The effectiveness of the role of advanced nurse practitioners compared to physician-led or usual care: A systematic review

The need for acute assessments in home healthcare - Swedish registered nurses' experiences

PURPOSE

The study aims to describe Swedish RNs' experiences of acute assessments at home. More patients with complex nursing needs are cared for at home due to an ageing population. Registered nurses (RNs) who work with home healthcare need a broad medical competence and clinical experience alongside adapted decision support systems for maintaining patient safety in acute assessments within home healthcare.

METHODS

A content analysis of qualitative survey data from RNs (n = 19) working within home healthcare in Sweden.

RESULTS

There were challenges in the acute assessments at home due to a lack of competence since several of the RNs did not have much experience working as an RN in home healthcare. Important information was missing about the patients, such as access to medical records due to organizational challenges and limited access to equipment and materials. The RNs needed support in the form of cooperation with a physician, support from colleagues, and a decision support system.

CONCLUSION

To increase the possibility of patient-safe assessments at home, skills development, collegial support, and an adapted decision support system are needed. Collaboration with primary healthcare, on-call physicians, and nursing staff, and having the opportunity to consult with someone also provide security in acute assessments.

Continued restrictions on nurse practitioners: A qualitative study of the early implementation of full practice authority in Massachusetts

BACKGROUND

In January 2021, the Commonwealth of Massachusetts granted nurse practitioners (NPs) full practice authority (FPA). Little is known about how care delivery changed after FPA legislation.

PURPOSE

To understand the NP perception of early implementation of FPA in Massachusetts.

METHODS

Qualitative descriptive design using inductive thematic analysis of open-ended responses to a web-based survey of NPs in Massachusetts from October to December 2021.

FINDINGS

Survey response rate was 50.3% (N = 144). Inductive thematic analysis of open-ended responses identified four themes, including: (a) internal and external barriers obstructed FPA implementation, (b) employer communication about scope-of-practice changes was minimal, (c) NPs led initiatives to implement FPA, and (d) some efforts effectively implemented FPA.

DISCUSSION

Almost 1 year after FPA was passed, external policies persisted that financially incentivized employers to not change NP scope-of-practice. Concerted efforts are needed to ensure that federal and payer policies, such as incident-to billing, are aligned with state law to encourage the implementation of FPA.

Chronicling the pursuit for full practice authority in Tennessee: Recommendations for a path forward

BACKGROUND

The quest for full practice authority (FPA) for Tennessee Advanced Practice Registered Nurses (APRNs) began with promise in the late 1960s. However, progress has stalled in the ensuing time, and prospects for advancing FPA do not look promising.

PURPOSE

The purpose of this article is to chronicle the pursuit of FPA in Tennessee, offer reflections on what has transpired to date, and suggest a path forward.

METHODS

Various data from various sources were used to chronicle the history of FPA in Tennessee, make the case for its need, and identify better approaches for success.

DISCUSSION

As one of a dwindling number of states without FPA, access to primary care health services and the economic vitality of Tennessee communities are of concern.

CONCLUSION

The path forward for achieving FPA in Tennessee necessitates changes in approach and players. Specific recommendations are offered.

A national postgraduate nurse practitioner and physician assistant fellowship in cystic fibrosis: An innovative approach to the provider shortage in complex and rare disease

ABSTRACT

Cystic fibrosis (CF) is a complex life-limiting genetic condition that affects the respiratory, digestive, reproductive system, and sweat glands. Advances in treatment have led to improved survival and quality of life. Today, most persons with CF live to adulthood but require highly specialized care at accredited CF Care Centers. The growing and aging CF population combined with the provider workforce shortage have increased the demand for qualified CF providers. Nurse practitioners (NPs) and physician assistants (PAs) have been providing CF care for decades, but most learned on the job. The Leadership and Education for Advanced Practice Provider (LEAPP) fellowship in CF care aims to address the provider gap, ease transition to practice, and ensure access to specialized care. Unlike other institutional based joint NP/PA fellowships, LEAPP was designed to train providers at various locations across the national CF care center network. The program is innovative in several ways: (1) LEAPP employs a flipped classroom that pairs an online curriculum with case-based virtual discussion with content experts from the CF care network; (2) fellows receive mentored clinical training at their home CF center; (3) LEAPP partnered with a university-based team to ensure best practices and evaluation for adult learners; and (4) LEAPP promotes organizational enculturation through program components of professional mentoring, quality improvement, and leadership. This innovative approach may be suitable for other complex conditions that require highly specialized care, such as sickle cell disease, spina bifida, and solid organ transplant.

Toward a new paradigm of care: a surgical leaders' Delphi consensus on the organizational factors of the new pancreas units (E-AHPBA PUECOF study)

Pancreas units represent new organizational models of care that are now at the center of the European debate. The PUECOF study, endorsed by the European-African Hepato-Pancreato-Biliary Association (E-AHPBA), aims to reach an expert consensus by enquiring surgical leaders about the Pancreas Units' most relevant organizational factors, with 30 surgical leaders from 14 countries participating in the Delphi survey. Results underline that surgeons believe in the need to organize multidisciplinary meetings, nurture team leadership, and create metrics. Clinical professionals and patients are considered the most relevant stakeholders, while the debate is open when considering different subjects like industry leaders and patient associations. Non-technical skills such as ethics, teamwork, professionalism, and leadership are highly considered, with mentoring, clinical cases, and training as the most appreciated facilitating factors. Surgeons show trust in functional leaders, key performance indicators, and the facilitating role played by nurse navigators and case managers. Pancreas units have a high potential to improve patients' outcomes. While the pancreas unit model of care will not change the technical content of pancreatic surgery, it may bring surgeons several benefits, including more cases, professional development, easier coordination, less stress, and opportunities to create fruitful connections with research institutions and industry leaders.

Healthcare professionals' perspectives towards the role of ward-based advanced practice nurses: A cross-sectional study

AIMS

1. To explore the perceptions of physicians, registered nurses (RN) and allied health professionals (AHP) towards the role of ward-based advanced practice nurse (APN). 2. To examine healthcare professionals' perception of APN role expansion in inpatient care.

DESIGN

Cross-sectional study.

METHODS

A 43-item survey comprising of five domains was conducted on healthcare professionals' perceptions towards ward-based APNs in five medical wards of a tertiary hospital from November 2022 to February 2023. The participants were recruited using convenience sampling via email and cross-platform messaging service.

RESULTS

A total of 181 completed respondents including 26 physicians, 102 nurses and 45 AHPs. Statistical analysis was performed with IBM SPSS Version 28.0. APNs were perceived to be spending a great extent of time across all five domains, namely, 'direct comprehensive care', 'support of systems', 'research', 'education' and 'publication and professional leadership'. Significant differences were noted in perceptions based on prior experience with APNs and between different healthcare professions. The majority recognized APNs' positive impact on patient safety, efficiency and patient-centeredness.

CONCLUSION

This study offers valuable insights into ward-based APNs' practice patterns, roles and impact, revealing a positive shift in their acceptance and expanding roles within inpatient general wards. It also highlights the valuable roles and impact of ward-based APNs in direct patient care, system support, research, education and leadership, despite ongoing challenges in role clarity, particularly in treatment planning and ward rounds.

