1
|
Justice L, Florez AR, Diller C, Moellinger A, Ellis M, Riley C, Dugan E, Heichel J, Williams B, Dykton TI, Foerster LA, Callow L. Development and implementation of a paediatric cardiac intensive care advanced practice provider curriculum. Cardiol Young 2023; 33:1288-1295. [PMID: 35929440 DOI: 10.1017/s1047951122002542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Education of paediatric advanced practice providers takes a generalist approach which lacks in-depth exposure to subspecialties like paediatric cardiac intensive care. This translates into a knowledge gap related to congenital cardiac physiology and management for APPs transitioning to the paediatric cardiac ICU. METHODS A specialised interprofessional peer-reviewed curriculum was created and distributed through the Pediatric Cardiac Intensive Care Society. This curriculum includes a textbook which is complemented by a didactic and simulation review course. Course evaluations were collected following each course, and feedback from participants was incorporated into subsequent courses. Pediatric Cardiac Intensive Care Society partnered with the Pediatric Nursing Certification Board to develop a 200-question post-assessment (exam) bank. RESULTS From December 2017 to January 2022, 12 review courses were taught at various host sites (n = 314 participants). Feedback revealed that courses improved preparedness for practice, contributed to advanced practice provider empowerment, and emphasised the importance of professional networking. 97% of attendees agreed/strongly agreed that the course improved clinical knowledge, 97% agreed/strongly agreed that the course improved ability to care for patients, and 88% agreed/strongly agreed that the course improved confidence to practice. 49% of participants rated the course as extremely effective, 42% very effective, 6% moderately effective, and 3% as only slightly effective. CONCLUSIONS A standardised subspecialty curriculum dedicated to advanced practice provider practice in cardiac intensive care was needed to improve knowledge, advance practice, and empower APPs managing critically ill patients in the cardiac ICU. The developed curriculum provides standardised learning, increasing advanced practice provider knowledge acquisition, and confidence to practice.
Collapse
Affiliation(s)
- Lindsey Justice
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Amy R Florez
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christin Diller
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ashley Moellinger
- Department of Cardiology, Children's of Alabama, Birmingham, AL, USA
| | - Misty Ellis
- Department of Critical Care, Kentucky Children's Hospital, Lexington, KY, USA
| | - Christine Riley
- Division of Cardiac Critical Care, Children's National Medical Center, Washington, DC, USA
| | - Erin Dugan
- Department of Cardiology, Levine Children's Hospital at Atrium Health, Charlotte, NC, USA
| | - Jenna Heichel
- Department of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brenda Williams
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Louise Callow
- Department of Pediatric Cardiac Surgery, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| |
Collapse
|
2
|
Florez AR, Riley CM, Zender JE, Cooper DS, Henry BM, Justice LB. Evaluation of Pediatric Cardiac Intensive Care Advanced Practice Provider's Leadership Education and Experience During Emergencies. Dimens Crit Care Nurs 2022; 41:216-222. [PMID: 35617587 DOI: 10.1097/dcc.0000000000000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The number of advanced practice providers (APPs) in pediatric critical care has increased dramatically over recent years, leading to increased opportunities to lead resuscitation teams during pediatric emergent events. OBJECTIVES The aim of this study was to better understand the emergency leadership experience, training, and education that pediatric cardiac intensive care unit APPs receive. METHODS This study was a cross-sectional descriptive studying using survey responses. The self-administered survey was administered to APP and attending physician members of the Pediatric Cardiac Intensive Care Society. Survey results were analyzed. RESULTS One hundred seven pediatric cardiac intensive care unit APPs (n = 53) and attending physicians (n = 54) responded to the survey. Half of APPs felt that attendings allowed APPs to lead emergent events, and 50.9% had never functioned in the team leader role. Most respondents (77.5%) rated their comfort functioning in the role during emergent situations as moderate or lower. Increased APP experience level was associated with a higher number of codes led, increased comfort leading codes, and improved mental model sharing (all Ps < .0001). The number of codes an APP had previously led was associated with increased comfort leading codes (P < .0001) and mental model sharing (P = .0002). One-third of attendings said they allow APPs to lead codes in their unit. Half of attendings who do not allow APPs to function as the team leader would follow formal training. DISCUSSION Opportunities for APPs to function as team leaders during emergent events continue to increase. A leadership educational program would be beneficial to pediatric critical care APPs. It may also have the additional benefit of improving physician comfort with APPs leading code events and patient outcomes.
