Nurse-Physician Communication Tools to Enhance use of Nursing Evidence-Based Protocols by Tochi Onyenwe Ubani MSN, Walden University, 2011 BSN, Chamberlain College of Nursing, 2009 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2015 In the current health care environment, consumers are demanding collaboration among clinicians even when traditional attitudes minimize nurses' input on the direction of clinical care. Compounding this problem is that nursing practices have not always been derived from randomized clinical trials, but instead from personal experiences. The purpose of this study was to explore the perceptions of nurses, physicians, and administrators on clinical protocols, including the use of nurse evidence-based practice (EBP) in practice settings. The study aimed at fostering clinical decisions anchored on shared knowledge, collegiate interactions, and emotions. A survey designed using nurse-physician communication tools was disseminated among a convenience sample of 50 nurses, 12 physicians, and 3 administrators. Content analysis was applied to survey responses. The findings revealed that effective communication between nurses, physicians, and administrators enhanced the use of nursing EBPs; these findings were used to generate the Nurse-Physician Communication Tools (NPCT) as a mechanism to enhance the translation of nursing EBP in clinical setting. The use of NPCT provided a mechanism for practice changes needed to improve clinical collaboration and enhance use of nursing EBPs in patient care.

Orientador: Wilza Carla Spiri / Resumo: Introdução: uma das atividades fundamentais, no trabalho de Enfermagem, é a passagem de plantão, a qual é crucial para a garantia da continuidade das ações que estão sendo dispensadas aos pacientes. Nesse sentido, a comunicação torna-se indispensável para que as equipes consigam planejar e executar bem suas atividades, adotando um fluxo adequado de comunicação com canais bem estruturados, facilitando o funcionamento das rotinas assistenciais e administrativas. Objetivo: descrever o processo de validação semântica de um instrumento de passagem de plantão utilizando a metodologia SBAR (Situation-Background-Assessment-Recommendation). Método: trata-se de estudo metodológico para construção e validação de um instrumento de passagem de plantão. Foi realizada uma revisão bibliográfica abrangente sobre a ferramenta SBAR e elaboração do instrumento de passagem de plantão. O instrumento foi validado em março de 2019 por dez juízes da área de ensino e assistência. Posteriormente o instrumento foi aplicado na enfermaria de Gastroenterologia cirúrgica, do hospital cenário da pesquisa no mês de fevereiro de 2019, por 11 técnicos de enfermagem que compõem o quadro funcional dessa enfermaria e que responderam um questionário avaliando o instrumento validado para a passagem de plantão. As análises foram realizadas considerando a estatística descritiva. Resultados: os resultados demonstram que os juízes foram constituídos por mulheres (80%), com média de idade de 42,5 anos e tempo de profissã... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: one of the fundamental activities in nursing work is the change of shift, which is crucial to guarantee the continuity of the actions that are being dispensed to patients. In this sense, communication becomes indispensable for teams to plan and execute their activities, adopting an adequate flow of communication with well-structured channels, facilitating the functioning of care and administrative routines. Aim: to describe the process of semantic validation of a change of shift instrument using the SBAR (Situation-Background-Assessment-Recommendation). Method: This is a methodological study for the construction and validation of a change of shift instrument. A comprehensive bibliographic review was done on the SBAR tool and preparation of the change of shift instrument. The instrument was validated by ten judges from the academic and assistance area. Afterwards, the instrument was applied to the surgical gastroenterology ward of the research scenario by 11 nursing technicians who compose the functional picture of this ward and who answered a questionnaire evaluating the validated instrument for the change of shift. The analyzes were performed considering the descriptive statistics. Findings: the results show that the judges consisted of women (80%), with a average of age of 42.5 years and a profession of 16 years, 40% of professors and 30% of managers and assistants, with graduation (40% ), doctorate (30%), specialization (20%), master's degree and post-doctora... (Complete abstract click electronic access below) / Mestre

