BACKGROUND & AIMS: PURPOSE:To explore patient satisfaction, intention to adhere to nurse practitioner (NP) plan of care, and the impact of managed care on NPs' patients in multiple settings, the final phase of a three-part study of NPs and managed care. DATA SOURCES:Postvisit questionnaires and narrative comments about patient satisfaction with NP communication, overall satisfaction with visit, recall of plan of care, intention to adhere to NP's recommendations, and impact of managed care on ease of obtaining healthcare resources. CONCLUSIONS:Patients were very satisfied with NP communication and with their healthcare visit. They mostly intended to adhere to the NP-recommended plan of care but less so to recommended lifestyle changes. Patients trusted their NPs, valued their expertise, were confident in the NPs' care, and believed that the NPs considered their best interests. They appreciated that the NPs took time to listen to their concerns and helped them to obtain healthcare resources. Most patients were not greatly impacted by managed care and obtained needed healthcare resources with little difficulty. IMPLICATIONS FOR PRACTICE:Although the first two phases of this study found that many NPs had strong negative attitudes toward managed care, these attitudes were not conveyed toward patients in this sample. NPs, however, will continue to face new challenges as third-party payers attempt to reduce healthcare costs, further testing NP adaptability and resourcefulness.

背景与目标：

BACKGROUND & AIMS: :While the nephrology nursing shortage persists despite the continued growth of the population of individuals with Stage 5 chronic kidney disease, there is a paucity of empirical data regarding nephrology nurses' perceptions of their work environments. Moreover, there are no studies that have examined the relationship of work environment attributes to patient and nurse outcomes in dialysis settings. The purpose of this study was to examine the relationships between staff nurses' perceptions of dialysis work environments, nurses' intentions to leave their current jobs, nurse turnover, patient satisfaction, and patient hospitalization rates. A descriptive, correlational design was used. Nurse level and facility level data were obtained. The sample for nurse-level data consisted of 199 registered nurses in staff nurse roles in 56 dialysis facilities of a national dialysis company. The sample for facility-level analysis consisted of 46 dialysis facilities, and nurse-level data were aggregated for facility-level analysis. The Practice Environment Scale-Nursing Work Index (PES-NWI) was used to measure nurses' perceptions of the dialysis work environment. Nurses' intention to leave their jobs and facility-level turnover rates were the nurse outcomes examined in this study. Facility-level patient satisfaction and hospitalization rates were the patient outcomes examined. Correlation coefficients were computed to measure the relationships between study variables, and independent t-tests were performed to examine subgroup differences in work environment perceptions. Overall, nurses rated the work environment somewhat favorably. Nurses who expressed intention to leave their jobs rated the work environment more negatively compared to nurses who intended to stay. Significant correlations were found between nurses' perceptions of the dialysis work environment, nurses' intention to leave their jobs, nurse turnover rates, and patient hospitalizations. Study findings suggest that nurses' perceptions of the dialysis work environment are important for nurse and patient outcomes in dialysis settings. Further research is needed to explore the predictive ability of the work environment for nurse and patient outcomes in hemodialysis units.

背景与目标： : 尽管患有5期慢性肾脏病的人群持续增长，但肾脏病护理短缺仍然存在，但有关肾脏病护士对其工作环境的看法的经验数据很少。此外，没有研究检查透析环境中工作环境属性与患者和护士结果之间的关系。这项研究的目的是研究护士对透析工作环境的看法，护士离职的意图，护士更替，患者满意度和患者住院率之间的关系。采用描述性、相关设计。获得护士级别和设施级别数据。护士级数据的样本由一家国家透析公司的56个透析设施中的199名担任护士角色的注册护士组成。用于设施级别分析的样本由46个透析设施组成，并汇总了护士级别的数据以进行设施级别分析。实践环境量表-护理工作指数 (pes-nwi) 用于衡量护士对透析工作环境的看法。护士离职的意图和机构级别的更替率是本研究中检查的护士结果。设施级别的患者满意度和住院率是检查的患者结局。计算相关系数以衡量研究变量之间的关系，并进行独立的t检验以检查工作环境感知的亚组差异。总体而言，护士对工作环境的评价有些不错。与打算留下的护士相比，表示打算离职的护士对工作环境的评价更为负面。在护士对透析工作环境的看法，护士离职的意愿，护士更替率和患者住院之间发现了显着的相关性。研究结果表明，护士对透析工作环境的看法对于透析环境中的护士和患者结果很重要。需要进一步的研究来探索血液透析单元中工作环境对护士和患者结果的预测能力。

