How do nurse practitioners work in primary health care settings? A scoping review

Nurses' Roles in Caring for Older People in Domiciliary Settings: A Scoping Review Protocol

Due to global shifts in demographics and advances in chronic illness management over the past few decades, domiciliary care has become the primary setting for caring for older people. In this regard, nurses play a crucial role, promoting quality care and minimizing hospital admissions and the need for institutionalization. However, historical and geographic variation in nursing titles and the multitude of labels for different roles have been obstacles to the creation of a clear map outlining specific nursing roles in home care for older people. The aim of this scoping review is to map the evidence on the different nurses' roles in caring for older people in domiciliary settings. This review will include primary, secondary, and gray literature on nurses' roles in domiciliary settings for older people, sourced through comprehensive searches of various databases (MEDLINE, Embase, CINAHL) and reference scanning. No language restrictions will be applied. Two independent reviewers will conduct screening and data extraction. The tabulated results will be informed by descriptive frequencies and content analysis, presenting comprehensive findings. The review protocol was retrospectively registered within OSF database on the 23 November 2023.

Interprofessional education within a nurse practitioner led paediatric service: A multi-methods study

AIM

This project explored whether a nurse practitioner led mobile paediatric screening service in early learning centres could incorporate allied health and nursing students and develop their confidence in interprofessional collaboration.

BACKGROUND

Interprofessional collaboration is essential for health professionals across all contexts of care, including early childhood screening and intervention that enables children to thrive.

METHODS

This multi-methods study (pre-test/post-test design) was conducted with nursing, physiotherapy, occupational therapy and nutrition and dietetics students attending clinical placement within the nurse practitioner led mobile paediatric service. Data were collected via pre and post placement surveys (ISVS-21) and post placement semi-structured interviews.

RESULTS

Twelve students participated from July to December 2022. Survey findings demonstrated students improved inter-professional socialisation and readiness, supported by qualitative findings that uncovered unique mechanisms for how positive experiences were achieved. Unique pedagogical elements included 1) the nurse practitioner's professional attributes and 2) the mobile nature of the service leveraging learning opportunities within the shared commute.

CONCLUSIONS

This study provides proof-of-concept of a placement model that facilitates interprofessional collaboration in nursing and allied health students. Further research should explore longer-term outcomes and scalability.

The transition to advanced practice nursing: A systematic review of qualitative studies

BACKGROUND

Advanced practice nurses have made important contributions to the tasks of stabilising the operation of the health system and improving the quality of care. However, taking on the role of an advanced practice nurse is always challenging and can even result in the intention to leave the profession. Insights into advanced practice nursing role transitions are important to implement effective interventions to help nurses cope with the corresponding turbulence and changes.

AIM

To explore the experiences of advanced practice nurses during their role transition from registered nurses to their current role.

DESIGN

A systematic review of qualitative studies.

DATA SOURCES

Five databases were searched from inception to August 2022: PubMed, Web of Science, Cochrane, Embase and CINAHL.

REVIEW METHODS

This review was reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. Two reviewers independently conducted study selection and data extraction, and quality appraisal was performed using the Joanna Briggs Institute critical appraisal instrument for qualitative research. Data synthesis was conducted using thematic analysis.

FINDINGS

A total of 14 studies were included in this review. Three analytical themes emerged: (1) trudging along a narrow road, (2) driving and restraining forces in the transition, and (3) embracing the new identity. Four subthemes were graded as high confidence and the other four were moderate confidence. Establishing a new role was a priority and a significant challenge for advanced practice nurses. Beliefs regarding advanced practice, the attitudes of colleagues, and the support of mentors impacted the transition process. Advanced practice nurses expressed appreciation for their new role and developed new ambitions at the end of the transition.

CONCLUSIONS

Advanced practice nurses face a series of challenges during the process of role development, especially struggles with vague feelings and a lack of confidence in practice. These difficulties could be exacerbated without the support of team and organisational managers. The implementation of mentorship and the mediation of interprofessional conflicts are necessary to facilitate successful role transitions.

The interagency care team: A new model to integrate social and medical care for older adults in primary care

To integrate management of social drivers of health with complex clinical needs of older adults, we connected patients aged 60 and above from primary care practices with a nurse practitioner (NP) led Interagency Care Team (ICT) of geriatrics providers and community partners via electronic consult. The NP conducted a geriatric assessment via telephone, then the team met to determine recommendations. Thirteen primary care practices referred 123 patients (median age = 76) who had high rates of emergency department use and hospitalization (28.9% and 17.4% respectively). Issues commonly identified included medication management (84%), personal safety (72%), disease management (69%), food insecurity (63%), and cognitive decline (53%). Referring providers expressed heightened awareness of older adults' social needs and high satisfaction with the program. The ICT is a scalable model of care that connects older adults with complex care needs to geriatrics expertise and community services through partnerships with primary care providers.

