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Canga-Armayor N. Academic training of nurses developing advanced practice roles. ENFERMERIA INTENSIVA 2024:S2529-9840(24)00032-6. [PMID: 39341765 DOI: 10.1016/j.enfie.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/19/2024] [Accepted: 03/01/2024] [Indexed: 10/01/2024]
Abstract
The nursing profession, without losing its essence, is in continuous evolution in order to face and respond to the ever-changing health challenges of the population. Advanced Practice Nursing is a clear example of this development. The performance of advanced practice roles entails greater responsibility, expansion and depth of nursing practice, which is only possible with additional education beyond the bachelor's degree - a master's or doctoral degree in nursing - and greater expertise in clinical practice in a particular area of specialization. Advanced practice nursing is intrinsically linked to the level of education since, further academic development of nursing promotes the advancement of autonomous practice. This article addresses the education of Advanced Practice Nurses, and focuses on its core aspects; providing detailed information on competencies, curricular structure, curriculum and key components of training programs. Finally, special mention is made of advanced role training in the critical care setting.
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Affiliation(s)
- N Canga-Armayor
- Departamento de Enfermería Comunitaria y Materno Infantil, Facultad de Enfermería, Universidad de Navarra, Navarra, Spain; Grupo de investigación en el Cuidado de Enfermería, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Navarra, Spain.
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North N, Brysiewicz P, Coetzee M. 'We are pulled to the four corners': Qualitative role descriptions of advanced practice children's nurses in Malawi. J SPEC PEDIATR NURS 2024; 29:e12433. [PMID: 38800936 DOI: 10.1111/jspn.12433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/25/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE This study investigated emerging roles among specialist child health nurses (CHNs) in Malawi. Advanced nursing role development is globally advocated. Nursing role descriptions provide an evidential basis for workforce planning. Rigorously developed role descriptions are scarce worldwide, especially for Africa. Advanced nursing roles were introduced in Malawi's child health system a decade ago. DESIGN AND METHODS We followed guidance on generating nursing role descriptions to collect and analyse qualitative data from interviews and focus groups, using qualitative content analysis. We used COREQ reporting standards. RESULTS More than half (41/80) of Malawi's child health nursing workforce participated. Richly descriptive accounts of roles elicited three themes: leading and developing new services and improving existing ones; holding rare knowledge which uplifts care quality; and responsibility for developing the role. These responsibilities are experienced as a privilege and a burden, often meaning CHNs are 'pulled to the four corners'. PRACTICE IMPLICATIONS We found evidence of remarkable achievements by Malawi's CHNs but also suggestions that they are under heavy strain. Because multi-stakeholder agreement about role content is crucial to successfully implementing advanced nursing roles, we hope the approach taken by this study, and the information generated, could be useful as part of human resources for health strategy development in other lower-resourced countries globally.
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Affiliation(s)
- Natasha North
- Department of Paediatrics and Child Health, The Harry Crossley Children's Nursing Development Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Petra Brysiewicz
- School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Minette Coetzee
- Department of Paediatrics and Child Health, The Harry Crossley Children's Nursing Development Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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Gorjian Z, Asadizaker M, Zarea K, Irajpour A, Ahmadi F, Rokhafroz D. Experiences and attitudes of clinical and academic nurses about infection prevention and control nursing curriculum and duties - a qualitative study. BMC MEDICAL EDUCATION 2024; 24:672. [PMID: 38886696 PMCID: PMC11184893 DOI: 10.1186/s12909-024-05633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 06/05/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Infectious diseases are becoming more widespread and re-emerging, causing psychological, social, economic, and health effects at both national and international levels. Specialist nurses can help prevent and control these infections. However, in Iran, there are currently no specialist infection prevention and control (IPC) nurses to manage and control infections. This study aims to explore clinical and academic nurses' attitudes toward IPC nursing curriculum and duties. METHODS The study used a qualitative content analysis approach. Thirty-six participants, including clinical and academic nurses, were selected using a purposeful sampling method. Data was collected through seven focused group discussions. The accuracy and validity of the research tools were measured using the Four-Dimension Criteria developed by Lincoln and Guba. Data analysis was conducted using directed content analysis. RESULTS The data analysis of the discussions held in the seven focus groups extracted 628 codes. Three themes were developed from the qualitative analysis: "Core characteristics of the curriculum", "Expected competencies and skills", and "Evaluation." These themes were derived from nine main categories and 25 subcategories. CONCLUSIONS Specialist IPC nurses can play important roles in various positions and environments. Therefore, educational policymakers in Iran should consider establishing IPC nursing courses. It is also recommended that policymakers and decision-makers in the nursing field of other less developed countries should prioritize this issue.
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Affiliation(s)
- Zahra Gorjian
- Student Research Committee, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, Abadan University of Medical Sciences, Abadan, Iran
| | - Marziyeh Asadizaker
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Kourosh Zarea
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Irajpour
- Nursing & Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Ahmadi
- Infection and Tropical Disease Research Center, Health research institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Dariush Rokhafroz
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Current Practice and Practice Competencies of Clinical Nurse Specialists Working in US Emergency Care Settings: A Survey Study. CLIN NURSE SPEC 2023; 37:64-77. [PMID: 36799702 DOI: 10.1097/nur.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
PURPOSE/AIMS The aim of this study was to investigate the current practice of clinical nurse specialists working in US emergency care settings to (1) explicate the application of the Emergency Nurses Association core competencies and define the specialized clinical nurse specialist role in emergency care and (2) align current clinical nurse specialist practice in emergency settings with the National Association of Clinical Nurse Specialists core competencies and the identified substantive areas of clinical nurse specialist practice. DESIGN This study used a quantitative exploratory descriptive approach using survey data. METHODS A purposive convenience sample was recruited from the Emergency Nurses Association and the National Association of Clinical Nurse Specialists. Participants completed a 39-item survey based on a consensus process to develop competencies for emergency department (ED)-situated clinical nurse specialists. RESULTS Respondents (n = 285) reported spending more than 50% of their work time in a primary clinical nurse specialist role. Significant differences in practice were found between geographic location, setting, educational preparation, title protection status, and type of institution. CONCLUSIONS Our findings suggest that that the competencies ascribed to ED-situated clinical nurse specialists are valid in both frequency and importance. However, ED-situated clinical nurse specialists are not fully credentialed or practicing to the full extent of their education and licenses, because of professional, legislative, and environmental limitations.
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Dening KH, Aldridge Z, Hayo H. Admiral Nursing: supporting generalist nurses to work with families affected by dementia. Nurs Stand 2023; 38:41-45. [PMID: 36519394 DOI: 10.7748/ns.2022.e12006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 06/17/2023]
Abstract
The number of people with dementia in the UK is expected to significantly increase over the next two decades, which has implications for service demand and delivery, as well as for the development of the workforce across all health and social care services. The health and social care workforce requires a range of knowledge and skills to enable staff to meet the complex needs of people with dementia and their families. In the UK, a framework outlining dementia training standards was developed to address this; however, the quality and efficacy of this training is unclear and there are growing doubts that such a 'one-size-fits-all' approach can meet the diverse needs of the workforce. This article discusses the education needs of the health and social care workforce in relation to dementia and outlines how the specialist role of the Admiral Nurse can support these needs. The article also details two case studies that demonstrate the role of the Admiral Nurse in identifying and supporting the education needs of generalist nurses working in acute hospital and primary care settings.
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Jokiniemi K, Tervo‐Heikkinen T, Peltokoski J, Mikkonen S. Construct validity of Advanced Practice Role Delineation tool: A confirmatory factor analysis. Int J Nurs Pract 2022; 28:e13064. [PMID: 35633049 PMCID: PMC9788128 DOI: 10.1111/ijn.13064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 04/25/2022] [Indexed: 12/30/2022]
Abstract
AIM To test the psychometric properties and latent structure of the modified Strong Model of Advanced Practice tool. BACKGROUND The Strong Model of Advanced Practice tool, developed in the United States in 1990s and its Australia modification, has been increasingly used to delineate nursing and advanced practice nursing roles. Few research-driven efforts to develop and validate these tools have taken place. DESIGN Psychometric testing of the modified Strong Model of Advanced Practice tool. METHODS A confirmatory factor analysis was undertaken to examine the factors of the modified Strong Model of Advanced Practice tool and compare the model to the Australian Advanced Practice Role Delineation tool. The data were collected in September 2020. RESULTS The analysis of the data provided construct validity evidence of the underlying theoretical structures of the five-factor modified Strong Model of Advanced Practice tool. The 45-item modified Strong Model of Advanced Practice tool demonstrated satisfactory, slightly better psychometric properties and construct validity than the 40-item Advanced Practice Role Delineation tool. CONCLUSIONS Psychometric properties of the scale were evaluated and reported. Based on the statistical analysis, we suggest the use of the 45-item modified Strong Model of Advanced Practice tool.