IMPLICATIONS FOR THE PROFESSION

APNs are highly regarded as competent and a consistent personnel in the wards. However, there are divided views on clinical activities that APNs undertake.

IMPACT (ADDRESSING)

What problem did the study address? ○ Role ambiguity for ward-based APNs. ○ Healthcare professionals' readiness and acceptance of APNs. What were the main findings? ○ APNs are perceived to have a strong involvement in direct patient care, support of system, research, education and leadership. ○ APNs are recognized for their significant impact on patient safety, efficiency and patient-centredness, but there were varied perceptions on the extent of time they spend in different practice domains. ○ The critical roles of APNs participating in daily ward rounds and initiating discharge plans were highlighted, emphasizing their importance in timeliness and continuity of care. Where and on whom will the research have an impact? ○ It will affect healthcare professionals including physicians, nurses, allied health professionals and healthcare administrators by providing insights into the roles and contributions of ward-based APNs. ○ The findings will guide policymakers and nurse leaders in making informed decisions about the implementation and development of APN roles, ultimately improving patient care and outcomes.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Exploring a pilot alcohol and other drug (AOD) nurse practitioner mentoring program: Empirical research mixed methods: A pilot nurse practitioner mentoring program

AIM

To explore the effectiveness and acceptability of a pilot mentoring program for alcohol and other drug (AOD) nurse practitioners (also known globally as addiction nurse practitioners).

DESIGN

Mixed method evaluation.

METHODS

Two-phase evaluation comprising survey (demographics, pre- and post-program perceived competency and confidence) with 15 participants completing the pre survey and 10 participants completing the post survey, and qualitative interviews after the program with 10 participants.

RESULTS

The quantitative results indicate statistically significant increases in some domains of perceived competence and confidence in treatment. Qualitative findings indicate that participants valued peer support and mentoring from experienced nurse practitioners. Where formal residency or internship programs for nurse practitioners do not exist, informal mentoring programs may address issues inherent in nurse practitioner transition that may impact retention. We recommend further exploration of mentoring programs with larger sample sizes to determine if self-reported clinical improvements are noted.

IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE

Nurse practitioners are a vital part of the healthcare system; their advanced skills and knowledge place them in an ideal position to address prescriber shortages and access to care for populations underserved by healthcare. However, literature indicates that they are often underutilised, and transition to autonomous practice remains a challenge. Our exploration of a pilot mentoring program for nurse practitioners shows that their knowledge and perceived skills are high, yet peer assistance is valued in transitioning from advanced practice registered nurse to autonomous nurse practitioner. We recommend further trialling and evaluation of nurse practitioner mentoring programs to both increase supply of nurse practitioners and provide greater access to quality healthcare for underserved populations.

IMPACT

What problem did the study address? The ability of nurse practitioners to offer advanced practice interventions such as diagnosis and medication management potentially provides a solution to healthcare resource shortages. However, current literature indicates that advanced nurses transitioning to nurse practitioner roles suffer transition shock, leading to burnout and poor retention. What were the main findings? Although this pilot mentoring program shows significant improvements in survey responses on confidence and capability, qualitative data shows that neophyte nurse practitioners value peer support and mentoring from more experienced practitioners. Participants described maintaining ongoing connections with both mentors and fellow mentees, which aided transition to the role of autonomous nurse practitioner. Where and on whom will the research have an impact? The results of this pilot mentoring program indicate that there is benefit to these programs for neophyte nurse practitioners in many specialties. This paper indicates that mentoring programs for nurse practitioners may provide a community of practice and may have a positive impact on transition shock.

REPORTING METHOD

Good Reporting of a Mixed Methods Study (GRAMMS) checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Home ventilation in low resource settings: Learning to do more, with less

Long-term ventilation (LTV) in children at home, especially invasive ventilation, is not widely available nor practised in low-resource settings (LRS). Barriers to providing LTV include underdeveloped pediatric critical care services, limited expertise in pediatric LTV, limited capacity to screen for sleep-disordered breathing (SDB) and high cost of LTV equipment and consumables. Additional challenges encountered in LRS may be unreliable electricity supply and difficult socioeconomic conditions. Where LTV at home has been successfully implemented, caregivers and families in LRS must often take full responsibility for their child's care as professional home-based nursing care is scarce. Selecting suitable children and families to offer LTV in LRS may therefore face difficult ethical decisions when families are disempowered or incapable of providing 24-h care at home. Early caregiver participation and hands-on training in tracheostomy care and LTV equipment is key to success, irrespective of the caregiver's level of education. The use of overnight oximetry, mobile phone technology, spirometry, and clinical evaluation are simple tools that can aid recognition and monitoring of children needing LTV. As children survive longer supported by LTV, engaging with adult services at an early stage is important to ensure suitable pathways for transition to adult care are in place. Building capacity and expertise in pediatric LTV in LRS requires targeted training of health professionals in related disciplines and advocacy to policymakers and funders that LTV in appropriately selected circumstances is worthwhile, life-changing, and cost-saving.

Continuing education for advanced practice nurses: A scoping review

AIM

The aim of the study was to identify the nature and extent of scientific research addressing continuing education for advanced practice nurses.

DESIGN

A scoping review.

REVIEW METHODS

The Joanna Briggs Institute's methodology for scoping reviews.

DATA SOURCES

Electronic search was conducted on 17 September 2023 via CINAHL, PsycINFO, PubMed, Scopus, Web of Science, Cochrane Library and the Joanna Briggs Institute's Evidence-Based Practice Database for research articles published between 2012 and 2023.

RESULTS

Nineteen papers were included in this review. Scientific research on continuing education for advanced practice nursing roles (i.e. nurse practitioner, clinical nurse specialist) has primarily been conducted in the United States and mostly addresses online-delivered continuing education interventions for clinical care competency. Most of the interventions targeted nurse practitioners.

CONCLUSION

Continuing education has a pivotal role in supporting advanced practice nursing competency development. In addition to clinical care, future continuing education research should focus on other advanced practice nursing competencies, such as education, leadership, supporting organizational strategies, research and evidence implementation.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Continuing education programmes for advanced practice nurses should be rigorously developed, implemented and evaluated to support the quality and effectiveness of patient care.

IMPACT

Continuing education for advanced practice nursing roles is an understudied phenomenon. This review highlights future research priorities and may inform the development of continuing education programmes.

REPORTING METHOD

PRISMA-ScR.

Setting up a nurse-led 2-week-wait head and neck cancer diagnostic service

The number of urgent '2-week-wait' referrals to hospital for people with suspected head and neck cancer being sent by primary care is constantly growing and it is becoming increasingly difficult for head and neck cancer services to meet this demand. In order for trusts to meet their Faster Diagnosis Standards, there needs to be an effective and efficient way to ensure there is capacity for patients to receive the appropriate assessments and diagnostic investigations without compromising the quality of care delivered. This article presents the proposal of introducing a nurse-led 2-week-wait clinic to meet the ever-growing demands on the service. There is discussion of the consultant-led training programme used to upskill an advanced nurse practitioner in a single-centre study, as well as explanation of the processes followed to maintain patient safety throughout the pilot project. There will also be consideration of clinical governance and discussion of how patient satisfaction with the novel service will be measured.

