AACN News—October 2000—Practice

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Vol. 17, No. 10, OCTOBER 2000

Advanced Practice Work Group Tackles Challenging Agenda

Members of the Advanced Practice Work Group are (from left, seated) Dorrie Fontaine, Kathleen McCauley, Mary McKinley and Sheila Melander, and (from left, standing) Mary Fran Tracy, Marilyn Hravnak, Lisa Kohr, Kathleen Miller, Julie Marcum and Kathleen Vollman.

By Dorrie Fontaine, RN, DNSc, FAAN,
and Mary McKinley, RN, MSN, CCRN

Clearly differentiating the roles of the nurse practitioner (NP) and clinical nurse specialist (CNS) in caring for acute and critically ill patients is a major focus of the AACN Advanced Practice Work Group for 2000-01.

Chaired by Mary McKinley, RN, MSN, CCRN, a past president of AACN, the work group met for the first time in August 2000 to begin work on the scope and standards of practice for the CNS, which is a major part of its overall agenda to support the practice of AACN members who are advanced practice nurses (APNs). The first step was to review a set of foundational documents, including the “Scope and Standards of Practice of the Acute Care Nurse Practitioner,” the National Association of Clinical Nurse Specialists’ (NACNS) “Statement on Clinical Nurse Specialist Practice and Education,” the American Nurses Association’s “Scope and Standards of Advanced Practice Registered Nursing” and AACN’s “Standards for Acute and Critical Care Nursing Practice (2000),” as well as the blueprint for the CCNS exam offered by AACN Certification Corporation.

The “Scope and Standards for the Clinical Nurse Specialist in Acute and Critical Care” is expected to be completed by May 2001, and available at AACN’s National Teaching Institute, May 19 through 24, 2001, in Anaheim, Calif., where the Advanced Practice Institute (API) will again be offered. A part of the Advanced Practice Work Group’s ongoing work involves recommending topics and speakers to balance the program and meet specific requests for clinical content at the API. A work group subcommittee will develop and implement a survey of APNs to assess their content interests and needs for future APIs.

The work group also plans to continue to identify and foster relationships with other organizations, such as NACNS, nurse practitioner groups and the Society of Critical Care Medicine.

Other initiatives before this group this year include identifying resources and tools for APNs and recommending criteria for a research grant that would study outcomes related to APNs. An APN outcomes database, which would include an extensive review of more than 150 articles, is being developed as one source of information.

In addition, a series of articles by work group members will be published in AACN News throughout the year to highlight the group’s work and focus on current topics of significant interest to critical care APNs. Among the topics that will be covered are “NP and CNS Role Congruence,” “Marketing the Role of the APN” and “Using Protocols and Guidelines.”

The Advanced Practice Work Group will meet again in January 2001 to continue its challenging action agenda toward assisting AACN members who are APNs to better meet the needs of patients and families in acute and critical care settings.

Other members of the work group are Dorrie Fontaine, RN, DNSc, FAAN, AACN board liaison, Marilyn Hravnak, RN, PhD, CCRN, ACNP, CS, FCCM, Lisa Kohr, RN, MSN, CCRN, NP, Julie Marcum, RN, MSN, CCRN, CS, Kathleen McCauley, RN, PhD, CS, FAAN, AACN board liaison, Sheila Melander, RN, DSN, FCCM, Kathleen Miller, RN, EdD, ACNP, CS, Nancy Molter, RN, MN, Mary Fran Tracy, RN, PhD, CCRN, and Kathleen Vollman, RN, MSN, CCNS, CCRN, CS.

Nominations Due for 2001 Distinguished Research Lecture Award

Nov. 1, 2000, is the deadline to submit nominations for the Distinguished Research Lecturer award for 2001. Part of AACN’s Circle of Excellence recognition program, the award will be presented to a nationally known researcher, who will deliver the Distinguished Research Lecture at the National Teaching Institute, May 4 through 9, 2002, in Atlanta, Ga.

The recipient will receive a $1,000 honorarium and complimentary registration, airfare and hotel accommodations for the NTI.

Candidates should be nurse researchers who are nationally recognized for publications, presentations and mentorship in research relevant to acute and critical care.

Candidates may be nominated by an AACN member, committee member, committee chairperson or member of the Board of Directors.

For more information about this award, call (800) 899-AACN (2226), or visit the “Research” area of the AACN Web site at http://www.aacn.org.

Datex-Ohmeda Funds Grant to Study Nutritional Issues

A new AACN research grant to study the issue of nutritional assessment in the critically ill patient is being sponsored by Datex-Ohmeda. Proposals for this $5,000 must be received by Feb. 1, 2001.

Examples of study topics include the impact of continuous metabolic monitoring; the assessment of the nutritional and metabolic condition of the critically ill patient; current practices of nutritional assessment of the critically ill patient; the use of the Harris-Benedict Equation vs. indirect calorimetry in nutritional assessment; and the evaluation of the accuracy or efficacy of continuous metabolic monitoring in the critically ill patient.

