Ethical practice guidelines: an evaluation

Ethical practice guidelines (EPGs) were developed for use in Central Sydney Area Mental Health Service to guide contemporary mental health nursing practice and serve as a resource for clinical mental health nurses in relation to their professional conduct and practice. This survey of mental health nurses aimed to ascertain feedback on the application of the EPGs in the clinical arena. Nurses from the Central Sydney Area Mental Health Service (n = 350) were asked to complete a 15-item survey developed by the authors. A total of 121 nurses completed the survey. Findings from the survey reveal that the information provided in the EPGs is useful (91%) and the EPGs provide sufficient guidance for practice (94%). Most respondents (96%) reported feeling confident dealing with ethical practice situations and 75% indicated interest in further education and training in this domain. Findings from this survey support the need to explore avenues to facilitate education, discussion and reflective practice in relation to ethical mental health nursing practice.

Making the transition from enrolled to registered nurse

Each year among the university graduates who become eligible to register as nurses for the first time, there are a number of people who have previously trained and practiced as enrolled nurses. There is little research that examines the experiences and needs of this unique group of simultaneously experienced and novice nurses. In this paper, a phenomenological approach was used to examine the lived experience of nine former enrolled nurses making the transition from nursing student to graduate nurse. Data from extensive interviews with these nine nurses was examined using van Manen's (1990) steps of thematic analysis. The grouping of concepts into subthemes led to the identification of three main themes that described the nurses' experiences of transition: responsibility and accountability, change, and job satisfaction. Excerpts from interview transcripts are used as exemplars in discussion of the meaning and importance of these findings. The findings of this study will inform nurse education and graduate transition support services.

Resolving ethical dilemas. Applying the institute for Global Ethics' Ethical Fitness model to occupational and environmental health practice issues

1. Technological advancements have rapidly increased the need for careful ethical choices to preserve life and environment of the global community. 2. No formula exists to resolve ethical dilemmas, but using an ethical decision making model can help maintain a state of ethical fitness. 3. The Ethical Fitness model relies on the assumption that certain core values are universal. Maintaining ethical fitness is essential to resolve ethical dilemmas. 4. The process of resolving ethical dilemmas consists of analyzing the dilemma using nine checkpoints, four dilemma paradigms, and three resolution principles.

Statutory and regulatory recognition for clinical nurse specialists in Oregon

Clinical nurse specialists (CNSs) in Oregon initiated the process of achieving statutory and regulatory recognition several years ago. Throughout this process, specific phases of activity and events helped CNSs to identify what was required to achieve this goal. The resulting lessons learned are shared in this report. Statutory recognition of CNSs in Oregon occurred in 1999, and the administrative rules for CNS practice were published in 2001. These administrative rules delineate the CNS scope of practice and other aspects of CNS practice consistent with national standards.

Non-physician practitioners in radiation oncology: advanced practice nurses and physician assistants

PURPOSE

With changes in reimbursement and a decrease in the number of residents, there is a need to explore new ways of achieving high quality patient care in radiation oncology. One mechanism is the implementation of non-physician practitioner roles, such as the advanced practice nurse (APN) and physician assistant (PA). This paper provides information for radiation oncologists and nurses making decisions about: (1) whether or not APNs or PAs are appropriate for their practice, (2) which type of provider would be most effective, and (3) how best to implement this role.

METHODS

Review of the literature and personal perspective.

CONCLUSIONS

Specific issues addressed regarding APN and PA roles in radiation oncology include: definition of roles, regulation, prescriptive authority, reimbursement, considerations in implementation of the role, educational needs, and impact on resident training. A point of emphasis is that the non-physician practitioner is not a replacement or substitute for either a resident or a radiation oncologist. Instead, this role is a complementary one. The non-physician practitioner can assist in the diagnostic work-up of patients, manage symptoms, provide education to patients and families, and assist them in coping. This support facilitates the physician's ability to focus on the technical aspects of prescribing radiotherapy.