BACKGROUND & AIMS: :This discussion paper seeks to explore an approach that metal health nurses can adopt that ensures the patient is at the centre of training and professional development opportunities. Although nurse training and education is shaped by practice and theory, the lived experiences of the patients as an educational resource often become lost in the milieu of 'doing' nursing. We argue that in addition to theoretical knowledge and practice knowledge, there is the need to harness the equally important patient experience knowledge. Drawing upon Ptolemaic concepts, this paper explores the potential tensions for mental health nurses resulting from the imbalance in power when engaging in therapeutic relationships with patients. It is argued that in order for mental health nurses to become more effective, they need to learn how to relinquish some of their power, even where this gives rise to uncomfortable tensions for the nurse. Such tensions result from the centrality afforded to theoretical knowledge and ritualized practice that underpins nursing and the difficulties this may cause for many nurses in accepting the value of patient experience as a primary source of knowledge. The difficulties of adopting this approach point to a need for mental health nurses and nurse educationalists to take a more reflexive approach to their patient encounters and within their encounters with each other.

背景与目标： : 本讨论文件旨在探索金属保健护士可以采用的方法，以确保患者处于培训和专业发展机会的中心。尽管护士的培训和教育是由实践和理论决定的，但作为教育资源的患者的生活经验常常在 “做” 护理的环境中丢失。我们认为，除了理论知识和实践知识外，还需要利用同样重要的患者经验知识。本文借鉴托勒密的概念，探讨了与患者进行治疗关系时权力不平衡所导致的精神卫生护士的潜在紧张关系。有人认为，为了使精神卫生护士变得更有效，他们需要学习如何放弃一些权力，即使这会给护士带来不舒服的紧张情绪。这种紧张关系是由理论知识和仪式化实践所提供的核心作用所造成的，这些理论知识和仪式化实践是护理的基础，以及这可能给许多护士在接受患者经验作为主要知识来源的价值方面带来的困难。采用这种方法的困难表明，精神卫生护士和护士教育家需要对患者的遭遇以及彼此的遭遇采取更具反身性的方法。

BACKGROUND & AIMS: :Psychosocial interventions (PSI) offer a range of problem-centred activities designed to improve the health and quality of life of clients and their carers. The paper reports the findings of a study on the roles and perspectives of mental health nurse practitioners towards clients with enduring mental illness and their carers following completion of PSI training. Focus groups interviews were conducted with PSI mental health nurse practitioners (n = 8) and data were analysed for thematic content. The results of the study indicated that PSI practitioners developed positive attitudes towards their client following PSI training and this attitudinal change enabled clients to develop more confidence and autonomy in managing the symptoms of their illness in a more empowered way. Focus group participants observed reduced levels of anxiety among clients and their carers. This was attributed to the 'sense of hope' within the caring milieu which was established as a result of collaborative working with the client and family. The findings suggest that there is a need for further exploration of the PSI practitioner role with a particular focus on the centrality of positive attitudes on the development of the therapeutic milieu for clients with severe and enduring mental ill health.

背景与目标： : 社会心理干预 (PSI) 提供了一系列以问题为中心的活动，旨在改善客户及其护理人员的健康和生活质量。本文报告了一项关于精神卫生护士从业人员在完成PSI培训后对患有持久精神疾病的客户及其护理人员的作用和观点的研究结果。对PSI精神卫生护士从业人员 (n = 8) 进行了焦点小组访谈，并分析了主题内容的数据。研究结果表明，PSI从业人员在PSI培训后对客户产生了积极的态度，这种态度的变化使客户能够以更有能力的方式在管理疾病症状方面建立更多的信心和自主权。焦点小组参与者观察到客户及其护理人员的焦虑水平降低。这归因于与客户和家人合作建立的关怀环境中的 “希望感”。研究结果表明，有必要进一步探索PSI从业者的角色，特别关注积极态度对患有严重和持久精神疾病的患者的治疗环境发展的中心作用。

