The Nurse as Coach: Building High Performing Teams.

The provision of modern health care in the United States faces significant challenges, as evidenced by multiple national reports of a workforce in distress. In response to these challenges, the practice of coaching emerges as a transformative skill, recommended for individuals in high-stress environments. Coaching in health care focuses on developing nurses and building teams by fostering self-understanding, deploying strengths, improving relational strategies, and gaining moral clarity. It serves as a potent strategy for nurse leaders to navigate the complexities of their systems. This paper explores the practice of coaching as an important mindset and skill. A coaching mindset is characterized by trust, deep listening, curiosity, embracing both/and thinking, discernment over judgment, and fosters an environment where nurses can flourish. It promotes a shift from telling to asking, empowering individuals to contribute innovative ideas and solutions. Additionally, the paper provides guidance for coaching and tools for maintaining a coaching mindset in the face of chronic stress. By fostering a coaching mindset, employing powerful questions, and using tools to sustain emotional integrity, leaders can empower nurses to thrive in complexity, enhance workplace well-being, and contribute to a resilient health care culture.

Group visits hold great potential for improving diabetes care and outcomes, but best practices must be developed.

A diagnosis of diabetes can require multiple changes in a person's behavior, diet, and lifestyle. Efforts to sustain these changes and manage this complex chronic disease can be difficult. Group visits, in which several patients meet together with a primary care provider and transdisciplinary team, have tremendous potential to improve health care quality, cost, and access. When group-based diabetes self-management education and a primary care visit occur within a single appointment, people with the disease can address multiple needs in one visit and take advantage of peer groups for support and motivation. A review of the literature demonstrates that the efficacy of group visits has a promising evidence base-but more needs to be learned about optimal group size and aspects of the model that should be standardized. An important first step is introducing a procedural code for group visits, so that providers and researchers can better track the efficacy of the group-visit model and develop best practices before the model is adopted systemwide.

Anger: a common form of psychological distress among patients at the end of life.

Psychological distress is common in palliative care patients and their families, and anger is a complex component of distress experienced by many patients at the end of life. Anger can be a form of tension release, as well as a coping mechanism for the patient and a way to disguise fear and anxiety. The interdisciplinary team are responsible for recognising psychological distress in patients, assessing their needs, and providing adequate psychological support. Although a certain level of psychological distress such as anger is expected in terminally ill patients owing to their situation, such responses may also be dysfunctional. This paper aims to highlight the challenges and complexities of adequately assessing and supporting palliative care patients who are presenting with psychological distress in the form of anger, in order to relieve their suffering and assist them in resolving their issues and improving their quality of life. Anger can be difficult to treat, and for some patients can be more distressing than some physical symptoms. Hence this paper also aims to offer anger management guidance to palliative care practitioners.

Are regulations more consumer-friendly when boards of nursing are the sole regulators of nurse practitioners?

The widely varied regulations in the 50 states often limit consumer access to nurse practitioners (NPs). In 22 states, the Board of Nursing (BON) must share NP regulatory authority with another profession, usually physicians. This study examines the relationship between the BON as the sole authority regulating NPs or sharing that authority with another profession and the NP regulatory environment. Independent t tests compared the NP regulatory environments for consumer access and choice in states with sole BON regulation with those in states with involvement of another profession. The states' NP regulatory environments were quantified with an 11-measure tool assessing domains of consumer access to NPs, NP patients' access to service, and NP patients' access to prescription medications. BON-regulated states were less restrictive (P < .01, effect size 1.02) and supported NP professional autonomy. Entry into practice regulations did not differ in the two groups of states. Having another profession involved in regulation correlates with more restrictions on consumer access to NPs and more restrictions to the full deployment of NPs.

Acknowledge the paradoxes and advance the profession.

The delivery system in the United States is multifaceted, convoluted, and interrelated; one aspect cannot be changed without looking at its entirety. One of the most important characteristics of a learned profession is the ability to hold opposing ideas as true. As we engage in health reform, nurses will be more effective in shaping a system which actually makes people whole by not holding all ideas as certain and final. Nursing's task is to develop the language for a delivery system that is truly patient centered, longitudinal, relationship based, available 24/7, in person and online, delivered by a joyful workforce who employs evidence based care.

Removal of a femoral sheath following PTCA in cardiac patients.

Patients with coronary heart disease may require a percutaneous transluminal coronary angioplasty, involving the use of a balloon catheter to dilate the arteries introduced via a sheath. It is now increasingly common for the removal of the sheath to be a nursing procedure. This paper reviews the literature, best practice, potential complications and post-removal nursing care.

Opportunities in preparing global leaders in nursing.

During the past decade, there has been a large increase in the number of international nurses pursuing doctoral education in the United States. The influx of these nurses has ramifications for the institutional systems providing education as well as on international and American nursing students. To begin understanding the issues presented by international doctoral nursing education, a survey of U.S. schools of nursing as well as a focus group of currently enrolled international doctoral students was conducted. The survey revealed that both international students and nursing programs experience challenges with regard to language, communication, financing, and support systems. More specifically, information gathered from the focus group identified issues regarding (1) lack of familiarity with the U.S. health care system, (2) lack of previous experience with the seminar format used in doctoral programs, (3) restricted opportunities to participate in faculty research, and (4) stress from a heavy course load to finish the program within a very short time period. Universally, the surveys and focus group lauded the positive global perspective imbued on all students and faculties via the international connection. Nonetheless, schools of nursing need to identify more effective strategies to aid international students in their development as successful global leaders. Meleis's framework for culturally competent scholarship is offered as a guide for schools of nursing.