An integrative telehealth platform managed by nurses

Objective

Our aim was to assess the feasibility and preliminary results of implementing a telehealth system, Alice Agora, as a tool for optimizing health delivery in a new primary care-based health system.

Results

We had 4193 consultations over the last 6 months (February and August 2021). Preliminary results show patients high level of satisfaction (Consumer satisfaction score of 4.92). The chief complaints were related to upper respiratory tract (n = 1542; 28.5%), gastrointestinal (n = 781; 14.43%), musculoskeletal (n = 607; 11.22%), and other (n = 643; 11.88%). We found that 20.1% (842) of the cases were solved digitally, that is, by a chat only with a nurse, through the use of health protocols, and 43.9% were solved by nurses with medical assistance. Only 6.6% (277) of the cases had to be referred to the emergency room (ER). This means that 64% of the cases were completely resolved by our nurses-driven system. Forty-eight hours readmission rates were higher for the uncoordinated ER cases compared with the coordinated cases (14.81% vs. 5.87%; p = 0.016). The same pattern was observed for the 72-h readmission rates (16.67 vs. 7.26%; p = 0.02).

Tendency and foci of nurse practitioners: bibliometric analysis based on the CiteSpaceV†

Objective

Nurse practitioners (NPs) have drawn significant attention recently and played a major role in healthcare. We aim to find the evaluation of NPs through published studies and then visualize the research status and hotspots in this field.

Methods

All data came from the Web of Science Core Collection, and the data were counted and entered into Excel 2016. The key documents nodes were excavated by analyzing the knowledge network map using CiteSpaceV software. In this study, these nodes of “author, country, institution, keyword, co-citation (reference\cited-author\cited-journal), and grant” were harvested for analysis and comparison.

Results

A total of 4912 records, which were published between 2007 and 2018 and pertained to NPs, were retrieved from the Web of Science Core Collection database (WoSCC) from a diversity of languages. The total and the annual number of publications and citations of these continually increased over time. Most publications were in 2018 (618 records). This study involved 8241 authors located in 98 countries and 4557 institutions totally. The United States (2737 records) and the University of Michigan (90 records) dominated in publication frequency. There are 902 journals and 2449 articles with funding support that have been analyzed. Most articles were from JAMA: The Journal of the American Medical Association (1386, IF = 47.661), followed by the Journal of Advanced Nursing (1359, IF = 2.267), and The New England Journal of Medicine (1109, IF = 79.258). The reference “The Role of Nurse Practitioners in Reinventing Primary Care” was co-cited most frequently, which revealed it as the highest landmark article in NP. The top-ranked keyword was “Care,” other than “Nurse practitioner,” which has an ultra-high frequency. Some of the high-frequency keywords represent the significant direction of NPs.

Conclusions

NPs are at the crux of health-care delivery and play an important role in providing high-quality nursing. Publications on NPs in WoSCC have increased notably during the recent years, and have appeared in some journals that have a high impact factor. Research frontiers and developmental trends were revealed by the analysis in this study, which can be used to forecast future research developments in NPs and taken as a reference to choose the right directions by subsequent researchers who wish to use these results. However, the grant support from administration or research institutions is still in need of improvement and the scope of research in NPs should be broadened in the future.

Competencies of nurse practitioners in family practices: A scoping review

AIMS AND OBJECTIVE

To explore the existing literature related to nurse practitioner (NP) competencies in family practices and to examine the evidence and develop a list of competencies.

BACKGROUND

The integration of NPs into the healthcare system is at different stages of progress around the world. Therefore, an overview and clarification of competencies are important to ensure successful implementation of new roles in existing healthcare systems. However, detailed knowledge is lacking about the competencies of NPs in adult care in family practices.

DESIGN AND METHODS

We conducted a scoping review in accordance with the JBI methodology for scoping reviews and the PRISMA-ScR guidelines. We considered studies published in English, German or French from 1965 to the present. Databases searched included MEDLINE, CINAHL, Web of Science and PsycINFO. Sources of grey literature that were searched included ProQuest Dissertations and Theses, OpenGrey and websites of national NP organisations. Two reviewers retrieved full-text studies and extracted data independently. We described the competencies using Hamric's model of advanced practice nursing.

RESULTS

We included 23 publications. Competencies in direct clinical practice were described most often particularly pertaining to nursing or medical tasks. Indirect care activities were frequently mentioned. Less information was found regarding competencies in leadership, ethical decision-making and evidence-based practice. We found elementary and extended competencies required to perform the role in family practices. Depending on the country, the role was either emerging or already well-established.