Staffing and Workload in Primary Care Facilities of Selected Geographically Isolated and Disadvantaged Communities in the Philippines

Background and Objective

Staffing shortages and health inequities are persistent barriers in the Philippines toward achieving universal health care. To ensure an adequate and responsive health workforce, there is a need to evaluate the Human Resources for Health (HRH) status across health facilities, particularly those in underserved communities. Hence, this study aims to determine the staffing requirements and workload pressure among primary care facilities in selected geographically isolated and disadvantaged areas (GIDAs) in the Philippines.

Methods

The study utilized the workload indicators of staffing need (WISN) methodology from the World Health Organization to determine the staffing and workload situation among three health worker cadres (physicians, nurses, and midwives) in the study sites. Particularly, six primary care facilities (four rural health units and two community hospitals) located in Surigao del Norte were involved in the study. WISN-related data (health service statistics, available working time, and health professionals' workload components) were collected through records review, focus group discussions, and key informant interviews. The WISN software was used to analyze the staffing levels and workload pressure in the selected facilities.

Results

A total of 40 health workers, including physicians (n = 5, 13%), nurses (n = 21, 52%), and midwives (n = 14, 35%) participated in the study. The findings noted varying levels of staffing and workload pressures among the three cadres in selected primary care facilities, which were influenced by several factors. Particularly, health facilities with additional human resources obtained from deployment programs indicated adequate staffing and low to normal workload pressures. However, further analysis revealed potential HRH maldistribution and reliance on the temporary nature of the staff augmentation program in delivering primary care services, which need to be addressed to optimize health workforce planning. Service workload may also have been impacted by the temporary closure of health facilities due to disasters. Among the few cadres that reported staffing shortage and high workload pressure, these were due to higher service demands, increased task delegation, and inadequate service coordination. Hence, context-specific challenges and situational factors in GIDAs need to be considered when determining the staffing and workload requirements.

Conclusion

There is a need to improve the capacities of health facilities and local government units (LGUs) to engage in evidence-based HRH planning through the WISN methodology. Doing so could improve staffing and workload distribution among health care facilities in the country. Moreover, interorganizational collaboration (DOH, LGUs, and health facilities) should be strengthened to improve delineation and prevent duplication/omission of health services, rationalize HRH distribution and augmentation, and streamline the priority health services based on the local contextual factors.

Advancing Nursing Practice to Forward Universal Health Care in the Philippines

     The constantly changing healthcare landscape requires the health workforce to enhance their competencies and respond to the complex needs of the population they serve. In the Philippines, Universal Health Care (UHC) is a national priority, which aims to ensure equitable access to affordable and quality health services for all Filipinos. The UHC Act (Republic Act No. 11223)1 stresses that the health system provides comprehensive services across the spectrum of health promotion, illness prevention, health restoration, rehabilitation, and palliation. Moreover, the UHC primarily requires health service delivery to be people-centered, cognizant of their necessities, culture, and values. Primary Health Care, which involves accessible, continuous, and comprehensive care from initial patient contact, together with coordinated care among healthcare workers, is the most inclusive and effective means to achieve UHC.2 Therefore, an adequately supplied and well-equipped human health resources are crucial to guarantee that population’s healthcare needs are appropriately recognized, prioritized, and addressed.    The Philippines continues to face health problems as it aims to achieve UHC, considering the underserved populations suffering from high prevalence of communicable and non-communicable diseases, adolescents and young adults confronting the epidemic of sexually transmitted infections, mothers and newborns dying from preventable causes, and older adults requiring increased healthcare demands. While policymakers continue to explore reasonable means to address these problems, what is clear is that the status quo in the current health system cannot be allowed to persist. Rather, health agencies should be reoriented, and the healthcare workforce supported to respond to the growing, yet preventable healthcare problems.    Nurses are critically positioned to advance the universal health care of Filipinos. With almost half of the health workforce both locally and globally,3 nurses can significantly contribute to the country’s objective of achieving better health outcomes – by promoting health and preventing illnesses among the well and at-risk groups, supporting the treatment of the sick and disabled, and empowering families and communities to attain health and well-being. As nurses provide quality care in various settings, particularly in primary health care, enabling nurses to practice their profession fully can contribute to the goal of “Health for All”. Hence, we enjoin the call for the development and implementation of advanced practice nursing in the Philippines, aiming to provide safe, quality, accessible, and affordable healthcare.    An advanced practice nurse (APN), as defined by the International Council of Nurses, is one who has an “expert knowledge base, complex decision-making skills, and clinical competencies for expanded nursing practice,” wherein such qualities are influenced by the country or context where the person is certified to practice.3 The last phrase emphasizes that the APN scope of practice is heterogeneous across nations and is shaped by the local healthcare situation. Nonetheless, it should be stressed that the APN is essentially a nursing role and is rooted in principles inherent in the profession. Therefore, APNs should not be perceived as substituting for another practice role, competing with other professionals, or obtaining domain expertise from other healthcare disciplines. Instead of utilizing the traditional biomedical model, APNs are guided by interdisciplinary knowledge and nursing, which places the patient at the center of healthcare. This is because the APN role is grounded on the core of nursing – caring. 4 Notably, facilitating a holistic approach, fostering effective communication, and building therapeutic relationships are crucial to human caring practice, which can be articulated well through advanced practice.4 APNs aim to manage not only the physical domains of persons nursed, but also their psychosocial or spiritual needs across the health continuum. Such aspects of care are consistent in achieving UHC through primary health care, that is, meeting the health needs of persons across the lifespan with accessible and comprehensive healthcare services delivery.    A recent global survey of low- and middle-income countries incorporating advanced practice nursing in their health systems revealed that the primary reason for developing APN roles was the need to care for underserved populations.5 This is particularly relevant to the Philippines, where healthcare access remains a significant challenge for those in geographically isolated and economically disadvantaged communities. Meanwhile, a country-wide study by the Department of Health and the United States Agency for International Development (USAID) in 2019 revealed that primary care workers, including nurses and midwives, performed their duties beyond their professional training due to significant taskshifting and sharing, thereby recommending the need to revise their scopes of practice.6 In particular, a study in this Nursing Issue reported that nurses working in some underserved areas prescribed and administered medications for common illnesses, ordered laboratory examinations, sutured skin lacerations, and facilitated labor and deliveries, upon collaborative agreements with the physicians.7 With the literature reporting positive results in client satisfaction, cost-effectiveness, consultation waiting times, and chronic disease management from APN-facilitated care,8 the development and integration of APNs in the local health system could be a promising means to promote better healthcare access for all Filipinos.    The country’s progression toward the integration of APNs in the health system requires support from various stakeholders, including professionals, healthcare and educational institutions, and government agencies. This is because additional education, training, certification, and regulation are needed for APNs to provide health services effectively and legally. Moreover, the perennial shortage of health workers is another potential barrier toward this endeavor. Nevertheless, advanced practice nursing might promote better career advancement and salary opportunities for our Filipino nurses, which could aid in improving their recruitment and retention. This is consistent with the recommendations of a national policy dialog to support the resilience and retention of healthcare workers beyond the COVID-19 pandemic, which is reported in this Nursing Issue.9 The Philippines can learn from more than 70 countries on how to facilitate the development and integration of APNs in our health systems.3 It should be noted that such numbers include developing countries in Asia and Africa, as they realized the importance of APNs in delivering quality and accessible health services to their constituents.    Today more than ever, nurses provide safe and quality care to patients beyond the hospital walls – building relationships and fostering partnerships with communities to empower them towards better health. Thus, we reiterate the call among various local and national agencies to support the advancement of nursing practice to provide primary care across communities, which will contribute to forwarding UHC in the country. As underscored by the WHO Declaration of Astana in 2018,10 Health for All could be realized by investing in the education, development, recruitment, and retention of health human resources prepared to deliver primary health care to the population.

Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review

BACKGROUND

Advanced practice providers (APPs), including physician assistants/associates (PAs), nurse practitioners (NPs) and other non-physician roles, have been developed largely to meet changing healthcare demand and increasing workforce shortages. First introduced in primary care in the US, APPs are prevalent in secondary care across different specialty areas in different countries around the world. In this scoping review, we aimed to summarise the factors influencing the development, recruitment, integration, retention and career development of APP roles in hospital health care teams.

METHODS

We conducted a scoping review and searched Ovid MEDLINE, Ovid Embase, Ovid Global Health, Ovid PsycINFO and EBSCOhost CINAHL to obtain relevant articles published between Jan 2000 and Apr 2023 that focused on workforce management of APP roles in secondary care. Articles were screened by two reviewers independently. Data from included articles were charted and coded iteratively to summarise factors influencing APP development, recruitment, integration, retention and career development across different health system structural levels (macro-, meso- and micro-level).

RESULTS

We identified and analysed 273 articles that originated mostly from high-income countries, e.g. the US (n = 115) and the UK (n = 52), and primarily focused on NP (n = 183) and PA (n = 41). At the macro-level, broader workforce supply, national/regional workforce policies such as work-hour restrictions on physicians, APP scope of practice regulations, and views of external collaborators, stakeholders and public representation of APPs influenced organisations' decisions on developing and managing APP roles. At the meso-level, organisational and departmental characteristics, organisational planning, strategy and policy, availability of resources, local experiences and evidence as well as views and perceptions of local organisational leaders, champions and other departments influenced all stages of APP role management. Lastly at the micro-level, individual APPs' backgrounds and characteristics, clinical team members' perceptions, understanding and relationship with APP roles, and patient perceptions and preferences also influenced how APPs are developed, integrated and retained.

CONCLUSIONS

We summarised a wide range of factors influencing APP role development and management in secondary care teams. We highlighted the importance for organisations to develop context-specific workforce solutions and strategies with long-term investment, significant resource input and transparent processes to tackle evolving healthcare challenges.

The role of an advanced practice midwife in perinatal mental health: Outlining the process of role development and implementation

INTRODUCTION

Perinatal mental health disorders (PMDs) are a global health concern. In industrialized countries, the prevalence of PMDs is estimated to be 20%, and they are associated with serious negative effects for women, their children and their families, along with high societal costs related to long-term impacts. In Switzerland, the PMD detection rate during obstetrical healthcare provision is very low (1-3%), and specialized healthcare services are limited. This study aimed to develop and implement an advanced practice midwife (APM) role at a Swiss obstetrics and gynecology hospital using the PEPPA framework to provide adequate screening and first-consultation services.

METHODS

The study uses a qualitative approach and follows the research stages using the 8-step from the participatory, evidence-based, patient-focused process for advanced practice nursing role development, implementation and evaluation (PEPPA) framework to develop and implement the APM role.

RESULTS

Utilizing the PEPPA framework, we were able to develop, implement, and evaluate the APM role in the field of perinatal mental health. Through appropriate screening and first-consultation services, we were able to identify affected women early and facilitate treatment.

CONCLUSIONS

In addition to stakeholder engagement and interprofessional collaboration, PEPPA serves as a beneficial framework for the process of role development, implementation, and evaluation in the midwifery profession. This study aims to assist midwives with Master's degrees in establishing corresponding roles within their practice areas, thereby enhancing care delivery. Furthermore, the current APM approach is intended to be continuously evaluated to gain new insights into its effectiveness.

Nurse practitioners' degrees and associations with time use, functional autonomy, and job outcomes

BACKGROUND

Doctorate of Nursing Practice preparation is recommended for entry to nurse practitioner (NP) practice but there are few comparative studies, and their designs conflate educational pathways.

PURPOSE

To investigate time use, functional autonomy, and job outcomes among NPs without a doctorate, NPs whose initial NP preparation and doctorate were separated by 2 or more years, and NPs whose NP preparation and doctorate were concurrent.

METHOD

We selected all NPs from the 2018 National Sample Survey of Registered Nurses, except those whose doctorates focused on research. We controlled for confounding and applied sample weights to produce nationally representative results.

DISCUSSION

NPs' educational pathways are associated with distinct practice roles and, moving forward, policy should be informed by evidence that accounts for their differences.

CONCLUSION

Concurrent NPs had higher levels of functional autonomy compared with NPs without a doctorate, but patterns of time use were essentially the same. Separate doctoral education was associated with teaching and administration.

The deployment of advanced practice nurses in the French health system: From clinics to professional networks

AIM

The aim of this study is to contribute to an understanding of the role deployment of advanced practice nurses (APNs) in French healthcare settings.

INTRODUCTION

The introduction of APNs was formalised in France by the decrees issued on 18 July 2018, which described the areas, activities and training of APNs.

BACKGROUND

A qualitative study on the role implementation of APNs was conducted between July 2021 and May 2022 following a call for projects launched by the Île-de-France Regional Health Agency to evaluate the deployment of APNs in the area.

METHODS

Data were collected through field observations and semi-structured interviews in order to explore both the APNs deployment processes in nine healthcare structures and the roles played by APN networks and associations with regard to the deployment of APN activities in their working environments.

RESULTS

The projects proved to be evolutionary, and their development was marked by various forms of APN isolation and multiple obstacles that were specific to their professional practice settings. Some APNs relied on a variety of forms of mutual assistance and advocacy deployed throughout APN networks and associations.

DISCUSSION

The deployment of APNs' role was impacted by diverse configurations of professional power relations and the nature of the obstacles that were structural for APNs in primary care. Their experience of isolation derived from the novelty of their role, the challenge they posed to the cohesion of the nursing profession and a lack of supportive policies for their deployment. Their participation in APN networks and associations enabled them to access advocacy and manage the uncertainties and unknowns related to the deployment of their activities.

CONCLUSION

The results suggest that the formalisation of schemes for mutual assistance among APNs and advocacy should be integrated into the guidelines for the implementation of their role.

IMPLICATIONS FOR NURSING POLICY

APN policy should strengthen a bottom-up approach, relying in particular on the development of different forms of collaboration and communication between APN networks and associations on the one hand and the public authorities on the other.

