ABSTRACT
Advanced practice nurses (APNs) have traditionally been a diverse group in terms of titles, education, credentials, and roles. The classification of APN usually encompasses the nurse practitioner (NP), certified nurse midwife (CNM), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS). NP, CRNA, and CNM roles have been more clearly delineated than the CNS roles. In light of healthcare reform, the CNS roles have been critically reviewed and analyzed. Attempts have been made to clarify responsibilities and outcomes, and to quantify the financial impact of this role. In this article, seven APN roles clearly defined in terms of minimal qualifications and competencies critical to accomplishment of the duties, responsibilities, and expected outcomes are presented. Comparison of competency requirements are also presented. The roles presented are designed to facilitate healthcare institutions in meeting the demands for serving patients with increasingly complex needs, as well as cost-containment goals.
Subject(s)
Clinical Competence , Health Care Reform , Job Description , Nurse Clinicians/organization & administration , Nurse Practitioners/organization & administration , Certification , Forecasting , Humans , Nurse Clinicians/education , Nurse Practitioners/educationABSTRACT
Patient and family education is an important component of the organ transplant programs at the University of Nebraska Medical Center. The Medical Center is in the process of planning a new transplant center which will employ the family-centered, educationally-intensive cooperative care concept. This approach was chosen as the model for the delivery of care at the Lied Transplant Center because it emphasizes efficient, effective clinical care by requiring active participation by the family or essential other, thereby better preparing both the patient and the family for the transition to home and to the community. This article presents the evolution of patient education in our transplant programs, discusses the educational needs of transplant patients across the continuum of care, provides insight into the process of planning educational programs for the new center and provides a sample module for teaching which is based on the Cooperative Care concept.
Subject(s)
Family , Organ Transplantation/methods , Patient Education as Topic/organization & administration , Curriculum , Health Services Needs and Demand , Humans , Patient Participation , Planning Techniques , Program DevelopmentABSTRACT
This within-subject study compared the effects of hyperinflations with 20% above maintenance oxygen (O2) level and 100% O2 hyperinflations before and after endotracheal suction in 11 acutely ill patients with chronic obstructive pulmonary disease. Four hyperinflations were delivered at 1.5 times the calculated tidal volume (10 ml/kg) with 100% O2 or 20% above maintenance O2 level via resuscitator bag, followed by 10 seconds of continuous endotracheal suctioning. This sequence was repeated three times. No statistically significant differences (p less than 0.05) were found between the two protocols for arterial oxygen saturation, blood pressure, or heart rate (analysis of variance for repeated measures). There was no change in heart rhythm for any of the subjects. The results of this study suggest that hyperinflation with 20% above maintenance O2 level can be used for oxygenation in patients with chronic obstructive pulmonary disease before and after endotracheal suctioning. Replication is needed before clinical implementation.
