Spotlight on.... Teaching health assessment in advanced practice nursing programs

Looking is not seeing and listening is not hearing: effect of an intervention to enhance auditory skills of graduate-entry nursing students

Inspection/observation and listening/auscultation are essential skills for health care providers. Given that observational and auditory skills take time to perfect, there is concern about accelerated students' ability to attain proficiency in a timely manner. This article describes the impact of music auditory training (MAT) for nursing students in an accelerated master's entry program on their competence in detecting heart, lung, and bowel sounds. During the first semester, a two-hour MAT session with focused attention on pitch, timbre, rhythm, and masking was held for the intervention group; a control group received traditional instruction only. Students in the music intervention group demonstrated significant improvement in hearing bowel, heart, and lung sounds (p < .0001). The ability to label normal and abnormal heart sounds doubled; interpretation of normal and abnormal lung sounds improved by 50 percent; and bowel sounds interpretation improved threefold, demonstrating the effect of an adult-oriented, creative, yet practical method for teaching auscultation.

Advanced Health Assessment in Nurse Practitioner Programs: Follow-Up Study

The increase in advanced practice graduate programs and the inclusion of content and skills related to advanced health assessment as a core competency for practice served as the impetus for a 5-year follow-up study to track the changes, methodologies, and integration of technology into practitioner programs. The questionnaire was mailed to the faculty/schools listed as current members in the National Health Service Corps Nurse Practitioner Faculty Advocate Network. The number of responding schools was 135 (44%). The family nurse practitioner program continues to be the most offered advanced practice nursing program. Nearly all institutions offer a post-master's program and an advanced health assessment course to their clinical graduate students. Health assessment is usually taught concurrently or as a prerequisite for clinical experiences; there continues to be a strong emphasis on the physical examination component. Ethnic and cultural assessment and gerontological assessment content increased since the original study. Both class and laboratory class sizes decreased. Qualitative data that centered on differences in graduate versus undergraduate health assessment revealed a shift in focus in several areas: differential diagnoses, abnormals, and the inclusion of advanced skills. There was an emergence of more creative strategies: the use of standardized patients, online coursework, videotaping, "live" patients, and simulations.

Advanced nursing practice: policy, education and role development

AIMS AND OBJECTIVES

This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice.

BACKGROUND

The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required.

CONCLUSION

The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community.

RELEVANCE TO CLINICAL PRACTICE

In a rapidly changing people-centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research.