First-year experience of transitioning from registered nurse to nurse practitioner.

BACKGROUND: Transitioning to advanced practice, novice nurse practitioners need to take on new roles, learn new practice areas, and develop new skills. This process requires breaking old practices and work habits and facing new challenges. PURPOSE: To explore the nature of nurse practitioners' work experiences during the first year of transition from registered nurse to nurse practitioner. METHODS: This qualitative study was based on Husserl's phenomenological methodology. A purposive sample of 16 first-year nurse practitioners was recruited. Data were collected through in-depth interviews and analyzed by thematic content analysis. The approaches of Lincoln & Guba were applied to improve the validity of the study. RESULTS: Results showed that the first-year experience of transitioning from registered nurse to nurse practitioner fell into two overarching themes: challenge and adjustment. The challenge consists of five subthemes: "facing the expectation-reality gap," "managing others' expectations," "striving to acquire professional skills," "handling situational variability," and "bearing emotional burdens" subthemes. The adjustment includes five subthemes: "finding resources," "gaining experiences," "building relationships," "relieving stress," and "overcoming obstacles." IMPLICATIONS FOR PRACTICE: Novice nurse practitioners face many challenges as they adjust to a new role during their first year on the job. New nurse practitioners develop coping strategies to help themselves adjust to their work. They also gradually gain new resources and experiences to help them stay positive in stressful situations and restore work-life balance. The challenges of transitioning from a registered nurse to a nurse practitioner cannot be overlooked. Novice nurse practitioners need appropriate support measures to adapt to advanced practice roles.

Perspectives of Decision-Making for Corneal Donation: A Qualitative Research Among Cancer Patients.

This study investigates the subjective experiences of terminal cancer patients who expedite their corneal donation decisions. The percentage of cancer patients who donate their corneas postmortem is low in Taiwan. The reasons are complex and needs further exploration. A qualitative design using content analysis was used. A semistructured interview approach was adopted to interview cancer patients recruited from a cancer ward in northern Taiwan. The study findings show that the factors contributing to an aversive preference of cancer patients included the necessity to consider the emotions of family members, traditional perceptions, religious reasons, disease, and no reason at all. Most cancer patients maintain a negative stance toward corneal donation. The results obtained in the present study can be used as a reference for future in-service education and promotional efforts regarding corneal donation. Discussing cornea donation needs to become a routine end-of-life care discussion.

[Spiritual care model for terminal cancer patients].

Providing spiritual care to patients with advanced cancer may improve the quality of life of these patients and help them experience a good death. Cancer patients are eager for additional spiritual care and for a sense of peace at the end of their life. However, spirituality is an abstract concept. The literature on spiritual care focuses primarily on elaborations of spirituality theory. Thus, first-line medical care professionals lack clear guidelines for managing the spiritual needs of terminal cancer patients. The purposes of this article were to: 1) introduce a spiritual care model based on the concept of repair and recovery of relationships that addresses the relationship between the self and God, others, id, and objects and 2) set out a four-step strategy for this model that consists of understanding, empathizing, guiding, and growing. This article provides operational guidelines for the spiritual care of terminal cancer patients.

[A project to improve the "do not resuscitation" consent completeness rate for terminal cancer patients].

BACKGROUND: Signed do-not-resuscitate (DNR) consent is the essential first step for terminal cancer patients to choose palliative care and a quality marker of terminal care. DNR consent completeness helps deliver correct information, ensure consent legal validity, reduce medical disputes, and protect patient and family rights. The DNR consent completeness rate during May and June 2005 was only 33.9% in our hospital. Reasons indicated for this low rate included: (1) lack of a standard operating procedure for DNR consent; (2) multiple DNR consent versions; (3) lack of DNR-related education; and (4) lack of monitoring procedures. Our team developed a project to resolve these problems and improve terminal care quality. PURPOSE: The goal of this project was to increase the rate of DNR consent completeness from 33.9% to 80%. RESOLUTION: The plan, implemented between August and December 2009, included the following components: (1) establish standard guidelines for DNR consent; (2) simplify and unify DNR consent procedures; (3) provide DNR education for hospital staff; and (4) establish a DNR consent monitoring system. RESULTS: The DNR consent completeness rate rose from 33.9% to 90%. The goal of this project was thus achieved. CONCLUSION: This project effectively improved the DNR consent completeness rate at our hospital. The project ensured patients a good death and enhanced terminal care quality and patient satisfaction. Our experience may provide a reference to help other hospitals increase DNR their consent completeness rates.