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Ylimäki S, Oikarinen A, Kääriäinen M, Pölkki T, Mikkonen K, Holopainen A, Kaakinen P, Kanste O, Meriläinen M, Jansson M, Immonen K, Tuomikoski AM. Advanced practice nurses' evidence-based healthcare competence and associated factors: A systematic review. J Clin Nurs 2024; 33:2069-2083. [PMID: 38413769 DOI: 10.1111/jocn.17075] [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] [Received: 10/28/2023] [Revised: 12/21/2023] [Accepted: 02/05/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Evidence-based healthcare (EBHC) enables consistent and effective healthcare that prioritises patient safety. The competencies of advanced practice nurses (APNs) are essential for implementing EBHC because their professional duties include promoting EBHC. AIM To identify, critically appraise, and synthesise the best available evidence concerning the EBHC competence of APNs and associated factors. DESIGN A systematic review. DATA SOURCES CINAHL, PubMed, Scopus, Medic, ProQuest, and MedNar. METHODS Databases were searched for studies (until 19 September 2023) that examined the EBHC competence and associated factors of APNs were included. Quantitative studies published in English, Swedish and Finnish were included. We followed the JBI methodology for systematic review and performed a narrative synthesis. RESULTS The review included 12 quantitative studies, using 15 different instruments, and involved 3163 participants. The quality of the studies was fair. The APNs' EBHC competence areas were categorised into five segments according to the JBI EBHC model. The strongest areas of competencies were in global health as a goal, transferring and implementing evidence, while the weakest were generating and synthesising evidence. Evidence on factors influencing APNs' EBHC competencies was contradictory, but higher levels of education and the presence of an organisational research council may be positively associated with APNs' EBHC competencies. CONCLUSION The development of EBHC competencies for APNs should prioritise evidence generation and synthesis. Elevating the education level of APNs and establishing a Research Council within the organisation can potentially enhance the EBHC competence of APNs. IMPLICATIONS FOR THE PROFESSION We should consider weaknesses in EBHC competence when developing education and practical exercises for APNs. This approach will promote the development of APNs' EBHC competence and EBHC implementation in nursing practice. REGISTRATION, AND REPORTING CHECKLIST The review was registered in PROSPERO (CRD42021226578), and reporting followed the PRISMA checklist. PATIENT/PUBLIC CONTRIBUTION None.
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Affiliation(s)
- Saija Ylimäki
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Wellbeing Services County of North Ostrobothnia, Oulaskangas Hospital, Oulainen, Finland
| | - Anne Oikarinen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Maria Kääriäinen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland
- Wellbeing Services County of North Ostrobothnia, Oulu University Hospital, Oulu, Finland
| | - Tarja Pölkki
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland
| | - Kristina Mikkonen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Arja Holopainen
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland
- Nursing Research Foundation, Helsinki, Finland
- WHO Collaborating Centre for Nursing, Helsinki, Finland
| | - Pirjo Kaakinen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Outi Kanste
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Merja Meriläinen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Wellbeing Services County of North Ostrobothnia, Oulu University Hospital, Oulu, Finland
| | - Miia Jansson
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Kati Immonen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- 2M-IT Oy, Turku, Finland
| | - Anna-Maria Tuomikoski
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland
- Wellbeing Services County of North Ostrobothnia, Oulu University Hospital, Oulu, Finland
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Serra-Barril MA, Ferro-Garcia T, Fernandez-Ortega P, Sanchez-Lopez C, Martinez-Momblan MA, Benito-Aracil L, Romero-Garcia M. The role experience of advanced practice nurses in oncology: An interpretative phenomenological study. J Adv Nurs 2024; 80:2512-2524. [PMID: 38054402 DOI: 10.1111/jan.15997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 11/06/2023] [Accepted: 11/19/2023] [Indexed: 12/07/2023]
Abstract
AIM(S) To understand the experiences of advanced practice nurses working in cancer care. DESIGN Phenomenological qualitative study. METHODS Three focus groups were held to collect qualitative data. Participants were recruited through theoretical non-probabilistic sampling of maximum variation, based on 12 profiles. Data saturation was achieved with a final sample of 21 oncology advanced practice nurses who were performing advanced clinical practice roles in the four centers from December 2021 to March 2022. An interpretative phenomenological analysis was performed following Guba and Lincoln's criteria of trustworthiness. The centers' ethics committee approved the study, and all participants gave written informed consent. Data analysis was undertaken with NVivo 12 software. RESULTS Three broad themes emerged from the data analysis: the role performed, facilitators and barriers in the development of the role and nurses' lived experience of the role. CONCLUSION Advanced practice nurses are aware that they do not perform their role to its full potential, and they describe different facilitators and barriers. Despite the difficulties, they present a positive attitude as well as a capacity for leadership, which has allowed them to consolidate the advanced practice nursing role in unfavourable environments. IMPLICATIONS FOR THE PROFESSION These results will enable institutions to establish strategies at different levels in the implementation and development of advanced practice nursing roles. REPORTING METHOD Reporting complied with COREQ criteria for qualitative research. PATIENT OR PUBLIC CONTRIBUTIONS No patient or public contribution.
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Affiliation(s)
- M Antònia Serra-Barril
- Innovation and Quality Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, L'Hospitalet, Spain
| | - Tàrsila Ferro-Garcia
- Innovation and Quality Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, L'Hospitalet, Spain
| | - Paz Fernandez-Ortega
- Department of Public Health, Mental Health and Maternal Care, Faculty of Medicine and Health Sciences, University of Barcelona, Campus Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Sanchez-Lopez
- Catalan Institute of Oncology, Oncology Hospitalization/Inpatient Unit, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Antonia Martinez-Momblan
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, L'Hospitalet, Spain
| | - Llúcia Benito-Aracil
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, L'Hospitalet, Spain
- IDIBELL, Institute of Biomedical Research, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Romero-Garcia
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, L'Hospitalet, Spain
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Byrne AL, Brown J, Willis E, Baldwin A, Harvey C. Nurse Navigators - Champions of the National Rural and Remote Nursing Generalist Framework: A solution. Aust J Rural Health 2024; 32:475-487. [PMID: 38506495 DOI: 10.1111/ajr.13107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Nurse Navigators were introduced in Queensland, Australia, in 2016. Nurse Navigators coordinate person-centred care, create partnerships, improve care coordination and outcomes and facilitate system improvement, independently of hospital or community models. They navigate across all aspects of hospital and social services, liaising, negotiating and connecting care as needed. People stay with Nurse Navigators for as long as required, though the intent is to transition them from high-care needs to self-management. Nurse Navigators are a working model in rural and remote areas of Queensland. OBJECTIVE To describe where the rural and remote Nurse Navigator position fits within the Rural Remote Nursing Generalist Framework and to define the depth and breadth of the rural and remote Nurse Navigator's scope of practice. DESIGN Using template analysis, data from focus groups and interviews were analysed against the domains of the recently released National Rural and Remote Nursing Generalist Framework. Navigators working in rural and remote areas across Queensland Health were invited to an interview (n = 4) or focus group (n = 9), conducted between October 2019 and August 2020. FINDINGS Rural and remote Nurse Navigators are proficient in all domains of the framework and actively champion for their patients, carers and the communities where they live and work. DISCUSSION This research demonstrates that rural and remote Nurse Navigators are a working model of advanced nursing practice, acting as 'champions' of The Framework. CONCLUSION The Nurse Navigator model of care introduced to Queensland exemplifies proficient registered nurse practice to the full extent of their knowledge and skill.
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Affiliation(s)
- Amy-Louise Byrne
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Janie Brown
- Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
| | - Eileen Willis
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
- College of Nursing and Health Science, Flinders University, Bedford Park, South Australia, Australia
| | - Adele Baldwin
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Clare Harvey
- School of Nursing, Massey University, Albany, New Zealand
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Dowling M, Pape E, Geese F, Van Hecke A, Bryant-Lukosius D, Cerón MC, Fernández-Ortega P, Marquez-Doren F, Ward A, Semple C, King T, Glarcher M, Drury A. Advanced Practice Nursing Titles and Roles in Cancer Care: A Scoping Review. Semin Oncol Nurs 2024; 40:151627. [PMID: 38556366 DOI: 10.1016/j.soncn.2024.151627] [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] [Received: 02/08/2024] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES Advanced practice nursing roles in cancer care are diverse and exist across the cancer care continuum. However, the titles used and the scope of practice differ across countries. This diversity is likely to be misleading to patients and influence nurses' contribution to health care. An understanding of the current state of advanced practice nursing roles in cancer care internationally is needed to inform opportunities for future role development and enhance cancer nursing career pathways. METHODS This scoping review included a systematic search of four databases: MEDLINE, CINAHL, PsycINFO, and Academic Search Complete. Independent screening for papers meeting the review's inclusion criteria was undertaken using online screening software. Data extraction, coding, and mapping were undertaken in NVivo 12. RESULTS Of the 13,409 records identified, 108 met the review's inclusion criteria. A variety of roles in cancer care settings were described. The United States and the United Kingdom had the most titles for advanced practice nursing roles. Tumor-specific roles were described and integrated into different phases of the cancer care continuum. Trends in continuing professional development for advanced practice nurses in cancer care included the rise in Fellowship programs in the United States and practice-based education in the United Kingdom. CONCLUSIONS The differences in advanced practice nursing roles in cancer care allow regional and institutional variation to meet the needs of patient populations and health care system demands. However, a lack of clarity surrounding titles and roles results in confusion and underutilization of these nurses' highly specialized skill sets. IMPLICATIONS FOR NURSING PRACTICE Incongruence in titles and scope of practice internationally will ultimately result in a merging of roles. There is a need for international agreement on education requirements for advanced practice nursing roles to promote career pathways.
