ARTICLE 10 marby mananquil and francis lo

francis_christian21 · Posts: 20 Join date: 2009-06-21

Journal Study on the research article “The post-infarction nurse practitioner project: A prospective study comparing care in a non-high-risk myocardial infarction population”

The importance of continuing education and training is bigger than one can imagine. It is the torch that lights the way to constant improvement. Thus, making an effort to develop competent nurses helps upgrade the practice of nursing. This journal is a study about the importance of experienced nurse practitioners within the critical care pathways. They play an important role in the overall recovery of every patient.

A study was conducted by Nurse Practitioners in Medical Center Alkmaar, Netherlands about the delivery of qualitatively equal care to non-high-risk patients with recent myocardial infarction as compared with conventional care.

Conventional Care- is a clinical treatment managed by residents and attending physicians.

Nurse Practitioner Care-involves daily clinical rounds, necessary clinical decision making, educating, suggesting lifestyle changes, teaching self monitoring and management, coordinating care with other healthcare, and providing rehabilitation support.

The study was made within November 2001 to November 2006 and was divided into three phases.

1.)The Pilot Phase (November 2001- March 2002) was designed to screen eligible participants. In this phase, 145 consecutive patients were assessed and 101 of them were eligible to undergo the clinical and outpatient treatment by a nurse practitioner.
Results were: 7% of the 145 consecutive patients died because of cardiac problems two days after admission while still on the coronary care unit. No nurse practitioner in this phase.

2.)Safety Phase- (March 2002 to July 2003) was designed to examine the difference between conventional care to nurse practitioner care on a 200 randomized consecutive patients.

3.)The implementation phase (July 2003 to November 2006) composed of 500 consecutive stable post MI patients managed by a nurse practitioner.
Results were remarkable, 37% of the patients in the pilot phase suffered inferior myocardial infarction and there were more multi-vessel disease patients in the pilot phase, 60% compared with 41% in the nurse practitioner phase. In the pilot phase, the length of stay was 11.1 days compared to 6.2 days in the nurse practitioner phase.

Conclusion:
Nurse practitioners were effective in delivering equal quality care to non high risk patients with MI as compared with the conventional care. Being with a nurse practitioner in the ward significantly decreases length of stay in the hospital.

Quote:

“Nurse specialist/practitioners can play an intermediate role between the attending consultants, nurses and patients.”

Collaboration requires antecedent variables of trust and respect. Teaching hospitals present unique challenges to the development of trust and respect as a result of a constant influx of new learners. In these settings, unit leaders play a critical role in establishing cultural norms, including the expectation of respectful relationships between nurses and physicians.

Quote:

Nurse Practitioner Care-involves daily clinical rounds, necessary clinical decision making, educating, suggesting lifestyle changes, teaching self monitoring and management, coordinating care with other healthcare, and providing rehabilitation support.

There is a body of evidence indicating that advanced nursing practice has brought about an improvement in patient outcomes. In light of this, the advanced nurse practitioner has a valuable role to play in providing a beneficial contribution and filling a gap in healthcare services.

Quote:

The practical training of the nurse practitioner in the hospital should preferably be integrated into an existing training structure.

During recent past decades, the moving on education has replaced the more practically focused, but often ritualistic, training structure of conventional preparation. Nurse education integrates today a broader awareness of other disciplines allied to medicine, often involving inter-professional education, and the utilization of research when making clinical and managerial decisions.

References:

L. Callaghan (2008 January) “Advanced nursing practice: an idea whose time has come” from http://www.ncbi.nlm.nih.gov/pubmed/17419786?ordinalpos=28&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

E. Henneman (2007) “Unreported Errors in the Intensive Care Unit: A Case Study of the Way We Work” from http://ccn.aacnjournals.org/cgi/content/full/27/5/27?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=medication+error-+the+way+we+work&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

http://alliedglobalnursing.com/nursing/blog/nursing-education-degree.html

jm_babera · Posts: 14 Join date: 2009-06-20

Quote:

Nurse practitioners were effective in delivering equal quality care to non high risk patients with MI as compared with the conventional care. Being with a nurse practitioner in the ward significantly decreases length of stay in the hospital.