The purpose of this research has been to trace the development of the nurse practitioner role in New Zealand. Established in 2001, this advanced nursing practice role was birthed amid controversy as historical forces at play both inside and outside nursing struggled for power to control the future of the profession. Using a discourse analytical approach informed by the work of Michel Foucault, the study foregrounds the discourses that have constructed the nurse practitioner role within the New Zealand social and political context. Discourses, as explained by Foucault, are bodies of knowledge construed to be ‘truth’ and connected to power by reason of this assumption, serving to fix norms and making it virtually impossible to think outside them. Discourses of nursing and of medicine have established systems of disciplinary practices that produce nurses and physicians within defined role boundaries, not because of legislation, but because discourse has constructed certain rules. The nurse practitioner role transcends those boundaries and offers the possibility of a new and potentially more liberating identity for nurses and nursing. A plural approach of both textuality and discursivity was used to guide the analysis of texts chosen from published literature and from nine interviews conducted with individuals who have been influential in the unfolding of the nurse practitioner role. Both professionally and industrially and in academic and regulatory terms dating back to the Nurses Registration Act, 1901, the political discourses and disciplinary practices serving to position nurses in the health care sector and to represent nursing are examined. The play of these forces has created an interstice from which the nurse practitioner role in New Zealand could emerge. In combination with a new state regime of primary health care, the notion of an autonomous nursing profession in both practice and regulation has challenged medicine’s traditional right to surveillance of nursing practice. Through a kind of regulated freedom, the availability of assessment, diagnostic and prescribing practices within a nursing discourse signals a radical shift in how nursing can be represented. The nurse practitioner polemic has revolutionised the nursing subject, and may in turn lead to a qualitatively different health service.

Despite nurses having legitimate ethical rights and responsibilities, they are often constrained in practice from acting in ways they believe to be morally correct. This thesis presents a qualitative exploration of factors that influenced eight newly graduated nurses as they endeavoured to practice ethical mental health nursing in New Zealand. Data was gathered from in depth interviews with the participants and analysed using a thematic analysis method. A critical lens was employed to view the data so as to make visible aspects of the social and political context within which the participants were situated. The participants? moral practice was profoundly influenced by a number of relational experiences they had. These relationships were then determinants in their moral development, professional socialization and their ability to practice in accordance to their moral beliefs. Key aspects of these relationships were their experiences with nursing education and the influence of the organisations where they worked. Recommendations are made to both areas to enable and support moral nursing practice for new graduate mental health nurses. New graduate nurses inherently desire to practice in a way that honours the client and is therefore inherently ethical. Moral nursing practice is an everyday occurrence that must be situated in a culture of respect and regard for both clients and nurses. New graduate nurses have much to offer the profession and the tangata whaiora of the mental health services. They must be valued and supported to act in accordance to their moral ideals.

Includes bibliographical references. Electronic publication: Full text available in PDF format; abstract in HTML format. Private practice as a career option for nurses has been slowly increasing since the 1980's. However, the reasons for this development have not been fully investigated so that it can be understood and placed within the changing contexts of health care and health services. The expansion and extension of nurses' roles is a contemporary topic in health care reform and therefore one that deserves investigation. The aims of this study were to develop a theory on private practice nursing and to describe the characteristics and work of the self-employed nurse in Australia. Electronic reproduction.[Australia] :Australian Digital Theses Program,2001.xvii, 350 leaves : ill. (some col.) ; 30 cm.

"March 2003." Includes bibliographical references (leaves 340-350). Aims to develop a theory on private practice nursing and to describe the characteristics and work of the self-employed nurse in Australia. Enables nurses to provide direct information on being self-employed and enhances the profession's ability to articulate about this area of nursing. Results suggest that private practice nursing can contribute effectively to broadening the range of primary health services available to the population and to addressing the issues of retention and recruitment of nurses. Self-employed nurse entrepreneurs push the boundaries of the profession and expand the realm of nursing practice.