BACKGROUND & AIMS: BACKGROUND:Nurse education has undergone considerable changes creating new opportunities and challenges for nurse teachers. Limited comparative research of the working lives of nurse teachers has been reported, thus similarities and differences that may exist are unidentified. AIM:This paper reports a study of the working lives of nurse teachers in mainland China and the United Kingdom. DESIGN:A cross-sectional questionnaire survey. PARTICIPANTS:Census sample of nurse teachers working in four nursing schools in mainland China (n=3) and the United Kingdom (n=1). The overall response rate was 56.8% (China=61, 61.0%, UK=60, 53.1%). METHODS:Completion of questionnaire specifically developed for the study but comprising six validated tools to collecting data on: job satisfaction, sense of coherence, role conflict and role ambiguity, work empowerment and professional identification. Data on self-reported roles and personal details were also collected. Data were collected between September 2008 and January 2009. RESULTS:Both samples were satisfied with their jobs overall but reported low levels of satisfaction with promotion. Chinese nurse teachers working full-time reported the lowest level for sense of coherence and professional identification. Nurse teachers working full-time in the United Kingdom reported the highest role conflict score. Sense of coherence and work empowerment were significantly and positively correlated to job satisfaction. Role conflict and role ambiguity were negatively correlated (but not always significantly) to job satisfaction and its facets. For respondents in mainland China, professional identification was significantly and positively correlated with overall job satisfaction and its facets. CONCLUSIONS:Strategies to improve job satisfaction with promotion opportunities for both samples are indicated. Respondents working full-time in both mainland China and the United Kingdom experienced greater challenges at work than their part-time colleagues.

背景与目标：

BACKGROUND & AIMS: :Nurse practitioner (NP) employment in specialty practice areas, such as subspecialty ambulatory practices and inpatient units is growing substantially. The Consensus Model provides guidelines to help states aligning NP education and certification with specialty practice area. Despite expansion of the Consensus Model, significant misalignment exists between specialty NPs' education, certification, and practice location. Therefore, further implementation of the Consensus Model across states could have significant impact on health systems and NPs working in specialty settings. More than 10 years after its introduction, it is time to evaluate the policy and practice implications of the Consensus Model. Important next steps include examination of the impact of the Consensus Model and how to help health systems with alignment when and if the Model is more widely implemented.

背景与目标： : 专业执业领域 (如亚专业门诊执业和住院单位) 的护士执业人数正在大幅增长。共识模型提供了指导方针，以帮助各州使NP教育和认证与专业实践领域保持一致。尽管扩大了共识模型，但专业np的教育，认证和执业地点之间仍存在明显的错位。因此，在各州之间进一步实施共识模型可能会对在专业环境中工作的卫生系统和NPs产生重大影响。在引入共识模型十多年后，是时候评估共识模型的政策和实践含义了。重要的后续步骤包括检查共识模型的影响，以及如何在何时以及是否更广泛地实施该模型时帮助卫生系统保持一致。

BACKGROUND & AIMS: OBJECTIVE:To measure the relationships among stressors (personal factors, job/role factors, hospital factors), job stress, and outcomes experienced by nurse leaders and examine moderation of autonomy and leadership style on outcomes of job stress. DESIGN:A cross-sectional, quantitative design. SETTING:Acute and nonacute care settings throughout North America. PARTICIPANTS:A nonprobability convenience sample of 392 was drawn from a population of nurse leaders across the United States and Canada who were members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). METHODS:A mailing list was obtained from AWHONN, and a total of 3,986 recruitment and follow-up postcards were sent to nurse leaders. Participants were asked to complete the survey online or request a hard copy to return by mail. Study variables were measured using previously published scales with demonstrated psychometric properties. RESULTS:Nurse leaders reported stress averages above the midpoint of the scales. Personal factors did not significantly predict stress, but role overload, organizational constraints, and role ambiguity were found to be the best predictors of stress. Job satisfaction, intent to quit, and mental health symptoms were the most significant outcomes of stress. Autonomy moderated relationships between perceptions of stress and outcomes with low autonomy showing greater negative outcomes when levels of stress are higher. CONCLUSION:Nurse leaders experience significant job stress that may suggest a need to design and implement evidence-based interventions to reduce stress among this group.