Although it maybe true that more people get well faster when an Advanced Nurse Practitioner cares for them rather than a conventional health care professional, it is very interesting to note that what may help patients get well faster is the intervention, and not solely the individual care provider. We must look on the other side of the coin, as the authors of this review have quoted,” There is a body of evidence indicating that advanced nursing practice has brought about an improvement in patient outcomes... During recent past decades, the moving on education has replaced the more practically focused, but often ritualistic, training structure of conventional preparation. Nurse education integrates today a broader awareness of other disciplines allied to medicine, often involving inter-professional education, and the utilization of research when making clinical and managerial decisions.”
I do not discredit the Advanced Practitioner with the abovementioned statement, in fact I shall present an argument in their favor; according to the study conducted by Szczepura et al (2008), the introduction of advanced practice nurses in the form of specialist nursing in-reach teams in residential homes promoted cost savings, development of new skills in home care, and enhanced quality care. Moreover, the patients did not need to be moved to a higher care facility; they can stay in more familiar surroundings. [1] To drive my point, I want to reiterate that the quick recovery of the patient is solely not because of the advanced practitioner or on the interventions alone; without the nurse, who will perform the intervention? Without the interventions developed, what will the nurse do? On the lighter note, it is, indeed, nice to note the fact that someone has proven the worth of advanced practice nurses in the improvement of post-infarct patients.

1 - Ala Szczepura, Sara Nelson, and Deidre Wild (2008), In-reach specialist nursing teams for residential care homes: uptake of services, impact on care provision and cost-effectiveness, lifted from the Bio Med Central Health Services Research Journal, accessed June 22, 2009 retrieved from www.pubmedcentral.nih.gov

tomasmapataciii · Posts: 16 Join date: 2009-06-21 Age: 21

Comments:

Continuing education is very much beneficial for both the client and the health care practitioner. This type of program is designed to broaden the knowledge and skills in a specific filed. With this tactic, the delivery of care would be more effective since, this will allow the nurse to abreast new technique and skills and help the nurse attain expertise in a chosen field.
Caring for clients who are in risk of MI is a crucial yet requires methodical skill of a nurse. By means of this, the delivery of care could be more effective and the chances of patients to develop complications would be minimal and may allow the patient less confinement in the hospital and cut back the expenses of the family.

Reference:
Barabara Kozier, Glenora Erb, Audrey Berman, Shirlee Snyder, Fundamentals of Nursing, (7th ed.) p. 26, New Jersey, Pearson Education Inc.,

melissa.juco · Subject: Re: ARTICLE 10 marby mananquil and francis lo Tue 23 Jun 2009, 7:27 am

Quote:

During past decades, the moving on education has replaced the more practically focused, but often ritualistic, training structure of conventional preparation. Nurse education integrates today a broader awareness of other disciplines allied to medicine, often involving inter-professional education, and the utilization of research when making clinical and managerial decisions.

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While I agree that the presence of Advance Nurse Practitioners in a particular clinical setting would be beneficial to the quality of care handed out by the nursing staff in the area, I also believe that it is not a guarantee that patients will get well faster as commented earlier. Other factors such as the quality of intervention carried out by the nurse, effective interpersonal communication skills, nurse empowerment, team collaboration and patient-centered approaches to health care may be sufficient enough for the conventional practice, that is, IF these principles are emphasized and given utmost importance in the hospital setting.

Not all nurses can afford advancements in education --- a masters degree, for that matter. But upgrading oneself of a continuing education would be a very essential and lasting tool in improving one's knowledge and skills on his field of expertise. Thus, I would highly recommend that nurses undergo the process of continuing education to enhance themselves further. This would not only increase their potential in clinical performance but it would also empower them remarkably in other areas of their character as well, most especially their decision-making skills.

In a study conducted in 2005 on "A model for empowerment of nursing in Iran" by authors Hajbaghery, et al., the relevance of empowerment in nurses was highlighted:

"Therefore, empowerment is essential for enhancing nurses' role, strengthening the professional image, and continuously improving the healthcare system nationally and globally. Restructuring nursing services will eliminate barriers to poor quality nursing care, inadequate educational preparation, role ambiguity and low self-esteem among nurses."

The same research argued that maintaining continuing education among nurses can also be limited to those who have the resources in doing such. At the same time, some nurses who have undergone the continuing education process with research-based knowledge would limit their knowledge for promotion purposes only and not for the delivery of quality care.

"(Hajbaghery, et al. 2005) Research utilization or the implementation of evidence-based practice was difficult for nurses for a variety of reasons. These are, the traditional structure of hospitals, poor quality of education, lack of continuing education, heavy workloads, no time, no mentoring and/or training in designing and conducting research, lack of financial resources, poorly defined nursing roles, lack of team work, and no opportunities for interdisciplinary relationships. These barriers are evident in the following quote of a nurse educator: "the research findings don't use in our nursing practice at all. We are two groups in nursing. One group is teachers and mainly teaches in nursing schools, another group is clinical nurses who are very busy and are also not educated for doing research... some of nurse educators also conduct researches not to be used in practice but only with the purpose of their promotion."