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Affiliation(s)
- Krista Jokiniemi
- Department of Nursing Science, Faculty of Health SciencesUniversity of Eastern FinlandKuopio
| | - Tarja Tervo‐Heikkinen
- Clinical Development, Education and Research Centre of NursingKuopio University HospitalKuopioFinland
| | | | - Santtu Mikkonen
- Department of Environmental and Biological Sciences and Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
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Gabbard ER, Klein D, Vollman K, Chamblee TB, Soltis LM, Zellinger M. Clinical Nurse Specialist: A Critical Member of the ICU Team. AACN Adv Crit Care 2021; 32:413-420. [PMID: 34879134 DOI: 10.4037/aacnacc2021511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To describe the role of the clinical nurse specialist, an advanced practice registered nurse in the intensive care setting. The value and impact of the clinical nurse specialist role as a member of the ICU is presented along with a review of clinical nurse specialist education, licensure, and certification requirements as well as a description of the clinical nurse specialist role, scope of practice, and competencies. In addition, a selected review of clinical nurse specialist-led quality improvement and research that resulted in improved patient outcomes is provided. DATA SOURCES Review of published medical and nursing literature and expert opinion guidance from a collaborative effort between the Society of Critical Care Medicine, American Association of Critical-Care Nurses, and National Association of Clinical Nurse Specialists. STUDY SELECTION Not applicable. DATA EXTRACTION Not applicable. DATA SYNTHESIS Not applicable. CONCLUSIONS The utilization of a clinical nurse specialist, an advanced practice role, in the ICU is a unique and valuable approach for organizations who strive to move evidence into sustainable practice and drive quality through an interprofessional approach. The valuable contributions made by the clinical nurse specialist efficiently and effectively meet the needs of patients, clinicians, and organizations while improving patient outcomes and optimizing cost avoidance strategies, which further lower economic demands on the healthcare system.
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Affiliation(s)
| | - Deborah Klein
- Deborah Klein is at Cleveland Clinic, Cleveland, Ohio
| | - Kathleen Vollman
- Kathleen Vollman is at Advancing Nursing LLC, Northville, Michigan
| | | | - Lisa M Soltis
- Lisa M. Soltis is at UNC Healthcare, Chapel Hill, North Carolina
| | - Mary Zellinger
- Mary Zellinger is at Emory University Hospital, Atlanta, Georgia
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Jokiniemi K, Heikkilä A, Meriläinen M, Junttila K, Peltokoski J, Tervo-Heikkinen T, Mattila E, Mikkonen S. Advanced practice role delineation within Finland: A comparative descriptive study. J Adv Nurs 2021; 78:1665-1675. [PMID: 34655100 DOI: 10.1111/jan.15074] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/18/2021] [Accepted: 09/16/2021] [Indexed: 01/10/2023]
Abstract
AIM To identify and differentiate the practice patterns of generalist, specialist and advanced practice nursing roles in specialist and central hospital contexts. BACKGROUND In Finland, as in other Nordic countries, advanced practice nursing roles emerged around 2000. There are over 60,000 registered nurses/midwives in Finland and the clinical career pathway from a registered nurse to advanced practice nurse has been described yet not fully implemented in healthcare organizations. However, the number and activities of nonadvanced and advanced practitioner roles are not well known. DESIGN A descriptive comparative study. METHODS An online self-report survey was conducted between August and October 2020 using an advanced practice role delineation tool. A census sample of registered nurses, registered midwives, specialist nurses and advanced practice nurses in five university hospitals and one central hospital was recruited. Descriptive statistics were used to summarize the characteristics of participants and group differences were compared using analysis of variance (ANOVA). The STROBE checklist was used as the reporting guideline. RESULTS A total of 1497 responses were obtained (response rate = 10%). Overall, nurses used comprehensive care and education activities most frequently. The least used activities were research and publication and professional leadership. Univariate analysis of variance test between role effects, when education and grouped age were taken into account, showed statistically significant difference in all of the observed five activities (p < .001). CONCLUSION Identifying activities in different levels of nursing is a crucial first step in delineating nursing roles thus improving the governance of the human resource management. IMPACT The study results add to the international literature, delineating nursing roles in the spectrum of generalist to advanced practice nursing. As these roles become more formalized, we may incorporate novel ways of promoting the career development and optimal use and assessment of nursing roles and practice in various career levels.
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Affiliation(s)
- Krista Jokiniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Asta Heikkilä
- Development Services, Hospital District of Southwest Finland, Turku, Finland
| | - Merja Meriläinen
- Oulu University Hospital, Medical Research Center (MRC) Oulu, Oulu, Finland
| | - Kristiina Junttila
- Nursing Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Tarja Tervo-Heikkinen
- Clinical Development, Education and Research Centre of Nursing, Kuopio University Hospital, Kuopio, Finland
| | | | - Santtu Mikkonen
- Department of Environmental and Biological Sciences and Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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Gabbard ER, Klein D, Vollman K, Chamblee TB, Soltis LM, Zellinger M. Clinical Nurse Specialist: A Critical Member of the ICU Team. CLIN NURSE SPEC 2021; 35:271-276. [PMID: 34398549 DOI: 10.1097/nur.0000000000000624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the role of the clinical nurse specialist, an advanced practice registered nurse in the intensive care setting. The value and impact of the clinical nurse specialist role as a member of the ICU is presented along with a review of clinical nurse specialist education, licensure, and certification requirements as well as a description of the clinical nurse specialist role, scope of practice, and competencies. In addition, a selected review of clinical nurse specialist-led quality improvement and research that resulted in improved patient outcomes is provided. DATA SOURCES Review of published medical and nursing literature and expert opinion guidance from a collaborative effort between the Society of Critical Care Medicine, American Association of Critical Care Nurses, and National Association of Clinical Nurse Specialists. STUDY SELECTION Not applicable. DATA EXTRACTION Not applicable. DATA SYNTHESIS Not applicable. CONCLUSIONS The utilization of a clinical nurse specialist, an advanced practice role, in the ICU is a unique and valuable approach for organizations who strive to move evidence into sustainable practice and drive quality through an interprofessional approach. The valuable contributions made by the clinical nurse specialist efficiently and effectively meet the needs of patients, clinicians, and organizations while improving patient outcomes and optimizing cost avoidance strategies, which further lower economic demands on the healthcare system.
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Affiliation(s)
- Erika R Gabbard
- Author Affiliations:SCP Health, Atlanta, GA (Gabbard), Cleveland Clinic, Cleveland, OH (Klein), Advancing Nursing LLC, Northville, MI (Vollman), Children's Health, Dallas, TX (Chamblee), UNC Healthcare, Chapel Hill, NC (Soltis), Emory University Hospital, Atlanta, GA (Zellinger)
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Jokiniemi K, Hølge-Hazelton B, Kristofersson GK, Frederiksen K, Kilpatrick K, Mikkonen S. Core competencies of clinical nurse specialists: A comparison across three Nordic countries. J Clin Nurs 2021; 30:3601-3610. [PMID: 34096111 DOI: 10.1111/jocn.15882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/25/2021] [Accepted: 05/07/2021] [Indexed: 01/10/2023]
Abstract
AIM To describe and compare the clinical nurse specialist core competency use in Finland, Denmark and Iceland. BACKGROUND Clinical nurse specialist roles were first developed more than 60 years ago in the United States. Within the Nordic countries, the clinical nurse specialist role emerged around 2000. There is scarcity of clinical nurse specialist competency descriptions outside of North America, and research has been limited to examine or validate established competencies across different countries. DESIGN A descriptive correlational study. METHODS An online survey was conducted from May to September 2019. A population sample of clinical nurse specialists in Finland, Denmark and Iceland was recruited. A validated self-report questionnaire of clinical nurse specialist competencies was used. The data were analysed using descriptive and inferential statistics, and the STROBE checklist was used as the reporting guideline. RESULTS A total sample of 184 clinical nurse specialists, 52 from Finland, 95 from Denmark and 37 from Iceland, participated in the study (response rate = 72%, 35% and 48%, respectively). Overall, clinical nurse specialists utilised the organisational competency most frequently followed by the patient, clinical nursing leadership and scholarship competency. Univariate analysis of variance test between-country effects showed statistically significant difference in patient competency (p = .000) and in organisational competency (p < .05). There were no statistically significant differences between counties in the utilisation of clinical nursing leadership and scholarship competency. CONCLUSION A small variability was found in the comparison of the clinical nurse specialist use of core competency in the spheres of patient, nursing, organisation and scholarship within three Nordic countries. RELEVANCE TO CLINICAL PRACTICE The CNS competency scale may be utilised in benchmarking clinical nurse specialist roles and practice within and across countries. The long-term goal for the competency descriptions is to enhance the clinical nurse specialist role clarity, integration and evaluation as well as inform post-graduate education.