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE

This review provides insight into current knowledge about competencies of NP in family practices. The identified competencies can be used to develop job descriptions or to conceptualise professional development programmes in countries where such roles are just recently emerging. A list of competencies will promote a common understanding of the NP role and to help clarify interprofessional collaboration in clinical practice.

Rethinking Primary Care Delivery Models: Can Integrated Primary Care Teams Improve Care Experience?

Background:

Integrated Primary Care Teams (IPCTs) have four key characteristics (intensive interdisciplinary practice; advanced nursing practice with an expanded role; group practice; increased proximity and availability) aimed at strengthening primary care in Quebec, Canada. The purpose of this paper is to examine the care experience over time of patients who have an IPCT as their primary source of care.

Methods:

We used a quasi-experimental longitudinal design based on a pre-and-post administered survey at a 2-year interval without a control group. We measured patient-reported accessibility, continuity, comprehensiveness, responsiveness and outcomes of care.

Results:

Results showed that patients who were newly registered with an IPCT had a significant increase in reported care experience, whereas patients who have been registered with an IPCT for 2 years prior to the first round of data collection had already high reported care experience that was maintained over time. Moreover, linear regression models showed statistically significant different increases in the dimensions of care experience by site and patients’ characteristics.

Conclusions:

Our results suggest that the IPCT model is tailored to the needs of its target populations, resulting in improved Patient Reported Experience Measures. These results imply that broader implementation of innovative and flexible community-based care models should be considered by policymakers.

Electronic Consultation by Advanced Practice Nurses to Improve Access to Specialist Care for Older Adults

Older adults face several challenges when accessing specialist care. Advanced practice nurses (APNs) can perform an important role in primary care for older adults, particularly when bolstered with digital tools. In the current study, we conducted a multiple case study of electronic consultations (eConsults) involving APNs to assess how these practitioners use the service to improve access to care. All eConsults submitted by or to an APN in 2019 on behalf of patients aged ≥65 years were reviewed to identify examples from six settings representative of the range of advanced nursing practices. For each setting, a final case was chosen using an iterative process and stratified by specialty and type of advice. Included cases were assessed using a conceptual framework for health care access. Selected cases illustrate how APNs can be effective users of eConsults in a diversity of health care settings. The framework allowed for an in-depth study of access over the range of interactions that take place among patients, caregivers, providers, and the health care system. [Journal of Gerontological Nursing, 48(4), 33-40.].

Psychosocial vulnerability among carers of persons living with a chronic illness: A scoping review

AIMS

To outline and examine evidence related to the meaning of 'psychosocial vulnerability' among caregivers of persons with chronic illnesses.

BACKGROUND

The number of informal caregivers continues to rise globally. Their risk of psychosocial vulnerability is frequently overlooked, but understanding their psychosocial vulnerability may offer insights into meeting their needs.

DESIGN

Scoping review following the PRISMA 2020 extension guidelines.

DATA SOURCES

The databases CINAHL, Embase, Medline/Pubmed, Cochrane Library, PsycINFO, Web of Science, Google Scholar, Lenus and ProQuest were systematically searched to identify original research. No date limit was set, and 23 studies were included.

REVIEW METHODS

A five-step approach using the Arksey and O'Malley framework. Thematic analysis guided data analysis.

RESULTS

Carers' psychosocial vulnerability occurs when they experience barriers to resources while access and use of supports reduce risk. Antecedents of psychosocial vulnerability include a carer's age and sex, socioeconomic status and their health and wellbeing. Psychosocial vulnerability affects carers' relationships and causes personal losses.

CONCLUSIONS

The concept of carers' psychosocial vulnerability is complex. Recognition of carers at risk for psychosocial vulnerability would help nurses direct relevant support and information to carers who need it most.

Gut leben zuhause mit Multimorbidität

Living well at home with multimorbidity - A project on the contribution of advanced practice nursing in home health care Abstract. Background: Multimorbidity has increased among the elderly, leading to loss of autonomy, lower quality of life, complex treatment plans and higher rates of complications and hospitalisations. Functional impairment and challenging therapy management make the use of home health nursing services essential. Experience in primary care and in hospitals has shown that Advanced Practice Nurses (APN) lead to a better quality of care for patients with multimorbidity. However, there is no data yet regarding the potential contribution of APNs to the care of these patients in home healthcare settings. Aim: To develop the role of the APN in a home health nursing organisation for patients with multimorbidity, applying internationally established APN core competencies. Methods: Characteristics of referred clients were collected and presented in case studies in an APN practice development project based on the PDCA-cycle. Benefits for clients, family caregivers, the nursing team, and for interprofessional collaboration were elaborated. Results: During the project period, a total of 40 clients were assigned to APN-care. An increase in stability in complex situations and higher confidence of clients and family caregivers in their individual health management were achieved. Discussion: The key factors were the APN's leadership role in best practice development and interprofessional collaboration. The APN played an important role in coordinating the numerous parties involved. Limits and transfer: This role must be further established. Empirical research is required to show the effect on quality of care.

