Clinical Nurse Specialist: A Critical Member of the ICU Team

Global Scope of Practice of an APN Anesthesia: A Scoping Review

PURPOSE

Perioperative care requires health care professionals with more competencies and skills in clinical assessment, patient education, and advocacy to respond to current and future challenges in health care. Advanced practice nurses (APN) in Anesthesia may represent an approach to improve perioperative care. Specialization in anesthesia care already exists in many countries, but rarely on advanced practice level. An APN Anesthesia is an additional role with expanded skills and competencies and is not yet established in all countries. Therefore, defining the role of APN Anesthesia is necessary. To establish the role of APN Anesthesia effectively, the current evidence on the competencies and scope of practice (SOP) of established roles of APN Anesthesia was summarized.

DESIGN

A scoping review according to the framework by Arksey and O'Malley and the JBI reviewer's manual.

METHODS

We conducted a scoping review by searching the PubMed, PsycINFO, CINAHL, and Scopus databases. The literature search included papers from 2010 to 2023 dealing with the prerequisites and SOP of APN Anesthesia. Descriptions of APN Anesthesia from the United States of America, Asia, and Europe were assessed.

FINDINGS

A total of 1,749 papers were identified of which 24 were included in this review. There is no uniform SOP for APN Anesthesia. The certified registered nurse anesthetist as an established Advanced Practice role in the United States of America, with a high degree of autonomy, is best described. Some APN Anesthesia focus on specific medical conditions such as dementia or autism. APN Anesthesia also works in postoperative care, outpatient clinics, pediatric day surgery, or palliative care settings. Practice development, clinical assessment, education, and family involvement encompass the expanded role of an APN Anesthesia compared with the specialist nurse in Anesthesia.

CONCLUSIONS

The APN Anesthesia is a complementary role in anesthesia because they possess both nursing expertise and advanced medical knowledge. APN Anesthesia provides preoperative assessments with patient and family education, intraoperative care for specific patient populations, and expanded duties in the postanesthesia care unit and palliative care.

The Clinical Nurse Specialist: Maximizing Return on Investment

The United States health care system is facing an unprecedented nursing shortage, increasing complexity of care, and fewer experienced nurse mentors. These factors contribute to a cycle of burnout, turnover, decreased quality and safety, and a worsening financial bottom line. Improving these contributing factors depends on our ability to mitigate the structural causes of burnout and turnover. The clinical nurse specialist role is essential to improving the work environment, advancing evidence-based nursing practice, reducing turnover, and stabilizing the bottom line.

Effects of nurses-led multidisciplinary-based psychological management in spinal surgery: a retrospective, propensity-score-matching comparative study

BACKGROUND

Patients in spine surgery often have emotional disorders which is caused by multi-factors. Therefore, a multidisciplinary and multimodal intervention program is required to improve emotional disorders during the perioperative period. However, related studies were rare. This study aimed to confirm that the multidisciplinary-based psychological management leading by nurses was effective in treating emotional disorders and show the assignments of the members of the multidisciplinary team with the orientations of nurses.

DESIGN

A retrospective, comparative study.

METHOD

This study was a retrospective cohort research and compared the results between the intervention group and control group using the Huaxi Emotional Distress Index (HEI) which was used to evaluate emotional disorders. The intervention group consisted of patients who underwent surgery between January 2018 and December 2020 after psychological management was implemented. The control group consisted of patients with regular care who underwent surgery between January 2015 and December 2017. To improve comparability between the two groups, baseline data from the recruited patients were analyzed using propensity-score-matching (PSM) based on age, sex, marital status, education, and disease region.

RESULTS

A total of 539 (11.5%) people developed emotional disorders, of which 319 (6.8%), 151 (3.2%) and 69 (1.5%) had mild, moderate mood and severe emotional disorders, respectively. 2107 pairs of patients were matched after PSM. Scores of HEI in the intervention group were heightened compared with those in the control group (P<0.001) after matching. Moreover, the incidence of emotional disorders in patients decreased after implementing psychological management (P = 0.001). The severity of emotional disorders was alleviated with statistical significance as well (P = 0.010).

CONCLUSIONS

Nurses-led Multidisciplinary-Based psychological management was able to reduce the incidence of emotional disorders and improve the severity of these in spine surgery patients.

Transition of Care for Older Adults Undergoing General Surgery

The demand for surgical intervention and hospitalization is expected to increase with the growth of the older adult population. Despite advances in technology and minimally invasive surgical procedures, the needs of the older adult in the perioperative period are unique. Transitions of care from the decision to support surgery through surgical intervention, subsequent hospitalization, and postacute discharge must be supported to achieve optimal patient outcomes. The clinical nurse specialist is well suited to address care delivery and assure implementation of best practices across the continuum.