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Affiliation(s)
- Krista Jokiniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Bibi Hølge-Hazelton
- Institute of Regional Health Research at University of Southern Denmark, Denmark.,Research Support Unit, Zealand University Hospital, Roskilde, Denmark
| | | | | | - Kelley Kilpatrick
- Ingram School of Nursing McGill University, Susan E. French Chair in Nursing Research and Innovative Practice, Montreal, QC, Canada
| | - Santtu Mikkonen
- Department of Environmental and Biological Sciences and Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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Abstract
OBJECTIVES To describe the role of the clinical nurse specialist, an advanced practice registered nurse in the intensive care setting. The value and impact of the clinical nurse specialist role as a member of the ICU is presented along with a review of clinical nurse specialist education, licensure, and certification requirements as well as a description of the clinical nurse specialist role, scope of practice, and competencies. In addition, a selected review of clinical nurse specialist-led quality improvement and research that resulted in improved patient outcomes is provided. DATA SOURCES Review of published medical and nursing literature and expert opinion guidance from a collaborative effort between the Society of Critical Care Medicine, American Association of Critical Care Nurses, and National Association of Clinical Nurse Specialists. STUDY SELECTION Not applicable. DATA EXTRACTION Not applicable. DATA SYNTHESIS Not applicable. CONCLUSIONS The utilization of a clinical nurse specialist, an advanced practice role, in the ICU is a unique and valuable approach for organizations who strive to move evidence into sustainable practice and drive quality through an interprofessional approach. The valuable contributions made by the clinical nurse specialist efficiently and effectively meet the needs of patients, clinicians, and organizations while improving patient outcomes and optimizing cost avoidance strategies, which further lower economic demands on the healthcare system.
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Jokiniemi K, Pietilä AM, Mikkonen S. Construct validity of clinical nurse specialist core competency scale: An exploratory factor analysis. J Clin Nurs 2021; 30:1863-1873. [PMID: 33259668 DOI: 10.1111/jocn.15587] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/29/2020] [Accepted: 11/13/2020] [Indexed: 01/10/2023]
Abstract
AIM To conduct a construct validity test on a clinical nurse specialist core competency scale. BACKGROUND Clinical nurse specialists' competency development dates back to the late 20th century; however, there is scarcity of competency descriptions from outside of North America. Furthermore, little knowledge is available on the previous research-driven efforts to develop and validate clinical nurse specialist core competencies. DESIGN A descriptive study, using an online self-report questionnaire, was conducted from May to September 2019 in three Nordic countries. METHODS An exploratory factor analysis using principal axis factoring and rotation method oblimin with Kaiser normalisation was undertaken to examine factors in the 50-item scale. Parallel analysis with eigenvalue Monte Carlo simulation and scree plot was used to determine the number of factors to extract. Psychometric properties of the scale were evaluated, and subjective interpretation was used to modify the tool in line with the statistical analysis. The STROBE checklist was used as the reporting guideline for this study. RESULTS One hundred and eighty-four responses were obtained (Finland n = 52, Denmark n = 95, Iceland n = 37) with an overall response rate of 45%. The results provided construct validity evidence of the underlying theoretical structures of the four competency spheres of patient, nursing, organisation and scholarship. Cronbach's alpha coefficient for the original overall scale was 0.94, thus indicating adequate reliability of the scale. CONCLUSIONS Based on the analysis and subjective interpretation, we suggest a 47-item clinical nurse specialist core competency scale. Further study should be conducted to validate the core competency content and construct in other contexts beyond the present study. RELEVANCE TO CLINICAL PRACTICE The scale may be used to guide clinical nurse specialist practice and identify areas for professional development, develop graduate-level programme curricula and inform future competency research.
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Affiliation(s)
- Krista Jokiniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Pietilä
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Santtu Mikkonen
- Department of Environmental and Biological Sciences and Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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Li X, Zhou M, Wang H, Hao W. Factors associated with core competencies of emergency-room nurses in tertiary hospitals in China. Jpn J Nurs Sci 2020; 17:e12337. [PMID: 32239754 DOI: 10.1111/jjns.12337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/26/2019] [Accepted: 02/26/2020] [Indexed: 12/25/2022]
Abstract
AIM Quantitative studies using validated questionnaires on core competencies of emergency nurses in China are rare and the baseline core competencies must first be evaluated before improvizations to the competencies can be implemented. This study aimed to investigate the factors potentially involved in the level of core competencies of emergency nurses from tertiary hospitals in northwest China. METHODS In this cross-sectional study, male and female emergency nurses (n = 277) from tertiary hospitals of northwest China were enrolled to complete the Competency Inventory for Registered Nurses (CIRN) questionnaire comprising of a total of seven dimensions with 58 items. General self-efficacy and perceived stress were also evaluated. Pearson correlation test and multivariate stepwise linear regression analysis were performed to assess the association between various factors associated with core competencies. RESULTS Senior nurses had higher CIRN scores than junior nurses (p < .001). Married and widowed nurses had higher CIRN scores than unmarried and divorced nurses (p = .008). Nurses satisfied with their career had better CIRN scores than those who were dissatisfied (p < .001). CIRN scores were correlated with age (r = .356, p < .001), working years (r = .374, p < .001), and the general self-efficacy scale (r = .547, p < .001). Multivariable stepwise linear regression analysis showed that higher professional titles and job satisfaction were independently associated with higher CIRN scores (both p < .001). CONCLUSIONS Emergency nurses from tertiary hospitals of northwest China with senior titles and job satisfaction had high CIRN scores which necessitates empowering the junior nurses by way of education and training programs to gain higher core competencies in order to deliver better nursing care to patients.
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Affiliation(s)
- Xinxia Li
- Department of Nursing, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Mei Zhou
- School of Nursing, Inner Mongolia Medical University, Hohhot, China
| | - Hui Wang
- Department of Emergency, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Wennv Hao
- Department of Emergency, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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Fulton JS, Mayo A, Walker J, Urden LD. Description of work processes used by clinical nurse specialists to improve patient outcomes. Nurs Outlook 2019; 67:511-522. [DOI: 10.1016/j.outlook.2019.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/28/2019] [Accepted: 03/15/2019] [Indexed: 01/26/2023]
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Roulin MJ, Coraboeuf B, Hof F. Le modèle de pratique des infirmières spécialistes cliniques aux Hôpitaux universitaires de Genève. SOINS; LA REVUE DE RÉFÉRENCE INFIRMIÈRE 2018; 63:14-17. [PMID: 30366695 DOI: 10.1016/j.soin.2018.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
THE CLINICAL NURSE SPECIALIST PRACTICE MODEL AT GENEVA UNIVERSITY HOSPITALS.: A clinical nurse specialist practice model has been implemented at Geneva University Hospitals. It details the five dimensions of the function-clinical practice, coaching-consultation-guidance, research, leadership and collaboration, ethics-and its three spheres of influence-patients and their family, nursing teams, institutions. Arising from practice rather than the world of academia, it constitutes a tool to aid reflection among the nursing profession.
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Affiliation(s)
- Marie-José Roulin
- Hôpitaux universitaires de Genève, 4, rue Gabrielle-Perret-Gentil, 1205 Genève, Suisse.
| | - Brigitte Coraboeuf
- Hôpitaux universitaires de Genève, 4, rue Gabrielle-Perret-Gentil, 1205 Genève, Suisse
| | - Frank Hof
- Hôpitaux universitaires de Genève, 4, rue Gabrielle-Perret-Gentil, 1205 Genève, Suisse
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Abstract
PURPOSE/AIMS The purpose of this study was to validate a tool to assess alcohol withdrawal in acute care patients. Study aims included (1) establish content validity, (2) examine criterion-related validity, (3) test interrater reliability, and (4) assess nurse usability. DESIGN A psychometric research study was designed to evaluate the Alcohol Withdrawal Assessment Tool. METHODS Validation was conducted using an expert panel to determine content validity. The Clinical Institute Withdrawal Assessment for Alcohol-Revised was used as comparison for the criterion related validity. Interrater reliability was determined by having 2 investigators simultaneously complete the assessment on the same patients. Usability was determined using a Likert scale survey. RESULTS The average age of participants was 53 years, with a range of 27 to 81 years. Interrater reliability was supported by a κ statistic range of 0.61 to 0.6957, and content validity was supported by a content validity index of 1.0. Criterion-related validity was supported with a Pearson r correlation of 0.665 (P < .000). Of nurses surveyed, all answered agree or strongly agree to the usability survey. CONCLUSIONS The assessment tool may be an effective alternative to utilize in the acute care setting. It is easy to use and drives frequency of assessment and appropriate pharmacologic treatment.