Collapse
|
3
|
McDermott KL, Schindler CA, Olson KR, Petersen TL. Acute Care Pediatric Nurse Practitioners as Leaders: Perceptions, Self-Identity, and Role Congruity. J Pediatr Health Care 2021; 35:559-563. [PMID: 33879358 DOI: 10.1016/j.pedhc.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This study aimed to gain an understanding of practicing acute care pediatric nurse practitioners' (AC-PNPs') perceptions of themselves as leaders in both clinical and professional contexts. METHOD This qualitative study was conducted at a midwestern quaternary care children's hospital. Cultural domain analysis, semistructured interviews, and free listing techniques were employed to identify areas of consensus and variation among a convenience sample of AC-PNPs. RESULTS Findings demonstrated the AC-PNPs have a limited self-view of leadership. DISCUSSION Nurse practitioners need additional leadership capacity and capability building during graduate education, the transition to practice, and throughout their careers.
Collapse
|
4
|
Justice LB, Callow L, Loomba R, Harvey J, FitzGerald M, Cooper DS. Evaluation of Pediatric Cardiac ICU Advanced Practice Provider Education and Practice Variation. Pediatr Crit Care Med 2019; 20:1164-1169. [PMID: 31274773 DOI: 10.1097/pcc.0000000000002069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The education, training, and scope of practice of cardiac ICU advanced practice providers is highly variable. A survey was administered to cardiac ICU advanced practice providers to examine specific variations in orientation format, competency assessment during and at the end of orientation, and scope of clinical practice to determine gaps in resources and need for standardization. DESIGN This study was a cross-sectional descriptive study utilizing survey responses. SETTING Pediatric cardiac ICUs in the United States. SUBJECTS The survey was delivered to a convenience sample of advanced practice providers currently practicing in pediatric cardiac ICUs. INTERVENTIONS A list of pediatric cardiothoracic surgery programs was generated from the Society of Thoracic Surgery database. A self-administered, electronic survey was delivered via email to advanced practice providers at those institutions. Descriptive data were compared using a chi-square test or Fisher exact test depending on the normalcy of data. Continuous data were compared using a Student t test or Mann-Whitney U test. MEASUREMENTS AND MAIN RESULTS Eighty-three of 157 advanced practice providers responded (53% response rate, representing 36 institutions [35% of institutions]). Sixty-five percent of respondents started as new graduates. Ninety-three to one-hundred percent obtain a history and physical, order/interpret laboratory, develop management plans, order/titrate medications, and respiratory support. Ability to perform invasive procedures was highly variable but more likely for those in a dedicated cardiac ICU. Seventy-seven percent were oriented by another advanced practice provider, with a duration of orientation less than 4 months (66%). Fifty percent of advanced practice providers had no guidelines in place to guide learning/competency during orientation. Sixty-seven percent were not evaluated in any way on their knowledge or skills during or at the end of orientation. Orientation was rated as poor/fair by the majority of respondents for electrophysiology (58%) and echocardiography (69%). Seventy-one percent rated orientation as moderately effective or less. Respondents stated they would benefit from more structured didactic education with clear objectives, standardized management guidelines, and more simulation/procedural practice. Eighty-five percent were very/extremely supportive of a standardized cardiac ICU advanced practice provider curriculum. CONCLUSIONS Orientation for cardiac ICU advanced practice providers is highly variable, content depends on the institution/preceptor, and competency is not objectively defined or measured. A cardiac ICU advanced practice provider curriculum is needed to standardize education and promote the highest level of advanced practice provider practice.