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Affiliation(s)
- Maura Dowling
- School of Nursing and Midwifery, University of Galway, Ireland.
| | - Eva Pape
- Cancer Center, Ghent University Hospital, Belgium; Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium and Ghent University Hospital, Centre for Nursing Expertise, Belgium
| | - Franziska Geese
- Department of Nursing, Clinical Practice Development and Digitalisation, Bern University Hospital, Inselspital, Insel Gruppe, Switzerland
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium and Ghent University Hospital, Centre for Nursing Expertise, Belgium; Nursing Department, Ghent University Hospital, Belgium
| | - Denise Bryant-Lukosius
- School of Nursing and Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - M Consuelo Cerón
- Escuela de Enfermería, Facultad de Enfermería y Obstetricia, Universidad de los Andes-Chile
| | - Paz Fernández-Ortega
- Catalan Institute of Oncology and Faculty of Nursing, University of Barcelona, Spain
| | - Francisca Marquez-Doren
- School of Nursing, PAHO Collaborating Center, Pontificia Universidad Católica de Chile and School of Nursing Pontificia Universidad Católica de Chile, PAHO Collaborating Center and Sigma Chapter Alfa Beta Ómicron
| | - Ashleigh Ward
- School of Medicine, Dentistry and Nursing College of Medicine, Veterinary and Life Sciences, University of Glasgow, Scotland; NHS Forth Valley, Stirling, UK
| | - Cherith Semple
- Institute of Nursing and Health Research, Ulster University / Cancer Services, South Eastern Health and Social Care Trust, Belfast, Northern Ireland
| | - Tracy King
- Cancer Care Research Unit (CCRU) Susan Wakil School of Nursing and Midwifery, The University of Sydney, Australia; Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Manela Glarcher
- Institute of Nursing Science, Paracelsus Medical University, Salzburg, Austria
| | - Amanda Drury
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Ireland
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Pedreira-Robles G, Garcimartín P, Sevilla-Guerra S, Bach-Pascual A, García-Martínez M, Morín-Fraile V. Nurse-led clinical activity in kidney transplantation care in Spain: A cross-sectional observational study. J Ren Care 2024; 50:168-175. [PMID: 36906846 DOI: 10.1111/jorc.12463] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/11/2023] [Accepted: 02/25/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVES To explore the presence of specialist outpatient nursing activity in care for kidney transplant recipients in Spain and to determine the level of competence development of this activity according to the Advanced Practice Nurse model. DESIGN Descriptive, cross-sectional study. PARTICIPANTS AND MEASUREMENTS All outpatient nurses specialising in renal transplantation in the 39 transplant hospitals in Spain were included. To fulfil the study objectives, an ad hoc questionnaire and the 'Advanced Practice Nurse Role Definition Instrument (IDREPA)' were administered to assess the nurses' level of competence development. RESULTS Of the facilities included in the study, 25 (64.1%) had posttransplant nursing activity, 13 (33.3%) had pretransplant nursing activity and 11 (28.2%) had nursing activity involving kidney donor candidates. Twenty-seven specialist nurse's offices were identified. The results of the IDREPA reflect the presence of advanced practice in the domains of 'expert care planning' and 'comprehensive care'. Three (11.1%) nurses met all criteria for advanced nursing practice. CONCLUSION The results on specialised outpatient nursing activity at the 39 transplantation facilities in Spain indicate a low presence of this type of activity, with an even lower presence of advanced practice nurses. IMPLICATIONS FOR CLINICAL PRACTICE Management teams should consider investing in the quality of care provided by advanced nurse practice to ensure that suitable treatment is provided and better clinical outcomes are obtained.
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Affiliation(s)
- Guillermo Pedreira-Robles
- Nephrology Department, Hospital del Mar, Barcelona, Spain
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra affiliated, Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Nursing and Health PhD Programme, University of Barcelona, Barcelona, Spain
| | - Paloma Garcimartín
- Nursing direction, Hospital del Mar, Barcelona, Spain
- Department of Biomedical Research in Heart Diseases, Hospital del Mar Institute for Medical Research (IMIM), Barcelona, Spain
| | - Sonia Sevilla-Guerra
- Gerència de Processos Integrats de Salut, Àrea Assistencial, Catalan Health System, Barcelona, Spain
| | | | | | - Victoria Morín-Fraile
- Department of Public Health, Mental and Maternal and Child Health, Nursing School, University of Barcelona, Barcelona, Spain
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Nozu H, Tamura H, Kudo T, Araki T, Sato H, Watanabe T, Sasagawa I. The role of advanced practice nurses in improving healthcare outcomes for patients with chronic kidney disease: A scoping review protocol. PLoS One 2024; 19:e0301676. [PMID: 38574093 PMCID: PMC10994302 DOI: 10.1371/journal.pone.0301676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 03/15/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION The number of patients with chronic kidney disease is increasing worldwide; previous studies have suggested that advanced practice nurses, including nurse practitioners and clinical nurse specialists, with expert practice skills can provide high-quality care and solve complex healthcare problems. In general, nurse practitioners are generalist nurses who work as autonomous clinicians with whole personal care. Clinical nurse specialists, in contrast, are nurses with advanced nursing knowledge and skills for individuals or specific populations. Their roles are independent and different; however, similarities exist in their role in potentially improving healthcare outcomes. Although two previous studies described the role of nephrology nurse practitioners, they were systematic reviews, and their outcomes were limited. To clarify the overall aspect of advanced practice nurses' role, it is necessary to extract the studies illustrating advanced practice nurses' practices for patients with chronic kidney disease. OBJECTIVE This study aims to map the literature describing the role of advanced practice nurses in improving healthcare outcomes for patients with chronic kidney disease. MATERIALS AND METHODS This scoping review will be conducted using the Joanna Briggs Institute methodology for scoping review. Online databases will be searched across MEDLINE (PubMed), CINAHL (EBSCOhost), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Web of Science. Only studies published in English will be included, and no date limit will be set. Chronic kidney disease, renal replacement therapy, and advanced practice nurses as keywords and related search terms will be used. Two independent reviewers will screen the title and abstract/full-text; in case of discrepancy, a third reviewer will make the final decision. The results will be extracted and presented following the review question concerning the study characteristics, patients' characteristics, condition of chronic kidney disease, and role of advanced practice nurses.
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Affiliation(s)
- Hanako Nozu
- Department of Nursing, Yamagata Tokushukai Hospital, Yamagata, Yamagata, Japan
| | - Haruka Tamura
- Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Takemi Kudo
- Graduate School of Health and Environment Sciences, Tohoku Bunka Gakuen University, Sendai, Miyagi, Japan
| | - Tomoko Araki
- Graduate School of Health and Environment Sciences, Tohoku Bunka Gakuen University, Sendai, Miyagi, Japan
| | - Hidetaka Sato
- Graduate School of Health and Environment Sciences, Tohoku Bunka Gakuen University, Sendai, Miyagi, Japan
| | - Takao Watanabe
- Graduate School of Health and Environment Sciences, Tohoku Bunka Gakuen University, Sendai, Miyagi, Japan
| | - Isoji Sasagawa
- Department of Urology, Yamagata Tokushukai Hospital, Yamagata, Yamagata, Japan
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Scott VJ. Assessing the benefits of advanced clinical practice for key stakeholders. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:300-305. [PMID: 38512792 DOI: 10.12968/bjon.2024.33.6.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Advanced clinical practice roles, usually filled by nurses, have had positive effects on clinical effectiveness, including in patient satisfaction, but their benefits for other stakeholders (such as employers, health professionals, education providers and commissioners and professional/regulatory bodies) are less clear. AIM This study aimed to identify UK research on the potential benefits of advanced clinical practice and evaluate the evidence base for key stakeholders in this field. METHOD A mixed-methods systematic literature review was carried out to inform a narrative interpretive synthesis. FINDINGS 44 articles of mixed quality were identified. Consensus was found regarding the definition of and barriers and facilitators to advanced clinical practice. This role is split into substitution (eg, of doctors) and supplementation (eg, adding value) aspects, and the clinical practice element dominates. Training for the role varies, as do scope of practice and regulation. CONCLUSION There are several barriers to the implementation of advanced clinical practice and therefore the realisation of its benefits for key stakeholders. Areas requiring attention include training, support from others for role expansion and organisational issues.
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Affiliation(s)
- Vikki-Jo Scott
- Senior Lecturer, Advanced Practice Programme Lead and PhD student, School of Health and Social Care, University of Essex; Senior Fellow Advance HE
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Kechichian A, Pommier D, Druart L, Lowry V, Pinsault N, Desmeules F. "Cooperation between physicians and physios fosters trust you know": a qualitative study exploring patients' experience with first-contact physiotherapy for low back pain in French primary care. BMC PRIMARY CARE 2024; 25:69. [PMID: 38395795 PMCID: PMC10885482 DOI: 10.1186/s12875-024-02302-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Physiotherapists working in collaboration with family physicians in French multidisciplinary primary healthcare clinics are now able to manage acute low back pain patients as first-contact practitioners in advanced practice roles. This includes medical act delegation such as making a medical diagnosis and prescribing medication. The aim of this study is to explore patients' experience and perceptions when attending a first-contact physiotherapist (FCP) in an advanced practice collaborative primary care model for acute low back pain (LBP). METHODS A qualitative study using semi-structured interviews was conducted. Patients that consulted a FCP for acute LBP care in new collaborative model were included. Interviews were transcribed verbatim and inductive thematic analysis was performed to generate themes related to patients' experience and perceptions. RESULTS Ten patients were interviewed (3 women, 7 men; mean age 36.5 ± 9.63 years). All LBP participants experienced important level of pain and disability. Four overarching themes related to patients' experience with the new FCP model were formalized: 1) "Going to see a physiotherapist who specializes in painful movements, well that makes sense to me", 2) "Physiotherapist offered to give me exercises to do at home to relieve the back pain", 3) "I went there feeling confident", 4) "The physiotherapist can do more than just send you to see more appropriate people". Participants highlighted the need to receive timely and high-quality care and were receptive with being autonomously managed by a FCP. Overall, patients' experiences with FCP model of care were positive. Participants were highly confident in the FCP's ability to perform delegated medical tasks including making a medical diagnosis and prescribing oral medication such as analgesic drugs. Patients felt that a greater expansion of FCPs' scope of practice was needed to improve the model. CONCLUSION Findings from this study can inform the implementation of FCP in countries where patients are not typically granted FCP by underlining that patients are favourable towards the advance practice model as such models support timely and high-quality care. Further research is needed to better determine the future advance practice physiotherapists' scope of practice in French primary and secondary care settings.
