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Background: Clinical elective courses provide additional specialty knowledge for prelicensure nursing students; however, it is unknown how these courses impact nurses' clinical practice after graduation. Purpose: To describe how clinical nursing electives impact graduates' clinical practice. Methods: A mixed-methods descriptive design was used. Students who graduated from a prelicensure nursing program were sent an electronic survey and participated in qualitative interviews. Results: Thirty-three graduates completed the survey, with 9 participating in interviews. Sixteen graduates worked in the clinical practice areas that were the same, or related to, the clinical elective they took. Many graduates felt that taking the elective course improved their confidence in the clinical setting and provided increased knowledge that put them at an advantage over their peers. Conclusion: Clinical electives may offer a means to meet health care system needs by preparing a more confident, knowledgeable new graduate in specialty areas in which nurses are needed most. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess healthcare utilization costs of a dedicated outpatient clinic for patients with atrial fibrillation (AF). Methods: We conducted a registry-based retrospective study in patients with a first-time AF diagnosis from 2009 to 2011 (control group) and 2013 to 2015 (intervention group). The control group had physician-led usual care, and the intervention group received multidisciplinary care. The primary outcome was total costs of AF-related resource utilization. Exploratory outcomes were ischemic stroke, intracranial hemorrhage, and all-cause mortality. Multiple regression methods were used to control for confounders in the assessment of effects on outcomes. Results: A total of 1552 patients were included, hereof 850 in the intervention group. Total AF-related costs were €2746 for the control group and €3154 for the intervention group, which was not statistically significant. Average outpatient costs were significantly higher in the control group than in the intervention group (€522 vs €344, respectively; P = .003). There was no difference in the number of AF-related hospital admissions and outpatient visits between the control group and the intervention group (incidence risk ratio, 1.03 vs 0.85; and 95%confidence interval, 0.92--1.16 vs 0.69--1.05, respectively). There was a trend toward reduced all-cause mortality (hazard ratio, 0.86; 95% confidence interval, 0.63--1.16) in the intervention group, which was not statistically significant. Conclusion: Total expenses for AF-related hospital resource utilization in the intervention group were higher, but the expenses for AF-related outpatient visits were significantly lower. There was a trend toward lower all-cause mortality in the intervention group, although the differences were not statistically significant. More research is needed investigating whether a multidisciplinary AF clinic is cost-effective. [ABSTRACT FROM AUTHOR]

Purpose/objectives: With rapidly evolving oncology care, the role of the outpatient clinical nurse specialist is most valuable and essential. The purpose of this article is to describe the role of the clinical nurse specialist in the ambulatory oncology settings and highlight the clinical nurse specialists' unique influence across the spheres of impact., Description of the Project/program: This article shares several contributions of an outpatient clinical nurse specialist, which include ways this role impacts nursing practice, patient care, and standardizing organizational guidelines. A method of recording the clinical nurse specialists' encounters or indirect consults was also utilized to provide a process to log consultation received in the day-to-day practice. Work exemplars were included to further demonstrate the impact of this role in this setting., Conclusion: Outpatient clinical nurse specialist need is rising especially in the oncology setting where the majority of cancer care and treatment is delivered. It is important to continue to disseminate and highlight the value it brings to the organization., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Many Dutch nurse practitioners (NPs) work together with physicians and specialized nurses (SNs) in outpatient clinics, although the latter have questioned the added value of NPs in the outpatient clinic. Clarification of the distinction between and the added value of both nursing professions in relation to each other could lead to optimal use of the unique competencies of each type of nurse. Purpose: To explore NPs' perspectives on their added value in relation to SNs in the outpatient clinic. Methodological orientation: Data were analyzed by Braun and Clarke's thematic analysis. The CanMEDS competences were used to identify the NPs' comments about their practice. Sample: Twelve semi-structured interviews were conducted with NPs from two hospital settings. Conclusions: The added value of NPs was most evident in: nursing leadership, integrating care and cure and performing an expert level of nursing expertise, and competencies in science. To optimize their roles, NPs and SNs need to make all team members aware of their unique competences and promote role clarification. Implications for practice: This study provides barriers in barriers that influence optimal positioning of NPs within the interdisciplinary team, stresses the importance of discussion on the optimal skill mix within the interdisciplinary team, and describes the NPs' leadership role because this is the encompassing link between the main competencies of their practice. Addressing and overcoming these findings could improve the NPs' positioning and effective collaboration within (the outpatient clinic's) interprofessional teams. [ABSTRACT FROM AUTHOR]

Background: The number of patients with diabetes has been increasing rapidly according to a 2017 report by the International Diabetes Federation. Diabetes has become one of the most challenging public health problems, and there will be an estimated 143 million patients with diabetes in China by 2035. This puts considerable pressure on nurses who specialize in the care of patients with diabetes in China and increases related social and financial burdens. Clinical practice has proven that strengthening the core competencies of nurses and establishing an evaluation system of core competencies improve both healthcare quality and patient quality of life. However, no core-competence system framework currently addresses the unique characteristics of nurses in China., Purposes: The purpose of this study was to construct a core-competence system framework for primary nurse specialists in diabetes care., Methods: A brainstorming approach was conducted that worked to conceptualize the core competencies of nurse specialists in diabetes care in China. Next, a study group organized this information and conducted a seminar; 50 experts and patients with diabetes were invited to develop the first draft of the framework. Afterward, 50 experts were selected to participate in the Delphi survey. Most indicators were retained after a three-round Delphi process, and the superiority chart was used to determine the weights of the six dimensions., Results: Forty-seven experts completed the consultation. The experts' rate of response ranged from 94% to 100%, the authority coefficient was .91, and the Kendall's coefficients of concordance in Grades 1-3 were .793, .418, and .542, respectively. An increasingly detailed, three-grade system framework was developed, including six first-grade indicators (diabetes professional knowledge, diabetes-related knowledge, communication skills and health education ability, specialized skills, clinical judgment, and specialty development capacity), 23 second-grade indicators, and 87 third-grade indicators. The weights of the six first-grade indicators were .221, .149, .192, .209, .160, and .069, respectively., Conclusions: The core-competence system framework includes six core competencies, which represent the main characteristics of primary nurse specialists in diabetes care who are highly recommended by experts. It is important to keep in mind that this is only a theoretical framework and thus must be further tested in clinical practice settings in China.

