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While vast numbers of nurses across the globe contribute in all areas of healthcare delivery from primary care to acute and long-term care in community settings, there are significant differences in how they are educated, as well as the precise nature of their practice. This comprehensive handbook provides a research-informed and international perspective on the critical issues in contemporary nurse education. As an applied discipline, nursing is implemented differently depending on the social, political and cultural climate in any given context. These factors impact on education, as much as on practice, and are reflected in debates around the value of accredited programmes, and on-the-job training, apprenticeship, undergraduate and postgraduate pathways into nursing. Engaging with these debates amongst others, the authors collected here discuss how, through careful design and delivery of nursing curricula, nurses can be prepared to understand complex care processes, complex healthcare technologies, complex patient needs and responses to therapeutic interventions, and complex organizations. The book discusses historical perspectives on how nurses should be educated; contemporary issues facing educators; teaching and learning strategies; the politics of nurse education; education for advanced nursing practice; global approaches; and educating for the future. Bringing together leading authorities from across the world to reflect on past, present and future approaches to nurse education and nursing pedagogy, this handbook provides a cutting-edge overview for all educators, researchers and policy-makers concerned with nurse education.

The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles-including limits on nurses' scope of practice-should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.

Purpose To compare skills acquired by undergraduate nursing students enrolled in a medical‐surgical course. To compare skills demonstrated by students with no previous clinical practice (undergraduates) and nurses with clinical experience enrolled in continuing professional education (CPE). Design In a nonrandomized clinical trial, 101 undergraduates enrolled in the “Adult Patients 1” course were assigned to the traditional lecture and discussion (n = 66) or lecture and discussion plus case‐based learning (n = 35) arm of the study; 59 CPE nurses constituted a comparison group to assess the effects of previous clinical experience on learning outcomes. Methods Scores on an objective structured clinical examination (OSCE), using a human patient simulator and cases validated by the National League for Nursing, were compared for the undergraduate control and intervention groups, and for CPE nurses (Student's t test). Findings Controls scored lower than the intervention group on patient assessment (6.3 ± 2.3 vs 7.5 ± 1.4, p = .04, mean difference, ‐1.2 [95% confidence interval (CI) ‐2.4 to ‐0.03]) but the intervention group did not differ from CPE nurses (7.5 ± 1.4 vs 8.8 ± 1.5, p = .06, mean difference, ‐1.3 [95% CI ‐2.6 to 0.04]). The CPE nurses committed more “rules‐based errors” than did undergraduates, specifically patient identifications (77.2% vs 55%, p = .7) and checking allergies before administering medication (68.2% vs 60%, p = .1). Conclusions The intervention group developed better patient assessment skills than the control group. Case‐based learning helps to standardize the process, which can contribute to quality and consistency in practice: It is essential to correctly identify a problem in order to treat it. Clinical experience of CPE nurses was not associated with better adherence to safety protocols. Clinical Relevance Case‐based learning improves the patient assessment skills of undergraduate nursing students, thereby preparing them for clinical practice.

Agitation is a common, challenging symptom affecting large numbers of people with dementia and impacting on quality of life (QoL). There is an urgent need for evidence-based, cost-effective psychosocial interventions to improve these outcomes, particularly in the absence of safe, effective pharmacological therapies. This study aimed to evaluate the efficacy of a person-centred care and psychosocial intervention incorporating an antipsychotic review, WHELD, on QoL, agitation, and antipsychotic use in people with dementia living in nursing homes, and to determine its cost. This was a randomised controlled cluster trial conducted between 1 January 2013 and 30 September 2015 that compared the WHELD intervention with treatment as usual (TAU) in people with dementia living in 69 UK nursing homes, using an intention to treat analysis. All nursing homes allocated to the intervention received staff training in person-centred care and social interaction and education regarding antipsychotic medications (antipsychotic review), followed by ongoing delivery through a care staff champion model. The primary outcome measure was QoL (DEMQOL-Proxy). Secondary outcomes were agitation (Cohen-Mansfield Agitation Inventory [CMAI]), neuropsychiatric symptoms (Neuropsychiatric Inventory-Nursing Home Version [NPI-NH]), antipsychotic use, global deterioration (Clinical Dementia Rating), mood (Cornell Scale for Depression in Dementia), unmet needs (Camberwell Assessment of Need for the Elderly), mortality, quality of interactions (Quality of Interactions Scale [QUIS]), pain (Abbey Pain Scale), and cost. Costs were calculated using cost function figures compared with usual costs. In all, 847 people were randomised to WHELD or TAU, of whom 553 completed the 9-month randomised controlled trial. The intervention conferred a statistically significant improvement in QoL (DEMQOL-Proxy Z score 2.82, p = 0.0042; mean difference 2.54, SEM 0.88; 95% CI 0.81, 4.28; Cohen's D effect size 0.24). There were also statistically significant benefits in agitation (CMAI Z score 2.68, p = 0.0076; mean difference 4.27, SEM 1.59; 95% CI -7.39, -1.15; Cohen's D 0.23) and overall neuropsychiatric symptoms (NPI-NH Z score 3.52, p < 0.001; mean difference 4.55, SEM 1.28; 95% CI -7.07,-2.02; Cohen's D 0.30). Benefits were greatest in people with moderately severe dementia. There was a statistically significant benefit in positive care interactions as measured by QUIS (19.7% increase, SEM 8.94; 95% CI 2.12, 37.16, p = 0.03; Cohen's D 0.55). There were no statistically significant differences between WHELD and TAU for the other outcomes. A sensitivity analysis using a pre-specified imputation model confirmed statistically significant benefits in DEMQOL-Proxy, CMAI, and NPI-NH outcomes with the WHELD intervention. Antipsychotic drug use was at a low stable level in both treatment groups, and the intervention did not reduce use. The WHELD intervention reduced cost compared to TAU, and the benefits achieved were therefore associated with a cost saving. The main limitation was that antipsychotic review was based on augmenting processes within care homes to trigger medical review and did not in this study involve proactive primary care education. An additional limitation was the inherent challenge of assessing QoL in this patient group. These findings suggest that the WHELD intervention confers benefits in terms of QoL, agitation, and neuropsychiatric symptoms, albeit with relatively small effect sizes, as well as cost saving in a model that can readily be implemented in nursing homes. Future work should consider how to facilitate sustainability of the intervention in this setting. ISRCTN Registry ISRCTN62237498.

One of the premier reference books for geriatric nurses in hospital, long-term, and community settings, this 4th edition has been thoroughly updated to provide the most current, evidence-based protocols for care of common clinical conditions and issues in elderly patients. Designed to improve the quality, outcomes, and cost-effectiveness of health care, these guidelines are the result of collaboration between leading practitioners and educators in geriatric nursing and New York University College of Nursing. Protocols for each clinical condition have been developed by experts in that particular area, and most have been systematically tested by over 300 participating hospitals in \"Nurses Improving Care for Health System Elders\" (NICHE). Evidence is derived from all levels of care, including community, primary, and long-term care. A systematic method in compliance with the AGREE appraisal process was used to rate the levels of evidence for each protocol. Protocols are organized in a consistent format for ease of use, and each includes an overview, evidence-based assessment and intervention strategies, and an illustrative case study with discussion. Additionally, each protocol is embedded within chapter text, which provides the context and detailed evidence for the protocol. Each chapter contains resources for further study.