The capability of nurse practitioners may be diminished by controlling protocols

Capability as a concept in advanced practice nursing and education: a scoping review

OBJECTIVE

The objective of this review was to map the literature about the concept of capability in advanced practice nursing education and practice to achieve greater clarity on the concept and its application.

INTRODUCTION

Advanced practice nursing roles make up a growing segment of the global nursing workforce. Capability has been proposed as an overarching description of the attributes of advanced practice nursing roles within complex workplace environments. Capability includes knowing how to learn, and the ability to creatively integrate prior knowledge, skills, judgment, and experience in both new and familiar situations.

INCLUSION CRITERIA

This review looked at the literature about capability applied to advanced practice nursing in any setting globally. We were guided by the International Council of Nurses' definition of advanced practice nursing, which includes nurses with both graduate education and an expanded scope of practice. Drawing from an initial review of the literature, we used a working definition of capability, which was a combination of knowledge, skills, experience, and competencies that enables advanced practice nurses to provide appropriate care for patients in both known and unfamiliar clinical settings. We included literature about individual capability as a concept in any setting related to advanced practice nursing and education.

METHODS

We searched 18 electronic databases and included qualitative, quantitative, and mixed methods study design methodologies, reviews, and reports. The gray literature search included policy and practice documents from the World Health Organization, the International Council of Nurses, and websites of 48 nursing and health organizations. Two reviewers independently completed title and abstract screening prior to full-text review and data extraction. Conflicts were resolved via discussion or with a third reviewer. Extraction was completed by 2 reviewers using a piloted data extraction tool. Articles published in English from 1975 to the present were included. Sources in languages other than English were not included in the review due to the difficulties in accurately translating the concept of capability.

RESULTS

Thirty-five sources were included in the review with publication dates from 2000 to 2023. Most sources originated from Australia, the United Kingdom, and the United States. Sources included frameworks and clinical guidelines, peer-reviewed articles, and gray literature. Capability was discussed in a range of settings, including specialized clinical roles. Applications of capability in educational settings included the use of capability frameworks to guide nurse practitioner education, nursing practice doctorates, and postgraduate nurse practitioner training. Definitions of capability, where provided, were relatively consistent. Capability was proposed as a distinguishing characteristic of advanced practice nursing, as a descriptor of clinical proficiency that moved beyond competency, and as a framework that accounted for complexity in health care settings.

CONCLUSION

Capability was used as a concept and framework to describe advanced practice nursing within complex practice environments that necessitate flexible approaches. Capability frameworks were applied holistically and to specific areas of practice or education, including in pregraduate and postgraduate advanced practice nursing education. Strategies for teaching and learning capability focused on flexibility, student-directed learning, and development of flexible learning pathways.

SUPPLEMENTAL DIGITAL CONTENT

A Norwegian-language version of the abstract of this review is available: http://links.lww.com/SRX/A58.

Advanced practice nurse capabilities: A mixed methods systematic review

BACKGROUND

Global health challenges demand the optimal use of nurses' professional competence and capability. Competencies related to the roles of advanced practice nurses have been developed, but research on these nurses' capabilities remains limited.

AIM

To summarise and compare the literature on the capabilities of advanced practice nurses and the dimensions of these capabilities.

METHODS

We carried out a mixed methods systematic review, using CINAHL, PubMed, and Scopus to search literature published between 1998 and 2021. The quality of the selected articles was evaluated with the JBI Critical Appraisal Tools. We employed abductive content analysis, including deductive and inductive analysis. The reporting was guided by the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement.

RESULTS

Eleven articles out of 357 met the inclusion criteria. We identified all five dimensions of Hase and Davis's (1999) capability framework: can apply competencies in familiar as well as unfamiliar situations, is creative, has a high degree of self-efficacy, knows how to learn, and works well in teams. Additionally, we found a new dimension of capability: identifies factors affecting the scope of practice.

LIMITATIONS

This mixed methods systematic review was conducted about a little-studied topic. Because country-specific differences exist and consensus on advanced practice nursing roles is lacking, the concept of advanced practice nurse capabilities cannot be directly generalised.