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Affiliation(s)
- Amélie Kechichian
- University Grenoble-Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Grenoble, France.
- Department of Physiotherapy, University Grenoble-Alpes, 175 Avenue Centrale, Saint-Martin d'Hères, Grenoble, 38400, France.
| | - Dylan Pommier
- Department of Physiotherapy, University Grenoble-Alpes, 175 Avenue Centrale, Saint-Martin d'Hères, Grenoble, 38400, France
| | - Léo Druart
- University Grenoble-Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Grenoble, France
- Department of Physiotherapy, University Grenoble-Alpes, 175 Avenue Centrale, Saint-Martin d'Hères, Grenoble, 38400, France
| | - Véronique Lowry
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Nicolas Pinsault
- University Grenoble-Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, Grenoble, France
- Department of Physiotherapy, University Grenoble-Alpes, 175 Avenue Centrale, Saint-Martin d'Hères, Grenoble, 38400, France
| | - François Desmeules
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
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Kechichian A, Viain E, Lathière T, Desmeules F, Pinsault N. First-contact physiotherapists' perceived competency in a new model of care for low back pain patients: a mixed methods study. Arch Physiother 2024; 14:56-64. [PMID: 39285952 PMCID: PMC11403588 DOI: 10.33393/aop.2024.3056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/16/2024] [Indexed: 09/19/2024] Open
Abstract
Background A new advanced practice model of care enables French physiotherapists to perform medical acts for low back pain (LBP) patients as first-contact physiotherapists (FCPs). Objective The aim of this study is to determine the self-perceived competency of FCPs and to further explore factors underpinning this feeling. Methods A mixed-methods explanatory sequential design was conducted. A survey was used to self-assess the perceived competency of FCPs in performing medical tasks. Semi-structured interviews were then performed to explore determining factors of perceived competency. Inductive thematic analysis was performed. Results Nine FCPs answered the survey and were interviewed (mean age 40.1, standard deviation [SD]: ±10.0). FCPs felt very competent with making medical diagnosis (3.44/4, SD: ±0.53), analgesic prescription (3.11, SD: ±0.78) and referring onward to physiotherapy (3.78, SD: ±0.55). They did not feel competent with nonsteroidal anti-inflammatory drug prescription (2.78, SD: ±0.67) and issuing sick leave certificate (2.67, SD: ±1.0). The main identified influencing factors were previous FCPs' experience, training, knowledge, collaboration with family physicians, high responsibility and risk management associated with decision-making. Conclusion French FCPs appeared to have the necessary skills to directly manage LBP patients without medical referral. Future training focusing on analgesic prescription and issuing sick leave certificate is however needed.
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Affiliation(s)
- Amélie Kechichian
- THEMAS Team, TIMC-IMAG Laboratory, UMR CNRS-UGA, Grenoble - France
- Department of Physiotherapy, University Grenoble-Alpes, Grenoble - France
- Interprofessional University Primary Healthcare Center, University Grenoble-Alpes, Saint-Martin d'Hères - France
| | - Elsa Viain
- Department of Physiotherapy, University Grenoble-Alpes, Grenoble - France
| | - Thomas Lathière
- THEMAS Team, TIMC-IMAG Laboratory, UMR CNRS-UGA, Grenoble - France
- Department of Physiotherapy, University Grenoble-Alpes, Grenoble - France
| | - François Desmeules
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec - Canada
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec - Canada
| | - Nicolas Pinsault
- THEMAS Team, TIMC-IMAG Laboratory, UMR CNRS-UGA, Grenoble - France
- Department of Physiotherapy, University Grenoble-Alpes, Grenoble - France
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Bednarek A, Klepacz R, Bodys-Cupak IE. The Role of the Nurse in the Care and Management of Patients with Rheumatic Diseases Arising from the Current EULAR Recommendations: A Literature Review. Healthcare (Basel) 2023; 11:2434. [PMID: 37685467 PMCID: PMC10486762 DOI: 10.3390/healthcare11172434] [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: 07/20/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
In some countries, restructuring of the healthcare system has contributed to the introduction of a new domain in professional nursing-the Advanced Practice Nurse (APN). In order to provide the highest quality of care to patients, nurses working at the advanced level are expected to develop knowledge and to initiate services and practices carried out in collaboration with other professionals. In 2018, the European League Against Rheumatism (EULAR) updated its recommendations for the role of the nurse in the management and care of patients with rheumatic conditions. The objective of the study was a presentation of the scope of medical services provided by nurses for patients with rheumatic diseases based on current EULAR recommendations. A review of the literature on the participation of nurses, as members of a multidisciplinary team, in the education, management, psychosocial support, and promotion of self-care in patients with rheumatic diseases was presented. The expert group formulated three overarching principles and eight recommendations. The literature review and expert recommendations indicated that nurses' tasks in relation to patients with rheumatic diseases should include an initial assessment of health needs, routine follow-up care, and counseling for patients on self-care and lifestyle changes. In the EULAR recommendations, nursing care is also defined as a practice model in which nurses, in collaboration with physicians, provide support, education, and disease monitoring to patients with rheumatic conditions. The requirement for extended nursing education at the advanced practice level, aimed at acquiring diagnostic, therapeutic, caring, and educational knowledge and skills was highlighted, particularly with regard to the EULAR recommendations.
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Affiliation(s)
- Anna Bednarek
- Department of Health Promotion, Faculty of Health Sciences, Medical University of Lublin, 20-093 Lublin, Poland
| | - Robert Klepacz
- Department of Clinical Pathomorphology, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Iwona Elżbieta Bodys-Cupak
- Department of Nursing Fundamentals, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland;
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Kerr H, McSorley O, Donovan M. Registered Nurses' Perspectives of the Impact of a Post-registration Education Qualification on Patient Care and Clinical Practice in Cancer Care: a Qualitative Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:900-905. [PMID: 35939206 PMCID: PMC9358638 DOI: 10.1007/s13187-022-02205-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 06/02/2023]
Abstract
Student evaluation of teaching is routinely completed as modules and programmes of study at higher education institutions conclude. The evaluations are often focused on the educational value and experience. For programmes with healthcare professionals as students, the impact of the learning on patient care and clinical practice is not routinely captured in these student evaluations. These insights are crucial as the definitive impact of learning for many educational programmes of study for healthcare professionals is to enhance patient outcomes. The aim of this qualitative research study was to capture the impact of a post-registration Specialist Practice in cancer pathway for registered nurses in the context of Northern Ireland following completion of the programme. Eleven participants engaged in interviews in 2021 who had completed the education programme from 2013 to 2021. Two themes inductively emerged from the data which provided insights into the specific impact of the education programme on patient care and clinical practice. Theme one identified patient outcomes improved, and was related to five sub themes; development of nurse's clinical knowledge; enhanced awareness of the holistic impact of cancer; greater understanding of patient services available; development of clinical networks; and greater decision-making ability. Theme two related to the impact of the qualification on clinical practice through an increase in their professional credibility within the multidisciplinary team in cancer services. The debate on how to capture the impact of education on patient care and clinical practice in cancer care, should consider how to routinely capture this data.
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Affiliation(s)
- Helen Kerr
- School of Nursing and Midwifery, Queen’s University Belfast, Northern Ireland, UK
| | - Oonagh McSorley
- School of Nursing and Midwifery, Queen’s University Belfast, Northern Ireland, UK
| | - Monica Donovan
- School of Nursing and Midwifery, Queen’s University Belfast, Northern Ireland, UK
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Woodman H, Spencer S. Advanced clinical practice in paediatric haematology and oncology: developing a capability document. Nurs Child Young People 2023; 35:27-33. [PMID: 35875922 DOI: 10.7748/ncyp.2022.e1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 01/06/2023]
Abstract
Specialist roles have been developed to provide holistic care to children and young people with cancer, one of which is the advanced clinical practitioner (ACP) in paediatric oncology and haematology. A survey showed that paediatric oncology and haematology ACPs in the UK work in a wide variety of roles and that their numbers vary greatly between treatment centres. The survey also confirmed the need for a national standardised framework delineating the knowledge, skills and expertise required of ACPs working in paediatric oncology and haematology. This article describes the development of a capability document to support and standardise advanced practice in paediatric oncology and haematology. The document reflects the advanced level of critical thinking, autonomy and decision-making required of ACPs and has been endorsed by the Children's Cancer and Leukaemia Group and by the Royal College of Nursing. It is hoped that it will support ACPs to consistently deliver high-quality, safe care for the benefit of children and young people with cancer and their families.
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Affiliation(s)
- Helen Woodman
- oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, England
| | - Sally Spencer
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, England
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13
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Serra-Barril MA, Benito-Aracil L, Pla-Consuegra M, Ferro-García T. Delphi survey on the application of advanced practice nursing competencies: Strong points and unfinished business in cancer care. J Nurs Manag 2022; 30:4339-4353. [PMID: 36194472 PMCID: PMC10092559 DOI: 10.1111/jonm.13843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/09/2022] [Accepted: 09/28/2022] [Indexed: 12/30/2022]
Abstract
AIM This study assessed the application of advanced practice nursing competencies in cancer care to identify obstacles to their full implementation. BACKGROUND Internationally, the implementation of advanced practice nursing roles depends on the context and environment, which shape the definition, scope and competencies associated with these roles. METHODS Nurses participated in two rounds of an online Delphi survey about the competencies of advanced practice oncology nurses. The threshold for expert consensus was set at 75%. RESULTS Eleven competency domains were proposed; all yielded consensus of over 75%. However, for 57.8% of the specific competencies proposed in round 1 and for 62.2% in round 2, there was no consensus on which were applied in practice. There was more agreement on the competencies applied in the domains of direct clinical practice, consultation and collaboration and interprofessional relations than in dimensions such as health care promotion, quality improvement, evidence-based practice and research. Barriers related to unimplemented competencies were identified. CONCLUSIONS The competencies applied in advanced practice nursing reflect incomplete development of these roles. Domains related to direct clinical practice, consultation and collaboration and interprofessional relations are relatively well developed, whereas those related to leadership, research, evidence-based practice and quality improvement are not. The identified barriers hindering implementation of some competencies can inform strategies to develop this role in cancer care. IMPLICATIONS FOR NURSING MANAGEMENT Hospital administrators and nurse managers should reflect and be mindful of the development of advanced practice nurse (APN) competencies along with the challenges associated with implementing advanced practice roles.