Barriers and facilitators to the implementation of nurse's role in primary care settings: an integrative review

Background

The rapid evolution of the epidemiological picture and the recent SARS-COV-2 pandemic has expressed the vulnerabilities of health systems and focuses attention on the population’s needs.

The nurse’s figure in the care teams is universally identified; however, the implementation of the role within some care settings turns out to be complex and challenging. This integrative review aims to identify the barriers and facilitators in implementing the role of the nurse in primary care settings.

Methods

An integrative review was conducted on the Medline and Cinahl databases until 9 June 2020. Qualitative, quantitative, and Mixed-method research studies were selected to identify studies related to the barriers and facilitators of the nurse’s role in nursing facilities’ primary care. For the extraction of the results, the Consolidating Framework for Research Implementation (CFIR) was used to identify the factors that influence implementation in health care.

Results

Following the duplicates’ removal, the search identified 18,257 articles, of which 56 were relevant to the inclusion criteria; therefore, they were included in the summary.

The selected studies were conducted in thirteen countries, most from Oceania, Europe, North America, Latin America, and the Caribbean.

The barriers reported most frequently concern the nursing profession’s regulatory and regulatory aspects within the contexts of care, cultural and organizational aspects, training, and the transfer of specific skills, which were previously designated to doctors.

The facilitators are mainly linked to the nurse’s adaptability to the various contexts of care, recognizing the patient’s role, and the desire to develop multidisciplinary and effective working groups to respond to the health needs of the population in primary care contexts.

Conclusion

This review highlighted the main barriers and facilitators in implementing the nurse’s role in primary care settings. These results offer useful elements for stakeholders to identify effective strategies in preparing programs and activities for implementing the nurse’s role, acting on the elements identified as barriers and favouring the aspects that emerge as facilitators.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00696-y.

Curbside Consultation for the Nurse Practitioner: Qualitative Inquiry for Education, Policy, and Practice

BACKGROUND AND PURPOSE

Curbside consultation (CC), defined as pursuing information or recommendation regarding patient care, without request for formal consultation is a favored information source for nurse practitioners (NPs) when making clinical decisions in practice settings. Research and education concerning CC among NPs is lacking. The purpose of this study was to obtain an understanding of NP perceptions of interpersonal aspects of the CC process to inform NP clinical practice and education.

METHODS

Qualitative descriptive design and inductive content analysis was used. Twenty primary care and specialty care NP were recruited using purposive sampling for conduct of individual interviews.

RESULTS

Content analysis identified themes describing interpersonal components of the CC process. NP practiced in collaboration with physicians in variable roles within primary care and specialty care settings. These collaborations varied dependent upon supervisory relationships with physicians. Additional themes concerned NP professional experience and characteristics of experts desired for CC. These characteristics included NP perceptions of colleague experience and expertise, trust, and interpersonal relationship dynamics.

IMPLICATIONS FOR PRACTICE

CC processes for NPs are multidimensional, including interpersonal themes as components of this communication exchange. Given CC is a highly utilized resource for NPs, further inquiry is critical for understanding of its implications for NP practice, policy, and education internationally.

Quality of professional life of primary healthcare nurses: A systematic review

AIMS

To identify and critically appraise the available evidence on the overall quality of professional life of primary care nurses worldwide and its main influencing factors.

BACKGROUND

Quality of professional life of healthcare workers is a keystone that influences the quality of healthcare services provided by healthcare organisations. Nurses have a key role as healthcare services providers given the growing shortage of doctors in primary care.

DESIGN

A systematic review design in accordance with the PRISMA statement.

METHODS

The search was conducted through MEDLINE (PubMed), CINAHL, SCOPUS, Scientific Electronic Library Online (SciELO) and Web of Science databases. The grey literature was reviewed at OpenGrey. The search was limited to human studies published from April 2010-April 2020. No limit of original language publication was applied. Three independent reviewers analysed the methodological quality of the studies.

RESULTS

Ten studies were included from five countries. Five studies reported nurses were satisfied with their quality of professional life and the influencing factors identified were Workload, Job autonomy, Demographic variables, Management support, Recognition, Intrinsic motivation, Interpersonal relations, Compassion fatigue, Burnout, Turnover intention, and work was reported as a component of Quality of life.

