Developing clinical nurse specialist practice competencies.

BACKGROUND: In 1998, the National Association of Clinical Nurse Specialist (NACNS) developed the first ever core competencies for clinical nurse specialist (CNS) practice. PURPOSE: This article describes the method used to develop, validate, and revise CNS core practice competencies. METHODS: The stepwise method of identifying core CNS competencies included content analysis of CNS position/job descriptions, extensive literature review, development by role experts, first-tier corroboration, second-tier corroboration encompassing stakeholder review, final review/editing, approval by the board of directors, and dissemination. DISCUSSION: The process used by professional organizations to develop competencies and standards varies; however, it should be transparent and consist of adequate review and validation for accuracy and applicability by members of the representative group for whom the standards and competencies apply. CONCLUSIONS: The stepwise method used by the National Association of Clinical Nurse Specialist generated valid CNS core competencies and may be instructive to professional organizations interested in developing competencies and standards.

A description of clinical nurse specialist programs in the United States.

Changes have occurred in clinical nurse specialist educational requirements in recent years, and it is not known how programs have responded. The purpose of this descriptive survey was to identify the number of clinical nurse specialist programs in the United States, describe curricula, and examine enrollment and employment trends. This report contains data from 157 separate clinical nurse specialist programs/majors representing 139 different schools. The mean number of credit hours for semester- and quarter-based programs was 41.4 and 52.2, respectively. The mean number of clinical/practical clock hours was 416.2. Approximately half of the respondents (56%) used the National Association of Clinical Nurse Specialists to guide curricula. Nearly 66% of the programs had from 1 to 10 applicants during the previous year. The majority (68%) indicated that their graduates do not have difficulty finding employment after graduating. These findings indicate that efforts to revise curricula and clarify the CNS role must continue.

Pain intensity and postoperative pulmonary complications among the elderly after abdominal surgery.

OBJECTIVE: The purpose of this study was to determine whether postoperative pain intensity differs between elderly abdominal surgery patients in whom postoperative pulmonary complications (PPC) develop and those in whom they do not. METHODS: The exploratory secondary analysis of data from a prospective study of risk factors for PPC had a convenience sample of 86 patients (> or =60 years old) after abdominal surgery at 3 Midwestern hospitals. Daily measurements from postoperative day (POD) 1 to 6 included: pain (rated 0 to 10) at rest, with coughing, deep breathing, movement and walking, and frequency of ambulation. RESULTS: Sixteen subjects (18.6%) had a PPC develop. Subjects with PPCs had higher mean pain intensities on all measures on each POD than those without. Those with PPCs had significantly higher pain intensities at rest on POD4 (P = .010), with deep breathing on POD2 (P = .015), POD4 (P = .009), POD5 (P = .006), and POD6 (P = .009), were up to a chair significantly fewer times on POD2 (P = .043), and walked significantly fewer times on POD5 (P = .002) and POD6 (P = .000) than those without PPCs. Length of stay for those with PPCs (mean, 17.9 days; standard deviation, 15.9 days; median, 10.0 days) was significantly longer than for those without PPCs (mean, 8.5 days; standard deviation, 4.8 days; median, 7.0 days; P = .000). CONCLUSION: Results provide support for viewing pain as a factor that contributes to the development of PPCs among the elderly population after abdominal surgery. Therefore, nursing interventions of pain assessment and management, deep breathing, and ambulation may influence the incidence of this outcome.

The diabetes educator as an entrepreneur: starting your business.

If you determine that you have many of the attributes of an entrepreneur (including being a risk taker), if you have a passion for your products and services, and if you are willing to risk an uncertain income, then you are ready to be an entrepreneur. The steps outlined in this article provide a basic overview of how to set up a business. If you decide to become an entrepreneur, there are numerous books and Web sites to guide you through the steps of establishing and managing a business. Although the challenges of becoming an entrepreneur may seem intimidating, becoming an entrepreneur can be very rewarding.

A cost-effectiveness worksheet for patient-education programs.

This article describes the development, implementation, and evaluation of a worksheet used by nursing faculty in a graduate clinical nurse specialist course to assist students in learning to estimate the cost-effectiveness of patient-education programs.1 The worksheet was found to be a satisfactory method of facilitating student learning and could also be used in the service arena to evaluate the cost aspects of patient-education programs.