Indeed, continuing education is crucial in a nurse's career advancement in order for him to develop proper and critical discernment of things in the nursing practice. Taking some research units for that matter would enhance one's critical thinking and thought process, therefore allowing for more room weighing the pros and cons of decision-making. However, the use of continuing education should not only be limited in enhancing theoretical knowledge but it should also improve one's skill in patient care. Furthermore, it should also not be constrained for self-improvement / promotional purposes only as it should also serve as a leeway for uplifting quality intervention and care.

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REFERENCES:

1. Hajbaghery, M.A. & Salsali, M. 2005. A model for empowerment of nursing in Iran. Lifted from BMC Services Research on June 23, 2009. Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1079834&tool=pmcentrez

2. Stuber, K.J.; Grod, J.P.; Smith, D.L.; Powers, P. 2005. An online survey of chiropractors' opinions of continuing education. Lifted from Chiropractic and Osteopathy on June 23, 2009. Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1282582&tool=pmcentrez

Lacanilao, Fatima Grace · Subject: comment to article 10 by Lacanilao Tue 23 Jun 2009, 11:46 am

Quote:

We must look on the other side of the coin, as the authors of this review have quoted,” There is a body of evidence indicating that advanced nursing practice has brought about an improvement in patient outcomes...

Despite the presence of Advanced Nurse Practitioner, it is indeed the intimate moments of connection of the nurse and patient that makes the difference in the quality of care of the patient. Without t5his, do you think that a patient would comply or even cooperate to a certain treatment? The built relationship between the nurse and patient plays a big role in the health of patient. The advocacy of the nurse to aide in the quality of care and health of patient makes a big difference that the patient will live-through his whole life.

REFERENCE: Riley, J. (2000). Communications in Nursing. Retrieved last June 23, 2009, from http://www.questia.com/read/100733651?title=Communication%20in%20Nursing%20(Chap.%202%20%22The%20Client-Nurse%20Relationship%3a%20A%20Helping%20Relationship%22)

Ma. Martell Reyes · Posts: 10 Join date: 2009-06-21

“The built relationship between the nurse and patient plays a big role in the health of patient.”

In some studies, they claim that the patients handled by the nurse practitioners are satisfied and is at least as good as or greater than the doctors. It is because they spend and interact longer time with the patient rather than doctors. Effective communication is a vital tool that every nurses use. As stated,

“Nurse practitioners made more complete records and scored better on communication than did doctors.16,17 They also offered more advice on self care and management.11,12”

Therefore, building a good relationship through the use of communication is essential in providing quality health care.

Reference:

Horrocks, S., Anderson, E., & Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ, 324(7341):819-823. Retrieved June 23, 2009, from PubMed Central.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=100791&tool=pmcentrez

cliffrichard · Posts: 13 Join date: 2009-06-21

Continuing education has been strongly emphasized to us by our professors when we are still in our undergraduate program. The program can be beneficial to us as graduates because this could serve as our professional development and a lifelong learning, the program also ensures us that our knowledge pertaining to current treatment modalities is updated.

Updating our selves to current treatment modalities helps us to give the care intended for our patients. It would help us improve our skills, knowledge and attitude towards any circumstances than can be faced through the process.

As to caring for patients with myocardial infarction, it requires an effective delivery of care so that chances for the clients to develop complications will be minimized, in this case entering a continuing education program could probably help nurses to better understand the modes of care.

1. Griscti, Odette (O); Jacono, John (J); 2006 Effectiveness of continuing education programmes in nursing: literature review. Retrieved June 23. 2009 from http://www.find-health-articles.com/rec_pub_16866840-effectiveness-continuing-education-programmes-nursing-literature.htm

joyhn · Posts: 10 Join date: 2009-06-21

There is always a changing trend in health care and all health care professionals should not be left behind. Enhancement of knowledge and skills through continuing education is starting to become a new trend among nurses. With the constant updates in health care and number of competitions, having an advanced degree is certainly a good idea.
But having advancement in nursing education will not necessarily guarantee client satisfaction with nursing care. A patient would not leave his/her care just for a title but for having an established rapport and trust with the nurse. It always boils down to how effective nurses rendered care which is learned mostly from experience and practice.