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Use of a Systematic Consultation Process to Facilitate Nursing Research Projects: An Exemplar. CLIN NURSE SPEC 2018; 32:249-259. [PMID: 30095524 DOI: 10.1097/nur.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/OBJECTIVES The purpose of this article is to describe the use of a well-established, 5-stage consultation process, to advise a research team on planning strategies to engage domestic violence shelters (DVSs) as community partners in their study. The research team is testing a health promotion intervention for teens living in shelters with their parent and needed to enlist shelters as sites to recruit teens and conduct the intervention. Consultation aims were to (a) identify highly promising strategies described in peer-reviewed literature for identifying, recruiting, and collaborating with community organizations in research and (b) identify DVSs that would potentially serve as effective community partners for the study. METHODS A clinical nurse specialist and a public health master's degree student led the consultation. The consultation process included (a) a systematic review of 29 peer-reviewed articles about research or program evaluation studies that engaged community partners and (b) a comprehensive online search of information about DVSs. OUTCOMES Consultants identified 104 strategies used in studies to engage community partners and 10 specific DVSs most likely to effectively engage in the study. CONCLUSION Clinical nurse specialists are well situated to provide consultation to research teams and should follow well-established consultation processes and systematic data collection procedures.
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Wang J, Tong Y, Jiang Y, Zhu H, Gao H, Wei R, Que X, Gao L. The effectiveness of extended care based on Internet and home care platform for orthopaedics after hip replacement surgery in China. J Clin Nurs 2018; 27:4077-4088. [PMID: 29851157 DOI: 10.1111/jocn.14545] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 04/04/2018] [Accepted: 05/07/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Jie Wang
- The First Affiliated Hospital of Soochow University; Suzhou China
| | - Yahui Tong
- The First Affiliated Hospital of Soochow University; Suzhou China
| | - Yingqing Jiang
- The First Affiliated Hospital of Soochow University; Suzhou China
| | - Hongxia Zhu
- The First Affiliated Hospital of Soochow University; Suzhou China
| | - Hui Gao
- The First Affiliated Hospital of Soochow University; Suzhou China
| | - Rong Wei
- Affiliated Hospital of Nantong University; Nantong China
| | - Xianfeng Que
- Affiliated Hospital of Nantong University; Nantong China
| | - Luoluo Gao
- Taixing People's Hospital; Taixing China
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Jokiniemi K, Meretoja R, Pietilä AM. Constructing content validity of clinical nurse specialist core competencies: exploratory sequential mixed-method study. Scand J Caring Sci 2018; 32:1428-1436. [PMID: 29963720 DOI: 10.1111/scs.12588] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 05/13/2018] [Indexed: 11/29/2022]
Abstract
RATIONAL The demand to increase nursing competence is brought on by the requirement of safe, accessible and more effective use of healthcare provider expertise. Clinical nurse specialist competency development dates back to the late 20th century; however, an examination of the literature reveals a lack of research and discussion to support the competency development. OBJECTIVES To describe the formulation and validation process of the clinical nurse specialist core competencies. DESIGN Exploratory sequential mixed-method design. METHODS This mixed-method study, conducted between 2013 and 2017 in Finland, involved four phases: I) a Policy Delphi study (n = 25, n = 22, n = 19); II) cross-mapping of preliminary competency criteria against international competency sets; III) content validity study of expanded competency criteria (n = 7, n = 10); and IV) verification of competency criteria with practicing CNSs (n = 16). Data were analysed by both qualitative and quantitative analysis methods. RESULTS Seventy-four preliminary clinical nurse competency criteria were formulated in the first phase of the study. Through cross-mapping the competencies against the US and Canadian clinical nurse specialist competency sets, they were further concised to 61 criteria. The examination of Content Validity Indexes and experts' comments led to the clarification and consequent inclusion of 50 criteria to the final scale, with Scale Content Validity Index Average of 0.94. The competency criteria were evaluated to be a solid set with potential to clarify and uniform the clinical nurse specialist roles. CONCLUSIONS Through a rigorous research process, validated clinical nurse specialist competency criteria were formed with a high Scale Content Validity Index Average. The results allude to the potential of formulating international competency criteria to support global role clarity and understanding. However, further research is needed to validate the content and construct of the formulated competencies with a larger population across countries.
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Affiliation(s)
- Krista Jokiniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Riitta Meretoja
- University of Turku, Turku, Finland.,Helsinki University Hospital, Helsinki, Finland
| | - Anna-Maija Pietilä
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Social and Health Care Services, Kuopio, Finland
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Abstract
PURPOSE The purpose of the process improvement initiative was to improve the percentage of undertriaged patients to less than 10% (benchmark) using the Emergency Severity Index tool. Undertriaged patients have an increased potential for poor outcomes due to a lengthier waiting room stay, which results in delay of care. DESCRIPTION OF THE PROJECT An evidence-based project designed for staff development was conducted for a 7-month period. Project procedures consisted of triage chart reviews for a 3-month period during pre- and post-Emergency Severity Index training. Emergency Severity Index refresher training for nurses triaging in the emergency department was conducted for a 1-month period. OUTCOME Chart reviews revealed that 102 of 388 patients (26.3%) were undertriaged before Emergency Severity Index training. After Emergency Severity Index training, chart reviews depicted that 41 of 440 patients (9.3%) were undertriaged. This difference was statically significant (P < .001), when tested using a 1-sided t test at the 95% confidence level and achieving at least 80% power. IMPLICATIONS Regardless of previous training or years of emergency department nursing experience, triage refresher training has been shown to increase accuracy of triage categorization, thus leading to a decreased risk of poor patient outcomes.
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Doody O, Slevin E, Taggart L. Families’ perceptions of the contribution of intellectual disability clinical nurse specialists in Ireland. J Clin Nurs 2017; 27:e80-e90. [DOI: 10.1111/jocn.13873] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Owen Doody
- Department of Nursing and Midwifery; University of Limerick; Limerick Ireland
| | - Eamonn Slevin
- Interim Deputy Director; Autism Initiatives; Belfast UK
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From Hospital to Ambulatory Care: Realigning the Practice of Clinical Nurse Specialists. CLIN NURSE SPEC 2017; 30:271-6. [PMID: 27509563 DOI: 10.1097/nur.0000000000000231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE/OBJECTIVES This article describes how a large healthcare organization expanded the practice of clinical nurse specialists from the hospital to the ambulatory setting. BACKGROUND Clinical nurse specialist practice traditionally focused on actualizing the 3 spheres of influence (patient, nurse, and organization) in the hospital setting. RATIONALE Changes in the healthcare system shifting patient care to the ambulatory setting created opportunities for clinical nurse specialists to improve patient outcomes in this setting. DESCRIPTION An innovation framework from the Mayo Clinic Center for Innovation based on inspiration, generation of ideas, experimenting, and diffusion was used to assess and prioritize the work of clinical nurse specialists in the ambulatory setting. OUTCOMES Clinical nurse specialists became integral members of hospital and ambulatory nursing leadership. In the ambulatory setting, they are partnering to standardize patient care, providing tools for nurses to practice to full scope, and identifying and providing solutions for patient safety issues. CONCLUSION Aligning clinical nurse specialists in the hospital and ambulatory care settings allows partnership with multidisciplinary teams to ensure that evidence-based practices and standardized care are infused across the continuum of care. IMPLICATIONS Evidence-based practices and standardized care encourage nurses to practice to full scope and focus on improved patient outcomes.