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Affiliation(s)
- M Antònia Serra-Barril
- Innovation and Quality Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.,Fundamental Care and Medical-Surgical Nursing Department, School of Nursing. University of Barcelona, Health Sciences Campus Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Llúcia Benito-Aracil
- Fundamental Care and Medical-Surgical Nursing Department, School of Nursing. University of Barcelona, Health Sciences Campus Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.,IDIBELL, Institute of Biomedical Research, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Margarida Pla-Consuegra
- Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing. University of Barcelona, Health Sciences Campus Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Tarsila Ferro-García
- Innovation and Quality Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.,Fundamental Care and Medical-Surgical Nursing Department, School of Nursing. University of Barcelona, Health Sciences Campus Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Gutiérrez-Rodríguez L, García-Mayor S, León-Campos Á, Gómez-González AJ, Pérez-Ardanaz B, Rodríguez-Gómez S, Fajardo-Samper M, Morilla-Herrera JC, Morales-Asencio JM. Competency Gradients in Advanced Practice Nurses, Specialist Nurses, and Registered Nurses: A Multicentre Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148415. [PMID: 35886267 PMCID: PMC9323129 DOI: 10.3390/ijerph19148415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 02/04/2023]
Abstract
(1) Background: Identifying differences in the competencies of different areas of nursing is a crucial aspect for determining the scope of practice. This would facilitate the creation of a formal structure for clinical practice in advanced and specialised services. The aims of this study are to analyse the distribution of advanced competencies in registered, specialist and advanced practice nurses in Spain, and to determine the level of complexity of the patients attended by these nurses. (2) Methods: A cross-sectional study was developed on registered, specialist and advanced practice nurses, all of whom completed an online survey on their perceived level of advanced competencies and their professional characteristics. (3) Results: In total, 1270 nurses completed the survey. Advanced practice nurses recorded the highest self-perceived level of competency, especially for the dimensions of evidence-based practice, autonomy, leadership and care management. (4) Conclusions: Among registered, specialist and advanced practice nurses, there are significant differences in the level of self-perceived competencies. Patients attended by advanced practice nurses presented the highest levels of complexity. Understanding these differences could facilitate the creation of a regulatory framework for clinical practice in advanced and specialized services.
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Affiliation(s)
- Laura Gutiérrez-Rodríguez
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Silvia García-Mayor
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Álvaro León-Campos
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
- Correspondence: ; Tel.: +34-951-952-879
| | - Alberto José Gómez-González
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Bibiana Pérez-Ardanaz
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | | | | | - Juan Carlos Morilla-Herrera
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - José Miguel Morales-Asencio
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
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15
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Chau JPC, Lo SHS, Lam SKY, Saran R, Thompson DR. Critical elements in nursing graduates' transition to advanced practice roles and their perceived impact on patient care: an exploratory, descriptive study of graduates' and their managers' perceptions. BMC Nurs 2022; 21:122. [PMID: 35590330 PMCID: PMC9121560 DOI: 10.1186/s12912-022-00907-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While there is a growth in the number of advanced practice nurses, there is a dearth of research examining their role transition from registered nurses. This study aimed to identify critical elements in the career path of nursing graduates who have taken up advanced practice roles and examine their perceived impact on patient care. METHODS An exploratory descriptive study was performed. Individual semi-structured interviews were conducted face-to-face with 10 nursing graduates now in advanced practice roles, and their ten respective managers. All interviews were audio-recorded and transcribed verbatim for latent and manifest content analyses. RESULTS The nursing graduates, six of whom were male, had a mean age of 35 years. All possessed a master's degree and formal post-registration education and/or training. Six had at least three years' experience as an advanced practice nurse. The managers, all female, had a mean age of 49 years. Eight had at least one year's experience in their current position. Six key themes emerged: prior enhancement of personal and professional knowledge and skills; active participation in clinical roles and knowledge translation in preparation for advanced practice; adapting to new and diverse advanced practice nursing responsibilities; role of advanced practice nurses in leadership; personal qualities crucial for success in advanced practice; and provision of evidence-based patient-centered care. CONCLUSIONS Postgraduate education, management knowledge and leadership skills, and active participation in clinical roles and knowledge translation appear crucial ingredients for promotion of nursing graduates to advanced practice roles. Other ingredients include a positive outlook, flexibility and adaptability, and good interpersonal, communication and problem-solving skills.
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Affiliation(s)
- Janita P. C. Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Suzanne H. S. Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Simon K. Y. Lam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Ravneet Saran
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - David R. Thompson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
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Temper the Specialist Nurses Heterogeneity in the Interest of Quality Practice and Mobility—18 EU Countries Study. Healthcare (Basel) 2022; 10:healthcare10030435. [PMID: 35326913 PMCID: PMC8953535 DOI: 10.3390/healthcare10030435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The position of the specialist nurse profession varies across the European Union. Action is required to address the challenges to promote mobility and the contribution of specialist nurses to quality of care. The purpose of the study is to identify the interfaces of the specialist nurse profession across the European Union. Methods: A mixed method study was conducted in October 2019 and total of 40 answers from 18 different European Union countries were selected using a purposive sampling method. Results: The participants had completed various Bologna degree cycles and 57.2% had followed a specific educational programme to become a specialist nurse. More professional autonomy was acquired by 81.9% participants. Conclusion: A striving for homogeneity in the interpretation of the specialist nurses role and competencies is needed to achieve better quality of care provision and facilitate their mobility around the European Union. The lack of recognition identified in this study should encourage nurse managers to consider specialist nurse roles with the aim of capitalizing on the advanced care and expertise that specialist nurses provide. These results are an opportunity to improve the specialist nurses profession with an ultimate impact on management practices of streamlined, cost-effective clinical services.
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17
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Van Hecke A, Van Bogaert P, Decoene E, Dobbels F, Goossens E, Goossens G, Verhaeghe S, Goffin T. A legal framework on advanced practice nursing in Belgium: what do we and don't we know? Acta Clin Belg 2022; 77:65-70. [PMID: 32700632 DOI: 10.1080/17843286.2020.1795575] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Presenting the Belgian new framework for Advanced Practice Nursing (APN) - 'Verpleegkundig Specialist [VS]'/"Infirmier de pratique avancée [IPA]" outlined in the Law of 22 April 2019, followed by a discussion of the lack of clarity, the current challenges and future opportunities. METHODS The framework was analyzed by an expert in healthcare legislation and discussed by academics in Nursing Science and members of the board of directors of the Belgian Society of APN. RESULTS Relevant paragraphs within this new law are"Article 46 §1. No one is allowed to carry the title of 'VS/IPA' who does not possess a bachelor in nursing mentioned in article 45 and who does not meet the requirements specified in this article. At the minimum, a master's degree in Nursing Sciences is also required. §2. Additional to the scope of practice of nursing as mentioned in article 46, the 'VS/IPA' perform, in the context of complex nursing care, medical interventions in order to maintain, improve or restore the health of the patient. Care is provided in the context of a specific target group of patients and in close concertation with the physician and potential other healthcare professionals. CONCLUSION Although the legal recognition of the title of VS/IPA is a major breakthrough that will innovate healthcare, clarification is needed: How do VS/IPA distinguish themselves from other nursing functions, what is complex nursing care, which medical interventions can be performed, what is meant by specific target group of patients, what does 'in close concertation with the physician' entail, and will advisory power be possible?
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Affiliation(s)
- A. Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - P. Van Bogaert
- Center for Research and Innovation in Care, Department of Midwifery and Nursing Sciences, Antwerp University, Antwerp, Belgium
| | - E. Decoene
- Department of Oncology, Oncology Centre, Ghent University Hospital, Ghent, Belgium
| | - F. Dobbels
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Leuven, Belgium
| | - E. Goossens
- Center for Research and Innovation in Care, Department of Midwifery and Nursing Sciences, Antwerp University, Antwerp, Belgium
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, Leuven, Belgium
| | - G.A. Goossens
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Leuven, Belgium
- Department of Nursing, Nursing Centre of Excellence, University Hospitals, Leuven, Belgium
| | - S. Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Nursing, VIVES University College, Roeselare, Belgium
| | - T. Goffin
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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18
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Wright V, Chavez FS. Advanced Practice Nursing: Canadian Perspectives and Global Relevance. Rev Bras Enferm 2021; 75:e750101. [PMID: 34817032 DOI: 10.1590/0034-7167.2022750101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Vanessa Wright
- Crossroads Clinic Women's College Hospital. University of Toronto, Bloomberg Faculty of Nursing. Toronto, Canada
| | - Freida S Chavez
- University of Toronto, Dalla Lana School of Public Health, Bloomberg Nursing. Toronto, Canada
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Landstad BJ, Hole T, Strand AMS, Kvangarsnes M. Nursing qualifications needed in municipal emergency inpatient units. A qualitative study. BMC Nurs 2021; 20:223. [PMID: 34749712 PMCID: PMC8576997 DOI: 10.1186/s12912-021-00733-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/12/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Providing care to older individuals with complex needs and patients with chronic illness is a concern worldwide. In Norway, this situation led to the transfer of responsibility for care and treatment to the municipalities. Providing emergency care at the municipal level - thereby reducing the need for emergency hospital admissions - is part of the Coordination Reform in Norway. This reform from 2012 warrants a reconsideration of which nursing qualifications are needed in the municipalities. The aim of the study is to explore which professional qualifications nurses need to provide emergency care in municipal emergency inpatient units. METHOD A qualitative design with a hermeneutic approach was employed. Interviewing physicians about nursing qualifications may be considered inappropriate. We believe that this is important for developing knowledge that can strengthen interprofessional cooperation in emergency situations. Three focus groups were conducted. Physicians with experience in municipal emergency inpatient units were interviewed. RESULTS We synthesised three themes from the data: (1) broad medical knowledge; (2) advanced clinical skills; and (3) ethical qualifications and a holistic approach. The first theme is about knowledge, the second is about skills, and the third conveys the need for overall competence. CONCLUSIONS Nurses working in municipal emergency inpatient units need advanced ethical qualifications, which integrate broad medical knowledge, advanced clinical skills and the ability to take a holistic approach. They have a considerable responsibility to work independently and safely in a setting where both the patient and the patient's family play important roles. Establishing arenas for collaborative practice between physicians and nurses on clinical issues may be a way of strengthening patient safety and nurses' clinical judgement.