Collapse
Affiliation(s)
- Lindsey B Justice
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Rohit Loomba
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Mike FitzGerald
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - David S Cooper
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| |
Collapse
|
5
|
Gigli KH, Dietrich MS, Buerhaus PI, Minnick AF. Nurse Practitioners and Interdisciplinary Teams in Pediatric Critical Care. AACN Adv Crit Care 2018; 29:138-148. [DOI: 10.4037/aacnacc2018588] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objective:
To describe the members of pediatric intensive care unit interdisciplinary provider teams and labor inputs, working conditions, and clinical practice of pediatric intensive care unit nurse practitioners.
Methods:
A national, quantitative, crosssectional, descriptive postal survey of pediatric intensive care unit medical directors and nurse practitioners was administered to gather information about provider-team members, pediatric intensive care unit nurse practitioner labor inputs, working conditions, and clinical practice. Descriptive statistics, cross-tabulations, and χ2 tests were used.
Results:
Responses from 97 pediatric intensive care unit medical directors and 59 pediatric intensive care unit nurse practitioners representing 126 institutions were received. Provider-team composition varied between institutions with and without nurse practitioners. Pediatric intensive care units employed an average of 3 full-time nurse practitioners; the average nurse practitioner-to-patient ratio was 1 to 5. The clinical practice reported by medical directors was consistent with practice reported by nurse practitioners.
Conclusion:
Nurse practitioners are integrated into interdisciplinary pediatric intensive care unit teams, but institutional variation in team composition exists. Investigating models of care contributes to the understanding of how models influence positive patient and organizational outcomes and may change future role implementation.
Collapse
Affiliation(s)
- Kristin H. Gigli
- Kristin H. Gigli is a doctoral student, Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240 . Mary S. Dietrich is Professor, Vanderbilt University School of Nursing, Nashville, Tennessee. Peter I. Buerhaus is Professor, Montana State University College of Nursing, Bozeman, Montana. Ann F Minnick is Senior Associate Dean for Research, Julia Eleanor Chenault Professor of Nursing, Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Mary S. Dietrich
- Kristin H. Gigli is a doctoral student, Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240 . Mary S. Dietrich is Professor, Vanderbilt University School of Nursing, Nashville, Tennessee. Peter I. Buerhaus is Professor, Montana State University College of Nursing, Bozeman, Montana. Ann F Minnick is Senior Associate Dean for Research, Julia Eleanor Chenault Professor of Nursing, Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Peter I. Buerhaus
- Kristin H. Gigli is a doctoral student, Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240 . Mary S. Dietrich is Professor, Vanderbilt University School of Nursing, Nashville, Tennessee. Peter I. Buerhaus is Professor, Montana State University College of Nursing, Bozeman, Montana. Ann F Minnick is Senior Associate Dean for Research, Julia Eleanor Chenault Professor of Nursing, Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Ann F. Minnick
- Kristin H. Gigli is a doctoral student, Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240 . Mary S. Dietrich is Professor, Vanderbilt University School of Nursing, Nashville, Tennessee. Peter I. Buerhaus is Professor, Montana State University College of Nursing, Bozeman, Montana. Ann F Minnick is Senior Associate Dean for Research, Julia Eleanor Chenault Professor of Nursing, Vanderbilt University School of Nursing, Nashville, Tennessee
| |
Collapse
|
6
|
|
7
|
McBride ME, Beke DM, Fortenberry JD, Imprescia A, Callow L, Justice L, Bronicki RA. Education and Training in Pediatric Cardiac Critical Care. World J Pediatr Congenit Heart Surg 2017; 8:707-714. [PMID: 29187102 DOI: 10.1177/2150135117727258] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pediatric cardiac critical care is a new and emerging field. There is no standardization to the current education provided, and high-quality patient outcomes require such standardization. For physicians, this includes fellowship training, specific competencies, and a certification process. For advanced practice providers, a standardized curriculum as well as a certification process is needed. There is evidence that supports a finding that critical care nursing experience may have a positive impact on outcomes from pediatric cardiac surgery. A rigorous orientation and meaningful continuing education may augment that. For all disciplines and levels of expertise, simulation is a useful modality in the education in pediatric cardiac critical care.