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Lopatina E, Donald F, DiCenso A, Martin-Misener R, Kilpatrick K, Bryant-Lukosius D, Carter N, Reid K, Marshall DA. Economic evaluation of nurse practitioner and clinical nurse specialist roles: A methodological review. Int J Nurs Stud 2017; 72:71-82. [PMID: 28500955 DOI: 10.1016/j.ijnurstu.2017.04.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/21/2017] [Accepted: 04/28/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Advanced practice nurses (e.g., nurse practitioners and clinical nurse specialists) have been introduced internationally to increase access to high quality care and to tackle increasing health care expenditures. While randomised controlled trials and systematic reviews have demonstrated the effectiveness of nurse practitioner and clinical nurse specialist roles, their cost-effectiveness has been challenged. The poor quality of economic evaluations of these roles to date raises the question of whether current economic evaluation guidelines are adequate when examining their cost-effectiveness. OBJECTIVE To examine whether current guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles. METHODS Our methodological review was informed by a qualitative synthesis of four sources of information: 1) narrative review of literature reviews and discussion papers on economic evaluation of advanced practice nursing roles; 2) quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials; 3) review of guidelines for economic evaluation; and, 4) input from an expert panel. RESULTS The narrative literature review revealed several challenges in economic evaluations of advanced practice nursing roles (e.g., complexity of the roles, variability in models and practice settings where the roles are implemented, and impact on outcomes that are difficult to measure). The quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials identified methodological limitations of these studies. When we applied the Guidelines for the Economic Evaluation of Health Technologies: Canada to the identified challenges and limitations, discussed those with experts and qualitatively synthesized all findings, we concluded that standard guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles and should be routinely followed. However, seven out of 15 current guideline sections (describing a decision problem, choosing type of economic evaluation, selecting comparators, determining the study perspective, estimating effectiveness, measuring and valuing health, and assessing resource use and costs) may require additional role-specific considerations to capture costs and effects of these roles. CONCLUSION Current guidelines for economic evaluation should form the foundation for economic evaluations of nurse practitioner and clinical nurse specialist roles. The proposed role-specific considerations, which clarify application of standard guidelines sections to economic evaluation of nurse practitioner and clinical nurse specialist roles, may strengthen the quality and comprehensiveness of future economic evaluations of these roles.
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Affiliation(s)
- Elena Lopatina
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, 3C60, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Faith Donald
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
| | - Alba DiCenso
- School of Nursing and Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, Box 15000, 5869 University Avenue, Halifax, NS, B3H 4R2, Canada.
| | - Kelley Kilpatrick
- Faculty of Nursing, Université de Montréal, Research Centre Hôpital Maisonneuve-Rosemont, CSA - RC - Aile bleue - Room F121, 5415 boul. l'Assomption, Montréal, QC, H1T 2M4, Canada.
| | - Denise Bryant-Lukosius
- School of Nursing, McMaster University, 1280 Main Street West, HSC-3N28G, Hamilton, ON, L8S 4L8, Canada.
| | - Nancy Carter
- School of Nursing, McMaster University, 1280 Main Street West, HSC-3N28H, Hamilton, ON, L8S 4L8, Canada.
| | - Kim Reid
- KJResearch, Rosemere, QC, Canada.
| | - Deborah A Marshall
- Department of Community Health Sciences and Faculty of Medicine, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre, Room 3C58, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
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Association Between Clinical Nurse Specialist's Presence and Open Visitation in US Intensive Care Units. CLIN NURSE SPEC 2017; 31:30-35. [PMID: 27906731 DOI: 10.1097/nur.0000000000000263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Current evidence shows that an open visitation policy can benefit patients and families during intensive care unit (ICU) stays. Therefore, an unrestricted visitation policy in the ICU has been proposed as part of patient-centered care. PURPOSE The purpose of this secondary analysis is to explore the likelihood of an ICU with a clinical nurse specialist (CNS) having an open visitation policy when compared with an ICU without a CNS. DESIGN This is a secondary analysis of a survey conducted between 2008 and 2009, describing the ICU visitation practices in more than 600 hospitals across the United States. METHODS χ Analysis was performed comparing the presence of CNS in the ICU with visitation policies, with P < 0.05 considered statistically significant. RESULTS There were data from 347 hospitals used in the analysis, with 47 hospitals (13.5%) having open visitation policies. There were 108 hospitals (31%) that had a CNS present in the ICU; 14 of the hospitals (13%) had open visitation policies. No significant correlation was found between a CNS being present in the ICU and open visitation policy (odds ratio, 0.93; P = .83), regardless of hospital geographic regions. CONCLUSIONS Although CNS presence was not associated with open visitation in this study, given the strong evidence to support the benefits to patients and the CNS role as a change agent in the hospital system, liberalization of visitation in the ICU is an area that could benefit from CNS advocacy.
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Sastre-Fullana P, Morales-Asencio JM, Sesé-Abad A, Bennasar-Veny M, Fernández-Domínguez JC, De Pedro-Gómez J. Advanced Practice Nursing Competency Assessment Instrument (APNCAI): clinimetric validation. BMJ Open 2017; 7:e013659. [PMID: 28235968 PMCID: PMC5337725 DOI: 10.1136/bmjopen-2016-013659] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe the development and clinimetric validation of the Advanced Practice Nursing Competency Assessment Instrument (APNCAI) through several evidence sources about reliability and validity in the Spanish context. DESIGN AND SETTING APNCAI development was based on a multisequential and systematic process: literature review, instrument content consensus through qualitative Delphi method approach (a panel of 51 Advanced Practice in Nursing -APN- experts was selected) and the clinimetric validation process based on a sample of 600 nurses from the Balearic Islands public healthcare setting. METHODS An initial step for tool's content development process based on Delphi method approach of expert consensus was implemented. A subsequent phase of tool validation started from the analysis of APN core competencies latent measurement model, including exploratory and confirmatory techniques. Reliability evidence for each latent factor was also obtained. Items' scores were submitted to descriptive analysis, plus univariate and multivariate normality tests. RESULTS An eight-factor competency assessment latent model obtained adequate fit, and it was composed by 'Research and Evidence-Based Practice', 'Clinical and Professional Leadership', 'Interprofessional Relationship and Mentoring', 'Professional Autonomy', 'Quality Management', 'Care Management', 'Professional Teaching and Education' and 'Health Promotion'. CONCLUSIONS Adequate empirical evidence of reliability and validity for APNCAI makes it useful for application in healthcare policy programmes for APN competency assessment in Spain.
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Affiliation(s)
| | | | - Albert Sesé-Abad
- Faculty of Psychology, University of Balearic Islands, Palma, Spain
| | - Miquel Bennasar-Veny
- Nursing and Physiotherapy Department, Universitat de les Illes Balears, Palma, Spain
| | - Juan Carlos Fernández-Domínguez
- Evidence, Lifestyles and Health Research Group, Research Institute of Health Sciences, Universitat de les Illes Balears, Palma, Spain
| | - Joan De Pedro-Gómez
- Nursing and Physiotherapy Department, Universitat de les Illes Balears, Palma, Spain
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Bryant-Lukosius D, Valaitis R, Martin-Misener R, Donald F, Peña LM, Brousseau L. Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health. Rev Lat Am Enfermagem 2017; 25:e2826. [PMID: 28146177 PMCID: PMC5288863 DOI: 10.1590/1518-8345.1677.2826] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/26/2016] [Indexed: 11/21/2022] Open
Abstract
Objective: to examine advanced practice nursing (APN) roles internationally to inform role
development in Latin America and the Caribbean to support universal health
coverage and universal access to health. Method: we examined literature related to APN roles, their global deployment, and APN
effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally
suited as part of a primary health care workforce strategy in Latin America to
enhance universal health coverage and access to health. Brazil, Chile, Colombia,
and Mexico are well positioned to build this workforce. Role implementation
barriers include lack of role clarity, legislation/regulation, education, funding,
and physician resistance. Strong nursing leadership to align APN roles with policy
priorities, and to work in partnership with primary care providers and policy
makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically
assess country and population health needs to introduce the most appropriate
complement and mix of APN roles and inform implementation. Successful APN role
introduction in Latin America and the Caribbean could provide a roadmap for
similar roles in other low/middle income countries.
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Affiliation(s)
| | - Ruta Valaitis
- PhD, Associate Professor, School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Ruth Martin-Misener
- PhD, Professor, School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Faith Donald
- PhD, Associate Professor, Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Laura Morán Peña
- PhD, Professor, Escuela Nacional de Enfermería y Obstetricia de la Universidad Nacional Autónoma de México, Ciudad de México, DF, Mexico
| | - Linda Brousseau
- MSc, Nurse Practitioner (NP), Halton Region Health Unit, Oakville, ON, Canada
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Abstract
The vulnerable and underserved are populations that have higher risks in health care. A clinical nurse specialist is an advanced practice registered nurse who can help mitigate risks and provide holistic care for these patients. Researching clinical nurse specialists' perceptions of their role in caring for the vulnerable populations is important to ensuring quality care and filling in current practice weaknesses.
