Cognitive Appraisal of Health Scale: early instrument development in stroke.

Stroke, the leading cause of disability in the United States, results in significant limitations for an estimated 5.5 million American adults. The degree of physical limitations does not explain why some individuals with severe impairments adapt well, whereas others with little impairment are severely disabled. The concept of cognitive appraisal may partly explain this apparent contradiction. The purposes of this early instrument development study were to (1) identify appraisals made by community-dwelling stroke survivors and (2) seek evidence of the face and content validity for the 3 subscales of the Appraisal of Health Scale. A cross-sectional design was used to explore the survivors' appraisals. Responses to open-ended questions provided evidence of the face validity for all subscales. Threat and benefit subscales had acceptable evidence of content validity. Further instrument development is warranted and may lead to a more accurate measurement of how stroke survivors appraise the multiple demands of stroke recovery.

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.

The need for some sense making: doctor of nursing practice.

The American Association of Colleges of Nursing has developed a general proposal for a practice doctorate for nursing and the National Organization of Nurse Practitioner Faculties has developed a proposal for the practice doctorate for nurse practitioners. This article describes the current initiative for developing the practice doctorate and argues that the proposed practice doctorates raise substantial concerns for the discipline of nursing. The concerns addressed in this article include the rationale offered for the new degree, confusion over the focus of the degree, the impact of the degree on educational and economic resources for both students and employers, and the regulatory issues arising from the implementation of the degree. The authors recommend thorough debate by all involved stakeholders before moving forward with this degree.

The CNS regulatory quagmire--we need clarity about advanced nursing practice.

The current quagmire in the regulation of CNS practice is largely due to confusion about definitional approaches to advanced nursing practice. Establishing clarity about the nursing focused and medical focused definitions of advanced practice can greatly assist in developing and implementing appropriate levels of regulation for the CNS role and scope of practice. It has been my experience that state boards of nursing want to do their very best in helping to protect the public while not creating insurmountable problems that essentially put APRNs such as CNSs out of work and raise restraint of trade issues. Currently, in some states, there is real economic harm being experienced by CNSs because they cannot get jobs as CNSs when they have been practicing within the domains of the RN license for 10 or more years. I believe the inappropriate regulation of CNSs in some states is occurring because CNSs did not have an organization to represent them at national policy tables until 1995. Therefore, we weren't "at the table" in the early development of recognition strategies for APRNs to help state boards and other policy making groups understand how the CNS practice and role is different from other APRN roles. We must help state boards of nursing clarify the level of regulation needed for both the CNS without and the CNS with prescriptive authority. Then we must help them identify and implement reasonable solutions that do not create unnecessary barriers to CNS practice while assuring society's access to the full range of CNS services.

Cognitive self-care skills: a model for managing stressful lifestyles.

Feeling overwhelmed or overloaded and frequently experiencing anxiety, anger, guilt, and/or frustration is preventable and amenable to personal control. It takes self-awareness and lots of practice to modify long established ways of thinking about one's self and others. It is often helpful to have someone who will support identified goals to improve stress-reducing resources; to help with developing a sensitivity to self-generated stress-inducing demands; and/or to rehearse cognitive stress-reducing, self-care skills. The cognitive self-care skills outlined herein are powerful stress-reducing resources that can prevent psychological stress and that can promote a sense of wellness.

Psychological stress and coping: framework for poststroke psychosocial care.

The ability to deal with and manage a chronic condition such as stroke requires a learning process embedded in personal experience that is often emotionally taxing as well as physically fatiguing. Stroke survivors typically need help in balancing demands and resources and in preventing or effectively coping with stress emotions to conserve energy. The major constructs outlined in this article provide a framework for psychosocial care to promote the experience of wellness in stroke survivors.