Implementation strategy for advanced practice nursing in Gabon: A multicenter mixed-method study

AIM

To describe the expectations, acceptability, and challenges identified by nurses and key healthcare stakeholders regarding the implementation of advanced practice nursing in Gabon.

BACKGROUND

Advanced practice nursing presents an opportunity to address the epidemiological transition and the shortage of healthcare professionals in Africa. In anticipation of establishing a master's degree program in advanced practice nursing and its subsequent implementation, it is important to understand Gabon's specific needs and characteristics.

DESIGN

This study used a multicenter cross-sectional mixed-method design.

METHODS

From April to May 2022, a total of 187 healthcare professionals were included from two hospitals and two universities in Gabon. Data were collected through questionnaires and complemented by focus group discussions, guided by the existing literature, the PEPPA framework, and Hamric's model.

RESULTS

The implementation of advanced practice nursing was generally well accepted. Factors influencing acceptability included being female, awareness of advanced practice nursing, and supporting the role of advanced practice nurses in diagnosing chronic diseases. Barriers to implementation included the absence of a legal framework for the profession and a lack of recognition of nursing skills by both nurses and doctors. Facilitators included the establishment of a master's degree program, formalization of a legal framework, raising awareness, providing training to medical doctors and other healthcare professionals about advanced practice nursing, and the development of nursing leadership.

IMPLICATIONS FOR NURSING

Advanced practice nursing can play a crucial role in addressing healthcare resource shortages and the dual burden of chronic and infectious diseases in Gabon, as well as in other African countries.

IMPLICATIONS FOR NURSING POLICY

To successfully implement advanced practice nursing in Gabon and French-speaking Africa, it is essential to regulate the nursing and advanced nursing professions by creating a legal framework and establishing nursing councils. An effective implementation strategy for advanced practice nurses should be based on the specific needs of the country.

GUIDELINES

COREQ, STROBE.

Advanced practice nurse roles in Europe: Implementation challenges, progress and lessons learnt

BACKGROUND

Advanced practice nursing (APN) roles offer improved access to care and increased quality and more timely care. Despite the advantages of APN roles, there is a disparity between European countries when it comes to implementing APN roles.

AIM

To explore the implementation of APN roles in a range of European countries and to explore what factors facilitate or hinder the implementation of these roles.

METHODS

A case study evaluation of the process of implementing APN roles. The sample included four countries where APN roles were well developed (Ireland, Spain, Norway and the United Kingdom) and four where APN roles were implemented (Estonia, Slovenia, Cyprus and Romania). Interviews were conducted with key informants (n = 28) from government departments, regulatory bodies, nursing associations and universities. The consolidated criteria for reporting qualitative research (CPREQ) has been used throughout.

LIMITATIONS

The small number of countries when considering the size of the region and key informants representing the view of only three to four people in each country.

RESULTS

Four themes were identified, including the rationale for the development of the roles, influence, the evolutionary nature of role development and evidence. The data also revealed a mismatch between the perceptions of how the roles develop among the different countries in the early stages of implementation.

CONCLUSION

Successful role implementation is dependent upon a tripartite approach between managers, practitioners and educators. An evolutionary approach to role development was used. Regulation and policy come later on in the process of implementation.

IMPLICATIONS FOR NURSING POLICY

APN policy should be based on patient needs rather than on the workforce or professional imperatives. The process of implementation can take 15-20 years in total. Recognising the importance of the relationships between service managers and educators is key to the early development of these roles.

How do healthcare professionals and managers view the role of the advanced practice nurse?

BACKGROUND

Advanced practice nurses (APN) growth depends on the implementation and acceptance of APNs in each country.

INTRODUCTION

Given the diversity of the different contexts and varying population health needs where APNs are developing, this study focuses on exploring the viewpoints of the multidisciplinary and management team who have worked with APNs in public hospitals in Catalonia, Spain.

METHODS

A cross-sectional study with previously identified APNs, health professionals, and health managers. EVOHIPA, a valid and reliable scale, was used. The STROBE checklist was followed.

FINDINGS

The results showed high levels of agreement among the 746 participants (predominantly physicians and nurses), with statements relating to the APN's contribution in enhancing care continuity and processes, resulting in safer and more patient-centered care. The results showed low levels of agreement with statements relating to legal support for the APN position, regulation, and practice scope.

DISCUSSION

The study provides discussion elements and reflection to determine the axes on which it will be necessary to act to promote APNs and their conditions of service in the context of practice within hospital teams.

CONCLUSION

The study highlights the differences in opinion on APN roles among health professionals and managers who have worked with APNs and allows exploring expectations about current changes in workflows and clinical activities among healthcare team members.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Results highlight the importance of fostering a common understanding among healthcare teams to maximize the benefits of collaborative work and recognize the significant contributions of APNs within the multidisciplinary team. Health policy plays a crucial role in recognizing and promoting the contribution of APNs within hospital healthcare teams, acknowledging their autonomy and expertise in improving patient outcomes.

American Association of Nurse Practitioners Research Agenda, 2023-2028

ABSTRACT

This report highlights the 2023-2028 American Association of Nurse Practitioners Research Agenda (AANP-RA), which focuses on the research goals of AANP as an organization and is based on its mission and strategic plan. The purpose of the AANP Research Agenda is to outline research priorities that advance the AANP Strategic Plan and concurrently address gaps in nursing science. American Association of Nurse Practitioners supports research studies that are rigorously designed and conducted using quantitative, qualitative, and mixed-methods approaches, as well as implementation science with the potential to positively impact both NP practice and patient health outcomes. The AANP-RA strategy is guided by the PEARL acronym: examining NP Practice, Education, policy Advocacy, Research, and Leadership. A discussion of each area is presented along with suggested topics.

Nurses' Role in the Control and Treatment of Asthma in Adults: A Systematic Literature Review

Bronchial asthma is a chronic pathology and a global public health problem. However, asthma can be controlled and treated for the most part by patients, so the Portuguese General Directorate of Health recommends shared medical appointments in primary health care (PHC). The present study aims to identify the role of PHC nurses in the control and treatment of asthma in adults. Using the MeSH platform, the following descriptors were validated: asthma, nurses, adults. An individual search was carried out in the following databases: CINAHL (ESBSCO host), MEDLINE (Pubmed host), Web of Science, and Scopus. Out of a total of 280 publications, 79 of which were duplicates and 185 publications which did not meet the inclusion criteria, 16 publications remained readable. Of the eligible articles, there were 13 specialist reports, one mixed study, one quasi-experimental study, and one randomized trial. Education was the intervention most identified in the scientific evidence analyzed, and patient assessment, application of an asthma control questionnaire, verification and training of inhalation technique, empowerment for self-management of the disease, support, promotion of seasonal influenza vaccination, and use of written action plans were also identified. The results reveal that, although the scientific evidence on the intervention of these professionals is poorly developed, nurses play a crucial role in the control and treatment of asthma. The scientific evidence analyzed allowed the identification of interventions that can help the organization of a nursing health appointment, providing nurses with a crucial role in the control and treatment of asthma in adults in the context of PHC.