背景与目标：

BACKGROUND & AIMS: RATIONALE:The professional identity and experiences of nurses have been focused upon in different studies AIM:This is a longitudinal study whose aim was to understand how nurses experience the meaning of their identity as nurses, when they are students and nurses 2 years after graduation. DESIGN:Data were collected through interviews once a year during education and two years after graduation, and were analysed using a phenomenological hermeneutic method, inspired by the philosophy of Paul Ricoeur. FINDINGS:The analyses of the narratives resulted in four perspectives: 'Having the patient in focus', 'Being a team leader', 'Preceptorship' and 'Task orientation'. The nurses did not change perspectives but the perspective showed a transition over time. CONCLUSION:The nurses' not changing perspective over time is understood as being a life paradigm, remaining throughout the years.

背景与目标：

BACKGROUND & AIMS: AIMS:To explore the experiences and expectations of patients with chronic fatigue syndrome and general practitioners to develop the potential role of an advanced nurse practitioner at the diagnostic care path of abnormal fatigue developed for regional transmural implementation in the Belgian provinces of East and West Flanders. BACKGROUND:Patients with chronic fatigue syndrome experience an incapacitating chronic fatigue that is present for at least 6 months. Since many uncertainties exist about the causes and progression of the disease, patients have to cope with disbelief and scepticism. Access to health care may be hampered, which could lead to inappropriate treatments and guidance. DESIGN:Qualitative design. METHODS:Individual semi-structured interviews were conducted with patients with chronic fatigue syndrome and general practitioners in Belgium. Data were collected over 9 months in 2014-2015. All interviews were audio recorded and transcribed for qualitative analysis using open explorative thematic coding. RESULTS:Fifteen patients and 15 general practitioners were interviewed. Three themes were identified: mixed feelings with the diagnosis, lack of one central intermediator and insufficient coordination. Participants stressed the need for education, knowledge and an intermediator to provide relevant information at the right time and to build up a trust relationship. CONCLUSION:This qualitative exploration underscores some clear deficiencies in the guidance of patients suffering from chronic fatigue syndrome and abnormal fatigue. An advanced nurse practitioner as a central intermediator in the transmural care of these patients could promote interdisciplinary/multidisciplinary collaboration and effective communication, provide education and ensure a structured and coordinated approach.

背景与目标：

BACKGROUND & AIMS: PURPOSE:The purpose of this study was to interpret and describe the patient-nurse anesthetist (NA) interaction during regional anesthesia. DESIGN:Video recordings conducted during orthopedic surgery at a surgical clinic in Sweden formed the basis for the study, in which three patients and three NAs participated. METHODS:A hermeneutic analysis was conducted on the data. FINDING:The findings of the analysis demonstrated that the NA was in either "present" presence or "absent" presence in the awake patient's visual field during surgery. The NA's professional actions at times dominated the patient's existential being in the intraoperative situation. The findings conveyed insights about the patient-NA interaction that open up possibilities for nurses to understand and reflect upon their own practice in an expanded way. CONCLUSIONS:Using video recordings for reflections enables development of professional skills that positively influence the care quality for patients during regional anesthesia.

背景与目标：

BACKGROUND & AIMS: :The purpose of this pilot study was to examine the effectiveness of an 8-week, nurse-managed, peer-led smoking cessation intervention among HIV-positive smokers. The intervention was based on the Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline and was delivered by an ex-smoker who was HIV positive and had been trained by an advanced practice nurse to deliver cessation counseling. Eight male HIV-positive smokers were assigned to the intervention group and received (a) 21 mg nicotine patch therapy for 6 weeks, (b) weekly face-to-face or telephone counseling, and (c) skills training that included substitute strategies for dealing with not smoking. Those participants assigned to the control group received written self-help materials for smoking cessation. Abstinence rates at end of intervention and 8 months were compared between groups. At end of treatment, 62.5% of intervention group participants were biochemically confirmed as abstinent from smoking compared with 0% in the control group. Eight-month abstinence rates were 50% among the intervention group compared with 0% in the control group.