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Affiliation(s)
- Bodil J. Landstad
- Department of Health Sciences, Mid Sweden University, 831 25 Östersund, Sweden
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Kirkegata 2, 7600 Levanger, Norway
- Unit of Research, Education and Development, Östersund Hospital, Kyrkgatan 12, 831 50 Östersund, Sweden
| | - Torstein Hole
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Høgskoleringen 1, 7491 Trondheim, Norway
- Møre og Romsdal Hospital Trust, Åsehaugen 1, 6026 Ålesund, Norway
| | - Aasta-Marie Sveino Strand
- Department of Health Sciences, Norwegian University of Science and Technology, Campus Ålesund, Larsgårdsveien 2, 6009 Ålesund, Norway
| | - Marit Kvangarsnes
- Møre og Romsdal Hospital Trust, Åsehaugen 1, 6026 Ålesund, Norway
- Department of Health Sciences, Norwegian University of Science and Technology, Campus Ålesund, Larsgårdsveien 2, 6009 Ålesund, Norway
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20
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Werner J, Dimitriadou-Xanthopoulou N, Knisch-Wesemann A, Meißner K. [As Advanced Practice Nurse actively shaping nursing practice - A reflection]. Pflege 2021; 34:321-327. [PMID: 34661455 DOI: 10.1024/1012-5302/a000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
As Advanced Practice Nurse actively shaping nursing practice - A reflection Abstract. Background: The development of Advanced Practice Nurses (APN-roles) in Germany in the acute inpatient setting is heavily dependent on context factors. Establishing APN-roles in patient care represents a significant organisational development process. In the year 2010 the Florence-Nightingale-Hospital in Düsseldorf began the implementation of APN-roles. Aim: To reflect our experiences in the development of APN-roles and furthermore the identification of influencing factors. Understanding facilitators and barriers intends to support future APN-role developments and interventions. Methods: Four Advanced Practice Nurses carried out a partially structured review, with the help of the Consolidated Framework for Implementation Research (CFIR). For this purpose, the cyclical process of critical self-reflection according to Titchen (2009) was used. Results: The influencing factors were summarised in categories. The categories presented are: support from management, recognising the need for change, professional expertise, presence on site, self-efficacy and personal characteristics and role clarity. Discussion: The implementation of APN-roles requires time and perseverance, both from the organization as well as from the respective Advanced Practice Nurse. To achieve role clarity is, in this process, substantial. Boundaries and Transfer: This review presents context-related results. However, the identified influencing factors could provide a helpful framework for future implementation processes and developments of APN-roles.
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21
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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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Jansson J, Larsson M, Nilsson J. Advanced paramedics and nurses can deliver safe and effective pre-hospital and in-hospital emergency care: An integrative review. Nurs Open 2021; 8:2385-2405. [PMID: 33955702 PMCID: PMC8363369 DOI: 10.1002/nop2.866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 11/05/2022] Open
Abstract
AIM To explore and present an overview of scope of practice among registered nurses and paramedics with an advanced level of education in pre-hospital and in-hospital emergency care. DESIGN An integrative literature review. METHOD Studies published between 2006 and 2018 were retrieved by searching the databases CINAHL, PubMed, Scopus and Web of Science. Studies were selected by three independent researchers, and data were synthesized using thematic analysis. RESULTS The 25 studies identified focused on in-hospital (n = 15) and pre-hospital emergency care (n = 10) and included 13 professional titles originated from seven countries. The thematic analysis disclosed four themes; "Versatile care," "Safe care based on precision and accuracy," "Autonomous performance within boundaries" and "Beneficial towards patients and society." Advanced paramedics' and advanced nurses' services are characterized as safe, of high quality and of public benefit. Their services are being used in everyday practice as well as directed to certain categories of patients.
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Affiliation(s)
- Jörgen Jansson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
| | - Maria Larsson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
| | - Jan Nilsson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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Rakhab A, Jackson C, Nilmanat K, Butterworth T, Kane R. Factors supporting career pathway development amongst advanced practice nurses in Thailand: A cross-sectional survey. Int J Nurs Stud 2021; 117:103882. [PMID: 33621719 DOI: 10.1016/j.ijnurstu.2021.103882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 12/11/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Thailand has recently reformed its health care system and this change has contributed to the rapidly increasing need for skilled and experienced specialist nurses and in 2003 a new Advanced Practice Nursing role was formally introduced. While Advanced Practice Nursing is now accepted as a clinical career option, there is little understanding of the factors conducive to successful career development. This study offers the first examination of factors associated with successful career progression for Advanced Practice Nurses in Thailand. OBJECTIVES 1. To provide a description of the Advanced Practice Nurse population in Thailand, as represented by a purposive stratified national sample. 2. To examine the factors influencing successful career pathway development of Advanced Practice Nurses in Thailand. 3. To examine the factors which influence the extent to which Advanced Practice Nurses in Thailand engage in evidence-based practice and research. DESIGN National cross-sectional survey. SETTING Thailand. PARTICIPANTS 333 currently practicing Advanced Practice Nurses. METHODS A national cross-sectional survey was conducted in Thailand in order to identify and examine key influencing factors on the successful development of Advanced Practice Nurses. The research tool was a specifically designed questionnaire in the Thai language, informed by international academic literature on the development of the Advanced Practice Nurse role, validated and piloted with 30 Advanced Practice Nurses to assess its reliability using Cronbach's alpha. The data were analysed in SPSS (version 21). Initial parametric testing was done using the Kolmogorov-Smirnov test and Pearson's correlation analysis was performed to examine the relationship between the independent variables (those measuring demographic and support factors) and the dependent variables (measuring career pathway development). RESULTS A response rate of 90% was achieved. A lack of clear progression routes in the Advanced Practice Nurse structure was identified along with inconsistent patterns of working including variation in the number of days per week (range: 1-5 days) that nurses dedicated to the Advanced Practice Nurse role and the amount of autonomy achieved in this role. The study highlighted a lack of research productivity in and production of outputs (59% had never published) and given the expectation of Advanced Practice Nurses to both produce and utilise research evidence, this constitutes a significant gap in current practice. Other factors reported as important for career pathway development of Advanced Practice Nurses related to the environment, peer networks, institutional (hospitals) and external (government and the Thai Nursing Council) support. CONCLUSIONS Our study offers insights for national and local policymakers and highlights the need to firmly establish, standardised career pathways in Advanced Practice Nursing to support career progression and the implementation of evidence into practice. These findings also have implications for clinical departments which have a responsibility to ensure they provide an enabling environment for Advanced Practice Nurses to fully carry out their roles. Tweetable abstract: Our study reports findings from a first national survey in Thailand investigating the factors which support career development in Advanced Practice Nurses.
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Affiliation(s)
- Aranya Rakhab
- Faculty of Nursing, Surathani Rajabhat University, 272 Tambon Makham Tia, Surat Thani 84100, Thailand; School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, United Kingdom
| | - Christine Jackson
- School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, United Kingdom.
| | - Kittikorn Nilmanat
- Faculty of Nursing, Prince of Songkla University, 15 Kanjanavanich Rd, Kho Hong, Hat Yai District, Songkhla 90110, Thailand
| | - Tony Butterworth
- School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, United Kingdom.
| | - Roslyn Kane
- School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, United Kingdom.
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Mao X, Yang Q, Li X, Chen X, Guo C, Wen X, Loke AY. An illumination of the ICN's core competencies in disaster nursing version 2.0: Advanced nursing response to COVID-19 outbreak in China. J Nurs Manag 2020; 29:412-420. [PMID: 33107099 DOI: 10.1111/jonm.13195] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 01/10/2023]
Abstract
AIM This study aims to report on the actions and incident management of the advanced practice nurses of a disaster operation team who were deployed in response to the COVID-19 outbreak, and to explore how it illustrated the Core Competencies in Disaster Nursing Version 2.0 delineated by the International Council of Nurses in 2019. METHODS This is a descriptive study. The participants (responders) communicated and reported their actions in the operation with headquarter on a popular social media platform in China (WeChat), established specifically for the three-rescue teams. RESULTS The response approach of advanced nurses to COVID-19 encompassed six of the eight domains of the competencies outlined in ICN CCDN V2.0, namely on preparation and planning, communication, incident management systems, safety and security, assessment and intervention. CONCLUSIONS The response teams of advanced practice nurses in this study clearly demonstrated their competencies in disaster rescue, which fulfilled most of the core competencies set forth by the ICN. IMPLICATIONS FOR NURSING MANAGEMENT The findings of this study contributed to understand the roles played by advanced practice nurses and nurse managers in disaster management and how these relate to the competencies set forth by the ICN.