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Effects of a nurse-led heart failure clinic on hospital readmission and mortality in Hong Kong. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:415-9. [PMID: 27594868 PMCID: PMC4984577 DOI: 10.11909/j.issn.1671-5411.2016.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Heart failure (HF) is a physically and socially debilitating disease that carries the burden of hospital re-admission and mortality. As an aging society, Hong Kong urgently needs to find ways to reduce the hospital readmission of HF patients. This study evaluates the effects of a nurse-led HF clinic on the hospital readmission and mortality rates among older HF patients in Hong Kong. Methods This study is a retrospective data analysis that compares HF patient in a nurse-led HF clinic in Hong Kong compared with HF patients who did not attend the clinic. The nurses of this clinic provide education on lifestyle modification and symptom monitoring, as well as titrate the medications and measure biochemical markers by following established protocols. This analysis used the socio-demographic and clinical data of HF patients who were aged ≥ 65 years old and stayed in the clinic over a six-month period. Results The data of a total of 78 HF patients were included in this data analysis. The mean age of the patients was 77.38 ± 6.80 years. Approximately half of the HF patients were male (51.3%), almost half were smokers (46.2%), and the majority received ≤ six years of formal education. Most of the HF patients (87.2%) belonged to classes II and III of the New York Heart Association Functional Classification, with a mean ejection fraction of 47.15 ± 20.31 mL. The HF patients who attended the clinic (n = 38, 75.13 ± 5.89 years) were significantly younger than those who did not attend the clinic (n = 40, 79.53 ± 6.96 years) (P = 0.04), and had lower recorded blood pressure. No other statistically significant difference existed between the socio-demographic and clinical characteristics of the two groups. The HF patients who did not attend the nurse-led HF clinic demonstrated a significantly higher risk of hospital readmission [odd ratio (OR): 7.40; P < 0.01] than those who attended after adjusting for the effect of age and blood pressure. In addition, HF patients who attended the clinic had lower mortality (n = 4) than those who did not attend (n = 14). However, such a difference did not reach statistical significance when the effects of age and blood pressure were adjusted. A significant reduction in systolic blood pressure [F (2, 94) = 3.39, P = 0.04] and diastolic blood pressure [F (2, 94) = 8.48, P < 0.01] was observed among the HF patients who attended the clinic during the six-month period. Conclusions The finding of this study suggests the important role of nurse-led HF clinics in reducing healthcare burden and improving patient outcomes among HF patients in Hong Kong.
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Yafa H, Dorit R, Shoshana R. Gerontological nurse practitioners (GNPs) for the first time in Israel. J Am Assoc Nurse Pract 2016; 28:415-22. [PMID: 26797867 DOI: 10.1002/2327-6924.12343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/14/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Haron Yafa
- Reseach Department, Nursing Division, Ministry of Health, Jerusalem, Israel
| | | | - Riba Shoshana
- Nursing Division, Ministry of Health, Jerusalem, Israel
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Fulton JS, Mayo AM, Walker JA, Urden LD. Core Practice Outcomes for Clinical Nurse Specialists: A Revalidation Study. J Prof Nurs 2016; 32:271-82. [DOI: 10.1016/j.profnurs.2015.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Indexed: 11/24/2022]
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Kilpatrick K, Tchouaket E, Carter N, Bryant-Lukosius D, DiCenso A. Relationship Between Clinical Nurse Specialist Role Implementation, Satisfaction, and Intent to Stay. CLIN NURSE SPEC 2016; 30:159-66. [DOI: 10.1097/nur.0000000000000203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kilpatrick K, Tchouaket E, Carter N, Bryant-Lukosius D, DiCenso A. Structural and Process Factors That Influence Clinical Nurse Specialist Role Implementation. CLIN NURSE SPEC 2016; 30:89-100. [DOI: 10.1097/nur.0000000000000182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sastre-Fullana P, De Pedro-Gómez JE, Bennasar-Veny M, Fernández-Domínguez JC, Sesé-Abad AJ, Morales-Asencio JM. [Consensus on competencies for advanced nursing practice in Spain]. ENFERMERIA CLINICA 2015; 25:267-75. [PMID: 26260265 DOI: 10.1016/j.enfcli.2015.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/10/2015] [Accepted: 06/30/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION There is a lack of international consensus on the exact definition and core competencies of advanced practice nursing (APN) roles, a problem particularly acute in our national context due to the lack of APN role development, which has a significantly short history in our country. The main objective of this paper was the delineation of the competence framework for Advanced Practice Nurses in our national context based on expert consensus through the Delphi method METHOD Based on a preliminary literature review process, a conglomerate of 17 domains of competence (clusters of related competencies) were identified. This initial set was revised, refined and validated by a group of expert panellists on the subject (clinicians, researchers, managers, and teachers) through successive rounds in search of a suitable consensus on each of the various proposed items RESULTS The results helped to establish a solid foundation in the form of a skills map that could identify those sets of more specific competencies for advanced practice roles, regardless of regulatory and professional practice context, identifying domains such as Research and Evidence Based Practice, Clinical and Professional Leadership, or Care Management DISCUSSION This set of skills related to advanced practice roles in our environment can delineate competency standards common to this level of nursing practice, and serve as a reference for policy development, a review of roles, or the establishment of academic profiles.
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Affiliation(s)
- Pedro Sastre-Fullana
- Departamento de Enfermería, Facultad de Enfermería y Fisioterapia, Universitat de les Illes Balears, Palma de Mallorca, España.
| | - Joan E De Pedro-Gómez
- Departamento de Enfermería, Facultad de Enfermería y Fisioterapia, Universitat de les Illes Balears, Palma de Mallorca, España
| | - Miquel Bennasar-Veny
- Departamento de Enfermería, Facultad de Enfermería y Fisioterapia, Universitat de les Illes Balears, Palma de Mallorca, España
| | - Juan C Fernández-Domínguez
- Departamento de Fisioterapia, Facultad de Enfermería y Fisioterapia, Universitat de les Illes Balears, Palma de Mallorca, España
| | - Albert J Sesé-Abad
- Departamento de Psicología, Facultad de Psicología, Universitat de les Illes Balears, Palma de Mallorca, España
| | - José M Morales-Asencio
- Departamento de Enfermería, Facultad de las Ciencias de la Salud,Universidad de Málaga, Málaga, España
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Clinical Nurse Specialists’ Perceptions of Work Patterns, Outcomes, Desires, and Emerging Trends. J Nurs Adm 2015; 45:212-7. [DOI: 10.1097/nna.0000000000000187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Soltis LM. Role of the Clinical Nurse Specialist in Improving Patient Outcomes After Cardiac Surgery. AACN Adv Crit Care 2015. [DOI: 10.4037/nci.0000000000000070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Health care reform continues to focus on improving patient outcomes while reducing costs. Clinical nurse specialists (CNSs) should facilitate this process to ensure that best practice standards are used and patient safety is enhanced. One example of ensuring best practices and patient safety is early extubation after open heart surgery, which is a critical component of fast track protocols that reduces may reduce the development of pulmonary complications in the postoperative period while decreasing overall length of stay in the hospital. This project was an interdisciplinary endeavor, led by the CNS and nurse manager, which combined early extubation protocols with enhanced rounding initiatives to help decrease overall length of ventilation time as well as reduce pulmonary complications in patients in the cardiac surgery intensive care unit. The project resulted in a significant decrease in length of stay and a decrease in pulmonary complications in the postoperative period.