CONCLUSIONS

Capability is a requirement and a necessity in the performance of advanced practice nurses. Identifying and defining the dimensions of advanced practice nurses' capabilities will lead the way in developing the roles, education, and capability assessments of advanced practice nurses. Identification of advanced practice nurses' capability will facilitate role understanding, visibility, and implementation in health care services. This can improve the quality and accessibility of care and improve the cost-effectiveness of the use of health care professionals.

Nurse prescribing in Poland: Opinions expressed by primary care doctors, nurses, and patients

The aim of this study was to identify and examine the differences in opinions held by health care professionals and the general public concerning the right to administer and prescribe medication which has been awarded to nurses and midwives in Poland.The study was conducted from December 1, 2014 to July 1, 2015, in randomly selected primary health care clinics, among 2227 individuals, including 849 subjects representing medical personnel of primary health care and 1378 patients receiving primary care services. The study used 2 versions of a questionnaire. The relationships were examined with χ test for independence and Kruskal-Wallis test.Health professionals do not believe the new rights awarded to nurses and midwives will reduce the waiting time for medical consultations (P < 0.001). Nurses' qualifications for the new tasks were most highly rated by patients, whereas the least favorable opinion was expressed by doctors (P < 0.001).To introduce nurse prescribing it is necessary to develop a suitable strategy enabling implementation of the government's initiative and facilitating the process of taking up the new task by nurses.

[The impact of continuous renal replacement therapy training on nursing competence]

Specific training adapted to the needs of caregivers in intensive care enables professional competence and quality of care to be developed in continuous renal replacement therapy. In addition, it contributes to reducing the stress felt by caregivers and the costs of this technique.

Beyond competencies: using a capability framework in developing practice standards for advanced practice nursing

AIM

This paper presents a discussion on the application of a capability framework for advanced practice nursing standards/competencies.

BACKGROUND

There is acceptance that competencies are useful and necessary for definition and education of practice-based professions. Competencies have been described as appropriate for practice in stable environments with familiar problems. Increasingly competencies are being designed for use in the health sector for advanced practice such as the nurse practitioner role. Nurse practitioners work in environments and roles that are dynamic and unpredictable necessitating attributes and skills to practice at advanced and extended levels in both familiar and unfamiliar clinical situations. Capability has been described as the combination of skills, knowledge, values and self-esteem which enables individuals to manage change, be flexible and move beyond competency.

DESIGN

A discussion paper exploring 'capability' as a framework for advanced nursing practice standards.

DATA SOURCES

Data were sourced from electronic databases as described in the background section.

IMPLICATIONS FOR NURSING

As advanced practice nursing becomes more established and formalized, novel ways of teaching and assessing the practice of experienced clinicians beyond competency are imperative for the changing context of health services.

CONCLUSION

Leading researchers into capability in health care state that traditional education and training in health disciplines concentrates mainly on developing competence. To ensure that healthcare delivery keeps pace with increasing demand and a continuously changing context there is a need to embrace capability as a framework for advanced practice and education.

An examination of barriers to nurse practitioner endorsement in senior rural drug and alcohol nurses in New South Wales

INTRODUCTION AND AIMS

To examine barriers senior rural nurses in New South Wales drug and alcohol clinical settings perceive when considering endorsement to Nurse Practitioner (NP).

DESIGN AND METHODS

A survey was designed to record views of senior alcohol and drug nurses in rural New South Wales about becoming a NP. Participants were identified by Area Health Service Directors of Drug and Alcohol Services for each Area Health Service in NSW excluding metropolitan Sydney. Forty eight surveys were distributed, with 17 (35%) completed surveys included in the results.

RESULTS

Of the 17 participants, 12 (70.6%) expressed interest in becoming a NP. The majority (12, 70.6%) were unaware or unsure of endorsement processes. Lack of clarity about the NP role and processes and benefits to becoming a NP was found to be of most concern to all participants. Only 6 participants (35%) indicated they would consider seeking endorsement to NP.

