilled in their jobs and provide the highest level of care to the school children, there are some factors that could affect the state of health of the school children outside the school. One priority that should be specifically mentioned here is problems related to mental health of the child. This could spur from many things, on top of it dysfunctional families. Dysfunctional families could push a school child to certain addictions, withdrawal, or worse a negative view of self. The APN could therefore offer counseling services to school children as well as to the parents if the need arises; ·                                 Lastly, yet most importantly, APNs have the responsibility to provide health education to school children. The school-age period is a crucial period for the acquisition of behaviors and health practices for a healthy adult life (, 2004). Because cognition is advancing during the period, effective health education is therefore appropriate. Promotion of good health practices is a nursing responsibility (, 2004) and programs directed at health education should be frequently organized and conducted in the school. Some of these services provided will be summarized in a table below with the top school children concerns and health promotion interventions of the nurse explained briefly. SCHOOL AGE HEALTH CONCERNS HEALTH PROMOTION INTERVENTIONS PROVIDED BY THE APN Nutrition Provide nutrition education that promotes healthy lifestyle: food guide pyramid; limiting fat and saturated fat intake as these could lead to hypertension (Guyton & Hall, 2000), and other serious health complications. Provide assessment of nutritional status of school children. Oral Hygiene Review mechanics of dental hygiene: brushing and flossing. Stress the importance of regular dental check-ups. Infections Provide immunization services, information, and follow-up. Provide diagnosis and treatment. Teach infection prevention practices such as hand washing and care of minor skin injuries. Teach simple concepts of viral and bacterial illness. Tobacco, alcohol, and drug use Provide information regarding the hazards of use of tobacco, alcohol, and drugs. Provide tobacco, alcohol and drug use assessment and prevention programs. Human Sexuality Provide information about sexual maturation and reproduction in age-appropriate manner. Provide risk assessments for sexual abuse. Safe Environment Educate school children about safety measures to prevent accidents and injuries. Encourage school children to take responsibility of their own safety. Table 1. Health Promotion for School-Children   Potential Benefits The benefits of the proposed school-based clinic are categorized as serving several target populations: the patient, the service level and the staff. Benefits to the patient population based on the addition of the APN to both the development of the program and through her participation as an active staff member providing patient care are multiple. The student population is expected to see the primary benefits of the proposed APN administrated school-based clinic. An increase in student health and well-being should correlate to an increase in student grades, student school attendance and a corresponding increase in health skills the students can carry with them into their college and adult years. An increase in student mental health awareness and availability of mental health services at the clinic is also expected to ameliorate potential issues related to abuse (, 2005) or depression and anxiety ( 2004) often missed in the student population. Research tells us that teens who fail to receive necessary health care are at a significantly increased risk for not only physical but mental health issues but that when these students visit their school-based health clinic for physical issues, mental health problems are frequently uncovered by the APN ( 2003; , 2004). School staff and administration are expected to receive a number of benefits as well. As the school-based clinic evolves, it is anticipated that faculty and staff will receive healthcare from the facility on an as needed basis; however, for the first rollout, this will not be the case. But still, faculty and staff will experience higher attendance in their classes (, 2005), healthier and more attentive students who are more likely to be participative in classes and less disruptive. Clinic staff and collaborative associates, such as nearby hospital staff or on-call physicians for emergencies, will benefit from the experience of being led by the APN due to her wide range of administrative and practical abilities to work through the system. Immediate staff will benefit from her leadership and management skills at creating a functional yet comfortable environment and in her abilities to provide health care delivery options beyond that of the traditional school nurse. Taking care and ensuring that the school environment can promote wellness and good health in school children is one essential aspect of good health yet one that is oftentimes overlooked. Many school nurses develop plans for health promotion in school children, yet most often they focus on diagnosis, assessments, screenings, immunizations among others; and tend to forget the environment. It must always be remembered by the nurse that the environment is one of the primary determinants of health (, 2005). The environment, aside from being unclean, could be one that will present accidents and injuries to school children. Accidents and injuries are