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Affiliation(s)
- Lisa M. Soltis
- Lisa M. Soltis is Clinical Nurse Specialist, Cardiothoracic Surgery, Sentara Heart Hospital, 600 Gresham Dr, Norfolk, VA 23457
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Kilpatrick K, Kaasalainen S, Donald F, Reid K, Carter N, Bryant-Lukosius D, Martin-Misener R, Harbman P, Marshall DA, Charbonneau-Smith R, DiCenso A. The effectiveness and cost-effectiveness of clinical nurse specialists in outpatient roles: a systematic review. J Eval Clin Pract 2014; 20:1106-23. [PMID: 25040492 DOI: 10.1111/jep.12219] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Increasing numbers of clinical nurse specialists (CNSs) are working in outpatient settings. The objective of this paper is to describe a systematic review of randomized controlled trials (RCTs) evaluating the cost-effectiveness of CNSs delivering outpatient care in alternative or complementary provider roles. METHODS We searched CINAHL, MEDLINE, EMBASE and seven other electronic databases, 1980 to July 2012 and hand-searched bibliographies and key journals. RCTs that evaluated formally trained CNSs and health system outcomes were included. Study quality was assessed using the Cochrane risk of bias tool and the Quality of Health Economic Studies instrument. We used the Grading of Recommendations Assessment, Development and Evaluation to assess quality of evidence for individual outcomes. RESULTS Eleven RCTs, four evaluating alternative provider (n = 683 participants) and seven evaluating complementary provider roles (n = 1464 participants), were identified. Results of the alternative provider RCTs (low-to-moderate quality evidence) were fairly consistent across study populations with similar patient outcomes to usual care, some evidence of reduced resource use and costs, and two economic analyses (one fair and one high quality) favouring CNS care. Results of the complementary provider RCTs (low-to-moderate quality evidence) were also fairly consistent across study populations with similar or improved patient outcomes and mostly similar health system outcomes when compared with usual care; however, the economic analyses were weak. CONCLUSIONS Low-to-moderate quality evidence supports the effectiveness and two fair-to-high quality economic analyses support the cost-effectiveness of outpatient alternative provider CNSs. Low-to-moderate quality evidence supports the effectiveness of outpatient complementary provider CNSs; however, robust economic evaluations are needed to address cost-effectiveness.
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Affiliation(s)
- Kelley Kilpatrick
- Canadian Centre for Advanced Practice Nursing Research, Hamilton, Ontario, Canada; Faculty of Nursing, Université de Montreal, Montreal, Quebec, Canada; Hôpital Maisonneuve-Rosemont Research Centre, Montreal, Quebec, Canada
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Capture of Knowledge Work of Clinical Nurse Specialists Using a Role Tracking Tool. CLIN NURSE SPEC 2014; 28:323-31. [DOI: 10.1097/nur.0000000000000078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jokiniemi K, Haatainen K, Meretoja R, Pietilä AM. The Future of the Clinical Nurse Specialist Role in Finland. J Nurs Scholarsh 2014; 47:78-86. [DOI: 10.1111/jnu.12109] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 01/19/2023]
Affiliation(s)
- Krista Jokiniemi
- Doctoral student; University of Eastern Finland; Faculty of Health Sciences; Department of Nursing Science, and Assistant Head Nurse; Kuopio Finland
| | - Kaisa Haatainen
- Docent; University of Eastern Finland; and Patient Safety Manager; Kuopio University Hospital; Kuopio Finland
| | - Riitta Meretoja
- Docent; Universtity of Turku; and Development Manager; Corporate Headquarters; Hospital District of Helsinki; Uusimaa Helsinki Finland
| | - Anna-Maija Pietilä
- Professor; University of Eastern Finland; Faculty of Health Sciences; Department of Nursing Science; Social and Health Care Services; Kuopio Finland
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Sastre-Fullana P, De Pedro-Gómez J, Bennasar-Veny M, Serrano-Gallardo P, Morales-Asencio J. Competency frameworks for advanced practice nursing: a literature review. Int Nurs Rev 2014; 61:534-42. [DOI: 10.1111/inr.12132] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- P. Sastre-Fullana
- Department of Nursing; University of Balearic Islands; Palma de Mallorca Spain
| | - J.E. De Pedro-Gómez
- Faculty of Nursing and Physiotherapy; University of Balearic Islands; Palma de Mallorca Spain
| | - M. Bennasar-Veny
- Department of Nursing; University of Balearic Islands; Palma de Mallorca Spain
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Jokiniemi K, Haatainen K, Pietilä AM. From challenges to advanced practice registered nursing role development: Qualitative interview study. Int J Nurs Pract 2014; 21:896-903. [DOI: 10.1111/ijn.12334] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Krista Jokiniemi
- Faculty of Health Sciences; Department of Nursing Science; University of Eastern Finland; Kuopio Finland
- Nursing Department; Kuopio University Hospital; Kuopio Finland
| | - Kaisa Haatainen
- Nursing Department; Kuopio University Hospital; Kuopio Finland
- University of Eastern Finland; Kuopio Finland
| | - Anna-Maija Pietilä
- Faculty of Health Sciences; Department of Nursing Science; University of Eastern Finland; Social and Health Care Services; Kuopio Finland
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Mauk KL. The effect of advanced practice nurse-modulated education on rehabilitation nursing staff knowledge. Rehabil Nurs 2013; 38:99-111. [PMID: 23529948 DOI: 10.1002/rnj.70] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Rehabilitation is a specialty area with defined competencies and discrete nursing knowledge. Nurses need to be educated in the basic competencies of rehabilitation to provide safe, quality care to patients with chronic illnesses and disabilities. A critical appraisal of the literature showed that education increased knowledge in a specialty area and had positive benefits for nurses, organizations, and patients. The purpose of this paper is to describe an evidence-based educational intervention. Self-study modules on 15 rehabilitation competencies were developed for 16 nurses working on a new inpatient unit. Outcomes were evaluated using pre and post tests via the online Association of Rehabilitation Nurses (ARN) Competency Assessment Tool (CAT). Data were analyzed using the SPSS14.0 statistical package. Paired t-tests demonstrated a significant difference between pre and post test scores on 14 of the 15 competencies measured. Findings suggested that education of nursing staff resulted in increased knowledge about rehabilitation nursing competencies.
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Affiliation(s)
- Kristen L Mauk
- College of Nursing, Valparaiso University, Valparaiso, IN 46383, USA.
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Griffiths P, Simon M, Richardson A, Corner J. Is a larger specialist nurse workforce in cancer care associated with better patient experience? Cross-sectional study. J Health Serv Res Policy 2013; 18:39-46. [DOI: 10.1177/1355819612473451] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives: To assess whether variation in the provision of cancer specialist nurses is associated with the experiences of care for patients undergoing treatment for cancer. Methods: This is a cross-sectional study using routinely collected national survey data in 158 acute hospital National Health Service (NHS) Trusts in England. Patients with a primary diagnosis of cancer who attended hospital as inpatients or day cases in the first three months of 2010 responded to a national survey ( n = 67,713, response rate 67%). Patient perceptions of coordination of care, quality of information provision, emotional support and support for symptom management were studied. Results: Patients in Trusts that had the fewest patients per specialist nurse were more likely to report that people treating and caring for them worked well together (adjusted odds ratio 1.08, 95% confidence interval 1.01–1.15; p = 0.02) and provided enough emotional support during ambulatory treatment (1.15, 1.01–1.32; p = 0.04), but were no more likely to report being given the right amount of information (0.96, 0.88–1.05; p = 0.38) when compared to patients in Trusts with the most patients per specialist nurse. Breast cancer patients undergoing chemotherapy in the Trusts with fewer patients per specialist nurse were more likely to report good support for the control of side effects from chemotherapy (1.34, 1.02–1.75; p = 0.03). Conclusions: Cancer patients’ experience of care coordination and emotional support was better in Trusts with more specialist nurses. The absolute differences were small, and it was unclear whether particular roles or service configurations are associated with better experience.
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Affiliation(s)
- Peter Griffiths
- Professor of Health Services Research, Centre for Innovation and Leadership in Health Sciences, University of Southampton, UK
| | - Michael Simon
- Senior Research Fellow, Centre for Innovation and Leadership in Health Sciences, University of Southampton, UK
| | - Alison Richardson
- Clinical Professor of Cancer Nursing, Centre for Innovation and Leadership in Health Sciences, University of Southampton, UK, and Clinical Professor of Cancer Nursing, University Hospital Southampton NHS Foundation Trust, UK
| | - Jessica Corner
- Professor of Cancer and Palliative Care, Centre for Innovation and Leadership in Health Sciences, University of Southampton, UK, and Chief Clinician, Macmillan Cancer Support, UK
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Kilpatrick K, DiCenso A, Bryant-Lukosius D, Ritchie JA, Martin-Misener R, Carter N. Practice patterns and perceived impact of clinical nurse specialist roles in Canada: results of a national survey. Int J Nurs Stud 2013; 50:1524-36. [PMID: 23548169 DOI: 10.1016/j.ijnurstu.2013.03.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 02/15/2013] [Accepted: 03/08/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Clinical nurse specialists are recognized internationally for providing an advanced level of practice. They positively impact the delivery of healthcare services by using specialty-specific expert knowledge and skills, and integrating competencies as clinicians, educators, researchers, consultants and leaders. Graduate-level education is recommended for the role but many countries do not have formal credentialing mechanisms for clinical nurse specialists. Previous studies have found that clinical nurse specialist roles are poorly understood by stakeholders. Few national studies have examined the utilization of clinical nurse specialists. OBJECTIVE To identify the practice patterns of clinical nurse specialists in Canada. DESIGN A descriptive cross-sectional survey. PARTICIPANTS Self-identified clinical nurse specialists in Canada. METHODS A 50-item self-report questionnaire was developed, pilot-tested in English and French, and administered to self-identified clinical nurse specialists from April 2011 to August 2011. Data were analyzed using descriptive and inferential statistics and content analysis. RESULTS The actual number of clinical nurse specialists in Canada remains unknown. The response rate using the number of registry-identified clinical nurse specialists was 33% (804/2431). Of this number, 608 reported working as a clinical nurse specialist. The response rate for graduate-prepared clinical nurse specialists was 60% (471/782). The practice patterns of clinical nurse specialists varied across clinical specialties. Graduate-level education influenced their practice patterns. Few administrative structures and resources were in place to support clinical nurse specialist role development. The lack of title protection resulted in confusion around who identifies themselves as a clinical nurse specialist and consequently made it difficult to determine the number of clinical nurse specialists in Canada. CONCLUSIONS This is the first national survey of clinical nurse specialists in Canada. A clearer understanding of these roles provides stakeholders with much needed information about clinical nurse specialist practice patterns. Such information can inform decisions about policies, education and organizational supports to effectively utilize this role in healthcare systems. This study emphasizes the need to develop standardized educational requirements, consistent role titles and credentialing mechanisms to facilitate the identification and comparison of clinical nurse specialist roles and role outcomes internationally.