CONCLUSION

Primary healthcare nurses reported a high level of quality of professional life, but the scarce studies found do not provide solid consistency to assess the overall quality of professional life. Perception of high workload was the most frequently identified factor to negatively influence the quality of professional life of nurses.

RELEVANCE TO CLINICAL PRACTICE

Quality of professional life of primary care nurses is a key issue because of nurses' important relation with patient's care and satisfaction. Healthcare organisations should strive to address primary care nurses' quality of professional life to enhance their well-being and consequently patients' safety and high-quality healthcare services.

Paediatric nursing clinical competences in primary healthcare: A systematic review

AIMS

To identify and critically appraise the available evidence on paediatric nurses' clinical competencies performed autonomously regarding disease prevention and health promotion activities for children and adolescents in primary healthcare worldwide.

DESIGN

A systematic review design in accordance with the Preferred Reporting Items Systematic Reviews and Meta-Analyses statement.

DATA SOURCES

The search was conducted through MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, SCOPUS, The Cochrane Library, Scientific Electronic Library Online, Web of Science and The Joanna Briggs Institute EBP (Ovid) databases. The grey literature was reviewed at OpenGrey. Additional studies were located through a references list of selected studies identified on first search.

REVIEW METHODS

Database search employed MeSH terms: (paediatric nursing) AND (primary healthcare) AND ((clinical skills) OR (clinical competences)). Studies published from inception to October 2019 exploring paediatric nurses' clinical competencies in primary healthcare were eligible for inclusion. No language restrictions were applied in the main search. Selection was made by two reviewers independently. Three independent reviewers assessed the methodological quality of included studies.

RESULTS

Eighteen studies were included from six countries. The most common nursing competencies independently performed identified and described in studies were Health education and advice, Child and adolescent health and development assessment, Immunizations and Child health checks.

CONCLUSION

Studies describe clinical competencies of nurses in children care. No consistent scientific evidence is available about clinical competencies of paediatric nurses performed autonomously in primary care.

IMPACT

Few scientific studies identifying and assessing nurses' child primary healthcare skills were found and therefore recorded. Studies describe nurses' clinical skills in childhood, but results do not show firm consistency assessing their practice scope. Health policy-makers should encourage the development of nurses' competencies if they wish to preserve quality and equity of healthcare services to children. Therefore, the first step is to identify the autonomous competencies of paediatric nurses in primary care.

Weight Loss and Improvement of Metabolic Alterations in Overweight and Obese Children Through the I2AO2 Family Program: A Randomized Controlled Clinical Trial

Childhood obesity is a major public health concern. We wanted to evaluate the effectiveness of a multidisciplinary program based on healthy eating, exercise, cognitive-behavioral therapy, and health education to achieve weight loss and improve metabolic parameters in overweight and obese children. A randomized, controlled clinical trial with long-term follow-up (24 months) was conducted at a community care center in overweight and obese individuals aged 6-12 years. A sample of 108 children was divided into an experimental and a control group receiving a standard care program. The experimental groups received a 12-month interdisciplinary program; the results were evaluated at 4 months, the end of the intervention, and at follow-up 12 months later. Anthropometric and biological marker measurements related to metabolic alterations, dyslipidemia (based on total cholesterol), hyperglycemia, fasting glycaemia, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol in blood were recorded. The intervention had a significant effect (p < 0.001) in terms of decreased body mass index, skinfolds, and waist and arm circumferences. These changes were accompanied by biochemical changes underlying an improvement in metabolic parameters, such as a significant reduction in total cholesterol, low-density lipoprotein-cholesterol, triglycerides, and hyperglycemia and a significant increase in high-density lipoprotein-cholesterol. These effects were still significant for markers of excess weight or obesity in the experimental group 12 months after the end of the intervention, suggesting that an enduring change in healthy lifestyles had been maintained period. This interdisciplinary, nurse-led program helped to reduce childhood and adolescent excess weight and obesity and had long-lasting effects.

Nurses' perceptions: Addressing social determinants of health to improve patient outcomes

Nursing organizations and leaders adopted the social determinants of health (SDOH) as essential to the delivery of health care, but little is known about working registered nurses' (hereafter nurses) views on the SDOH. The purpose of this study was to (1) explore nurses' perceptions of how SDOH affect patient care and (2) describe nurses' ideas about how SDOH can be addressed to improve outcomes and services. Thirteen registered nurses with a baccalaureate in nursing beginning their online graduate advanced practice educational program were interviewed. This qualitative descriptive study used constant comparative analysis for data analysis. The analysis found two major themes: (1) SDOH are integrated into the nurses' care. The SDOH experienced by patients challenges the nurses to provide care at the patient's level and to provide usable patient education, and (2) health-care delivery change is needed to achieve equity and to provide health care to those in need. The nurses recommended more organized, seamless health-care delivery and interdisciplinary advocacy to achieve these needed changes. Nurse educators and nurse leaders can harness the frustration and ingenuity of nurses to help the nurses advocate for health-care change that integrates the SDOH.