背景与目标： : 这项初步研究的目的是研究在HIV阳性吸烟者中进行为期8周，由护士管理，由同伴主导的戒烟干预的有效性。该干预措施基于卫生保健政策和研究机构戒烟临床实践指南，由一名HIV阳性的前吸烟者提供，并接受了高级实践护士的培训，以提供戒烟咨询。8名男性HIV阳性吸烟者被分配到干预组，接受了 (a) 21 mg尼古丁贴片治疗6周，(b) 每周面对面或电话咨询，以及 (c) 包括替代策略的技能培训不吸烟。分配到对照组的参与者收到了书面的戒烟自助材料。比较两组干预结束和8个月的禁欲率。在治疗结束时，与对照组的0% 相比，干预组参与者的62.5% 被生化确认为戒烟。与对照组的0% 相比，干预组的8个月禁欲率50%。

BACKGROUND & AIMS: CONTEXT:  Research on non-time-loss (NTL) injuries, which result in less than 24 hours of restriction from participation, is limited. OBJECTIVE:  To describe the epidemiology of NTL injuries among collegiate and high school student-athletes. DESIGN:  Descriptive epidemiology study. SETTING:  Aggregate injury and exposure data collected from a convenience sample of National College Athletic Association varsity teams and 147 high schools in 26 states. PATIENTS OR OTHER PARTICIPANTS:  Collegiate and high school student-athletes participating in men's and boys' baseball, basketball, football, lacrosse, soccer, and wrestling and women's and girls' basketball, field hockey, lacrosse, soccer, softball, and volleyball during the 2009-2010 through 2013-2014 and the 2011-2012 through 2013-2014 academic years, respectively, participated. Collegiate student-athletes participating in men's and women's ice hockey were also included. MAIN OUTCOME MEASURE(S):  Injury data from the National Collegiate Athletic Association Injury Surveillance Program and the National Athletic Treatment, Injury and Outcomes Network were analyzed. Injury counts, rates per 1000 athlete-exposures (AEs), and rate ratios were reported with 95% confidence intervals (CIs). RESULTS:  A total of 11 899 and 30 122 NTL injuries were reported in collegiate and high school student-athletes, respectively. The proportion of NTL injuries in high school student-athletes (80.3%) was 1.61 times greater than that of collegiate student-athletes (49.9%; 95% CI = 1.59, 1.63). The NTL injury rate in high school student-athletes (8.75/1000 athlete-exposures [AEs]) was 2.18 times greater than that of collegiate student-athletes (4.02/1000 AEs; 95% CI = 2.13, 2.22). Men's ice hockey (5.27/1000 AEs) and boys' football (11.94/1000 AEs) had the highest NTL injury rates among collegiate and high school athletes, respectively. Commonly injured body parts in collegiate and high school student-athletes were the hip/thigh/upper leg (17.5%) and hand/wrist (18.2%), respectively. At both levels, contusions, sprains, and strains were the most frequent diagnoses. Contact with another player was the most cited injury mechanism (college = 38.0%, high school = 46.3%). CONCLUSIONS:  Non-time-loss injuries compose large proportions of collegiate and high school sports injuries. However, the NTL injury rate was higher in high school than in collegiate student-athletes. Tracking NTL injuries will help to better describe the breadth of injuries sustained by athletes and managed by athletic trainers.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The Robert Wood Johnson Foundation Nurse Faculty Scholars program was created to address the nursing faculty shortage and thereby decrease the nursing shortage. PURPOSE:The purpose of the study was to describe the program development, implementation, and ongoing outcome evaluation. METHODS:Data on scholarly productivity, impact of research, research funding, and leadership positions were compiled, including an h-index (impact of publications) comparison with a comparison group of other interdisciplinary faculty at the same institutions of the 90 current and alumni scholars. DISCUSSION:There is evidence of the achievements of the individual scholars; however, the effect of the synergy of the multiple components of the program is difficult to capture in traditional evaluation strategies. CONCLUSIONS:The sense of possibility and responsibility (to the profession, to improving the health of all Americans, and to one's school of nursing and university) was a significant outcome of the program. Lessons learned from the program are important for the leadership development and retention of nursing faculty.