Collapse
Affiliation(s)
- Mary E McBride
- 1 Division of Cardiology and Critical Care Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA.,2 Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - James D Fortenberry
- 4 Section of Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Louise Callow
- 5 Advanced Practice Nurse Cardiac Surgery, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Lindsey Justice
- 6 The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ronald A Bronicki
- 7 Department of Pediatrics, Section of Critical Care Medicine and Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| |
Collapse
|
8
|
Davies J, Lynch F, Nyman A, Riphagen S. The role and scope of retrieval nurse practitioners in the UK. Nurs Crit Care 2015; 21:243-51. [DOI: 10.1111/nicc.12167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/13/2015] [Accepted: 01/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Jo Davies
- Sister and Paediatric Retrieval Nurse Practitioner, Paediatric Intensive Care, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust; London UK
| | - Fiona Lynch
- Paediatric Intensive Care, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust; London UK
| | - Andrew Nyman
- Paediatric Intensive Care, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust; London UK
| | - Shelley Riphagen
- Paediatric Intensive Care, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust; London UK
| |
Collapse
|
9
|
Longden J. Advancing advanced practice. Nurs Crit Care 2014; 18:114-5. [PMID: 23577945 DOI: 10.1111/nicc.12022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
10
|
Reuter-Rice K. Acute care pediatric nurse practitioner: a practice analysis study. J Pediatr Health Care 2013; 27:410-8. [PMID: 22575783 DOI: 10.1016/j.pedhc.2012.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 04/11/2012] [Accepted: 04/14/2012] [Indexed: 11/16/2022]
Abstract
INTRODUCTION It is the responsibility of certification organizations to provide psychometrically sound and legally defensible examinations. Practice research serves as the certification framework for validating advanced practice roles and updating national qualifying examinations. This national study describes the practice of the acute care pediatric nurse practitioner (ACPNP) since the inception of the certified pediatric nurse practitioner-acute care (CPNP-AC) examination in 2005. METHOD A descriptive analysis of the 2009 practice survey of U.S. ACPNPs (291 respondents) was performed. RESULTS Most ACPNP respondents were White women; the mean age was 40 years, and 47.9% had been formally educated as ACPNPs. More than 40% practiced in the Midwestern United States. Most respondents (86.2%) practiced in urban areas. Respondents reported spending 71% of practice time in inpatient settings. The most frequently cited areas of practice were critical care (27.5%), followed by emergency department (10.7%) and specialty practices. DISCUSSION In light of recent advanced practice regulatory role distinctions, this re-examination of the ACPNP practice 5 years after initiation of the CPNP-AC certification examination demonstrates changes in clinical practice and educational preparation requirements.
Collapse
|
11
|
Abstract
The past 50 years have witnessed the emergence and evolution of the modern pediatric ICU and the specialty of pediatric critical care medicine. ICUs have become key in the delivery of health care services. The patient population within pediatric ICUs is diverse. An assortment of providers, including intensivists, trainees, physician assistants, nurse practitioners, and hospitalists, perform a variety of roles. The evolution of critical care medicine also has seen the rise of critical care nursing and other critical care staff collaborating in multidisciplinary teams. Delivery of optimal critical care requires standardized, reliable, and evidence-based processes, such as bundles, checklists, and formalized communication processes.