Identifying indicators sensitive to primary healthcare nurse practitioner practice: a review of systematic reviews protocol

INTRODUCTION

Primary healthcare nurse practitioners (PHCNPs) practice in a wide range of clinical settings and with diverse patient populations. Several systematic reviews have examined outcomes of PHCNP roles. However, there is a lack of consistency in the definitions used for the PHCNP role across the reviews. The identification of indicators sensitive to PHCNP practice from the perspective of patients, providers and the healthcare system will allow researchers, clinicians and decision-makers to understand how these providers contribute to outcomes of care.

METHODS AND ANALYSIS

A review of systematic reviews is proposed to describe the current state of knowledge about indicators sensitive to PHCNP practice using recognised role definitions. Outcomes of interest include any outcome indicator measuring the effectiveness of PHCNPs. We will limit our search to 2010 onwards to capture the most up-to-date trends. The following electronic databases will be searched: Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library Database of Systematic Reviews and Controlled Trials Register, Database of Abstracts of Reviews of Effects, EMBASE, Global Health, Health Economics Evaluation Database, Health Evidence, HealthStar, Health Systems Evidence, Joanna Briggs Institute, Medline, PDQ-Evidence, PubMed and Web of Science. The search strategies will be reviewed by an academic librarian. Reference lists of all relevant publications will be reviewed. Grey literature will be searched from 2010 onwards, and will include: CADTH Information Services, CADTH's Grey Matters tool, OpenGrey, Organisation for Economic Co-operation and Development, ProQuest Dissertation and Theses and WHO. The PROSPERO International Prospective Register of Systematic Reviews will be searched to identify registered review protocols. The review protocol was developed using Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols recommendations. A narrative synthesis will be used to summarise study findings.

ETHICS AND DISSEMINATION

No ethical approval is required for the study. The data used in the study will be abstracted from published systematic reviews. Dissemination strategies will include peer-reviewed publication, conference presentations and presentations to key stakeholders.

PROSPERO REGISTRATION NUMBER

CRD42020198182.

Engagement of nurse practitioners in primary health care in northern British Columbia: a mixed-methods study

BACKGROUND

Nurse practitioners (NPs) have been regulated primary care providers in British Columbia since 2005; however, many practices and contributions of NPs, especially those in northern or rural regions, remain unarticulated in primary health care. The objective of this study was to evaluate NP practices in the context of providing primary health care in northern BC.

METHODS

This was a qualitative-dominant mixed-methods study. We recruited NP participants working in northern BC; recruitment and data collection occurred between April and June 2018. Participants completed the validated 28-item Primary Health Care Engagement (PHCE) Scale to assess their perceptions of their workplace with 8 attributes of primary health care (quality improvement, community participation, patient-centred care, accessibility, intersectoral team, interdisciplinary collaboration, continuity and population orientation). We also interviewed NPs about their everyday practice. Transcribed data from the interviews were analyzed interpretively.

RESULTS

In total, 13 of 30 (43%) eligible NPs participated in the survey and interview. The PHCE Scale results showed that all NPs perceived their workplaces to be highly engaged in patient-centred care, but none reported their workplaces as accessible. Interview data were organized into 5 headings which described how NPs see patients who are medically and socially complex, address inequities in access, practice collaboratively, address local service gaps and improve patient abilities to access care.

INTERPRETATION

In interprofessional primary health care teams, NPs are key members and attend to both direct patient care and broader social conditions affecting health. Nurse practitioners can help accelerate advancements to deliver responsive community-based primary health care.

Nurse practitioner locums: a plausible solution for augmenting health care access for rural communities

With 2020 being designated the Year of the Nurse and Midwife, it is opportune to acknowledge and recognise the role that nurses undertake in primary care environments. Nurses and midwives play a pivotal role in the delivery of high-quality health care, particularly in geographically challenged areas of Australia, where they may be the only provider of care within their communities. Rural and remote health services require strategic planning to develop and implement solutions responsive to the challenges of rural and remote communities. Maintenance of health services in rural and remote areas is a challenge, crucial to the equity of health outcomes for these communities. Many small communities rely on visiting medical officers to provide the on-call care to facility services, including emergency departments, urgent care centres, acute wards and aged care facilities. It is increasingly difficult to maintain the current rural workforce models, particularly the provision of after-hours 'on-call' care necessary in these communities. An alternative model of health care service delivery staffed by nurse practitioners (NP) is one proposed solution. NPs are educated, skilled and proven in their ability to provide an after-hours or on-call service to meet the expectations of rural and remote communities. Achievement of high-quality health care that is cost-efficient, safe and demonstrates improved patient outcomes has been reported in NP-led health care delivery impact evaluations. The value of an NP locum service model is the provision of a transparent, reliable service delivering consistent, equitable and efficient health care to rural and remote communities.