Reconsidering the Role of Nurse Practitioners in Japan: What Direction Should Japanese Nurse Practitioners Aim for?

This article explores the dynamic role of nurse practitioners in Japan, contextualized against an aging population and declining birth rates. It emphasizes the imperative for Japanese nurse practitioners to broaden their scope of practice to effectively meet the nation's diverse healthcare demands within a constrained resource framework. The study highlights the critical need for Japan to align its nurse practitioners' training with international educational standards, advocating for a graduate-level curriculum that blends in-depth theoretical knowledge with practical skillsets. Central to the discourse is task shifting, wherein nurse practitioners progressively undertake duties traditionally associated with physicians. This expansion of roles requires meticulous evaluation to ensure its contribution to the efficacy of the healthcare system. The article identifies nurse practitioners as pivotal in team-based medical care, proficient in merging medical and nursing perspectives, and essential in facilitating communication and coordination among varied medical professionals. Comparative analysis of international nurse practitioner practice models reveals a necessity for Japan to enhance the scope and responsibilities of its nurse practitioners. Furthermore, the paper addresses the need for a comprehensive reevaluation of Japan's legal and policy framework concerning clinical nursing, aiming to redefine roles and responsibilities more distinctly. The article advocates for systemic reforms, particularly in education and multi-professional collaboration. These changes are deemed vital for Japanese nurse practitioners to respond to evolving healthcare needs effectively, ultimately elevating the standard of healthcare provision in Japan for a global audience.

Strategies employed by developed countries to facilitate the transition of internationally qualified nurses specialty skills into clinical practice: An integrative review

BACKGROUND

Recruitment of internationally qualified nurses as a labour source is a long-standing human resource strategy being implemented to address the current and increasing global nursing shortage. Internationally qualified nurses transitioning into the health workforce of developed countries following immigration often possess specialty skills. A lack of a clear pathway of specialty skill utilisation makes recognising and using these specialty skills complex for many nurses. The ability for nurses to transition between countries and maintain specialty practice demands immediate attention in the current atmosphere of the global pandemic and the predictions to recruit more specialist nurses from overseas.

AIM

To identify and synthesise strategies taken by various developed countries in transitioning specialist internationally qualified nurses into practice.

METHODS

An integrative review was conducted to identify common themes, patterns, and best practices in order to inform policy development and improve the successful integration of internationally qualified nurses into the healthcare systems of developed countries. The study employed the Whittemore and Knafl five-stage integrative review approach. To conduct a comprehensive search, four electronic databases, namely Medline, CINAHL Complete, ProQuest Health, and EMBASE, were systematically searched in October 2021. The search was updated in March 2022 to ensure the inclusion of the most recent literature. Additionally, Google Scholar was utilised to avoid overlooking any important articles. Prior to the full-text review, three reviewers independently evaluated titles and abstracts. The included papers' quality was determined using the JBI critical appraisal tools.

RESULTS

This study included 10 papers, comprising three studies and seven reports. However, none of these documents provided information on how internationally qualified nurses could transfer their specialty skills acquired overseas to developed countries after immigrating. The guidelines and policies reviewed only offered generic advice on becoming a specialist nurse. Although some countries mentioned that post-graduate qualifications were not mandatory for nurse specialists, the majority of documents in this review emphasised the need for a national framework of education at level eight or higher (equivalent to a post-graduate level) to attain the status of a nurse specialist. Moreover, the included documents did not provide clear information on whether an international specialisation degree would be recognised during the registration process. As a result, confusion persists regarding the requirement of post-graduate qualifications for nurses aiming to specialise and the recognition of international specialisation degrees during the registration process.

DISCUSSION

The lack of consistency in defining nurse specialty and the skill transferability among institutions and state borders were evident in this review. According to all the 10 documents analysed, developed countries appear to have minimum policies on the transfer of internationally qualified nurse's specialty skills. Recommendations for policymakers, employers, and aspirant migrants have been proposed. Limited research has been done on how developed countries used their internationally qualified nurses' overseas-acquired specialist skills after immigration, indicating a lack of a distinct specialist skill transition pathway.

CONCLUSIONS

This review presents data to support the need for greater research in this area to better utilise the abilities that internationally qualified nurses bring from their home country and put them to constructive use in the host country, especially in the context of a global pandemic.

Prognosis Discussion and Referral to Community Palliative Care Services in Patients with Advanced Pancreatic Cancer Treated in a Tertiary Cancer Centre

Advanced pancreatic cancer is associated with a poor prognosis, often less than 1 year. Honest prognosis discussions guide early community palliative care services input, facilitating timely advance care planning and improving quality of life. The aims were to assess if patients were offered prognosis discussions and community palliative care services referral. A retrospective analysis of consecutive case-notes of new advanced pancreatic cancer patients was conducted. Chi-squared test assessed the association with prognosis discussion and community palliative care services referral. In total, 365 cases (60%) had a documented prognosis discussion at any time-point in the treatment pathway; 54.4% during the first appointment. The frequency of prognosis discussion was greater with nurse clinician review at first appointment (p < 0.001). In total, 171 patients (28.1%) were known to community palliative care services at the first appointment. Of those not known, 171 (39.1%) and 143 (32.7%) were referred at this initial time-point or later, respectively. There was a significant association between the referral to community palliative care services at first appointment and the reviewing professional (this was greatest for nurse clinicians (frequency 65.2%)) (p < 0.001), and also if reviewed by clinical nurse specialist at first visit or not (47.8% vs. 35.6%) (p < 0.01). Prognosis discussions were documented in approximately two-thirds of cases, highlighting missed opportunities. Prognosis discussion was associated with clinician review and was most frequent for nurse clinician, as was referral to community palliative care services. Clinical nurse specialist review increased referral to community palliative care services if seen at the initial visit. Multi-disciplinary review, specifically nursing, therefore, during the first consultation is imperative and additive. It should be considered best practice to offer and negotiate the content and timing of prognosis discussions with cancer patients, and revisit this offer throughout their treatment pathway. Greater attention to prognosis discussion documentation is recommended.

Nursing workforce characteristics and effect on life expectancy and under-five mortality in the ASEAN

AIM

To assess the effects of the nursing workforce and advanced nursing practice on the outcomes of patients and life expectancy, including mortality rates of under-five children in Cambodia, and to develop policy recommendations to increase the influence of the nursing workforce.

BACKGROUND

In low-middle-income nations, life expectancy and under-five mortality are important measures of public health. However, there is still a dearth of literature related to the nursing workforce in Southeast Asia.

METHOD

The authors retrieved the data from the World Nursing Report produced by the World Health Organization 2020 for 10 member states. The transparent reporting of a multivariable prediction model for individual prognosis or diagnosis checklist has guided this study. The univariate linear regression model was applied to categorize the potential predictors for each outcome assessment. In addition, the Spearman rank correlation test was selected to assess the potential predictors, and a multivariate statistical analysis was carried out for each of the five outcomes.

RESULTS

According to the study's findings, nurse density and advanced practice nursing improve both female and male life expectancy. The existence of advanced nursing roles is associated with decreased under-five mortality.