Scudder, L. (2006). A Daily Dose of Continuing Education: Good News for Nurses. Medscape. Retrieved June 23, 2009 from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1682008&tool=pmcentrez

Aylward, S., Stolee, P., Keat, N., & Johncox, V. (2003). Effectiveness of Continuing Education in Long-Term Care: A Literature Review . The Gerontological Society of America. Retrieved June 23, 2009 from http://gerontologist.gerontologyjournals.org/cgi/content/full/43/2/259

Efren F. Alvarez Jr. · Posts: 11 Join date: 2009-06-21

Continuing education is an all encompassing term within a broad spectrum of post-secondary learning activities and programs. The term is used mainly in the United States. Recognized forms of post-secondary learning activities within the domain include: degree credit courses by non-traditional students, non-degree career training, workforce training, formal personal enrichment courses both on-campus and online. Self-directed learning such as through Internet interest groups, clubs or personal research activities and experiential learning as applied to problem solving.

Continuing education is a basic foundation for any professionals to be competent enough to practice his/her profession.
REFERENCE
Schugurensky, Daniel. "1907: The 'Wisconsin Idea' Brings the University to the Community". History of Education: Selected Moments of the 20th Century. The Ontario Institute for Studies in Education of the University of Toronto. http://fcis.oise.utoronto.ca/~daniel_schug/assignment1/1907wisconsin.html. Retrieved on 2009-03-01.
UW-Extension Chancellor's Office. "Highlight History of Extension in Wisconsin 1862 to 1999". About Us. The University of Wisconsin-Extension. http://www.uwex.edu/about/history/. Retrieved on 2009-03-01.
The IACET Standard: Continuing Education Units (CEUs)". International Association for Continuing Education and Training. http://www.iacet.org/content/continuing-education-units.html. Retrieved on 2008-11-13.

edyzonmarby10 · Posts: 14 Join date: 2009-06-21

I agree that nurse’s intervention really matters to every patient’s recovery. But it depends how the nurse execute the intervention. Man is a work of art. The complexity of human anatomy paves way to different kinds of commodities that man has ever created. From the inner core of the human cell to the outer surface of the skin that envelope the flesh, every fragment of the human body is truly a work of art. One of the commodities that are imperative to human consumption is healthcare.

How could a nurse give its quality intervention if she lacks knowledge to a certain point? This is dangerous. Nursing encompasses wide variety of fields. It is a profession that offers you many options and allows you to choose an expertise. A regular staff nurse may render a good care to post MI patient, which is not contestable. But if you are an advance nurse practitioner specializes in post MI, then the interventions may become much better. Different modalities of intervention may be rendered by these two nurses. Yes it is indeed experiences and practice truly molds the abilities of a nurse, but indulging oneself to advance/updated knowledge could be an ally/reinforcement to perform much better, safe care.

Patients are a more informed consumer that demands high-quality care. With more accessibility to health care information, today’s consumer expects nurses to use the most current data available to provide quality care. To do that, nurses must continuously explore new evidence and incorporate that evidence into nursing practice (Carol 1997).
Registered Nurses constitute the largest healthcare occupation, with 2.5 million jobs. This occupation also encompasses wide variety of fields to immerse with. When nurse students finished their baccalaureate and successfully got their license, some of them may choose several options: work in any healthcare facility as regular staff nurse, enter the academe and pursue a specialty (administrative or clinical), enter the world of the unknown, or simply be a bum.

RNs can specialize in one or more areas of patient care that depends upon their choice:
1) Work setting
2) Type of treatment,
3) Organ or body system
4) Well-defined population

Nurses may work in a particular setting he/she prefers like operating room, critical care unit, hospice/ palliative, med-surgical, perioperative, occupational, psychiatric or in the emergency department, etc. Nurses may also work with their preferred type of treatment such as diabetes, or oncology; nurses may also work depending on their preference of organ or body system such as cardiovascular, renal, orthopedic, respiratory, etc; and nurses may also dealt with patients with a well define population such as geriatric, pediatric, neonates, maternal, etc.
With this wide variety of fields to chose from, nurse may narrow down their choices and dealt with the type of expertise they want to pursue. An Orthopedic Nurse may not render the kind of care that a Cardiovascular Nurse could give to a cardiac patient and vice versa. Each nurse may choose an expertise and having that expertise could render to a more focused, well-defined plan of care.

Having an advance education could be an edge because it serves an additional credit, but the true essence why nurses SHOULD endeavor themselves to additional knowledge is to make their care more EFFICIENT, and profit will just come afterwards.

Peace brothers and sisters! cheers

United States Department of Labor: Bureau of Labor Statistics, “Occupational Handbook, 2009-2009 Edition”
http://www.bls.gov/oco/ocos083.htm

Boswell, Carol; Cannon, Sharon (2007) “Introduction to Nursing Research, Incorporating Evidence-based Practice” page 17.
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