DISCUSSION AND CONCLUSION

Despite agreeing that NP positions in alcohol and drug settings would improve patient access to treatment and care, senior nurses working in these settings in regional areas are unfamiliar with pathways to becoming endorsed. Barriers, such as a lack of internal support from management and colleagues, as well as the fact that respondents reported no foreseeable financial gain in endorsement, also need to be addressed, before more nurses will consider endorsement. Further evaluation of the views of senior nurses in metropolitan alcohol and other drug settings in the process to NP endorsement is needed before clients will benefit from the expertise and enhanced care that NP's may provide.

The first Australian nurse practitioner census: A protocol to guide standardized collection of information about an emergent professional group

Internationally, collection of reliable data on new and evolving health-care roles is crucial. We describe a protocol for design and administration of a national census of an emergent health-care role, namely nurse practitioners in Australia using databases held by regulatory authorities. A questionnaire was developed to obtain data on the role and scope of practice of Australian nurse practitioners. Our tool comprised five sections and included a total of 56 questions, using 28 existing items from the National Nursing and Midwifery Labour Force Census and nine items recommended in the Nurse Practitioner Workforce Planning Minimum Data Set. Australian Nurse Registering Authorities (n = 6) distributed the survey on our behalf. This paper outlines our instrument and methods. The survey was administered to 238 authorized Australian nurse practitioners (85% response rate). Rigorous collection of standardized items will ensure health policy is informed by reliable and valid data. We will re-administer the survey 2 years following the first survey to measure change over time.

How do nurses, midwives and health visitors contribute to protocol-based care? A synthesis of the UK literature

OBJECTIVES

To explore how nurses, midwives and health visitors contribute to the development, implementation and audit of protocol-based care. Protocol-based care refers to the use of documents that set standards for clinical care processes with the intent of reducing unacceptable variations in practice. Documents such as protocols, clinical guidelines and care pathways underpin evidence-based practice throughout the world.

METHODS

An interpretative review using the five-stage systematic literature review process. The data sources were the British Nursing Index, CINAHL, EMBASE, MEDLINE and Web of Science from onset to 2005. The Journal of Integrated Care Pathways was hand searched (1997-June 2006). Thirty three studies about protocol-based care in the United Kingdom were appraised using the Qualitative Assessment and Review Instrument (QARI version 2). The literature was synthesized inductively and deductively, using an official 12-step guide for development as a framework for the deductive synthesis.

RESULTS

Most papers were descriptive, offering practitioner knowledge and positive findings about a locally developed and owned protocol-based care. The majority were instigated in response to clinical need or service re-design. Development of protocol-based care was a non-linear, idiosyncratic process, with steps omitted, repeated or completed in a different order. The context and the multiple purposes of protocol-based care influenced the development process. Implementation and sustainability were rarely mentioned, or theorised as a change. The roles and activities of nurses were so understated as to be almost invisible. There were notable gaps in the literature about the resource use costs, the engagement of patients in the decision-making process, leadership and the impact of formalisation and new roles on inter-professional relations.

CONCLUSIONS

Documents that standardise clinical care are part of the history of nursing as well as contemporary evidence-based care and expanded roles. Considering the proliferation and contested nature of protocol-based care, the dearth of literature about the contribution, experience and outcomes for nurses, midwives and health visitors is noteworthy and requires further investigation.

Risk management in gynaecology: principles and practice

The majority of gynaecology patients are fit women receiving relatively straightforward care. However, human error is inevitable. Furthermore, new treatments and technologies are constantly emerging, today's trainees are less experienced than their predecessors, and the need for team work is greater than ever. These and other factors pose threats to patient safety. Patient safety can be improved through risk management. This review describes risk management principles and tools applicable to gynaecology and highlights common sources of patient safety incidents in gynaecology clinics, wards and operating theatres. It provides an overview of communication, consent, staff training and supervision, and use of clinical practice guidance. Underlying theoretical principles are amply illustrated by practical examples.