Evaluating dispensing error detection rates in a hospital pharmacy

OBJECTIVES

The filling of unit dose orders and checking for filling errors are two essential distributive responsibilities of a hospital pharmacy. Previous studies have shown that nonpharmacists, usually technicians, are capable of assuming these distributive tasks traditionally performed by hospital pharmacists. The study tested whether nonpharmacists, in this case licensed practical nurses/medication nurses, were as competent as pharmacists in checking for errors in unit dose cassettes prepared for hospital patients.

METHODS

A university teaching hospital was used for the study. Artificial errors (n = 812) were introduced into the drug distribution system during a 4-month period in 1995. Included in the study were seven staff pharmacists and nine medication nurses (licensed practical nurses) involved in the decentralized drug distribution system. The primary measure was the ratio of errors detected to the number of artificial errors introduced into the system. This primary measure is different from those used in prior studies that do not separate dispensing errors and checking errors.

RESULTS

Overall, pharmacists were significantly more accurate in detecting errors (87.7% vs. 82.1%). In one category of serious errors, that of wrong strength, the difference between pharmacists and licensed practical nurses was even greater (93.3% vs. 83.3%).

CONCLUSIONS

This study's results do not support conclusions of prior studies that nonpharmacists can match the error detection accuracy of pharmacists. It demonstrates the importance of considering the types of errors under examination and of using appropriate measures of error checkers when drawing conclusions on relative competence.

Improving your bedside manner

Positive bedside manners are essential when caring for patients. Positive bedside manners should be utilized wherever patients and their significant others are encountered. Putting your best foot forward is the first step in establishing a therapeutic relationship. Attention to one's professional image is important if the client is to see the licensed practical/vocational nurse as someone that can be trusted. Next is actively communicating interest and concern. It is also important to communicate empathy and respect through words and actions. The LP/VN must practice attending skills in order for the patient to experience the physical and psychological presence of the nurse. Communicating availability and following up on requests promote the establishment of trust. It is important for the nurse to avoid defensiveness, maintain a professional manner, answer questions honestly, demonstrate integrity, maintain a positive attitude and practice intentional encouragement. All the characteristics will demonstrate a positive bedside manner and will communicate caring and concern to clients and their significant others.

The role of the licensed practical nurse and the licensed vocational nurse in the clinical practice of intravenous nursing. The Intravenous Nurses Society

The Intravenous Nurses Society (INS) believes that the intravenous trained licensed practical nurse and the licensed vocational nurse can aid in the delivery of some aspects of intravenous therapy under the supervision of the registered nurse; however, the registered nurse shall be the primary practitioner in this specialty.

Finding a balance: client choice vs public protection

Choice should be a basic part of health care, yet questions arise when untrained individuals take on the responsibility of supervising their own care--questions of safety and appropriateness.

Screening for colorectal cancer by nurse endoscopists

BACKGROUND

Case-control studies have demonstrated that screening by sigmoidoscopy is effective in reducing mortality from colorectal cancer. If nurses performed screening examinations, more patients could be screened and, at current income levels, at a lower cost.

METHODS

Two registered nurses and two licensed practical nurses learned to perform examinations with the flexible fiberoptic sigmoidoscope in order to screen patients for colorectal tumors. They performed 1881 independent examinations of outpatients more than 45 years of age. During the same period, 730 examinations were performed by two gastroenterologists in similar patients.

RESULTS

The mean depth of insertion of the sigmoidoscope was slightly but significantly greater in the patients examined by the physicians than in those examined by the nurses (48 vs. 46 cm in men, P = 0.003; 41 vs. 38 cm in women, P = 0.002). Adenomas were found in 14 percent of the men and 8 percent of the women examined (P = 0.001). Nine cancers were found in men and four in women. There were no significant differences between the nurses and the physicians in the proportion of examinations that were positive for adenomas or cancer. No complications occurred during the initial examinations or during 894 follow-up sigmoidoscopic procedures. Among the patients whose initial examination results were normal, more of those examined by nurses returned for follow-up sigmoidoscopy after 12 months or more (45 percent, vs. 30 percent of those examined by physicians; P = 0.001).

CONCLUSIONS

Nurses can carry out screening by flexible sigmoidoscopy as accurately and safely as experienced gastroenterologists.