The role of the clinical nurse specialist in promoting evidence-based practice and effecting positive patient outcomes.

Clinical nurse specialists (CNSs) are vital members of the healthcare delivery leadership team. The knowledge and expertise of the CNS is germane to the quality of care a patient receives. More than 50 CNSs practice at Massachusetts General Hospital (the state's first Magnet hospital), where they share their clinical skills, mentor staff through difficult situations, identify learning needs, and implement innovative approaches to patient care. This article presents a brief history of the CNS role and describes how the CNS role is operationalized at Massachusetts General Hospital and its impact on unit-based and organizational outcomes. In addition, several programs and interventions identified by the CNSs in response to results of the Staff Perception of the Professional Practice Environment Survey are discussed. How the CNS influences the professional development of staff and potential implications for the future role of the CNS are described. An exemplar is included depicting a typical work day of a CNS on an acute adult medical unit.

The physical, psychological, and social implications of caring for the pregnant patient and newborn with cystic fibrosis.

Cystic fibrosis (CF) involves the exocrine glands and epithelial tissues of the pancreas, sweat glands, and mucus glands in the respiratory, digestive, and reproductive tracts. Significant pulmonary disease, poor nutritional status, and pulmonary hypertension are results of chronic infections. When the woman with CF becomes pregnant, her body may find it difficult to adjust to the normal physiological changes of pregnancy, with the pulmonary, cardiovascular, and nutritional status being particularly stressed. Both the mother and the fetus are at a significant risk for increased morbidity and mortality. The woman whose life and pregnancy are compromised by CF and/or the newborn who is diagnosed with CF offer the nurse an extremely challenging situation--one in which physical and psychological care are proportional in importance. As part of the healthcare team, which includes a perinatologist, a pulmonary medicine specialist, a neonatologist, an anesthesiologist, a geneticist, a dietitian, a respiratory therapist, a social worker, an ethicist, and perhaps a clergyman, the nurse helps to coordinate and carry out the care needed for a successful outcome.