Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP): This online degree program prepares graduates to practice as an advanced practice registered nurse in primary care settings providing health care management, health promotion, and disease prevention for adult and senior patients in out-patient primary care clinics. Graduates of this program are eligible to sit for national board certification as a nurse practitioner and to hold an advanced practice licensure status.
(MDM) offers rigorous and systematic approaches to decision making that are designed to improve the health and clinical care of individuals and to assist with health policy development. Published eight times a year, MDM presents theoretical, statistical, and modeling techniques and methods from a variety of disciplines including decision psychology, health economics, clinical epidemiology, and evidence synthesis. MDM promotes understanding of human decision-making processes so that individuals can make more informed and satisfying choices regarding their health.
More than ever, consumers must make difficult choices while trying to navigate through a complex and fragmented healthcare system, often while they are hurting and feeling sick, stressed and overwhelmed. To better understand what people think about their role as the “CEO of their healthcare,” Accolade created the Consumer Healthcare Experience Index, which sheds light on how individuals are making health-related decisions, what’s impacting these decisions and where they need the most help.
Additionally, the ACGME has created the Clinical Learning Environment Review (CLER) to ensure that hospitals engage residents in QI and PS improvement measures.5 Involving residents in this process is educational and pragmatic, because they can be keenly aware of factors that adversely impact clinical decision-making, such as poor communication, culture of blame, lack of supervision, inexperience, excessive workload, and duty hours.6-8 Some residency programs have started to implement QI curricula that utilize experiential learning as a key component of resident education.9-11 A select few programs have even encouraged trainees to take on leadership roles in the development of QI initiatives.12,13One opportunity to use QI is via systematic and structured reflection on the quality of clinical care.
Students can explore perspectives on how their personal values interact with those of others and how these interactions can be managed to create a meaningful and productive work environment. This will require knowledge, understanding and application of ethical theory, principles and professional skills in rational decision-making and leadership within a health and social care context. Students will be expected to articulate their competence as an accountable practitioner within a healthcare team and as an advocate for applied ethics in contemporary practice. A range of management styles will be considered for their impact on quality care and working practices. The use of evidence in clinical decision making, which respects partnership with service users, carers, agencies and other professionals will be the endpoint of leaning.
Should we consider bringing together, in the clinical setting, the nurse educator, the students and the nurse clinicians in the form of a journal club? Together, they can identify a patient problem; volunteers can then offer to search out the best evidence and bring it back for presentation and discussion with the group. This might provide a forum for learning from one another while at the same time helping nurses in the clinical setting, who lack time and critical appraisal skills.
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For the most part, nursing educators are not active clinicians, and nurse clinicians are not nursing educators. At Rush University College of Nursing, they have developed the nurse educator/practitioner/researcher role in which faculty members have an ongoing research involvement and clinical practice alongside their responsibilities as educators, lecturers and advisers ("Inside the Rush Model" 2003). Picture clinical settings in which the nurse educator/practitioner/researcher works closely with nursing staff to produce and disseminate new knowledge and, as an advanced practice nurse, models and facilitates evidence-based practice.
There is an increasing awareness of the importance of interdisciplinary learning to facilitate the effective working of the multidisciplinary healthcare team in service delivery. We are beginning to see how challenging it is to promote interdisciplinary service when learning has occurred in unidisciplinary silos. Is there an opportunity in the clinical setting to bring together students from programs such as nursing, midwifery, medicine, occupational therapy and physiotherapy to consider a common patient problem and to search out and discuss relevant research findings? For example, at McMaster University, a multidisciplinary team has been awarded funds from the provincial government to develop models for collaborative education and collaborative service delivery in long-term care, including family medicine residents, nurse practitioner students and pharmacy students. It is envisioned that both models will include the opportunity for these interdisciplinary learners and clinicians to work together through patient problems, identifying and using best evidence in their clinical decision-making.
There exist, however, numerous secondary sources of pre-appraised evidence that provide immediately applicable information for decision-making. Administrators of clinical settings can make a significant contribution to the development of evidence-based practice by providing access to these resources, along with opportunity for nurses to learn how to track down and efficiently use them. Such resources, which apply a methodological filter to original investigations and therefore ensure a minimum standard of validity, include (and other discipline-specific abstraction journals, such as ), high-quality clinical practice guidelines and an increasing number of computerized decision-support systems. Ready access to computers in the clinical setting and librarians is key. At a minimum, librarians can teach nurses how to frame an answerable question and how to use the secondary sources of pre-appraised evidence efficiently. The librarian becomes, in effect, a knowledge broker who is expert in sources of high-quality information and in teaching others how to access them efficiently.
Very little of this is possible without the support and provision of resources by the administrators of healthcare settings. Nurse managers may want to consider lobbying for inclusion of standards related to EBN practice in the accreditation mechanisms for their clinical settings. This action would appropriately highlight the importance of evidence-based practice and would ensure that essential resources be allocated to its development.
In clinical settings, let's consider computer and librarian resources, development and introduction of the nurse educator/practitioner/researcher role, journal clubs, interdisciplinary rounds and accreditation. Asking nurses to practise nursing without the tools to locate best evidence to inform their clinical decision-making is comparable to asking them to take a blood pressure measurement without a stethoscope. Many nurses, while highly motivated to become evidence-based practitioners, have not had any opportunity in their nursing education to learn searching and critical appraisal skills. To complicate matters further, time is more limited than ever.