a major health problem affecting school-age children (, 2004). It is not enough to think solely in terms of self when one thinks of health promotion. What affects the environment has a ripple effect and could affect everyone in the school. To start, the APN could come up with a plan that could ensure a clean and healthy environment within the school. This could be considered a prevention strategy which is of course better than finding cures when school children get diseases. Also, the provision of guidance and counseling services is a task that should be appointed not only to school guidance services but also to the APN. After all, a healthy well-being includes a healthy mind. When the child goes through adjustments, the nurse assists in promoting health. This could be done by helping the parents and child to identify potential stressors and by designing interventions to minimize stress and the child’s stress response (, 2004). The nurse needs to direct school children toward normal developmental behaviors, assist them in maximizing their abilities and use them to cope; all of which could function under the service of guidance and counseling provided in the clinic. By helping children achieve a necessary developmental balance, the nurse promotes health.   Key Outcome Criteria The APN run school-based clinic is expected to meet the following outcome criteria: <li class="MsoNormal" style="color: #333333; line-height: 200%"> Decrease school absenteeism due to illness by 50% by June, 2008 and 65% by June 2009; </li> <li class="MsoNormal" style="color: #333333; line-height: 200%"> Decrease the rate of asthma exacerbations and/or need for treatment among students by 40% by June 2008 and 60% by June, 2009; </li> <li class="MsoNormal" style="color: #333333; line-height: 200%"> Reduce the rate of teen pregnancy through pregnancy awareness programs by 30% by June 2008 and 50% by June, 2009; </li> <li class="MsoNormal" style="color: #333333; line-height: 200%"> Increase the number of students seeking help for mental health issues by 30% by June 2008 and 65% by June, 2009; </li> <li class="MsoNormal" style="color: #333333; line-height: 200%"> Achieve a follow-up appointment rating of 85%; </li> <li class="MsoNormal" style="color: #333333; line-height: 200%"> Achieve an 80% parent consent rate for the school year beginning September 2007 and a 90% parent consent rate for the school year beginning 2008; </li> <li class="MsoNormal" style="color: #333333; line-height: 200%"> Achieve a 80% rate of student participation or willingness to participate for the school year beginning 2007 and a 90% rate for the school year beginning 2008; </li> <li class="MsoNormal" style="color: #333333; line-height: 200%"> Achieve a Medicare reimbursement rate of not less than 80% of all services performed by the APN; </li> <li class="MsoNormal" style="color: #333333; line-height: 200%"> Budget to assure clinic achieves 75% self-sufficiency by June 2008 and 100% self-sufficiency by June 2009. </li>   Audit and Research Plan Once initial funding is provided to start-up costs, a detailed audit will be conducted from which to assess final budgetary figures and confirm facility and staff planning as detailed in this business case. Separate questionnaires will be presented to teachers and school administrators, students and parents or guardians. Each survey will be tailored to the participant population; all will focus on items relating to the efficacy of a school-based clinic and planned utilization, perceived benefits, areas of concern and perceived limitations of the facility, staff or fee structure. A one-year time frame is expected from the time initial grant funds are received from which to distribute and analyze survey responses, confirm or alter plans according to results and initiate the re-build, obtain necessary funding and arrange for the build-out and all hiring and administrative functions for the school-based clinic to become fully functional. Therefore, the clinic is expected to begin seeing students in September 2007. A second round of surveys distributed to the same target populations will be conducted at the end of January 2008 and during the last week of school in June 2008. The January and June 2008 surveys will be correlated with results of clinic records for number of patients/students seen, number of return visits, number of students utilizing Medicare, rate of Medicare reimbursement along with types of services performed.   Position Description The APN will be responsible for all primary activities related to the school-based health clinic, such as performing all administrative functions, grant writing activity, facilities management and project management, establishing collaborative relationships with local healthcare institutions and emergency transport providers, hiring and firing practices, serve as liaison to the school board, provide health promotion programs, and even function as a mental health nurse providing guidance and counseling services to disturbed school children as well as their parents. Additionally, the APN will manage all Federal and State compliance issues relative to position compliance for self and staff as well as service compliance areas. The APN is responsible for assuring compliance with State and Federal healthcare regulations such as HIPPA and electronic medical record transmission. The APN will also be responsible for providing healthcare services to the student population, developing awareness programs, leading seminars, interacting with faculty to bring healthcare awareness into the classroom. The APN will be responsible for medication management and medication administration policies and practices.             