Aprender brincando: validação semântica de tecnologia educacional sobre tuberculose para crianças escolares

Resumo Objetivo validar semanticamente tecnologia educacional sobre tuberculose para crianças escolares. Método estudo metodológico, realizado com 51 escolares, entre 10 e 12 anos, de escola pública em Belém, Pará. Na coleta de dados, apresentou-se às crianças a tecnologia educacional, um caça-palavras, com definição, transmissão, sinais e sintomas da tuberculose e, após sua aplicação realizou-se entrevista individual, com perguntas abertas e fechadas, sobre atributos associados à impressão geral, ao conteúdo e forma. Para descrever a concordância das respostas à entrevista, foi utilizado o índice de validade de conteúdo, com ponto de corte igual a 0,80. Na descrição das variáveis numéricas, utilizou-se o software Statistical Package for the Social Sciences, 22.0 e, para o corpus textual, empregou-se o software IRaMuTeQ 0.7, alpha 2. Resultados os índices de validade de conteúdo apresentaram resultados superiores a 90%. A descrição dos depoimentos gerou duas nuvens de palavras, referentes à compreensão sobre a doença e capacidade informativa da tecnologia. Conclusão e implicações para a prática a tecnologia foi considerada de fácil utilização, relevante e de conteúdo apropriado, portanto, válida para crianças compreenderem a doença, possibilitando atuarem como multiplicadores da informação para sua rede de convívio.

Role of Nurse Practitioners in Caring for Patients With Complex Health Needs

OBJECTIVE

The objective of this study was to estimate trends in the percentage of Medicare beneficiaries cared for by nurse practitioners from 2012 to 2017, to characterize beneficiaries cared for by nurse practitioners in 2017, and to examine how the percentage of beneficiaries cared for by nurse practitioners varies by practice characteristics.

DESIGN

An observational study of 2012-2017 Medicare fee-for-service beneficiaries' ambulatory visits. We computed the percentage of beneficiaries with 1 or more ambulatory visits from nurse practitioners and the percentage of beneficiaries receiving the plurality of their ambulatory visits from a nurse practitioner versus a physician (ie, predominant provider). We compared beneficiary demographics, clinical characteristics, and utilization by the predominant provider. We then characterized the predominant provider by practice characteristics.

KEY RESULTS

In 2017, 28.9% of beneficiaries received any care from a nurse practitioner and 8.0% utilized nurse practitioners as their predominant provider-an increase from 4.4% in 2012. Among beneficiaries cared for by nurse practitioners in 2017, 25.9% had 3 or more chronic conditions compared with 20.8% of those cared for by physicians. Beneficiaries cared for in practices owned by health systems were more likely to have a nurse practitioner as their predominant provider compared with those attending practices that were independently owned (9.3% vs. 7.0%).

CONCLUSIONS

Nurse practitioners are caring for Medicare beneficiaries with complex needs at rates that match or exceed their physician colleagues. The growing role of nurse practitioners, especially in health care systems, warrants attention as organizations embark on payment and delivery reform.

How the Institutional and Policy Context Shapes the Establishment of Nurse Practitioner Roles and Practice in New Zealand's Primary Health Care Sector

The implementation of the nurse practitioner (NP) workforce in primary health care (PHC) in New Zealand has been slow, despite ongoing concerns over persisting health inequalities and a crisis in the primary care physician workforce. This article, as part of a wider institutional ethnography, draws on the experiences of one NP and two NP candidates, as they struggle to establish and deliver PHC services in areas of high need, rural, and Indigenous Māori communities in New Zealand. Using information gathered initially by interview, we develop an analysis of how the institutional and policy context is shaping their experiences and limiting opportunities for the informants to provide meaningful comprehensive PHC. Their work (time and effort), with various health organizations, was halted with little rationale, and seemingly contrary to New Zealand's strategic direction for PHC stipulated in the Primary Health Care Strategy 2001. The tension between the extant biomedical model, known as primary care, and the broader principles of PHC was evident. Our analysis explored how the perpetuation of the neoliberal health policy environment through a "hands-off" approach from central government and district health boards resulted in a highly fragmented and complex health sector. Ongoing policy and sector perseverance to support privately owned physician-led general practice; a competitive contractual environment; and significant structural health sector changes, all restricted the establishment of NP services. Instead, commitment across the health sector is needed to ensure implementation of the NP workforce as autonomous mainstream providers of comprehensive PHC services.