CONCLUSIONS

There are great opportunities to improve the nursing workforce within Cambodia and other Association of Southeast Asian Nations member states to increase patient outcomes. Investment in nursing is essential for improved patient outcomes.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Health policy investments in these projects and future initiatives intended to advance nurse density, education, and practice are based on this study's results. Policy initiatives should focus on increasing density because nursing appears to impact life expectancy and other outcomes.

An Evaluation of an Advanced Practice Provider Led Weight Intervention in Liver Disease (WILD) Pathway

Within the scope of their practice, advanced practice providers provide similar patient care as physicians, but in some cases have outperformed physicians in terms of health outcomes, satisfaction, and cost-effectiveness. At an academic medical center, hepatology trained advanced practice providers, who were also certified in obesity management, led an interprofessional team to develop the Weight Intervention in Liver Disease pathway. In September 2018, patients who were seen in the hepatology practice and met criteria for enrollment were referred to the Weight Intervention in Liver Disease program for comprehensive care of obesity and related metabolic disorders. A program evaluation was conducted in 2021 to identify whether the effectiveness of the advanced practice provider-led structure and process, and the Weight Intervention in Liver Disease pathway, supported weight loss goals as well as improvement in alanine aminotransferase levels, patient satisfaction, and provider satisfaction. Results found that the structure of the pathway and the implementation are resulting in positive outcomes of 100% patient satisfaction, 80% provider satisfaction, and a total average sustained weight loss of 5.05% ( SD = 7.98, p < .01). A weight loss pathway led by trained advanced practice providers proves successful in long-term weight loss goals.

Using an individualized pain management plan for African American adults with sickle cell disease

BACKGROUND

The increased lifespan of individuals having sickle cell disease (SCD) causes an overall increase in hospitalizations and more instances in which pain may not be well controlled.

LOCAL PROBLEM

The mainstay treatment for severe pain is opioids and the underlying cause. Laws affecting opioid prescribing, implicit bias, racial inequity, poor research funding, and lack of knowledge contribute to poor patient outcomes.

METHOD

Data were collected retrospectively using electronic medical record data from before and after the intervention.

INTERVENTION

The individualized pain management plan (IPMP) was initiated in collaboration with the patient, pain nurse practitioner (NP), and hematologist.

RESULT

The mean length of stay for the traditional pain management plan (TPMP) was 7.89 days compared with 5.66 days for the IPMP, with a mean difference of 2.23 days, t = 2.278, p = .024 ( p < .05). There was a decrease in the admission of the individuals with the IPMP, with 25% readmitted within 30 days of discharge, versus 59.0% who were readmitted using the TPMP. Chi-square showed statistical significance (χ 2 = 61.667, p = .000) in using nonpharmacological interventions with the IPMP group.

CONCLUSION

The IPMP with a patient-centered approach did improve patient outcomes for African American adults living with SCD.

A first census of skin cancer specialist nurses across UK secondary care trusts

BACKGROUND

Skin cancer specialist nurses (SCSNs) support patients and work alongside healthcare professionals throughout the care pathway. Skin cancer management is rapidly evolving, with increasing and more complex treatment options now available, so the need for patient support is growing. While SCSNs are a major source of that support, the provision of SCSN resource across the UK has never previously been assessed. We therefore undertook a first SCSN census on 1st June 2021.

METHODS

An electronic survey was disseminated to UK hospital trusts and registered skin cancer healthcare professionals. Responses were identifiable only by the respective trust name.

RESULTS

112 responses from 87 different secondary care trusts were received; 92% of trusts reporting having at least 1 established SCSN post. Average SCSN staffing per trust was 2.4 (range 0-7) whole time equivalents, managing an average caseload of 83 (range 6-400) patients per week. SCSN workload had increased in 82% hospitals in the previous year and 30% of trusts reported being under-resourced. Most SCSN time was spent managing melanoma (as opposed to non-melanoma skin cancer) patients linked to surgical services. Regional variations existed, particularly associated with provision of lymphoedema services, nurse prescribing skills and patient access to clinical trials. The COVID-19 pandemic was associated with a marked increase in SCSN-led telemedicine clinics, but loss of training and education opportunities.

CONCLUSIONS

SCSNs based in secondary care hospitals play a major role supporting both clinicians and patients throughout the care pathway. This first UK census confirmed that SCSN workload is increasing and in one third of hospital trusts, the work was reported to outstrip the staffing available to manage the volume of work. Regional variations in SCSN resource, workload and job role, as well as availability of certain skin cancer services were identified, providing valuable information to healthcare commissioners concerned with service improvement.

The Patient Experience of Adolescents With Traumatic Injuries: Recommendations for Improvement

GOAL

Positive patient experience is associated with less healthcare utilization, better treatment adherence, increased likelihood of returning to the same hospital, and fewer complaints. However, hospitals have been able to collect few insights into the experiences of pediatric patients due to age limitations. As an exception to that reality, adolescents (aged 12-20 years) are able to share their experiences and recommend improvements, yet little is known about their hospital experiences with traumatic injuries. We examined the patient experience of adolescents with traumatic injuries and collected their recommendations for improving care.

METHODS

We conducted 28 semistructured interviews with English-speaking adolescents hospitalized at two trauma Level 1 hospitals (pediatric and adult) for physical injuries from July 2018 to June 2021. Interviews were transcribed and analyzed using modified thematic analysis.

PRINCIPAL FINDINGS

The patients expressed three basic desires: (1) autonomy and active involvement in their care, (2) human connections with their clinicians, and (3) minimal discomfort. Study participants provided actionable recommendations for improving the patient experience for adolescents with traumatic injuries.

PRACTICAL APPLICATIONS

Hospital administrators and clinicians can improve the patient experience for adolescents in their care by sharing information, expectations, and goals with them. Hospital administrators can also empower the clinical staff to connect with adolescents with traumatic injuries on a personal level.

Contributions of Advanced Practice Nursing to Primary Health Care: A Scoping Review

Objective: To map the contributions and strategies to implement advanced practice nursing in primary health care. Materials and methods: This scoping review was carried out following the guidelines of the Joanna Briggs Institute in six databases, namely: LILACS, MEDLINE, WoS, Embase, CINAHL, and Scopus, in addition to a bibliographic repository. A total of 3,076 studies were found, from which 12 were selected. Results: The contributions mentioned by the studies regarding advanced practice nursing were divided into three subcategories, as follows: care, educational or management, and preventive practices. They concern autonomy, specialized clinical skills, therapeutic counseling, and patient-centered interaction. Some strategies to implement advanced practice are related to continuing education, practice management, self-care, and disease management. Conclusions: There is a need to improve strategies for advanced practice nursing, especially in primary care, to address gaps in specialized care, the development of indicators, and therapeutic objectives.

Shared governance council to engage advanced practice registered nurses in a hospital setting

BACKGROUND

Health care organizations use advanced practice registered nurses (APRNs) to expand patient access and support high-quality care. However, turnover, often exacerbated by inadequate engagement, has steep financial and experiential costs.

