The practice doctorate: where do Canadian nursing leaders stand?

This article calls upon Canadian nursing leaders to examine the merits and downsides of the new practice doctorate degree - the Doctor of Nursing Practice (DNP). The impetus for the DNP arose from within the American nursing profession in order to address the knowledge and skills needed by advanced practice nurses to work in today's complex healthcare environment. The DNP is the newest practice doctorate degree and in 2015 will be the entry to practice degree required of all new advanced practice nurses in the United States. Advanced practice nurses who will have the practice doctorate include clinical nurse specialists, nurse practitioners, nurse midwives and nurse anaesthetists. With the establishment and acceptance of the DNP in the United States, American advanced practice nurses will have a different knowledge base than Canadian advanced practice nurses. The evolution and state of advanced practice nursing in Canada are discussed in this article. Canadian nursing leaders must discuss the DNP, its merits and downsides within the Canadian context and begin to make informed decisions about whether or not the DNP should come to Canada.

The relative value of nursing work: a study in progress.

The nursing shortage is likely to continue and, without intervention, may worsen. While retention and recruitment are constantly discussed among nursing leaders, the shortages, particularly in specialty areas, continue. Nurses have frequently stated that they are not valued for their knowledge. Yet many nurses have university degrees, post graduate degrees, specialty certificates and specialty credentials. Nurses seek recognition for what they know and what they do. To date, however, there is no objective method that is used to assess the value of nurses and their work. The study of relative value may provide a method for recognizing nurses' work. The concept of relative value deals with logical operators and facilitates assigning value to a nurse's overall knowledge base and capacity to perform nursing work. Currently, nursing shortages are concentrated in specialty areas. Nurses who work in specialized areas need specialized knowledge in a narrow field of nursing. Specialty nurses are not interchangeable with specialists in other areas or with generalists. A study is in progress to calculate the relative value of nursing work in 15 specialties. The goal is to assess relative value from the point of view of the knowledge base in the specialties and between specialties. In this paper, the research team reports on the background of the study, the study's parameters and its progress to date. Outcomes will include devising a way to recognize nurses' work, developing policies related to retention and recruitment and finding a long-term solution for dealing with the nursing shortage in specialty areas.

Scleroderma: living with unpredictability.

Every individual with scleroderma is unique. Symptoms vary in severity, duration, and effect on the individual. Many with scleroderma live an unpredictable life, as they struggle to understand the condition and to manage the unpredictable symptoms. Because of rarity of the condition, many nurses know little about scleroderma, its symptoms, and how to manage them. Nurses should equip themselves with information about rare conditions and not shy away from asking individuals about their condition and how best to help them. It is essential for occupational health nurses to appreciate the individuality of the condition and discuss workers' unique symptoms and care needs with them. Equipped with knowledge, caring for clients with scleroderma can be a rewarding experience for both the nurses and the client. In the work setting, the occupational health nurse can provide leadership to assist the individual with scleroderma to live as productive a life as possible. Nurses in all settings, hospital, community, and work, can do much to assist individuals with the management of chronic conditions such as scleroderma.

Life with a rare chronic disease: the scleroderma experience.

BACKGROUND: Little is known about the experience of living with a rare disease and how people with rare diseases cope with not only the disease but also the reactions of others. Scleroderma is a rare chronic connective tissue disease that results in fibrotic changes involving all or some organs of the body. The two types of scleroderma are systemic scleroderma, which involves the skin and internal organs and is the more serious type, and local scleroderma, which attacks the skin and surrounding tissues. Some people with scleroderma have signs that are visible to outsiders, while others have invisible signs. Having this chronic condition and being different from the general population may subject people with scleroderma to stigmatization by others. AIM: The aim of this study was to understand, from the individual's perspective, the experience of living with scleroderma. METHOD: Focus group interviews were conducted with two groups of individuals with scleroderma. Because of the rarity of the disease and the illness of the participants, only two groups were held. The same questions were asked of both groups. A moderator and assistant guided the groups. FINDINGS: Data analysis revealed five themes: physical manifestations, disclosure/non-disclosure to others, living, being normal and facing the future. The data are discussed in light of participants' having visible signs, invisible signs and the rarity of their condition. For those with visible signs, disclosure was automatic. They were conscious of being different from others without scleroderma. Those with invisible signs managed their disease information in such a way as to minimize the stigma of being different. The rarity of the disease added the problem of others not understanding their difficulties. Those who disclosed their disease not only had to deal with the reactions of others, but faced the additional burden of having to explain their condition. CONCLUSION: Nurses may have little knowledge about scleroderma. It is possible that they, through their ignorance of such rare conditions, may stigmatize individuals. Through understanding about rare diseases will they be able to teach patients the skills necessary to help them cope with their symptoms, as well as the reactions of others to their diagnosis and appearance.

Embedded assumptions in qualitative studies of fatigue.

Qualitative researchers have long recognized that fatigue is a common concern among those with chronic illness; however, the insights derived from this body of inquiry have not been synthesized into a coherent body of clinical knowledge that could provide direction for nursing practice. Using a synthesis approach of meta-study, the authors identify four predominant assumptions embedded in qualitative studies that have influenced the way researchers have interpreted and made sense of their findings about fatigue in chronic illness over the past two decades. They argue that these assumptions may have inhibited the development of more dynamic, comprehensive understandings of fatigue. They conclude that addressing some of the methodological issues within this body of research might lead to a more accurate portrayal of the complexity, fluidity, and contextual nature of the fatigue experienced in chronic illness.

An assessment of social support in people with inflammatory bowel disease.

The purpose of this descriptive study was to assess the perceived level of social support in a sample of people with inflammatory bowel disease. This assessment was to serve as the basis for the development and evaluation of a program of social support. The Personal Resource Questionnaire (PRQ-85), which measures perceived level of social support, was mailed to all members (n = 300) of the Northwestern Society for Intestinal Research. Adults who met the eligibility criteria were invited to participate. Questionnaires and consent forms were completed and returned by 97 subjects. Results indicated that subjects would use a variety of resources if confronted with situations that required social support. The perceived level of social support was high, with mean scores for this inflammatory bowel disease sample reported at 143.86 of a possible 175. A two-tailed t-test suggests there is no significant difference in perceived level of social support between those subjects with Crohn disease and those with ulcerative colitis at the 0.05 level of significance. Because the level of social support was so high in this sample, plans to develop a program of support were abandoned. The meaning of these results including an analysis of the scores and a critique of the questionnaire are discussed.

Chronic illness experience: insights from a metastudy.

Concurrent with the recent enthusiasm for qualitative research in the health fields, an energetic call for methods by which to synthesize the knowledge has been generated on various substantive topics. Although there is an emerging literature on meta-analysis and metasynthesis, many authors overestimate the simplicity of such approaches and erroneously assume that useful knowledge can be synthesized from limited collections of study reports without a thorough analysis of their theoretical, methodological, and contextual foundations and features. In this article, the authors report some of the insights obtained from an extensive and exhaustive metastudy of qualitative studies of chronic illness experience. Their findings reveal the complexities inherent not only in any phenomenon of interest to health researchers but also in the study of how we have come to know what we think we know about it.