To qualify for this new Datex-Ohmeda-AACN Research Grant, the principal investigator must be a regular or affiliate member of AACN and not currently conducting a study funded by an AACN research grant

For more information, or to obtain application materials and instructions, call (800) 899-AACN (2226), or visit the “Research” section of the AACN Web site at http://www.aacn.org.

Clinical Inquiry Grants Link With AACN Vision

AACN awards several grants for research that is relevant to critical care nursing practice. The deadline to apply for AACN Clinical Inquiry Grants is Jan. 1, 2001.

The Clinical Inquiry Grants fund provides awards of up to $250 to qualified AACN members who are carrying out clinical research projects that will directly benefit patients or families. The money will be awarded for projects that address one or more AACN research priorities and link with AACN’s vision.

To obtain application materials and instructions, call (800) 899-AACN (2226), or visit the “Research” section of the AACN Web site at http://www.aacn.org.


Work Seeks Ways to Assist Members With Ethical Issues

Members of the Ethics Integration Work Group are (from left) Donna Luebke, Natalie Correll-Yoder, Beth Glassford, Christine Westphal, Carol Braund, Pamela Popplewell, Fay Wright, Cheryl McGaffic, Rosemary Lee, Mary Garman and Barbara Krumbach.

By Beth Glassford, RN, MSHA
Chair, AACN Ethics Integration Work Group

The Ethics Work Group met for two days in August 2000 to finalize an agenda to support members’ needs for assistance in dealing with ethics issues at the bedside.

Building on priorities established by the 1999-2000 Ethics Work Group, this year’s group is focusing on further assessment of practice needs regarding ethics resources; reviewing, enhancing and developing resources, including online tools; and expanding information related to ethics considerations. A variety of approaches will be employed in pursuing these initiatives.

For example, the Ethics Work Group will further develop the “Ethics” area of the AACN Web site (www.aacn.org) to provide members with not only expanded resources and references, but also a mechanism for feedback on specific needs and interests. In addition, the work group hopes to use “quick polls” online, as well as other avenues, to help determine members’ needs for ethics resources.

To maintain a prominent role in ethics arenas, AACN will continue to partner with other organizations, including the End of Life Care consortium. In addition, the group will work to incorporate standards of practice relative to ethics into clinical case studies. AACN News articles, presented in a case-study format, will continue to address specific ethical issues.

Group members are accountable not only for helping to implement the ethics agenda, but also for acting as expert spokespeople on ethics issues.
Chairing the work group is Beth Glassford, RN, MSHA. Other members are Carol Braund, RN, CCRN, Natalie Correll-Yoder, RN, MN, CCRN, Mary Garman, RN, MS, CNAA, Barbara Krumbach, RN, MSN, BS, CCRN, Rosemary Lee, RN, MSN, CCRN, Donna Luebke, RN, MSN, CCRN, NP, CNP, Cheryl McGaffic, RN, PhD, CCRN, Pamela Popplewell, RN, AA, BSN, and Christine Westphal, RN, MSN, CCRN. Fay Wright, RN, MS, CCRN, ACNP, is the AACN board liaison to the group.
Also, for the first time this year, the Ethics Work Group will be joined online by two consultants, who will serve as expert resources for its work. They are Cynthia Rushton, RN, DNSc, FAAN, assistant professor at the Johns Hopkins Children’s Center, Baltimore, Md., and M.C. Sullivan, RN, JD, vice president and chief operating officer of the Midwest Bioethics Center, Kansas City, Mo. Both have been actively involved with the work group in the past.

If you want more information about AACN’s initiatives related to ethics in healthcare or if there are specific topics you would like to have addressed, call (800) 394-5995, ext. 401, or visit the “Ethics” area of the AACN Web site at http://www.aacn.org.

Circle of Excellence: Seabury & Smith/AACN Community Service Award

The Seabury & Smith/AACN Community Service Award recognizes significant service by acute and critical care nurses, as individuals or in groups, who make a contribution to their community. Individuals or groups selected receive a complimentary registration to the NTI, or they may choose up to $500 toward speaker fees for an educational symposium.

Following are excerpts from exemplars submitted by recipients of this award for 2000:

Sacramento Area Chapter—AACN Sacramento, Calif.
Sacramento, Calif., was one of five cities selected by the American Heart Association (AHA) in 1998 to pilot a stroke research project. The goal of the project was to educate healthcare providers and the general public about “brain attacks,” signs and symptoms and the urgency for early treatment, and to improve patient outcomes.
Carol Hope, RN, who was chapter president at the time, saw the project as an opportunity to also increase public awareness and appreciation of critical care nurses. She contacted the Metro Stroke Task Force (MSTF) that had been formed by AHA and Mercy Healthcare Sacramento to ask how chapter members could help.

Through their involvement in providing stroke screening in a variety of settings, including nursing homes, legislative sessions, educational programs and street fairs, the nurses were able to educate the public about the role of critical care nurses.