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Affiliation(s)
- Kelley Kilpatrick
- Canadian Centre for Advanced Practice Nursing Research, Faculty of Nursing, Université de Montréal, Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Hôpital Maisonneuve-Rosemont, CSA - RC - Aile bleue - Bureau F121, 5415 boul. l'Assomption, Montréal, QC, Canada H1T 2M4.
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Abstract
In this systematic literature review, we analyzed and synthesized the literature on one specialized advance practice nursing role in three countries for the purpose of describing and comparing these roles, as well as discussing whether an international consensus of the advance practice nursing definition is possible. A systematic search on CINAHL and PubMed Medline was conducted in 2011 to search the literature on the nurse consultant in the UK, the clinical nurse specialist in the USA, and the clinical nurse consultant in Australia. The studies (n = 42) were analyzed and combined using qualitative content analysis method. The roles of the nurse consultant, clinical nurse specialist, and clinical nurse consultant were similar. The variation in the roles appears to derive from organizational or individual choices, not the country in question. The study process comprised a synthesized representation of one specialized advance practice nursing role. More work is needed to further define the concept of the advance practice nursing, as well as its implementation on other cultures beyond this review. Based on this review, an international consensus regarding the definition of advance practice nursing and its subroles is possible.
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Affiliation(s)
- Krista Jokiniemi
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.
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Abstract
UNLABELLED Reporting relationships between clinical nurse specialists (CNSs) and administrators (ADMs) can facilitate or constrain CNS practice and affect patient outcomes. Limited information is available comparing reporting relationships and perspectives of CNSs and ADMs. PURPOSE The purpose of the present study was to describe CNS and ADM reporting relationships and compare their perspectives about the activities and outcomes of CNS practice in acute care settings. DESIGN The present study uses a descriptive survey. SETTING Four healthcare organizations in the midwestern United States. SAMPLE Clinical nurse specialist participants (n = 30) were master's degree prepared and employed in an acute care setting. Administrator participants (n = 7) were responsible for supervision and evaluation of CNSs in their organization. METHODS Questionnaires were developed from literature and content review by experts. The CNS and ADM questionnaires contained separate sections for CNS and organization information with parallel construction of questions about CNS activities and outcomes. FINDINGS There was variability across organizations related to reporting relationships and structure of CNS work. No significant differences were found when comparing CNS and ADM perspectives of work activity proportions and the importance of 10 activities and 7 outcomes. The most important CNS activities included developing clinical protocols and guidelines, quality improvement, and coordination of care. The most important outcomes included evidence-based nursing care and skilled and competent nursing staff. CONCLUSION Comparing perspectives of work activity time, priority activities, and outcomes provides a basis for collaboration between CNSs and ADMs in reporting relationships. IMPLICATIONS Clinical nurse specialists should develop positive interactions and shared understanding with ADMs to improve effectiveness and enhance patient outcomes.
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Newhouse RP, Weiner JP, Stanik-Hutt J, White KM, Johantgen M, Steinwachs D, Zangaro G, Aldebron J, Bass EB. Policy implications for optimizing advanced practice registered nurse use nationally. Policy Polit Nurs Pract 2012; 13:81-89. [PMID: 22941772 DOI: 10.1177/1527154412456299] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This article examines the potential benefits of enhanced use of advanced practice registered nurses (APRNs) given health care workforce projections that predict an inadequate supply of certain types of providers. The conclusions of a systematic review comparing the effectiveness of care provided by APRNs with that of physicians alone or teams without APRNs indicate the viability of this approach. Allowing APRNs to assume roles that take full advantage of their educational preparation could mitigate the shortage of primary care physicians and improve care processes. The development of health care policy should be guided by patient-centric evidence rather than how care has been delivered in the past.
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Hibbert D, Al-Sanea NA, Balens JA. Perspectives on specialist nursing in Saudi Arabia: a national model for success. Ann Saudi Med 2012; 32:78-85. [PMID: 22156643 PMCID: PMC6087647 DOI: 10.5144/0256-4947.2012.78] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In many parts of the world, vulnerable patient populations may be cared for by a clinical nurse specialist (CNS). Nurses desiring to develop themselves professionally in the clinical arena, within the specialty of their choice, have the opportunity to obtain the knowledge, skills, experience and qualifications necessary to attain advanced practice positions such as CNS or nurse consultant (NC). Although studies have demonstrated the benefits of such roles and while the World Health Organization (WHO) recommends it, advanced nursing practice is not yet integrated into the health care culture in Saudi Arabia. The reasons for this are multiple, but the most important is the poor image of clinical nursing throughout the country. This article aims to share a perspective on CNS practice, while casting light on some of the obstacles encountered within Saudi Arabia. A model is proposed representing specialist nurse-physician collaborative practice for implementation nationally. The model has been implemented in the care of the colorectal and stoma patient populations while taking into consideration patient population needs and local health care culture. This model is based on the concepts of holistic "patient-centered care", specialist nurse-physician collaborative practice, and the four practice domains for NCs (expert practice, leadership, research and education) as indicated by the Department of Health in the United Kingdom. We suggest this model will enable the introduction of advanced specialist nursing and collaborative partnerships in Saudi Arabia with benefits for patients, physicians, health care organizations and the nursing profession as a whole.
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Affiliation(s)
- Denise Hibbert
- Department of Nursing, Colorectal Therapy and Department of Surgery, Colorectal Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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Shiu ATY, Lee DTF, Chau JPC. Exploring the scope of expanding advanced nursing practice in nurse-led clinics: a multiple-case study. J Adv Nurs 2011; 68:1780-92. [PMID: 22118936 DOI: 10.1111/j.1365-2648.2011.05868.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This article is a report on a study to explore the development of expanding advanced nursing practice in nurse-led clinics in Hong Kong. BACKGROUND Nurse-led clinics serviced by advanced practice nurses, a common international practice, have been adopted in Hong Kong since 1990s. Evaluations consistently show that this practice has good clinical outcomes and contributes to containing healthcare cost. However, similar to the international literature, it remains unclear as to what the elements of good advanced nursing practice are, and which directions Hong Kong should adopt for further development of such practice. METHODS A multiple-case study design was adopted with six nurse-led clinics representing three specialties as six case studies, and including two clinics each from continence, diabetes and wound care. Each case had four embedded units of analysis. They included non-participant observation of nursing activities (9 days), nurse interviews (N = 6), doctor interviews (N = 6) and client interviews (N = 12). The data were collected in 2009. Within- and cross-case analyses were conducted. RESULTS The cross-case analysis demonstrated six elements of good advanced nursing practice in nurse-led clinics, and showed a great potential to expand the practice by reshaping four categories of current boundaries, including community-hospital, wellness-illness, public-private and professional-practice boundaries. From these findings, we suggest a model to advance the scope of advanced nursing practice in nurse-led clinics. CONCLUSION The six elements may be applied as audit criteria for evaluation of advanced nursing practice in nurse-led clinics, and the proposed model provides directions for expanding such practice in Hong Kong and beyond.
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Affiliation(s)
- Ann T Y Shiu
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong.
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