Clinical Nurse Specialist:
Nursing Practice: Editorial
NORRIS, ANNE E. PhD, RN, CS
ANNE E. NORRIS is an associate professor at Boston College School of Nursing, Chestnut Hill, Massachusetts.
We live in challenging times in which nursing and other healthcare professionals are asked to articulate their treatment outcomes and specify the interventions that produce those outcomes. However, as Donabedian1 notes, the links between healthcare interventions (i.e., process) and outcomes are not always clear. Fortunately, advanced practice nurses (APNs) have the educational preparation and the position within the healthcare system to begin identifying these links and demonstrating the difference that nursing makes. Now, more than ever, APNs are poised to have a critical impact on practice.
APNs are uniquely suited to these times because of their ability to use research in their practice to inform the practice of others. Consider three examples of how APNs use research in their practice. First, APNs identify promising new interventions to be implemented on a small scale while the efficacy of such interventions continues to be evaluated. This may occur when such interventions are described in the literature or when they are actually created by an APN in the course of his or her practice. These are unproven interventions that lack the supportive research base of a randomized placebo-controlled clinical trial. However, these are also interventions that do no harm, including detracting from or interfering with interventions with clear efficacy, and may actually be helpful to the patient. Karper, Hopewell, and Hodge's article in this section on the benefits of an exercise program for persons with fibromyalgia is a wonderful example of the type of small-scale implementation and evaluation of an intervention that APNs engage in as part of their practice. Indeed, it is irresponsible to implement a new intervention or a new program without some evaluation of its outcome. Moreover, this type of formative evaluation, in which the efficacy of a promising new intervention and its likely outcomes are explored,2 is a critical avenue by which APNs influence both the practice and the science of nursing.
Carroll's article in this section is a second example of APNs using research in their practice. Here the author uses research methods to describe the nursing intervention used to enhance recovery in unpartnered elders recovering from a myocardial infarction. Data regarding the intervention (e.g., data collection forms that logged the activities of the APN) were analyzed so that the nursing activities that work best to effect positive health outcomes could be identified. This type of research is critical to our ability to link outcomes to specific nursing activities. It is also another fine example of formative evaluation in which understanding the process of the intervention is a focus.
Finally, APNs may become involved with a summative evaluation research effort to assess the outcomes and impacts of programs using interventions with established efficacy.3 Note that this type of effort contrasts with the formative evaluation illustrated by the articles in this section because the efficacy, outcomes, and process of intervention have already been articulated.2 APNs play a critical role in summative evaluation, just as they do in formative evaluation. Their practice experience as both RNs and APNs garners them the wisdom to see the barriers to program implementation and evaluation. Meanwhile, their educational preparation affords them opportunities to be an active participant in many phases of the research effort (e.g., research design, design of data collection methods, interpretation of study results).
These are challenging times, yet they present opportunities for APNs to have a critical impact on nursing practice and on the state of nursing science itself. As seen from the articles in this section, the CNS offers herself as a forum for disseminating the results of APNs' efforts to influence practice through research. Let us use it to help grow the research base for practice!
1. Donabedian A. The quality of care: How can it be assessed? JAMA.
2. Flay BR, Best JA. (1982). Overcoming design problems in evaluating health behavior programs. Evaluation and the Health Professions.
3. Ritz LJ, Nissen MJ, Swenson KK, Farrell JB, Sperduto PW, Sladek ML, et al. Effects of advanced nursing care on quality of life and cost outcomes of women diagnosed with breast cancer. Oncology Nursing Forum.
Alzheimer's Association Sponsors Its 10th Annual Conference
New Directions in Alzheimer's Care July 15-18, 2001, Hyatt Regency, Chicago, Illinois
This conference will provide professionals in the field of Alzheimer care with practical and innovative approaches that focus on the individual with the disease.
Registration or exhibitor information can be obtained by contacting the association at 312-335-5790 or visiting http://www.alz.org.
© 2001 Lippincott Williams & Wilkins, Inc.