Background/Rationale
Driving forces that influenced this innovation include, but were not limited to, maintaining the professional nursing practice model and the need for management of diabetes and hyperglycemia in the hospital setting. Professional Nursing Practice models demonstrate the following organizational themes: (1) working with other nurses who are clinically competent; (2) good nurse-physician relationships; (3) nurse autonomy and accountability; (4) supportive nurse manager-supervisor; (5) control over nursing practice and practice environment; (6) support for education; (7) adequacy of nurse staffing; and (8) concern for the patient is paramount (McClure & Hinshaw, 2002). The prevalence of diabetes in adults hospitalized in the United States is significant and predicted to be at 12.4% to 25% (Clement et al, 2004). Following a needs assessment, nursing knowledge, autonomy, and control over practice in diabetes care were identified as opportunity areas for CNS intervention. The innovation was the development, implementation, and evaluation of bedside (sharp-end) RN unit-based diabetes care facilitators.
Description
The development, implementation, and evaluation of this role integrated Social Cognitive Learning Theory (Bandura, 1986). The CNS recruited activated, interested bedside nurses who were interested in advancing the practice of diabetes care within their respective nursing unit. Traditional educational opportunities have included the development of written material, subsequent classes, followed by posttests, which are not clear measures of learning. The intent of the CNS and Diabetes Team was to provide information and experiences that stimulate learning, resulting in diabetes nursing practice behavior change positively influencing a professional nursing practice model. Subprocesses governing observational learning include the following: Attentional Process, Retention Process, Production Process, and Motivational Process. Activities were designed to address each subprocess governing learning. What followed was unit-based diabetes care facilitator partnership with unit-based nursing leadership, advanced practice, and unit-based practice councils in the design, implementation, and evaluation of unit-based plans aimed at advancing the practice of unit-based diabetes nursing care.
Outcome
Multiple outcomes were experienced within the 3 spheres of CNS practice. Professional nursing practice influencing the assessment and management of patients diagnosed with hyperglycemia has resulted in patient outcomes that include, but are not limited to, a decrease in sternal wound infections among CABG population influenced by continuous insulin infusion within the first 24 hours postoperatively in the CVU; nursing demonstrated increased confidence and competency to assess and meet the complex needs of persons diagnosed with diabetes. Examples of system outcomes include, but are not limited to, bedside nursing verbalizing and demonstrating nursing autonomy and control over nursing practice influencing Magnet designation.
Interpretation/Conclusion
The CNS is perfectly positioned to influence a professional nursing practice model positively influencing high-quality nursing care. Without CNS competency support, the bedside nurse is limited to achieve and master control over their practice or to be able to collaborate with nursing peers or other disciplines to ensure high-quality care. Control over nursing practice promotes the recognition of the contribution of professional nursing to organizational goals and outcomes (Perley & Rabb, 1994).
Implication for CNS Practice
Implications for CNS practice include, but are not limited to, the following competencies: (1) use methods and instruments to assess patterns of outcomes related to nursing practice within and across nursing units of care; (2) gathers and analyzes data to substantiate desirable and undesirable patient outcomes linked to nursing practice; (3) draws conclusions about the evidence base and outcomes of nursing practice that require change, enhancement, or maintenance; (4) anchors nursing practice to evidence-based information to achieve nurse-sensitive outcomes; (5) evaluates the ability of nurses and nursing personnel to implement changes in nursing practice with individual patients and populations (NACNS, 2004).
Section Description
This year's annual NACNS conference is planned for Orlando, Fla, March 9-12, 2005. Over 300 clinical nurse specialists (CNSs) are expected to attend, and as with past conferences, attendees will also include graduate faculty from CNS programs, nurse administrators, and nurse researchers. The theme of the conference, CNS Leadership: Navigating the Healthcare Environment Toward Excellence, was selected to showcase the many ways CNSs acquire and disseminate knowledge and innovative practices in their specialty areas. Two preconference sessions are scheduled. One session, sponsored by NACNS Legislative/Regulatory Committee, targets information for CNSs interested in understanding the legislative/regulatory process as it deals with the practice of nursing, and will also help build skills CNSs need to engage in the process. The second session, sponsored by NACNS Education Committee, focuses on CNS education issues, and as with the education preconferences of past years, anticipates informative dialogue and much sharing among CNS educators around curriculum design, teaching strategies, and indicators of quality in the curriculum that link to the NACNS education standards to program review and excellence. The conference planning committee is proud and pleased to have Jeanette Ives Erickson, MS, RN, CNA, Senior Vice President for Patient Care Services and Chief Nurse Executive of Massachusetts General Hospital as the opening keynote speaker. She will begin the conference by highlighting the importance of CNS practice on patient safety. The planning committee is equally proud and pleased to have NACNS past-president Rhonda Scott, PhD, RN, Chief Nursing Officer of Grady Health System as the closing speaker. Dr Scott will challenge attendees to use the information from the conference to shape quality care delivered in a safe environment and to advance the profession of nursing through direct care to clients, influencing standards of care delivered by other nurses, and influencing the healthcare delivery system to be to support innovative, cost-effective, quality nursing care. A total of 64 abstracts for podium and poster presentations were selected in addition to graduate student posters. The abstracts address the 3 spheres of CNS practice with a strong emphasis on clinical practice improvements. As you will note from the abstracts published in this issue of the journal, specialty practice areas represented in the abstracts include children, adults, and gerontological patient groups; hospital, outpatient, and home care settings, and community health. In addition, a wide variety of specialty topics including smoking cessation programs, end-of-life care issues, and protocols outlining nursing approaches to improved diabetes, cardiovascular and ventilator management. A number of the abstracts described hospital and healthcare system level innovations that resulted from CNS practice. Collectively, these abstracts reflect the breadth, depth, and richness of CNS contributions to the well-being of individuals, families, groups, and communities. The following abstracts are from those presenters who elected to have their work published in the journal so those who are unable to attend this year's conference can share in the knowledge of the conference. As you read each abstract, consider the talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to improved outcomes for patients and healthcare organizations. You may want to contact individual presenters to network, collaborate, consult, or share your own ideas about these topics. Watch for next year's call for abstracts and consider submitting an abstract for presentation at NACNS's next conference in Salt Lake City, Utah, March 15-18, 2006.