Collapse
|
12
|
Collaborative practice in the PICU: the Nurse Practitioner role complementing delivery of care [corrected]. Aust Crit Care 2012; 25:210-1. [PMID: 22999300 DOI: 10.1016/j.aucc.2012.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 08/28/2012] [Indexed: 11/22/2022] Open
|
13
|
Brooten D, Youngblut JM, Deosires W, Singhala K, Guido-Sanz F. Global considerations in measuring effectiveness of advanced practice nurses. Int J Nurs Stud 2012; 49:906-12. [DOI: 10.1016/j.ijnurstu.2011.10.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 10/17/2011] [Accepted: 10/19/2011] [Indexed: 11/28/2022]
|
14
|
The acute care pediatric nurse practitioner: curriculum overview. J Pediatr Health Care 2012; 26:231-7. [PMID: 22177059 DOI: 10.1016/j.pedhc.2011.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 11/02/2011] [Accepted: 11/09/2011] [Indexed: 11/20/2022]
|
15
|
Tilford AK, Jones D, Keesing H, Sheehan A. A description of nurse practitioner practice: results of a NAPNAP membership survey. J Pediatr Health Care 2012; 26:69-74. [PMID: 22153146 DOI: 10.1016/j.pedhc.2011.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 07/06/2011] [Indexed: 11/20/2022]
|
16
|
Abstract
AIMS The comprehensive review sought to examine the impact of Critical Care Nurse Practitioner models, roles, activities and outcomes. METHOD The Medical Literature Analyses and Retrieval (MEDLINE), The Cumulative Index of Nursing and Allied Health Literature (CINAHL); PubMED; PROQUEST; ScienceDirect; and the Cochrane database were accessed for the review. Alternative search engines were also included. The search was conducted with the key words: critical care, intensive care, acute, adult, paediatric, trauma, disease management programs, disease management, case management, neonatal, cardiology, neurological, retrieval, transfer and combined with Nurse Practitioner. From the identified 1048 articles 47 studies were considered relevant. RESULTS Internationally, Critical Care Nurse Practitioners were located in all intensive care areas and services including post intensive care discharge follow-up, intensive care patient retrieval and transfers and follow-up outpatient services. The role focussed on direct patient management, assessment, diagnosis, monitoring and procedural activities. Critical Care Nurse Practitioners improved patient flow and clinical outcomes by reducing patient complication, morbidity and mortality rates. Studies also demonstrated positive financial outcomes with reduced intensive care unit length of stay, hospital length of stay and (re)admission rates. CONCLUSIONS Internationally, Critical Care Nurse Practitioners are demonstrating substantial positive patient, service and nursing outcomes. Critical Care Nurse Practitioner models were cost effective, appropriate and efficient in the delivery of critical care services. RELEVANCE TO CLINICAL PRACTISE: In Australia, there was minimal evidence of Critical Care Nurse Practitioner impact on adult, paediatric or neonatal intensive care units. The international evidence suggests that the contribution of the role needs to be strongly considered in light of future Australian service demands and workforce supply needs. In Australia, the Critical Care Nurse Practitioner role and range of activities falls well short of international evidence. Hence, it was necessary to scope the international literature to explore the potential for and impact of the Critical Care Nurse Practitioner role. The review leaves little doubt that the role offers significant potential for enhancing and contributing towards more equitable health services.
Collapse
Affiliation(s)
- Margaret Fry
- Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, NSW 2007 Australia.
| |
Collapse
|
17
|
Oddsdóttir EJ, Sveinsdóttir H. The content of the work of clinical nurse specialists described by use of daily activity diaries. J Clin Nurs 2011; 20:1393-404. [DOI: 10.1111/j.1365-2702.2010.03652.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
18
|
Abstract
The changing health care environment and provider shortage have required acute care pediatric nurse practitioners (AC PNPs) to play a vital role in hospital-based, subspecialty surgical services. The AC PNP is part of a multidisciplinary team providing care for children with congenital heart disease after heart surgery. The AC PNP provides high-quality, cost-effective care to acute and critically ill children, optimizing hospital throughput while ensuring patient safety. This article focuses on the history and emerging role of the AC PNP in the context of the Magnet component of transformational leadership, the physician/nurse practitioner collaborative practice, and the development of the AC PNP role in cardiothoracic surgery at the Children's Hospital Los Angeles.