背景与目标：

BACKGROUND & AIMS: :Although multiple studies of nurses' attitudes toward people living with HIV/AIDS (PLWAs) can be found in the literature, little is known about the attitudes, beliefs and practices of nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs). A survey including a 21-item AIDS Attitude Scale measuring the constructs of Avoidance and Empathy was sent to 1,291 NPs, CNMs and PAs in Louisiana, Arkansas and Mississippi to describe their attitudes and care practices related to PLWAs. Respondents who were more comfortable treating PLWAs had significantly lower avoidance scores and significantly higher empathy scores than respondents with lower comfort levels in providing care. Greater than 80% of respondents indicated that they would provide health care to HIV-infected individuals. Respondents who referred HIV/AIDS patients for all care did so primarily due to lack of experience with HIV and the availability of more experienced providers. Avoidance and empathy scores were not found to be significantly associated with referral for care. This study suggests that this group of providers has relatively low avoidance and high empathy toward PLWAs and is willing to care for HIV-infected individuals.

背景与目标： : 尽管在文献中可以找到有关护士对艾滋病毒/艾滋病感染者 (plas) 态度的多项研究，但对护士从业人员 (NPs)，认证护士助产士 (CNMs) 的态度，信念和做法知之甚少，和医师助理 (PAs)。向路易斯安那州，阿肯色州和密西西比州的1,291 NPs，CNMs和PAs发送了一项包括21项艾滋病态度量表的调查，以测量回避和同理心的结构，以描述他们与plas相关的态度和护理实践。与提供护理的舒适度较低的受访者相比，更舒适地治疗plas的受访者的回避得分和移情得分明显较低。超过80% 的受访者表示，他们将向艾滋病毒感染者提供医疗保健。将艾滋病毒/艾滋病患者转介为所有护理的受访者之所以这样做，主要是因为缺乏艾滋病毒的经验以及有经验的提供者的可用性。未发现回避和移情得分与转诊护理显着相关。这项研究表明，这组提供者对plas的回避度相对较低，并且有很高的同理心，并且愿意照顾受HIV感染的人。

BACKGROUND & AIMS: OBJECTIVES:To assess the acceptability and feasibility of using a theory-based electronic learning intervention designed to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers for patients presenting with common, acute, uncomplicated self-limiting respiratory tract infections (RTIs). DESIGN:Experimental with mixed methods; preintervention and postintervention online surveys and semistructured interviews. SETTING:Primary care settings across the UK. PARTICIPANTS:11 nurse and 4 pharmacist prescribers. INTERVENTION:A theory-based brief interactive animation electronic learning activity comprised a consultation scenario by a prescriber with an adult presenting with a common, acute, uncomplicated self-limiting RTI to support a 'no antibiotic prescribing strategy'. OUTCOME MEASURES:Recruitment, response and attrition rates were assessed. The overall usefulness of the intervention was assessed by analysing prescribers' self-reported confidence and knowledge in treating patients with RTIs before and after undertaking the intervention, and views on the relevance of the intervention to their work. Acceptability of the intervention was assessed in semistructured interviews. The feasibility of data collection methods was assessed by recording the number of study components completed by prescribers. RESULTS:15 prescribers (maximum sample size) consented and completed all four stages of the study. Prescribers reported high to very high levels of confidence and knowledge preintervention and postintervention, with slight postintervention increases in communicating with patients and a slight reduction in building rapport. Qualitative findings supported quantitative findings; prescribers were reassured of their own practice which in turn increased their confidence and knowledge in consultations. The information in the intervention was not new to prescribers but was applicable and useful to consolidate learning and enable self-reflection. Completing the e-learning intervention was acceptable to prescribers. CONCLUSIONS:It was feasible to conduct the study. The intervention was acceptable and useful to prescribers. Future work will add complex clinical content in the intervention before conducting a full trial.

背景与目标：