The Advanced Practice Nurse in Gastroenterology Serving as Patient Educator

Educational Interventions for Newly Diagnosed Patients With Inflammatory Bowel Disease: A Scoping Review

The latest consensus standards for patients with inflammatory bowel disease published by the European Crohn's and Colitis Organisation conclude that optimizing quality of care in inflammatory bowel disease involves information and education after diagnosis. A scoping review was performed to identify educational interventions in newly diagnosed inflammatory bowel disease patients. A systematic literature search was conducted using five databases and gray literature. Inclusion criteria were studies with at least one group of patients whom were less than 2 years from their initial inflammatory bowel disease diagnosis. The review process initially identified 447 articles, resulting in four relevant studies: three randomized controlled trials and one pre-/post-test. Only one study exclusively included newly diagnosed inflammatory bowel disease patients. All studies included a multidisciplinary assessment and three were based on a group intervention, but none of them was described in enough detail to be replicated. The content was the same for all patients regardless of the time elapsed since diagnosis. Education of newly diagnosed patients does not seem to be a priority given the lack of publications meeting our criteria despite the evidence of their need. Interventions and outcomes are heterogeneous. Interventions did not consider patient needs and suggest that they centered more on the professional than on the patient. More evidence is clearly needed about this topic.

Mid-level providers in gastroenterology

One response to the challenges of modern day clinical practice has been to employ "mid-level providers" (MLPs), such as physician assistants and nurse practitioners. MLPs may complement physicians by supporting patient self-management and performing routine, protocol-guided management. In turn, MLPs may improve health outcomes and simultaneously lower costs. Within gastroenterology, the prevalence of MLPs remains unknown, though it appears to be significant and increasing. Additionally, professional organizations predict that in the future, MLPs will play a central role in digestive disease care. Although incorporating MLPs into gastroenterology has great potential, numerous challenges exist, and their specific roles must first be defined and evaluated.

Review of advanced nursing practice: the international literature and developing the generic features

AIM

The aim of this article is to review the nursing literature on the notion of advanced nursing practice (ANP) and consequently provide clarifications on the concept of advanced nurse practitioner by developing its' generic features.

BACKGROUND

This paper commences by critically reviewing the concept of advanced nursing practice as it is portrayed within the literature. From this review, a series of contradictions emerged in terms of definitions and roles. On further analysis of the literature the core aims and goals of the ANP are revealed.

METHODS

An informative and narrative systematic literature review was undertaken, using specific inclusion and exclusion criteria. The mass of retrieved material was carefully screened and methods of data saturation were used. Consequently, the material was read, re-read and indexed as to develop seven thematic units that formed the generic features of the ANP.

FINDINGS

The generic features that emerged are: (i) the use of knowledge in practice, (ii) critical thinking and analytical skills, (iii) clinical judgement and decision-making skills, (iv) professional leadership and clinical inquiry, (v) coaching and mentoring skills, (vi) research skills and (vii) changing practice.

CONCLUSION

Reviewing the literature on the concept of ANP, a great variety of definitions, conceptualizations and roles emerged. Nonetheless, on a closer reading, a common goal was identified, which was the attainment of practice and professional autonomy via ANP roles for enhanced practice provision. Eventually, from the reviewed literature, seven generic features of the ANP were developed, thus providing clarification to the role and the characteristics of the ANP.

RELEVANCE TO CLINICAL PRACTICE

Clarifying the confusion surrounding advanced nursing practice and gaining an in-depth understanding of its' generic features would facilitate practitioners, practice educators and clinical managers to develop those skills that would allow them or their staff or students to practise at an advanced level.

Making nursing work: breaking through the role confusion of advanced practice nursing

AIM

This paper reports a study to develop a research-informed model of the service parameters and an analysis framework for advanced practice nursing roles.

BACKGROUND

Changing patterns of health care are forcing service planners to examine new service delivery models. Apparent is the call for nursing service that incorporates expanded levels of autonomy, skill and decision-making. A number of nursing roles conform to this description under the generic title of advanced practice nurse. However, there is confusion in the health service community internationally about nomenclature, role and scope for advanced practice nursing roles. An emerging priority in response to recent developments in the nurse practitioner role is to establish service parameters for advanced practice nursing and to differentiate operationally between advanced practice and practitioner nursing roles.

METHODS

We conducted an interpretive, qualitative examination of the practice of a random sample of nine advanced practice nurses working in three acute care hospitals in south east Queensland, Australia in 2006. Data collection involved individual in-depth interviews, which were deductively analysed and tested against published advanced practice nursing models.

RESULTS

The data most comprehensively supported the Strong Model of Advanced Practice as representing the practice experiences of the research participants. This model supports definition of the service parameters and the design of an operational framework for implementation and evaluation of advanced practice nursing roles.

CONCLUSION

The findings differentiate advanced practice nurse and nurse practitioner roles, and offer an operational framework to identify, establish and evaluate advanced and extended nursing positions. Subject to further validation, this outcome can provide operational information for implementing innovative nursing roles appropriate to consumer needs and specific health service models.

Hepatitis C

More than 4 million Americans are infected with the hepatitis C virus. Although overshadowed by acquired immune deficiency syndrome, the hepatitis C epidemic is now recognized as a major health problem. Prevalence is estimated to be anywhere from 1.2% to 10% in specific populations. Nurses continue to express confusion in understanding the disease process; therefore, many opportunities are missed to counsel patients and families who may be at risk or who have hepatitis C. Many patient questions go unanswered because nurses mistakenly assume the medical provider will educate these patients and families. However, nurses have more contact with patients, and one of the nurse's roles is to provide health education. The Society of Gastroenterology Nurses and Associates and the Joint Commission on Accreditation of Healthcare Organizations agree it is the nurse's role to educate patients. Accurate hepatitis C virus information helps nurses guide patients and families in understanding this disease process.