This article is a literature review to determine the state of the science regarding the impact of nursing interventions in the treatment of hepatitis C. Hepatitis C is a chronic disease impacting millions of people globally. Treatment is currently available that has the potential to cure the disease. Medication adherence is vital to the eradication of the disease. Nursing interventions could possibly assist in the improvement in medication adherence. By reviewing the literature, the factors influencing patient outcomes were identified. Four themes identified in the literature are influence of comorbidities, self-motivation, psychological factors, and provider support. The research studies are compared and contrasted within and across the themes. Identification of what is known and what is not known about nursing interventions in the treatment of hepatitis C is illustrated in the conclusion of the article. Finally, suggestions for future research are presented. Specific areas of study are identified for focus in the future research.

Background & Aims: Nutritional interventions for malnutrition in cancer patients can be helpful. However, concise intervention recommendations remain controversial. Thus, the aim of this study was to report on a nutrition intervention conducted by a multidisciplinary team of specialist nurses and to explore the effect of nutritional intervention on cancer patients., Methods: This prospective clinical trial study enrolled 110 colorectal cancer patients undergoing chemotherapy. The patients were evaluated upon admission using the 2002 Nutritional Risk Screening system (NRS-2002). The patients were randomly divided into intervention and control groups including 55 patients each. Patients in the control group were administered a normal diet, while those in the intervention group received individual recipes developed by a team of professional nurses, clinical doctors, dietitian, family caregivers, and the patients themselves. Patient weight and serum albumin and prealbumin levels were compared between the 2 groups at different time points., Results: There was a significant difference in patient weight and serum albumin and prealbumin levels before and after nutrition intervention in the intervention group (P < .05). In the control group, weight did not change during ordinary diet guidance. Serum albumin level was slightly improved after 12 cycles of chemotherapy, similar to the prealbumin results. There were statistically significant differences in serum albumin and prealbumin levels between the intervention and control groups after nutrition intervention (P < .05). However, there was no statistically significant difference in weight between the groups after nutrition intervention (P > .05)., Conclusion: A multidisciplinary team approach for nutrition intervention conducted by specialist nurses improved prealbumin levels in colorectal cancer patients undergoing chemotherapy, with no weight change.

Purpose: The purpose of this article is to describe the processes of exploring and implementing an academic-clinical study, engaging nursing staff in research, and maintaining their enthusiasm within the context of an academic-clinical research partnership., Description: The core competencies of the clinical nurse specialist (CNS) role address evidence-based practice, quality improvement, and research. Studies and exemplars of the CNS role in the literature illustrate expert practitioner and facilitator of evidence-based practice, but less attention is given to methods used by the CNS to engage staff in clinical research., Outcome: The CNS was successful in obtaining staff engagement in the research project from exploration through sustainment., Conclusion: Collaborative research between academic and clinical partners enhances the educational and professional environment for students and clinicians, promotes evidence-based practice, and from this project may promote Veteran and family-centered care. The CNS played a key role in engaging and sustaining staff commitment, which contributed to the success of this study.

The possible involvement, although limited to the diagnostic phase of the procedure, of nonmedical staff (particularly endoscopy nurses) in lower digestive endoscopy has recently been suggested. Computer-based simulators have demonstrated objective evaluation of technical skills in digestive endoscopy. The aim of this study was to evaluate basic colonoscopy skills of endoscopy nurses (naive operators), as compared with junior physician staff and senior endoscopists, through a virtual reality colonoscopy simulator. In this single-center, prospective, nonrandomized study, 3 groups of digestive endoscopy operators (endoscopy nurses, junior doctors [<150 previous colonoscopies], expert doctors [>500 previous colonoscopies and >200/year]) completed six diagnostic cases generated by an endoscopic simulator (AccuTouch, Immersion Medical, Gaithersburg, MD). The performance parameters, collected by the simulator, were compared between groups. Five parameters have been considered for statistical analysis: time spent to reach the cecum; pain of any degree; severe/extreme pain; amount of insufflated air; percentage of visualized mucosa. Statistical analysis to compare the three groups has been performed by means of Wilcoxon test for two independent samples and by means of Kruskal-Wallis test for three independent samples (p < .05). Sixteen operators have been studied (six endoscopy nurses, five junior doctors, and five senior doctors); 96 colonoscopic procedures have been evaluated. Statistically significant differences between experts and naive operators were observed regarding time to reach the cecum and induction of severe/extreme pain, with both Kruskal-Wallis and Wilcoxon test (p < .05); all other comparisons did not reach statistical significance. Although, as expected, expert doctors exceeded both junior doctors and naive operators in some relevant quality parameters of simulated diagnostic colonoscopies, the results obtained by less expert performers--and particularly by nursing staff--appear satisfactory as in regards to most of the considered quality parameters and suggest a potential value of this device in effectively teaching basic lower digestive endoscopy to beginners in a relatively short time.