Workloads in the Family Health Strategy: interfaces with the exhaustion of nursing professionals

OBJECTIVE

To identify the workloads of nursing teams working in the Family Health Strategy in the five regions of Brazil and their interfaces with their feelings of exhaustion.

METHOD

Qualitative study with nursing professionals from 20 Family Health Units, from eight cities in the five regions of the country. Data were collected through interviews, observation and analyzed according to the precepts of thematic analysis and the theoretical framework of workloads.

RESULTS

A total of 79 professionals participated in the study. Workloads were related to structural and managerial problems. Workloads that stood out were psychological workload, due to excessive demands and staff shortages; physiological workload, due to the overload of activities that generate physical pain and exhaustion; physical and mechanical workload, due to inadequacies in the work environment and equipment; biological workload, due to the presence of microorganisms; and chemical workload, due to exposure to dust and smoke.

CONCLUSION

The sources that increase workloads are similar in the five regions, indicating that there is a strong influence of psychological and physiological loads on exhaustion among workers. However, workloads are reduced by dividing and planning team actions and by the affinity with the assistance model.

Exploring novice nurse practitioner job satisfaction

BACKGROUND

With the continued increase in new nurse practitioners expected over the next 5 years and beyond, more individuals will experience nurse practitioner role transition. It is beneficial to nurse practitioners, patients, and the health care industry to understand factors relating to job satisfaction during role transition.

PURPOSE

The purpose of this study was to contribute to the understanding of the transition period of new nurse practitioners by exploring demographics and job satisfaction during the first 6 months to 2 years of practice.

METHODS

This nonexperimental quantitative study employed convenience sampling with survey methodology. Twenty-one Facebook groups/pages were posted on once a week for 6 weeks. Demographic information was collected, and personal experiences were measured with the Misener Nurse Practitioner Job Satisfaction Scale.

RESULTS

Practice setting, formal orientation programs, and intent to leave current position were related to overall nurse practitioner job satisfaction during the transition period (p < .05). Satisfaction with time and benefits varied among demographic groups (p < .05).

IMPLICATIONS FOR PRACTICE

Novice nurse practitioners are mostly satisfied in their new role. However, turnover intention in this population is high and orientation programs are lacking, warranting further study.

An Evidence-Based Checklist for Improving Scoping Review Quality

A scoping review aims to systematically explore and map the research available from a wide range of sources. The objective of this study was to produce a scoping review checklist to guide future scoping studies to enable rigorous review and critique of phenomena of interest. The methods used included a review of literature, expert consensus group meetings, a modified Delphi survey and, finally, verification against recent scoping study examples. Results showed that the checklist was able to identify key elements of scoping reviews. The 22-item Scoping Review Checklist (SRC), which includes two optional stakeholder consultation items, has been developed using rigorous recommended approaches. The checklist can be used to guide the conduct and critique of scoping studies.

Nursing strategies for child health surveillance

OBJECTIVE

to appreciate the strategies promoted by nurses in the context of child health surveillance relevant to early childhood development.

METHOD

this is a qualitative study with an inductive thematic analysis of the data, based on the conceptual principles of child health surveillance, and developed through semi-structured interviews with Brazilian nurses working with families in primary health care.

RESULTS

the nurses' strategies in favor of child health surveillance focus on actions that anticipate harm with continuous follow-up and monitoring of health indicators. The process of child growth and development is the basis for responses and benefits to health, connection with the daily lives of families, active search, articulations between professionals and services, access to comprehensive care, and intrinsic actions between promotion, prevention and health follow-up.

CONCLUSION

child health surveillance actions developed by nurses with families involve knowledge sharing, favor the resolution of problems, increase child health indicators, and strengthen the relationship between health and children's rights, which support the promotion of development in early childhood.

Leadership Advocacy: Bringing Nursing to the Homeless and Underserved

Nurses have historically played a key role in advocacy and service for all members of the community, including those who are traditionally underserved by other providers or the health system. Nurses from a local Atlanta community health system, both clinical and administrative, have continued this tradition by developing an advocacy and service program for the downtown homeless of Atlanta. From its beginnings as a highly informal volunteer program to its current structure as a strongly integrated community health center for the underserved and homeless of Atlanta, local nurses have demonstrated their strong value of service advocacy. Their leadership, insight, discipline, and strategic development have facilitated the growth of a focused, viable health service network for marginalized people of the city of Atlanta.