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Affiliation(s)
- Xiaorong Mao
- Sichuan Academy of Medical Sciences &, Sichuan Provincial People's Hospital, Chengdu, China
| | - Qin Yang
- Sichuan Academy of Medical Sciences &, Sichuan Provincial People's Hospital, Chengdu, China
| | - Xin Li
- Sichuan Academy of Medical Sciences &, Sichuan Provincial People's Hospital, Chengdu, China
| | - Xuemei Chen
- Sichuan Academy of Medical Sciences &, Sichuan Provincial People's Hospital, Chengdu, China
| | - Chunlan Guo
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Xianxiu Wen
- Sichuan Academy of Medical Sciences &, Sichuan Provincial People's Hospital, Chengdu, China
| | - Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
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25
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Blanck-Köster K, Roes M, Gaidys U. [Clinical leadership competencies in advanced nursing practice : Scoping review]. Med Klin Intensivmed Notfmed 2020; 115:466-476. [PMID: 32870328 DOI: 10.1007/s00063-020-00716-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/23/2020] [Accepted: 06/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The competencies of advanced practice nurses (APN) include clinical activity in a special field, coaching and consulting, collaboration, leadership, ethical decision-making, and research competence. Clinical leaders initiate and implement changes in the healthcare system and respond to the needs of patients and healthcare institutions. Clinical leadership based on advanced nursing practice can challenge existing management and care structures. OBJECTIVES The aim of the review is to provide an overview of clinical leadership competencies based on advanced nursing practice. The investigated question deals with which roles and competencies of APN are associated with clinical leadership from a national and international perspective. METHODS A systematic search in MEDLINE®(US National Center for Biotechnology Information (NCBI))/PubMed, CINAHL and the Cochrane Library as well as a hand search in library catalogs and journals (April 2019 to January 2020) produced a total of 235 hits. Eight studies were included in the review and analyzed. RESULTS Clinical leadership competencies are increasingly a topic of international studies and can be described and recognized in clinical practice on the basis of leadership models, and the role and leadership domains of APNs. Clinical leadership in nursing practice is recognized when APNs independently control treatment processes in complex nursing situations, exert influence, develop and implement change strategies, consult, coach, train, collaborate, and establish a connection to other health professionals and management. In order for clinical leadership competencies to be effective in nursing care processes, broad support in the multiprofessional team, structural support of the organization and legal legitimation are required. CONCLUSIONS There are hardly any studies in the German-language literature on the relevance, interpretation, and legitimacy of APN clinical leadership. Further research is needed on the interpretation of the roles of APNs, especially clinical leadership competencies, their influence on nursing care processes, leadership structures, and their interaction within the organizational culture.
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Affiliation(s)
- Katrin Blanck-Köster
- Department Pflege & Management, Hochschule für Angewandte Wissenschaften Hamburg, Alexanderstraße 1, 20099, Hamburg, Deutschland. .,Universität Witten/Herdecke, Witten, Deutschland.
| | - Martina Roes
- Universität Witten/Herdecke, Witten, Deutschland
| | - Uta Gaidys
- Department Pflege & Management, Hochschule für Angewandte Wissenschaften Hamburg, Alexanderstraße 1, 20099, Hamburg, Deutschland
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Abstract
Using a convenience sampling, nurse educators representing 10 countries were surveyed to describe required clinical education for advanced practice beyond basic traditional nursing education. This article explores the many factors currently influencing the structure and diversity of these clinical experiences worldwide.
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27
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Cooper MA, McDowell J, Raeside L. The similarities and differences between advanced nurse practitioners and clinical nurse specialists. ACTA ACUST UNITED AC 2019; 28:1308-1314. [DOI: 10.12968/bjon.2019.28.20.1308] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A lack of awareness exists within healthcare services on the differences between the roles of advanced nurse practitioner (ANP) and clinical nurse specialist (CNS). This may lead to ambiguity in relation to the development, scope of practice and impact of these roles. The aim of this review was to compare the similarities and differences between the ANP and CNS within the research literature. Databases (CINAHL, Medline and Embase) were searched using selected search terms. This resulted in 120 articles of potential interest being identified. Following a rigorous review process for content and relevance, this was reduced to 12. Both roles are valuable and effective, predominately being clinically based with education, leadership and research components. CNS roles are specialist, ANP are more likely to be generalist. Where there is regulation and governance the role of the ANP is clearly defined and structured; however, a lack of governance and regulation is evident in many countries.
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Affiliation(s)
- Mark A Cooper
- Consultant Nurse—Advanced Practice, NHS Greater Glasgow and Clyde, and Honorary Senior Clinical Lecturer, University of Glasgow
| | - Joan McDowell
- Honorary Senior Research Fellow, University of Glasgow
| | - Lavinia Raeside
- Advanced Neonatal Nurse Practitioner, NHS Greater Glasgow and Clyde
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28
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Goemaes R, Lernout E, Goossens S, Decoene E, Verhaeghe S, Beeckman D, Van Hecke A. Time use of advanced practice nurses in hospitals: A cross-sectional study. J Adv Nurs 2019; 75:3588-3601. [PMID: 31566771 DOI: 10.1111/jan.14198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 08/10/2019] [Accepted: 08/28/2019] [Indexed: 12/01/2022]
Abstract
AIMS To examine the use of time by advanced practice nurses and time use differences according to type of healthcare organization, work experience, and supervisor. DESIGN A cross-sectional, observational study. METHODS Non-participant observations were executed in Belgium (October 2015-January 2016). Time use was categorized in domains (patient/family, team, healthcare organization) and roles (clinical expert, educator/coach, change agent/innovator, researcher, leader, collaborator, and ethical decision-making facilitator). Proportional working time in domains and roles was calculated. Chi-squared tests identified differences in time use according to type of healthcare organization, number of years of work experience, and type of hierarchical/functional supervisor. RESULTS Participants mainly devoted time to the patient/family domain (30.78%) and the clinical expert role (34.19%). The role of leader and ethical decision-making facilitator covered, respectively, 4.84% and 0.07% of participants' time. Time distribution in domains and roles differed between participants in university and peripheral hospitals. CONCLUSION Activities were executed in all domains and roles, except for the ethical decision-making facilitator role. Further research could uncover barriers and facilitators for role execution, especially about leadership and ethical decision-making. IMPACT Advanced practice nurses, supervisors and policymakers could act to optimize advanced practice nurses' scope of practice.
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Affiliation(s)
- Régine Goemaes
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Emma Lernout
- Department of Public Health and Primary Care, Alumni Master of Science in Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Sophie Goossens
- Department of Public Health and Primary Care, Alumni Master of Science in Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Elsie Decoene
- Cancer Centre, Ghent University Hospital, Ghent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,VIVES University College, Roeselare, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
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29
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Scanlon A, Murphy M, Smolowitz J, Lewis V. Low- and lower middle-income countries advanced practice nurses: an integrative review. Int Nurs Rev 2019; 67:19-34. [PMID: 31364775 DOI: 10.1111/inr.12536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIM To review published literature descriptions of advanced practice nurses' roles in low- and lower middle-income countries. BACKGROUND Advanced practice nurse roles have the potential to address insufficient healthcare resources in low- and lower middle-income countries. INTRODUCTION This integrative review highlights advanced practice nurses' roles in the delivery of healthcare services in low- and lower middle-income countries. METHODS Three electronic databases PubMed, CINAHL complete and ProQuest Health & Medicine were searched. No limits by year or language were set. The names for low- and lower middle-income countries and combinations 'related to advanced practice nurses' titles were used to identify papers. In addition, a review of publication type was performed. Themes found within the publications were assessed against the advanced practice nurses' International Council of Nurses' characteristics. An integrative review facilitated an appraisal of the papers identified. RESULTS The initial search identified 5778 publications in 16 languages. This number was reduced to 23, from 18 low- and lower middle-income once exclusion criteria were applied. Six publications were from 1977 to 1999, and six between 2000 and 2010, with the remaining 11 from 2011 to 2018. Zambia had the most publications. Notably, 63 countries were not represented. Of those meeting inclusion criteria, the majority addressed education with a lesser extent focusing on practice and regulation of advanced practice nurse's roles. The majority were published during the last decade. DISCUSSION This review of the published literature identified advanced practice nurses' roles and function within some healthcare systems. However, not all components were reported. Examination of the grey literature could provide additional information about the actual and potential benefits of advanced practice nurses' in low- and lower middle-income countries. CONCLUSION The published literature that referred to advanced practice nurses' identified their contribution to positive impacts on health care over the last 40 years. However, with only 11 publications identified in the last 7 years, further review is required to understand the advanced practice nurses' roles in these countries. IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY Further development of advanced practice nurses' in low- and lower middle-income countries is supported by the lack of published literature.