LOCAL PROBLEM

The project site, a large urban academic institution with quaternary care capabilities, employs more than 300 APRNs to provide patient care. Due to variations in hiring entity, leadership structure, and organizational visibility, efforts to maintain APRN engagement were complex. In addition, inconsistencies in standardization of clinical, credentialing, and privileging procedures created organizational risk.

METHODS

Quality improvement principles informed the implementation of a shared governance council for APRNs that included nurse practitioners and certified registered nurse anesthetists. Data were collected pre and postintervention using validated engagement questions.

INTERVENTION

Implementation of a shared governance council to support the organizational engagement of APRNs through decisional involvement in professional practice issues.

RESULTS

Analysis included the percentage of change in aggregate scores and the Wilcoxon rank-sum test to obtain p values of the 2 independent samples. There was an 8.9% increase in aggregate postintervention scores and statistical improvement in measures of quality improvement involvement.

CONCLUSION

Participation in the shared governance council increased APRN engagement through enhanced opportunities to communicate professional and clinical practice issues, decisional involvement, and collaboration. Statistically significant improvements in quality improvement involvement values potentially affirm the council's role in facilitating work environment improvements. Potential long-term gains include improved job satisfaction, retention, and organizational cost savings.

A real opportunity to modify cardiovascular risk through primary care and prevention: A pilot study

Cardiovascular diseases (CVDs) represent a major threat to health and primary prevention outstands as the most effective instrument to face this issue, addressing multiple risk factors at a time and influencing behavioral patterns. Community nurses have been involved in many interdisciplinary prevention activities, resulting in effective control of CV risk factors. We conducted a pilot study aiming at describing the impact on the CV risk profile of an 18-month interdisciplinary intervention on lifestyle habits. From September 2018 to May 2020, four general practitioners (GPs) working in the Roman neighborhood of Torresina recruited patients having a cardiovascular risk score (CRS) equal to or higher than 3% and lower than 20%; those patients were included in a nutritional, physical, and psychological counseling program. Assessments of patients' health status were led at baseline, 6, 12, and 18 months by a nutritionist, a physiotherapist, a psychologist, their GPs, and a community nurse. The CRS was estimated at every examination, based on the Italian Progetto Cuore algorithm. A total of 76 patients were included (mean age of 54.6 years; 33 men and 43 women). Mean CRS showed a significant reduction between baseline and 12 months (from 4.9 to 3.8); both total cholesterol and systolic blood pressure (SBP) significantly decreased at 6 months of follow-up (respectively, from 211.1 to 192 and from 133.1 to 123.1). Nonetheless, the reduction was later maintained only for SBP. However, during the last 6 months of the intervention, the COVID-19 pandemic broke out, thus, it is not possible to know how much the results achieved at 18 months were influenced by the restrictive measures introduced by the Italian government. When stratifying according to the presence of hypertension/diabetes and physical activity, no differences in the CRS could be highlighted between the two groups. Our pilot study proved that an interdisciplinary counseling intervention program can improve CV risk profile and could be further spread to people that, according to their CRS, would benefit more from changes in lifestyles.

A Mixed-Methods Sequential Explanatory Study of the Factors That Impact Nurses' Perspectives toward Nurse Practitioners' Roles in Saudi Arabia

Nurse practitioners' roles need to be clearly defined in Saudi Arabia. Therefore, we aimed to explore potential factors that impact nurses' perspectives toward nurse practitioners' roles and whether they are interested in becoming nurse practitioners. A mixed-methods study design was employed using a questionnaire and focus groups. The survey was sent to nurses working at a public hospital in the Riyadh region. Participants (N = 77) reported that having more nurse practitioners would improve quality of care and patient safety. Additionally, most participants stated that an increased supply of nurse practitioners would have a positive impact on effectiveness, equity of care, and healthcare costs. In regression analysis, participants with favorable perspectives towards nurse practitioners were significantly more likely to have interest in becoming nurse practitioners (odds ratio [95% confidence interval]:1.04 [1.01-1.07]). In the qualitative domain, three positive factors were identified: effective collaboration with other staff, better contribution to quality care and patient safety, and better contribution to evidence-based practice. Two barriers were also determined: lack of motivation to become a nurse practitioner and unclear scope of practice. Results showed that nurse practitioners can provide quality healthcare services that meet patients' different needs. The growing role of this speciality warrants further research to show its value in daily practice.

Introduction of an advanced nurse practitioner (ANP)-led male lower urinary tract symptom (LUTS) clinic and development of integrated referral pathway

INTRODUCTION

Ireland's population is living longer, and the prevalence of any LUTS is estimated to be 63-83% in adult men, increasing with age. Ireland has one of the lowest urologists per population ratio in Europe, at approximately 1:127,027. The patients waiting the longest are those with routine benign conditions such as men with LUTS. The impact on quality of life for men experiencing LUTS can be profound.

METHODS

Sláintecare funded an ANP post in TUH to develop an integrated referral pathway for male LUTS and develop a secondary care nurse-led clinic for LUTS and tackle the ever increasing new and return waiting lists. The initial focus of this role was on reducing pre-existing outpatient (OP) waiting lists. This is a review of the first 12-month outcomes of this ANP post.

RESULTS

A total of 410 new patients were assessed over the 12-month period. The mean waiting time from referral to review was 24 months; however, some referrals dated back to 2014. Four hundred forty-two return patients were reviewed in the 12-month period. All these patients were waiting longer than 18 months for a return appointment. In absence of the ANP-led clinic, there was no capacity for any of these patients to be reviewed in the general urology clinics. Overall outcomes were as follows: 38% were given advice and education and discharged. Treatment was initiated in 42% and follow-up arranged. Physical review was deemed necessary for 11% of patients. Only 6% of patients reviewed required referral back to consultants' clinic.

CONCLUSION

This study demonstrates the safety, efficacy and financial advantage of an ANP-led clinic for adult men presenting with lower urinary tract symptoms previously triaged by a consultant urologist.

A Narrative Review of Specialist Parkinson's Nurses: Evolution, Evidence and Expectation

Extended nursing roles have existed since the 1940s. The first specialist nurse for Parkinson's disease, a complex neurodegenerative disease, was appointed in the United Kingdom (UK) in 1989. A review was undertaken using MEDLINE and Cumulative Index to the Nursing and Allied Health Literature (CINAHL), relating to the role and evidence for Parkinson's disease nurse specialists (PDNSs). PDNSs fulfil many roles. Trials of their effectiveness have failed to show a positive benefit on health outcomes, but their input appears to improve the wellbeing of people with Parkinson's. Now embedded in the UK Parkinson's multidisciplinary team, this care model has since been adopted widely, including successful dissemination of training to countries in Sub-Saharan Africa. The lack of evidence to support the benefit of PDNSs may reflect an insufficient duration and intensity of the intervention, the outcome measures selected or the need to combine PDNS input with other evidence-based interventions. Whilst the current evidence base for their effectiveness is limited, their input appears to improve subjective patient wellbeing and they are considered a vital resource in management. Better evidence in the future will support the development of these roles and may facilitate the application of specialist nurses to other disease areas.