Doctor of Philosophy / Similar to their colleagues throughout the world, nurses and midwives in New South Wales (NSW), Australia, welcome evidencebased practice (EBP) as a means to improve patient or client outcomes. This thesis explores the way nurses and midwives understand evidence for EBP and aims to determine whether members of these professions currently have the knowledge and skills necessary to implement evidence‐based care. Three separate studies were conducted to explore NSW nurses’ readiness for EBP. Attitudes, knowledge and skill were investigated using an EBP questionnaire returned by 383 nurses. The views of 23 nursing opinion leaders were elicited during qualitative in‐depth interviews, and their ideas on maximising the potential for future nurses to confidently engage in EBP were explored. Current approaches to teaching EBP in undergraduate nursing programs were investigated by examining documents issued by NSW nursing education providers. The results demonstrate many differences between the ways NSW nurses currently understand evidence for EBP, and a range of approaches to teaching EBP in undergraduate nursing programs. Under current conditions, nurses graduating from universities in NSW commence practice with varying levels of preparation for EBP and enter into a professional arena that is itself struggling to cope with the concepts and language of this approach to improving healthcare. v Evidence for the effectiveness of EBP is slowly accumulating and despite some small positive signs, the collective results of this thesis suggest that current educational approaches are not capable of producing the kind of results that are both necessary and desirable for the promotion of evidence‐based nursing practice in NSW. Articulating a commitment to EBP, using a common language and a consistent approach are among the recommendations made for the future promotion of EBP in nursing education.

Private practice as a career option for nurses has been slowly increasing since the 1980's. However, the reasons for this development have not been fully investigated so that it can be understood and placed within the changing contexts of health care and health services. The expansion and extension of nurses' roles is a contemporary topic in health care reform and therefore one that deserves investigation. The aims of this study were to develop a theory on private practice nursing and to describe the characteristics and work of the self-employed nurse in Australia. Nurses working in a variety of settings have been able to provide information on being self-employed. In doing so, this study was able to describe the persona of the nurse entrepreneur, explore the reasons why nurses and midwives in Australia establish private fee-for-service practices, identify the factors which have influenced this action and describe the scope of practice of nurses and midwives in private practice. This combined Delphi technique and Grounded Theory study is the first in-depth study of Australian nurses and midwives in private practice. The study enables nurses to provide direct information on being self-employed and enhances the profession's ability to articulate about this area of nursing. The significance of the research is in increasing the understanding of this area of practice development and affords greater insight into its efforts to improve and maintain quality nursing services within the Australian health care system. One hundred and six nurses and midwives were invited to participate in the study, in which participants completed two rounds of semi-structured postal questionnaires. Delphi technique was applied to rate responses on Likert scales to ascertain respondents' consensus on certain topics. Participants were also provided the opportunity to make additional comments. Results indicated that nurses in private practice are well experienced with an average of 21 years nursing experience and hold several qualifications. Job satisfaction, being able to be more involved in achieving quality health outcomes and maximising skills and abilities are significant influences for private practice. These results suggest that private practice nursing can contribute effectively to broadening the range of primary health services available to the population and to addressing the issues of retention and recruitment of nurses. Self-employed nurse entrepreneurs push the boundaries of the profession and expand the realm of nursing practice. Entrepreneurship is a path for the future of nursing as it offers expanded career opportunities for nurses and opportunities for increased ambulatory health services. In addition, the broad, expert knowledge nurses hold on many aspects of health can be disseminated throughout the health sector to the advantage of corporate health partners. There is further development required in this innovative and expanding area of the nursing profession. / Thesis (Ph.D.)--Department of Clinical Nursing, 2003.

The purpose of this project was to evaluate the effectiveness of a practice-based dermoscopy training program for dermatology healthcare providers in order to improve their technique of performing clinical skin exams for the early detection of melanomas. The overall incidence of melanoma continues to rise. More than 75% of all skin cancer deaths are from melanoma. Advanced melanoma spreads to lymph nodes and internal organs and can result in death. One American dies from melanoma almost every hour (American Cancer Society [ACS], 2009). Early diagnosis and excision are essential to reduce morbidity and to improve patient survival. This one-group before-and-after study design utilized a convenience sample of three dermatology healthcare providers (DHPs). The primary investigator conducted a retrospective review of the pathology logs for each provider. The time frame for the review was a three-month period in 2010, which represented the same time frame that the study was conducted in 2011. The DHPs participated in a four-hour training workshop that included pattern analysis recognition using dermoscopy. Following the workshop, each DHP was given a DermLite 3Gen DL100 to use in practice when performing clinical skin examinations. All DHPs completed a data collection sheet to document their pattern of decision making with and without a DermLite. The outcome of interest was the use of dermoscopy by DHPs to demonstrate an increased detection of melanoma when compared to naked-eye examination. The outcome was evaluated 12 weeks postworkshop training. There were 120 evaluations made with the DermLite as compared to the naked eye. The overall agreement was 0.52, AC1 coefficient (95% CI) was 0.36 (0.30, 0.42), p < .001, and kappa coefficient (95% CI) was 0.27 (0.20, 0.43), p < .001. Overall, the risk of lesion under exam being suspicion for skin cancer was higher on 27.5% (33 out of 120) of the evaluations and lower on 20.8% (25 out of 120) evaluations. The risk of lesion was evaluated the same on 51.7% (62 out of 120) of the evaluations. This is an indication of “Poor” agreement between the two methods. The diagnosis and disposition made using DermLite compared to naked-eye results for both coefficients provided an “Intermediate to Good” agreement between the two methods in assigning diagnosis and disposition. This indicates that there is no difference between DermLite and naked-eye evaluations. More studies are needed in order to provide better evidence on the value of dermoscopy in clinical practice at the Dermatology and Laser Center. Future projects should be more explicit regarding the methods used and lesion selection in order to better understand the benefits of dermoscopy.

