Giving voice to childbearing teens: views on sexuality and the reality of being a young parent.

Interpretive phenomenology was the qualitative research approach used to explore the lived experience of teenage mothers in regard to their sexuality and associated development, decision making, relationships, and hopes for the future. Several interviews were conducted with each of nine low-income, African-American teen mothers over the course of several months. This paper presents narrative exemplars from the lives of these teenage mothers gathered during interviews in the school nurse's office. Exemplars were: Sand Castles: the unreliability of support systems; Tough Boys, Soft Hearts: feeling less powerless with a strong male; Erosion of Trust: the deterioration of trusted kin networks; and Staying the Course: the intergenerational nature of adolescent pregnancy. Intervention and prevention implications for school nurses and other school professionals are suggested based on the findings.

Clinical exemplars describing expert staff nursing practices.

AIM: This study was undertaken to identify and describe expert staff nursing practices in a large teaching hospital in south-western USA. BACKGROUND: Differentiation of the skill level of staff nurses is important for assuring safe, quality care. In the current atmosphere of corporate, downsizing, shortened hospital stays, cross training and continued high staff nurse turnover rates, it is of critical importance to identify and describe the essential contributions of expert nursing practice and to recognize and reward nurses according to their skill level. METHOD: Clinical situation interviews and participant observations were conducted using the interpretative phenomenological research approach. Narrative data were obtained and analysed systematically in multiple stages to identify and describe recurring meanings, themes, exemplars and constitutive patterns. FINDINGS: The final stage of data analysis involved interpretation of the narrative text using Benner's (1984) 'domains and competencies of nursing practice' as a framework. These competencies were validated in this study and 16 new competencies were identified. CONCLUSIONS: Expert staff nursing practices described in this project are not behaviours commonly defined as organizational expectations in performance appraisals for staff nurses. These practices need to be incorporated into position descriptions, performance appraisals and clinical ladders to recognize, foster and acknowledge the significance of expert nursing practice.

Practical knowledge and competencies of the healing role of the nurse practitioner.

This qualitative study describes the practical knowledge and competencies of the healing role of the nurse practitioner. The conceptual framework is based on Benner's (1984) domains of nursing practice and aspects of practical knowledge and Brykczynski's (1985) study of the clinical practice of nurse practitioners. The healing role is described within the context of the healing domain of the National Organization of Nurse Practitioner Faculties' curriculum guidelines (Zimmer et al., 1990) and Benner's aspects of practical knowledge. The study used the interpretive research approach of Heideggerian hermeneutic phenomenology. The findings contribute two maxims that constitute aspects of practical knowledge: "little things mean a lot" and "healing begins with listening," and two additional healing competencies: sensitive humor and risk taking.

Qualitative distinctions and similarities in the practice of clinical nurse specialists and nurse practitioners.

Current debate over whether clinical nurse specialist (CNS) and nurse practitioner (NP) roles should be combined or remain separate are largely theoretical. Minimal research has been conducted comparing these roles. Most studies to date consist of graduate follow-up surveys and comparisons of curricula. Interpretive results of Fenton's investigation of the practice of CNSs and Brykczynski's study describing the practice of NPs were compared to highlight the commonalities and distinctions between the two roles. This comparison is significant in that it explores the actual practice of CNSs and NPs. Both studies were modeled after Benner's research exploring the development of clinical expertise and produced adaptations of Benner's domains and competencies of nursing practice specifically for CNSs and NPs. Participant observations and small group interviews were the data-gathering methods used in these interpretive research studies. The interpretive approach is described as a situational, contextual, or narrative research method for understanding the knowledge and meanings in everyday (naturalistic) settings. Comparative analysis of results of the CNS and NP studies showed a shared core of advanced practice competencies as well as distinct differences between the practice roles. These findings have implications for curriculum development in advanced nursing practice.

Developing national guidelines for nurse practitioner education: an overview of the product and the process.

In 1988, the National Organization of Nurse Practitioner Faculties appointed an ad hoc education committee (AHEC) to review existing nurse practitioner (NP) education curricula and to formulate national guidelines. An overview of the new NP guidelines are presented along with the philosophy, content, objectives, and competencies that are viewed as the foundation for NP education today. The guidelines are presented within the structure outlined in Brykczynski's (1985) research about NP practice. Thus, as a "product" of the Advanced Nursing Practice: Nurse Practitioner Curriculum Guidelines (NPCG), a new NP graduate for the 1990s could be described as one who demonstrates beginning competencies in primary health care theory and research within the five domains of practice identified by Brykczynski.

Judgment strategies for coping with ambiguous clinical situations encountered in primary health care [corrected].

This naturalistic study identifies and describes strategies for clinical problem solving in situations of uncertainty, from observations of patient/family visits in a family health center. Judgment strategies were described for four types of uncertainty: information, diagnosis, treatment, and patient response that roughly correspond to the phases of assessment, planning, implementation, and evaluation of the clinical problem-solving process. The study contributes to increased understanding of the practical (experiential) knowledge involved in clinical judgment.

An interpretive study describing the clinical judgment of nurse practitioners.

Devaluation of nursing practice by both practicing nurses and nurse educators is giving way to keen interest in clinical scholarship. A naturalistic study was conducted to provide a contextual account of the actual practice of experienced nurse practitioners. Data collection procedures consisted of clinical situation interviews with nurse practitioner pairs, participant observation of patient visits to nurse practitioners in four hospital-based ambulatory settings, individual interviews with nurse practitioners, and administration of a brief demographic questionnaire. The 199 clinical situations that constituted the resulting text were analyzed using phenomenological and existential perspectives. The clinical judgment of experienced nurse practitioners is described through interpretive analysis of the text according to the dictates of hermeneutical phenomenology. This methodology provides a way of describing and communicating the knowledge that develops among experienced practitioners and their patients. Text interpretation also produced an adaptation of Benner's (1984a) domains and competencies specifically for nurse practitioner practice, which may be useful as a conceptual framework for nurse practitioner practice, education, and research.

Health contracting.

Health contracting provides for clarification of expectations and responsibilities, client participation, open communication, motivation through feedback, evaluation with emphasis on outcomes, realistic goal setting, as well as clarity and accountability of nursing practice. According to Etzwiler, contracting may provide some protection against claims for malpractice. Health contracting also represents a model for problem solving that the client may utilize in solving other common problems of daily living. It constitutes a methodology for enhancing not only the measurability and the quality of care, but also the comprehensiveness of care.