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Affiliation(s)
- A Scanlon
- School of Nursing and Midwifery, La Trobe University, Bundoora, Vic., Australia.,School of Nursing, Montclair State University, Montclair, NJ, USA
| | - M Murphy
- School of Nursing and Midwifery, La Trobe University, Bundoora, Vic., Australia
| | - J Smolowitz
- School of Nursing, Montclair State University, Montclair, NJ, USA
| | - V Lewis
- Australian Institute for Primary Care & Ageing, Bundoora, Vic., Australia
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Jean E, Sevilla Guerra S, Contandriopoulos D, Perroux M, Kilpatrick K, Zabalegui A. Context and implementation of advanced nursing practice in two countries: An exploratory qualitative comparative study. Nurs Outlook 2019; 67:365-380. [DOI: 10.1016/j.outlook.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 01/09/2019] [Accepted: 02/02/2019] [Indexed: 11/15/2022]
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Van Hecke A, Goemaes R, Verhaeghe S, Beyers W, Decoene E, Beeckman D. Leadership in nursing and midwifery: Activities and associated competencies of advanced practice nurses and midwives. J Nurs Manag 2019; 27:1261-1274. [DOI: 10.1111/jonm.12808] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/01/2019] [Accepted: 05/27/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- Nursing Department Ghent University Hospital Ghent Belgium
| | - Régine Goemaes
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery Ghent University Ghent Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- Department Health Care VIVES University College Roeselare Belgium
| | - Wim Beyers
- Department of Developmental, Personality and Social Psychology Ghent University Ghent Belgium
| | - Elsie Decoene
- Cancer Centre Ghent University Hospital Ghent Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- Department of Public Health and Primary Care, Skin Integrity Research Group (SKINT) University Centre for Nursing and Midwifery, Ghent University Ghent Belgium
- School of Health Sciences Örebro University Sweden
- School of Nursing and Midwifery Royal College of Surgeons in Ireland Ireland
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32
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Hu J, Yang Y, Fallacaro MD, Wands B, Wright S, Zhou Y, Ruan H. Building an International Partnership to Develop Advanced Practice Nurses in Anesthesia Settings: Using a Theory-Driven Approach. J Transcult Nurs 2019; 30:521-529. [PMID: 31060444 DOI: 10.1177/1043659619846248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The International Federation of Nurse Anesthetists is calling for international collaboration to develop advanced nursing practice in anesthesia settings globally. However, international collaboration is challenging. Limited information is available about what process and factors specifically lead to a successful international collaboration partnership. This article aimed to describe a theoretical and empirical base that can be used to build and maintain long-term international partnerships. The Theoretical Framework of Developing International Partnerships was developed, which comprises seven interrelated concepts including partnerships, collaborations, environment, structure, process for collaborating, outcomes, and sustainability. It was used to guide an equitable horizontal collaboration partnership to develop anesthesia nursing care in local culture and context. Five major challenges were identified during the collaboration process. Sixty-six strategies were developed to facilitate collaboration using the theoretical framework. This work can inform others in establishing an international collaboration and partnership in advancing nursing knowledge and culturally congruent health care delivery.
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Affiliation(s)
- Jiale Hu
- Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- Virginia Commonwealth University, Richmond, VA, USA
| | - Yan Yang
- Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- Second Military Medical University, Shanghai, China
| | | | - Brenda Wands
- Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Hong Ruan
- Ninth People’s Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Nursing Association, Shanghai, China
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Ribeiro VDS, Garbuio DC, Zamariolli CM, Eduardo AHA, Carvalho ECD. Simulação clínica e treinamento para as Práticas Avançadas de Enfermagem: revisão integrativa. ACTA PAUL ENFERM 2018. [DOI: 10.1590/1982-0194201800090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Resumo Objetivo Analisar a contribuição do uso da simulação clínica como estratégia para o ensino e treinamento das práticas avançadas de enfermagem. Métodos Foi realizada uma Revisão Integrativa e feito as buscas nas bases de dados Embase, LILACS, PubMed, CINAHL e Scopus, com os descritores e palavras-chaves Advanced practice nursing AND simulation. Resultados Foram identificados 68 artigos; após serem excluídos os duplicados e os que não respondiam à questão norteadora, foram analisados 11 artigos. Os dados evidenciaram que a simulação permitiu um exame aprofundado para avaliar o desempenho dos alunos nas práticas avançadas em relação a abordagem do paciente e liderança; este método auxiliou o aluno a assumir responsabilidade nas tomadas de decisões, a conduzir os cuidados com o paciente, a direcionar a equipe, interagir com a família, além de demonstrar liderança, priorização, delegação, colaboração e profissionalismo. Conclusão Os trabalhos analisados evidenciaram que a simulação clínica contribuiu para o ensino das práticas avançadas de enfermagem aumentando a consciência clínica e o desenvolvimento de competências para manejo clínico avançado, habilidades de liderança e de trabalho em equipe; a maioria dos trabalhos foram realizados com pós-graduandos.
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Olímpio JDA, Araújo JNDM, Pitombeira DO, Enders BC, Sonenberg A, Vitor AF. Prática Avançada de Enfermagem: uma análise conceitual. ACTA PAUL ENFERM 2018. [DOI: 10.1590/1982-0194201800092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Resumo Objetivo Analisar o conceito de Prática Avançada de Enfermagem e elucidar os elementos-chave: atributos, antecedentes e consequências. Métodos O referencial metodológico para o estudo foi o modelo de análise conceitual de Walker e Avant (2011), estruturado mediante uma revisão integrativa da literatura conduzida nos meses de maio e junho de 2017. A busca foi realizada nas bases de dados Scopus, PubMed, CINAHL, Web of Science, Science Direct, Cochrane e Lilacs, considerando estudos que trataram do termo e que foram publicados em português, inglês ou espanhol. Resultados A amostra foi composta por 33 estudos conduzidos em oito países entre os anos 2000 e 2016, sendo 56% publicado no quinquênio 2011-2016. Foram identificados oito atributos: Preparação educacional em nível de mestrado ou doutorado, e especialização em área clínica; Prática baseada em evidências; Habilidade de desenvolver raciocínio clínico e pensamento crítico; Alto nível de autonomia; Avaliação avançada e ampla; Liderança; Capacidades diagnóstica, gerencial e administrativa; Promoção do ensino às outras enfermeiras. Foram identificados os antecedentes e consequências e foi desenvolvida uma definição do conceito. Conclusão Diante da expansão da ideia de enfermagem avançada pelo mundo, particularmente na América Latina, recomendam-se outros estudos relacionados à Prática Avançada de Enfermagem. É necessária uma compreensão aprofundada das questões na prática de implementação no Brasil para ajudar a determinar o conceito futuro de PAE para o país. Este estudo contribui a essa compreensão ao definir o conceito de PAE com seus antecedentes, atributos e consequências.
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35
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Mc Conkey RW, Hahessy S. Developing the advanced nursing practice role in non-muscle invasive bladder cancer surveillance in Ireland. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2018. [DOI: 10.1111/ijun.12168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Robert W. Mc Conkey
- Advanced Nurse Practitioner candidate in Urology; Galway University Hospital; Galway Ireland
| | - Sinead Hahessy
- School of Nursing and Midwifery; National University of Ireland; Galway
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36
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Giles M, Parker V, Conway J, Mitchell R. Knowing how to get things done: Nurse consultants as clinical leaders. J Clin Nurs 2018; 27:1981-1993. [DOI: 10.1111/jocn.14327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Michelle Giles
- Hunter New England Local Health District; Newcastle NSW Australia
- School of Health; University of New England; Armidale NSW Australia
| | - Vicki Parker
- Hunter New England Local Health District; Newcastle NSW Australia
- School of Health; University of New England; Armidale NSW Australia
| | - Jane Conway
- School of Health; University of New England; Armidale NSW Australia
| | - Rebecca Mitchell
- School of Business and Law; University of Newcastle; Callaghan NSW Australia
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37
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O'Connor L, Casey M, Smith R, Fealy GM, Brien DO, O'Leary D, Stokes D, McNamara MS, Glasgow ME, Cashin A. The universal, collaborative and dynamic model of specialist and advanced nursing and midwifery practice: A way forward? J Clin Nurs 2018; 27:e882-e894. [DOI: 10.1111/jocn.13964] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Laserina O'Connor
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Belfield Dublin Ireland
| | - Mary Casey
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Belfield Dublin Ireland
| | - Rita Smith
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Belfield Dublin Ireland
| | - Gerard M Fealy
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Belfield Dublin Ireland
| | - Denise O' Brien
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Belfield Dublin Ireland
| | - Denise O'Leary
- School of Hospitality Management & Tourism; Dublin Institute of Technology; Dublin 6 Ireland
| | - Diarmuid Stokes
- College of Health and Agricultural Sciences; University College Dublin; Dublin 4 Ireland
| | - Martin S McNamara
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Belfield Dublin Ireland
| | | | - Andrew Cashin
- Health and Human Sciences; Southern Cross University; Lismore NSW Australia
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Fougère B, Lagourdette C, Abele P, Resnick B, Rantz M, Kam Yuk Lai C, Chen Q, Moyle W, Vellas B, Morley JE. Involvement of Advanced Practice Nurse in the Management of Geriatric Conditions: Examples from Different Countries. J Nutr Health Aging 2018; 22:463-470. [PMID: 29582884 DOI: 10.1007/s12603-018-1008-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The increasing demand for healthcare services is placing great strain on healthcare systems throughout the world. Although the older population is increasing worldwide, there is a marked deficit in the number of persons trained in geriatrics. It is now recognized that early detection and treatment of geriatric conditions (e.g., frailty, sarcopenia, falls, anorexia of aging, and cognitive decline) will delay or avert the development of disability. At the same time, recent years have seen an increased interest and use of advanced practice nurses (APN). Models of best practices of supervision and collaboration have been promulgated by many organizations. APN's roles and scope of practice have been expanded in many countries and the quality and cost-effectiveness of healthcare systems have improved. Nevertheless, in older people, evidence of advanced practice roles remains scattered, and there is little synthesis of evidence, and therefore it is not easy to visualize the different practice models and their components. The aim of this paper is to explain the need for advanced practice nurses to manage geriatric conditions.
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Affiliation(s)
- B Fougère
- B. Fougère, Institut du Vieillissement, Gérontopôle, Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse, France, Tel: +33561145657 ; fax: +33561145640, E-mail:
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Doody O, Slevin E, Taggart L. Focus group interviews examining the contribution of intellectual disability clinical nurse specialists in Ireland. J Clin Nurs 2017; 26:2964-2975. [PMID: 27862506 DOI: 10.1111/jocn.13636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 01/24/2023]
Abstract
AIMS AND OBJECTIVES To explore the contribution of clinical nurse specialists in intellectual disability nursing in Ireland. BACKGROUND While clinical nurse specialists exist since the 1940s, they have only been a reality in Ireland since 2001. While the role of clinical nurse specialist has developed over the years, it still however is often seen as a complex multifaceted role that causes confusion, frustration and controversy. DESIGN A exploratory qualitative approach using focus groups with Irish intellectual disability clinical nurse specialists (n = 31). METHODS Five focus group interviews were conducted to gather qualitative data to gain insight into the attitudes, perceptions and opinions of the participants. Data were audio-recorded, transcribed and analysed using Burnard's (Vital Notes for Nurses: Research for Evidence-Based Practice in Healthcare, 2011, Blackwell Publishing, Oxford) framework. Ethical approval was gained from the researcher's university and access granted by the national council for the professional development of nursing/midwifery in Ireland. RESULTS The study highlights that intellectual disability clinical nurse specialists contribute to and support care delivery across a range of areas including client-focused and family-centred care, staff support, organisation support, community support and supporting other agencies. CONCLUSIONS Overall, the study shows the importance of intellectual disability clinical nurse specialists and their contribution across a range of services, care environments and the support they offer to clients/families/staff/multidisciplinary team members and outside agencies. RELEVANCE TO CLINICAL PRACTICE Ireland is in a unique position to develop knowledge regarding specialist care for people with intellectual disability that can be shared and adapted by other healthcare professionals in other countries that do not have specialised intellectual disability nurses.