To summarize, the APN provides specific nursing interventions in the school setting including health education, parent programming and counseling, communicable disease control, physical and mental assessment, crisis intervention, environmental safety, nutrition planning, and emergency care. Without the school nurse, an overall process of education within the school is not complete.   Budget for the Position According to research, the average salary for a school nurse is ,216 (“,” 2006). The average salary for an APN is ,203 (“,” n.d.). Many districts, such as those in Alabama provide a state budgetary allowance that allocates a specific allowance for both salary and benefits for school nurses, in Alabama this amount is ,888 although actual salaries are determined at the local levels (“,” 2006). While many districts are struggling with insufficient funding to properly meet health care needs within the state and local districts, when funding that has been allocated is not used, unused funds must be returned to the state (“,” 2006). The APN in this model is more than just a school nurse; the APN will design, develop and implement the school-based clinic model, teach and mentor other RNs and staff members and act as a community liaison. The APN in this case therefore completes the role of educator, consultant, manager, researcher, and practitioner. Making recommendations, developing a plan of care, and performing specific advanced procedures as are appropriate in the school setting are all tasks the APN may do. As such, it is inappropriate for the APNs salary to be paid with resources allocated for the facility’s RN. Funding for the APN will be paid through the provisions of a Federal, state or corporate grant as part of the program development costs. Planned staffing for the facility includes the APN as full time coordinator, a nurse, nurse practitioner and a part-time administrative assistant. Healthcare related supplies are estimated at 0,000, although healthcare supply corporations will be solicited for tax-deductible donations through goods and materials to support the community effort. In the current model, the proposed school location has a 1,275 square foot building, off site, adjacent to the football field currently being utilized for storage. Adequate storage facilities have been ascertained as available within the school building to enable the school-based clinic to remodel and bring the building up to code as a health care clinic. It is anticipated that costs associated with a build-out will significantly reduce costs that would otherwise be incurred for a new-build. Current estimates are 0,000 with a turn around time expected at 6 months. Start-up costs associated with permits, filing fees and assistance in grant preparation, miscellaneous expenses related to seeking community support and the purchase of a laptop computer, printer and associated supplies, plus salary for the APN are estimated at ,000. Initial sources of funding are expected from private corporate or community sponsorship funds and are not expected to come from the school budget. School clinics, though located on school campuses, are run primarily by community-based healthcare providers who all tap the same funding pool: federal and state grants; private donations and in-kind contributions from local hospitals ( 2005). Also, the provision of proper nutrition to school children is often a component of major programs of the government. Governments that could afford such programs ensures proper nutrition of the young which is essential for the good health and physical growth of children at that critical stage, and hopefully producing healthier citizens as these school children grow older. This facility is expected to provide services that can be reimbursed through Medicare at a rate of 85% (, 2002). According to school district records, 97% of the student body is enrolled in Medicare compliant managed care programs. Based on anticipated patient/student flow through combined with Medicare reimbursements, it is expected that the facility will be self-sustaining after a two-year period. This does not include the cost of potential upgrades and remodeling should the patient/student flow exceed delivery of care expectations. Of course, in all these, the level of economic activity determines to a large extent how much resources and budget can be devoted by the country to help these types of activities.   Constraints             There are several issues that will hinder the APN from providing the services that were mentioned. Sometimes, clinics could not function well not due to the APN assigned but to other factors such as lack of funding. No matter how capable and APN is, if there are not enough resources to support him or her, then it is likely that the services provided will not be of good quality.             References 1 Although this facility will only be available for healthcare services to students during the inaugural year, immunizations will be considered an exception and offered to faculty and staff as requested.   Credit:ivythesis.typepad.com

IMPLEMENTATION OF A NURSE PRACTITIONER ROLE IN THE STUDENT’S LOCAL ENVIRONMENT

A Business Case for the Implementation of a Nurse Practitioner Role in the Student’s Local Environment Executive Summary The decisio...