Impact of Wound Dressing Changes on Nursing Workload in an Intensive Care Unit

The objective of this study is to understand how the type of wound dressing changes (routine or frequent) in patients admitted to intensive care units influences nurses' workload. This study used a database of retrospective and analytical observational study from one Portuguese intensive care unit. The sample included 728 adult patients admitted between 2015 and 2019. The nursing workload was assessed by the TISS-28 scale, both at admission and at discharge. The linear regression results show that patients with frequent dressing changes are associated with a higher nursing workload, both at admission (Coef. 1.65; 95% CI [0.53; 2.77]) and discharge (Coef. 1.27; 95% CI [0.32; 2.22]). In addition, age influences the nursing workload; older people are associated with a higher nursing workload (at admission Coef. 0.07; 95% CI [0.04; 0.10]; at discharge Coef. 0.08; 95% CI [0.05; 0.10]). Additionally, an increase in nursing workload at admission would significantly increase the nursing workload at discharge (Coef. 0.27; 95% CI [0.21; 0.33]). The relative stability of the nursing workload over the studied years is also another important finding (the influence of studied years is non-significant). In conclusion, patients with frequent dressing changes presented higher TISS-28 scores when compared with patients with an exchange of routine dressings, which leads to a higher nursing workload.

The implementation of physicians assistant in a surgical ward improves continuity in daily clinical work and increases comprehensibility of nurses and physicians

Introduction

Physician Assistant (PA) have been deployed to increase the capacity of a team, supporting continuity and medical cover. The goal of this study was to assess the implementation of PAs on continuity of surgical rounds, on the collaboration of nurses and physicians and on support of administrative work.

Methods

This cross-sectional survey was performed on nurses and physicians who work full-time at a surgical ward in a Swiss reference center. PAs were introduced in our institution in 2019. Participants answered a self-developed questionnaire 6 and 12 months after the implementation of PAs. Administrative work, teamwork, improvement of workflow, and training of physicians has been assessed. Participants answered questions on a 5-point Likert scale and were stratified according to profession (nurse, physician).

Results

Participants (n = 53) reported a positive effect on the regular conduct of rounds (2.9, SD 1.1 points after 6 weeks and 3.5, SD 1.1 points after 12 weeks, p = 0.05). A significant improvement of nurse-doctor collaboration has been reported (3.6, SD 1.0 and 4.2, SD 0.8, p = 0.05). Nurses (n = 28, 52.8%) reported the that PAs are integrated in the physicians team rather than the nurses team (4.0, SD 0.0 points and 4.4, SD 0.7 points, p = 0.266) and a significant beneficial effect on the surgical clinic (3.7, SD 1.0 points and 4.4, SD 0.8 points, p = 0.043). Improved overall management of surgical cases was reported by the physicians (n = 25, 47.2%) (4.8, SD 0.4 and 4.3, SD 0.6, p = 0.046).

Conclusion

The implementation of PA has improved the collaboration of physicians and nurses substantially. Continuity of rounds has improved and the administrative workload for residents decreased substantially. Overall, the implementation of PA was reported to be beneficial for the surgical clinic.

Influencing Factors of Patients' Trust in Nurses During the COVID-19 Pandemic: A Mixed-Methods Study

OBJECTIVE

This study aimed to investigate the nurse-patient trust among in-patients in the context of the coronavirus disease (COVID-19) epidemic; it further analyzed the related influencing factors, which will provide a theoretical basis for developing corresponding measures.

METHODS

This study employed a mixed-method design and analyzed 149 patients at the Hongqi Hospital, affiliated with Mudanjiang Medical University, from December 2020 to February 2021. Quantitative analysis was carried out using the "Nurse Patient Trust Scale," and qualitative analysis was performed using a semi-structured interview with in-patients.

RESULTS

The average score on the scale was 46.65 ± 2.83, and the scores of the 2 dimensions were: 23.24 ± 1.51 for ability and peace of mind, and 23.32 ± 1.53 for attitude and care. According to the interview data, the factors included 3 aspects: a comfortable hospital environment and humane management measures; the nurse's own competence; and effective communication with patients.

CONCLUSION

During the COVID-19 epidemic, there are still many factors affecting patients' trust in nurses that can be addressed by taking different measures. All these factors must be considered by the relevant managers and clinical nursing staff to maintain a better nurse-patient trust relationship.