Collapse
|
19
|
Davies J, Bickell F, Tibby SM. Attitudes of paediatric intensive care nurses to development of a nurse practitioner role for critical care transport. J Adv Nurs 2010; 67:317-26. [PMID: 20946566 DOI: 10.1111/j.1365-2648.2010.05454.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM This paper is a report of a descriptive study of the attitudes and opinions of nurses before and after the introduction of independent Retrieval Nurse Practitioners into a critical care transport service for children. BACKGROUND Little is known about nurses' attitudes to advanced practice roles, particularly when these function as part of a team in a high-risk, remote setting (distant to the base hospital). Increasing knowledge in this area may give insight into ways of improving team working and enhancing quality of patient care. METHOD A qualitative questionnaire was sent to nurses pre- (June 2006) and post- (July 2007) retrieval nurse practitioner introduction. Questionnaires were analysed using an adapted phenomenological method. FINDINGS The response rates were 62% (2006) and 48% (2007). The main themes that emerged included fear, communication, trust, team working, role conflict, role division and role boundaries. In the first survey, most nurses anticipated difficulties during retrieval with retrieval nurse practitioners and felt anxious about the prospect of being part of a team with an independent retrieval nurse practitioner. However, by the second survey (after retrieval nurse practitioner introduction), the majority reported confidence in the retrieval nurse practitioners' knowledge and skills. CONCLUSION This advanced practice development has been a challenge for the nurses and the retrieval nurse practitioners, but initial anxieties and fears of a host of anticipated problems have been largely dispelled as enhanced communication and team working were reported.
Collapse
Affiliation(s)
- Joanna Davies
- Paediatric Intensive Care, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | | | | |
Collapse
|
20
|
|
21
|
Educational preparation and postgraduate training curriculum for pediatric critical care nurse practitioners. Pediatr Crit Care Med 2010; 11:205-12. [PMID: 19838142 DOI: 10.1097/pcc.0b013e3181b80a19] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nurse practitioners (NPs) in pediatric intensive care units have increased dramatically over recent years. Although state regulations are changing pediatric nurse practitioner certification, licensure and credentialing requirements, available acute care, and critical care educational programs are limited. Thus, entry-level practitioners continue to have varied clinical experience and educational preparation. OBJECTIVE To describe the current educational preparation and scope of practice of pediatric NPs and provide guidelines for postgraduate training to successfully integrate NPs into the pediatric intensive care unit (PICU). DESIGN A group of NPs practicing in pediatric critical care recognized the imminent need for comprehensive orientation guidelines that are readily accessible to physicians and other nurse practitioners to successfully transition entry-level NPs into the PICU. The NPs held many discussions to identify commonalities and differences in the education foundation in pediatric NP programs, expected clinical experience and knowledge of NP students, and anticipated needs and gaps for the entry-level practitioner. A convenience sample of 20 pediatric critical care nurse practitioners practicing for > or =5 yrs were interviewed to examine current orientation processes for entry-level NPs into the PICU. Sample orientation guidelines, job descriptions, and procedural competency forms were collected and reviewed from various PICUs across the United States. An orientation model was drafted and distributed to a secondary panel of ten experienced practitioners to gather expert opinions. Responses were reviewed and a revised draft of the document was distributed to a group of APNs involved in postgraduate education. RESULTS A PICU orientation model for entry-level pediatric critical care nurse practitioners was developed. CONCLUSIONS The orientation curriculum presented here may serve as a resource for NPs and collaborating physicians who are developing a training program for entry-level practitioners.
Collapse
|
22
|
Cramer CL, Orlowski JP, DeNicola LK. Pediatric intensivist extenders in the pediatric ICU. Pediatr Clin North Am 2008; 55:687-708, xi-xii. [PMID: 18501761 DOI: 10.1016/j.pcl.2008.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article explores the use of physician extenders in the pediatric ICU setting. The Libby Zion case is highlighted because of its impact on the use of manpower in the hospital setting. The history of physician extenders, including the hospitalist, physician assistant (PA), and nurse practitioner (NP), is discussed. Findings indicate a positive impact within the pediatric intensive care setting with the use of NPs and PAs. The American Academy of Pediatrics has supported the use of physician extenders in the care of hospitalized children.
