A snapshot of clinical educational experiences for advanced practice nurses worldwide.

Using a convenience sampling, nurse educators representing 10 countries were surveyed to describe required clinical education for advanced practice beyond basic traditional nursing education. This article explores the many factors currently influencing the structure and diversity of these clinical experiences worldwide.

Exploring the potential for advanced nursing practice role development in Kenya: a qualitative study.

BACKGROUND: Definitions of advanced nursing practice abound, yet little has been published concerning the context for advanced nursing in sub-Saharan Africa. This study set out to explore the existence of, and potential for, advanced nursing practice in Kenya. METHODS: Ten nurses were invited to participate in semi-structured qualitative interviews. Participants were purposively selected to provide insight into the practice of experienced nurses in urban, rural, community, hospital, public and private health care settings. Interview narratives were recorded, transcribed and subsequently analysed using a thematic approach. RESULTS: All participants reported that they were engaged in the delivery of expert, evidence-based care. The majority also undertook administrative activities, teaching in the practice area and policy and practice advocacy. However, only the two private practice nurses interviewed during the study were working with the level of autonomy that might be expected of advanced nurse practitioners. CONCLUSIONS: While participants were undertaking many of the activities associated with advanced nursing roles, advanced nursing practice as widely understood in the (largely western derived) international literature was not identified. The nurses practicing with the greatest autonomy were generally those with the lowest educational qualifications rather than the highest. Highly qualified nurses and midwives tend to move into management and education, and see little opportunity for advancement while remaining in clinical practice. It is notable that, although a growing number of universities offer master's level education, no African countries have yet regulated an advanced level of practice. The existence of the physician substitute 'clinical officer' cadre in Kenya, as in other Sub-Saharan African countries, suggests that the development of the advanced nurse practitioner role is unlikely at present. However, there is a pressing need for advanced nurses and midwives who can implement evidence-based practice and exercise clinical leadership in the drive to attain the Millennium Development Goals and their post-2015 successors.

Sleep disruption experienced by surgical patients in an acute hospital.

BACKGROUND: Sleep has a common structure and pattern and is thought to be a restorative process. Sleep deprivation and disruption can cause a myriad of physical and psychological changes, which can all have an impact on health care. As such, sleep is recognized as being beneficial to health and an important aspect of nursing care. METHOD: This study used an expansion component mixed-method design to describe the sleep experience of patients on surgical wards. This involved establishing the factors which disturb sleep and describing patients' experiences of sleep disruption. RESULTS: 17 of the 24 patients approached participated in the study, providing a 71% response rate. Environmental factors were found to be strongly correlated with sleep disruption with a Pearson's coefficient of +0.795. Personal factors were also found to be correlated with sleep disruption although, with a Pearson's coefficient of +0.590, not as strongly as environmental factors. DISCUSSION: This study found that environmental noise, pain and tension were most likely to disrupt the sleep of surgical patients. It has also established four recommendations to improve the sleep of hospital patients. LIMITATIONS: This study has some limitations that need to be considered: limited database access, a small sample size and a data collection tool which had not previously been tested for validity or reliability. CONCLUSION: This study produced some compelling findings. It is recommended, however, that these findings be tested by larger studies using simple random sampling and in-depth interviews.