The MSTF also asked the chapter to assist in initiating a screening program for the younger population in junior and senior high schools. Hope saw this as an opportunity to expand the chapter’s involvement into mentoring young people to consider nursing as a profession.

The nursing program director at California State University-Sacramento helped identify six nursing students who were willing to become involved with the project. With chapter guidance and MSTF affiliation, the students developed Students for Open Arteries, a stroke prevention program.

This is a perfect example of how one person’s vision can become reality. Hope’s initiative encouraged the chapter to venture out of the critical care units and into the lives of hundreds of citizens.

Christine Westphal
Allen Park, Mich.
Oakwood Healthcare Systems

James was admitted to the ICU with an exacerbation of chronic obstructive pulmonary disease. After his last intubation, he had insisted that he would never be placed on a ventilator again. Therapies did little to alleviate his suffocating dyspnea. Exhausted, James finally asked to be intubated.

The days passed with little weaning progress. When the subject of long-term ventilation was broached, James adamantly refused. His family and healthcare team had difficulty accepting his decision and questioned his competency to make such a decision.

Several months earlier, I had facilitated an advance care planning session with James and his family in their home. James was asked to write an advance directive that, based on his personal values and beliefs, clearly articulated his desire to forego life-sustaining therapies, including mechanical ventilation, if he would remain dependent upon “machines” and could not care for himself. Now, James’ advance directive would be his voice to tell everyone what his treatment choices would be.

I was asked to come to James’ bedside to talk with his family. They reflected that understanding James’ wishes was not difficult, when he discussed them in hypothetical situations. However, now it was difficult to do what James really wanted. Taking some comfort in the fact that James had expressed what he wanted, his family decided to have mechanicel ventilation withdrawn. James died peacefully several days later.

I have helped to lead many personalized advance care planning and other community initiatives, including the development of My Voice—My Choice, an advance directive education program, production of a public service announcement titled “What If…” and development of transcultural programs. All make a difference for those who need to rely on an advance directive to be their voice.

Mary Strozak, RN, MS, CCRN, CNS
Matawan, N.J.
Riverview Medical Center

Several years ago members of my parish, St. Benedict’s, established a retreat weekend called Genneseret for people who are seriously ill or dying. The purpose of the weekend is to allow the participants to come together and seek spiritual renewal and to help them to be defined by their person and not their illness. I have been a member of the health team for the retreat many times.

My roommate for one of the retreats was Anna, who arrived on Friday afternoon wrapped in Afghans, frail, weak and with large, dark circles under her eyes. During that first evening and through the night, I realized that Anna was much sicker than she appeared. Because of a continuous, rattling cough, speaking and eating were difficult for Anna. I truly felt that she might die while with us.

Seated opposite Anna during the Saturday evening anointing ceremony, I noticed a change in her appearance. After the anointing, there was a glow or an aura about her. When sharing her feelings, Anna stated, “I am at peace.”

That night Anna slept and the coughing spells were greatly diminished. When she left the retreat on Sunday, I noticed the difference in her appearance since Friday. She left the retreat smiling. I learned that Anna died on Tuesday.

I have been with many dying people during my critical care nursing experience. However, none have affected me in the way that Anna did. I am certainly able to care for other patients who may be dying with a much clearer perspective and, with them, I can share my experiences with Anna.

Exemplars for Circle of Excellence awards for 2001 are due Nov. 1, 2000. The annual awards program applauds exceptional practice on the part of critical care nurses in a number of arenas. For more information about the individual awards, call (800) 899-AACN (2226) or visit the AACN Web site at http://www.aacn.org.

AACN Online Quick Poll Update

Who pulls chest tubes at your facility?

Physician 67%
Advanced Practice nurse or PA 17%
Bedside RN 16%
Technician 0%

Number of Responses: 2,676

The AACN Online Quick Poll is a voluntary, nonscientific survey on a variety of topics. Participate by visiting the AACN Web site at http://www.aacn.org.

PRN and Geriatric Corner Columns to Return

Do you have a practice question or are you looking for resources do enhance your practice? AACN has a number of services that can help?

One of the most popular is the Practice Resource Network (PRN), where you cannot only obtain advice from specialists in the field but also network with your colleagues online. Call (800) 394-5995, ext. 217; e-mail practice@aacn.org or visit the “Practice” area of the AACN Web site at http://www.aacn.org.

Online you can post a question in the “Infolink” area and link to a variety of resources related to practice issues. Questions that are posed frequently on the PRN are answered in a “Practice Resource Network” column in AACN News, which will return soon.

Also returning soon will be the “Geriatric Corner” column, which presents age-related care information. If you have a age-related care story to share or an idea for a topic to be addressed, send it to AACN Practice Director Justine Medina, RN, MS, 101 Columbia, Aliso Viejo, CA 92656; fax, (949) 448-5520; e-mail, Justine.Medina@aacn.org, or call (800) 394-5995, ext. 401.

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