Dans le cadre de cette étude, nous nous sommes intéressés aux infirmières soignantes qui possèdent un diplôme d’études collégiales ou un baccalauréat. L’infirmière est celle ayant reçu une formation collégiale et la clinicienne, une formation universitaire de premier cycle. Au niveau législatif, selon que l’infirmière soit titulaire ou non d’un baccalauréat, le champ de pratique autorisé demeure le même. Cependant, l’étendue de la pratique pourrait varier selon la formation reçue et le poste occupé. Cette étude descriptive et interprétative de type qualitatif avait pour but de décrire l’étendue de la pratique des infirmières et des infirmières cliniciennes dans une unité de médecine et de chirurgie et d’identifier les facteurs organisationnels influençant l’étendue de la pratique. Le cadre de référence ayant été utilisé est le cadre d’analyse de l’étendue de la pratique conçu pour le Collège des infirmières autorisées de la Nouvelle-Écosse (CRNNS, 2005). Selon ce cadre, l’étendue optimale de la pratique des infirmières se divise en 4 catégories distinctes, soit le processus de soins infirmiers, les pratiques relationnelles, le leadership ainsi que l’enseignement et le transfert des connaissances. La collecte de données a été conduite au moyen d’entrevues individuelles semi-structurées auprès de 8 informateurs clés soit trois infirmières et trois infirmières cliniciennes d’une unité de médecine et de chirurgie et de deux gestionnaires. Les résultats semblent montrer que les différentes composantes de l’étendue de la pratique sont mobilisées tant chez les infirmières que chez les infirmières cliniciennes interviewées. Toutefois, les résultats semblent montrer que certaines composantes, soit le leadership et le transfert des connaissances, semblent davantage mobilisées chez les infirmières cliniciennes. De plus, l’étude a permis d’identifier les différents facteurs organisationnels qui semblent influencer l’étendue de la pratique des infirmières et des infirmières cliniciennes. La charge de travail semble être le principal facteur d’influence. Nous avons aussi pu constater l’influence certaines composantes reliées à l’environnement de travail et à la composition et aux caractéristiques des équipes de soins. / The goal of this descriptive and interpretative study was to first describe the scope of nursing practice of registered nurses with a Bachelor’s degree in nursing and those with a nursing diploma in a medical and surgical unit of a regional hospital. The second goal was to identify the organizational factors that influence the scope of nursing practice in that unit. The framework that has been used is the Framework to Analyse Scope of practice, made for the College of Registered Nurses in Nova Scotia (CRNNS, 2005). According to that framework, the full scope of practice of the registered nurse is divided in 4 components: the nursing process, the professional nursing relationships, the leadership and the fonction of teaching and knowledge transfert. For this study, 8 interviews have been realized. The participants were: 3 nurses with a nursing diploma, 3 nurses with a bachelor’s degree and 2 administrators. The results seems to show that all the components of the nursing scope of practice seems to be used by the nurses with a Bachelor’s degree in nursing and those with a nursing diploma. But, the results seem to show that the nursing scope of practice is not fully extended in that unit. We remarked also that two elements of the nursing scope of practice, the leadership and the teaching and knowledge transfert, are more used by nursed with a Bachelor’s degree, compared to those with a nursing diploma. The principal factors which seem to influence the scope of nursing practice in this unit are the nursing workload and some components according to the work environment and to the composition and caracteristics of the nursing teams.