Collapse
Affiliation(s)
- Cheryl L Cramer
- Pediatric Intensive Care Unit, University Community Hospital, 3100 East Fletcher Avenue, Tampa, FL 33613, USA
| | | | | |
Collapse
|
23
|
Kline AM, Reider M, Rodriguez K, Van Roeyen LS. Acute care pediatric nurse practitioners: providing quality care for acute and critically ill children. J Pediatr Health Care 2007; 21:268-71. [PMID: 17606167 DOI: 10.1016/j.pedhc.2007.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Accepted: 02/23/2007] [Indexed: 11/25/2022]
Affiliation(s)
- Andrea M Kline
- Division of Critical Care, Children's Memorial Hospital, Chicago, IL 60614, USA.
| | | | | | | |
Collapse
|
24
|
Abstract
PURPOSE The challenges of health care; its safety, effectiveness, and efficiency; the quality of care; and the outcomes patients experience are issues central to nursing practice. This centrality needs to be affirmed as the profession shapes its practice over the next 50 years. The purpose of this article is to initiate a dialogue on the future of nursing practice. METHODS The methods used are observation, reflection, dialogue, and proposed actions. FINDINGS The results of this process are preliminary. They suggest that the establishment of nursing hospitals is a distinct possibility. CONCLUSIONS This article concludes with a series of arguments for and against this position along with an invitation for your participation in this dialogue. NURSING IMPLICATIONS The major implications of this article are not "nursing" implications per se but client and patient implications and the future contribution of nursing to improved health and patient care.
Collapse
Affiliation(s)
- Mary Ann Lavin
- Saint Louis University School of Nursing, St. Louis, MO 63104, USA.
| | | | | |
Collapse
|
25
|
Mantzoukas S, Watkinson S. Review of advanced nursing practice: the international literature and developing the generic features. J Clin Nurs 2007; 16:28-37. [PMID: 17181664 DOI: 10.1111/j.1365-2702.2006.01669.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM The aim of this article is to review the nursing literature on the notion of advanced nursing practice (ANP) and consequently provide clarifications on the concept of advanced nurse practitioner by developing its' generic features. BACKGROUND This paper commences by critically reviewing the concept of advanced nursing practice as it is portrayed within the literature. From this review, a series of contradictions emerged in terms of definitions and roles. On further analysis of the literature the core aims and goals of the ANP are revealed. METHODS An informative and narrative systematic literature review was undertaken, using specific inclusion and exclusion criteria. The mass of retrieved material was carefully screened and methods of data saturation were used. Consequently, the material was read, re-read and indexed as to develop seven thematic units that formed the generic features of the ANP. FINDINGS The generic features that emerged are: (i) the use of knowledge in practice, (ii) critical thinking and analytical skills, (iii) clinical judgement and decision-making skills, (iv) professional leadership and clinical inquiry, (v) coaching and mentoring skills, (vi) research skills and (vii) changing practice. CONCLUSION Reviewing the literature on the concept of ANP, a great variety of definitions, conceptualizations and roles emerged. Nonetheless, on a closer reading, a common goal was identified, which was the attainment of practice and professional autonomy via ANP roles for enhanced practice provision. Eventually, from the reviewed literature, seven generic features of the ANP were developed, thus providing clarification to the role and the characteristics of the ANP. RELEVANCE TO CLINICAL PRACTICE Clarifying the confusion surrounding advanced nursing practice and gaining an in-depth understanding of its' generic features would facilitate practitioners, practice educators and clinical managers to develop those skills that would allow them or their staff or students to practise at an advanced level.
Collapse
Affiliation(s)
- Stefanos Mantzoukas
- Department of Adult Nursing, Institute of Health and Human Sciences, Thames Valley University, Ealing, London, UK.
| | | |
Collapse
|
26
|
Kline AM, Sorce L. Response to the article by Reider-Demer, Widecan, Jones, and Goodhue on the evolving responsibilities of the pediatric nurse practitioner. J Pediatr Health Care 2007; 21:134; author reply 135. [PMID: 17321916 DOI: 10.1016/j.pedhc.2006.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Accepted: 12/12/2006] [Indexed: 10/23/2022]
|