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Affiliation(s)
- Owen Doody
- Department of Nursing and Midwifery, North Bank Campus, University of Limerick, Limerick, Ireland
| | - Eamonn Slevin
- Autism Initiatives, Beechill Business Park, Beechill Road, Belfast, County Antrim, Northern Ireland
| | - Laurence Taggart
- University of Ulster, Jordanstown Campus, Newtownabbey, County Antrim, Northern Ireland
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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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Jakimowicz M, Williams D, Stankiewicz G. A systematic review of experiences of advanced practice nursing in general practice. BMC Nurs 2017; 16:6. [PMID: 28115913 PMCID: PMC5241982 DOI: 10.1186/s12912-016-0198-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/27/2016] [Indexed: 11/17/2022] Open
Abstract
Background Despite efforts to achieve conceptual clarity, advanced practice nursing continues to reside in a liminal space, unable to secure ongoing recognition as a viable means of healthcare delivery. This is particularly evident in general practice where advanced practice role development is more fluid and generally less supported by the hierarchical structures evident in the hospital system. This review synthesises published qualitative studies reporting experiences of advanced practice nursing in general practice. The panoramic view provided by patients, nurses and doctors within this novel context, offers a fresh perspective on why advanced practice nurses have struggled to gain acceptance within the healthcare milieu. Methods We conducted a systematic review of qualitative studies that explored the experiences of patients, nurses and doctors who had contact with advanced practice nurses working in general practice. Published work from 1990 to June 2016 was located using CINAHL and PubMed. The full text of relevant studies was retrieved after reading the title and abstract. Critical appraisal was undertaken and the findings of included studies were analysed using the constant comparative method. Emergent codes were collapsed into sub-themes and themes. Results Twenty articles reporting the experiences of 486 participants were included. We identified one major theme: legitimacy; and three sub-themes: (1) establishing and maintaining confidence in the advanced practice nurse, (2) strengthening and weakening boundaries between general practitioners and advanced practice nurses and (3) establishing and maintaining the value of advanced practice nursing. Conclusions We set out to describe experiences of advanced practice nursing in general practice. We discovered that general practitioners and patients continue to have concerns around responsibility, trust and accountability. Additionally, advanced practice nurses struggle to negotiate and clarify scopes of practice while general practitioners have trouble justifying the costs associated with advanced practice nursing roles. Therefore, much work remains to establish and maintain the legitimacy of advanced practice nursing in general practice. Electronic supplementary material The online version of this article (doi:10.1186/s12912-016-0198-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael Jakimowicz
- School of Health Sciences, University of Tasmania, 1 Leichhardt Street, Darlinghurst, NSW 2010 Australia
| | - Danielle Williams
- School of Health Sciences, University of Tasmania, Private Bag 135, Hobart, TAS 7001 Australia
| | - Grazyna Stankiewicz
- School of Health Sciences, University of Tasmania, Locked Bag 5052, Alexandria, NSW 2015 Australia
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Giles M, Parker V, Mitchell R. Understanding Nurse Consultant role engagement in metropolitan and rural contexts. Collegian 2016. [DOI: 10.1016/j.colegn.2016.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Goemaes R, Beeckman D, Goossens J, Shawe J, Verhaeghe S, Van Hecke A. Advanced midwifery practice: An evolutionary concept analysis. Midwifery 2016; 42:29-37. [DOI: 10.1016/j.midw.2016.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 09/02/2016] [Accepted: 09/11/2016] [Indexed: 11/24/2022]
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Abstract
School nurses, as leaders, are able to exhibit leadership skills through embracing, advocating for, and demonstrating a commitment to lifelong learning. With the continual changes in healthcare and technology, ongoing education is essential to maintain a high standard of expertise and practice. School nurses have many opportunities for continuing education. This article will briefly explore various levels of continuing education, as well as relating ongoing learning to leadership principles.
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Affiliation(s)
- Dawn Lambert
- Assistant Professor of Nursing, Eastern Mennonite University, Lancaster, PA
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Coyne I, Comiskey CM, Lalor JG, Higgins A, Elliott N, Begley C. An exploration of clinical practice in sites with and without clinical nurse or midwife specialists or advanced nurse practitioners, in Ireland. BMC Health Serv Res 2016; 16:151. [PMID: 27117714 PMCID: PMC4847185 DOI: 10.1186/s12913-016-1412-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 04/19/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Clinical specialist (CS) and advanced practitioner (AP) roles have increased in nursing and midwifery internationally. This study explored clinical practice in sites with and without clinical nurse or midwife specialists or advanced nurse practitioners in Ireland. METHODS Using a case study design, interview, observational and documentary data from postholding sites (CSs or APs employed) were compared with data from non-postholding sites (no CSs or APs employed). Interviews and observations were conducted with postholders (n = 23), and compared with data from healthcare professionals (nurses or midwives, doctors) (n = 23) in matched services. Interviews were held with Directors of Nursing and Midwifery (n = 23), healthcare professionals (n = 41), service users (n = 41) with experience of receiving care or working with postholders, and non-postholders in matched services. The data were analysed using Nvivo (Version 8). RESULTS The findings suggest that postholders' practice appeared to differ from non-postholders' in relation to case management and service provision. Postholders were seen as having an impact on readmission rates, waiting lists/times, collaborative decision-making, continuity of care and workload management. Postholders' autonomy to manage caseloads was perceived to lead to smoother transition of patients/clients through the healthcare system. Service-users' self-reports appeared to appreciate the individualised holistic care provided by postholders. Postholders' role in facilitating person-centred care and promoting interprofessional team working, are essential elements in quality care provision and in global healthcare workforce planning. CONCLUSIONS To meet changing healthcare demands, promote person-centred care, and improve service delivery, more specialist and advanced practice posts in nursing and midwifery should be developed and supported within healthcare.
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Affiliation(s)
- Imelda Coyne
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland.
| | - Catherine M Comiskey
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
| | - Joan G Lalor
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
| | - Naomi Elliott
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin 2, Ireland
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Gray A. Advanced or advancing nursing practice: what is the future direction for nursing? ACTA ACUST UNITED AC 2016; 25:8, 10, 12-3. [PMID: 26768039 DOI: 10.12968/bjon.2016.25.1.8] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Advanced nursing practice roles have emerged over the last 25 years in response to two major challenges: first, the significant reduction in available doctors; and, second, the rise in numbers of patients with complex health needs. It is suggested that, with a major drive to respond to the first problem, with its emphasis on the development of medical skills, the development of advanced nursing practice (which has the potential to have a significant impact on the second challenge of the rise in long-term conditions) has very much taken second place. Moreover, advanced nursing practice roles have become so medically focused that not only is advanced nursing practice not evident, but neither are the recognised sub-roles that are fundamental to advancing practice. These include innovation, education, research and clinical leadership. This article argues that in the current climate it is essential that advanced nurse practitioners not only demonstrate advanced practice, but also actively embrace the concept of 'advancing' nursing practice as the dominant feature of new roles.
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Affiliation(s)
- Alastair Gray
- Senior Lecturer (Emergency & Advancing Practice), Department of Nursing, Midwifery & Healthcare Practice, Faculty of Health and Life Sciences, Coventry University
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Hølge-Hazelton B, Kjerholt M, Berthelsen CB, Thomsen TG. Integrating nurse researchers in clinical practice - a challenging, but necessary task for nurse leaders. J Nurs Manag 2015; 24:465-74. [DOI: 10.1111/jonm.12345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Bibi Hølge-Hazelton
- Roskilde-Køge Hospitals and The Research Unit for General Practice and Section of General Practice Department of Public Health; University of Copenhagen; Denmark
| | - Mette Kjerholt
- Haematological Unit for Nursing Research; Department of Haematology; Roskilde - Køge Hospitals; Roskilde Denmark
| | | | - Thora Grothe Thomsen
- Roskilde and Køge Hospitals and Institute of Regional Health Services Research; University of Southern Denmark; Roskilde Denmark
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Morilla-Herrera JC, Garcia-Mayor S, Martín-Santos FJ, Kaknani Uttumchandani S, Leon Campos Á, Caro Bautista J, Morales-Asencio JM. A systematic review of the effectiveness and roles of advanced practice nursing in older people. Int J Nurs Stud 2015; 53:290-307. [PMID: 26542652 DOI: 10.1016/j.ijnurstu.2015.10.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To identify, assess and summarize available scientific evidence about the effect of interventions deployed by advanced practice nurses when providing care to older people in different care settings, and to describe the roles and components of the interventions developed by these professionals. BACKGROUND In older people, evidence of advanced practice roles remains dispersed along different contexts, approaches and settings; there is little synthesis of evidence, and it is not easy to visualize the different practice models, their components, and their impact. DESIGN Systematic review. DATA SOURCES Sixteen electronic databases were consulted (1990-2014). The research also included screening of original studies in reviews and reports from Centers of Health Services Research and Health Technology Agencies. REVIEW METHODS Studies were assessed by two reviewers with the Cochrane risk of bias tool. They were classified depending on the type of follow-up (long and short-term care) and the scope of the service (advanced practice nurses interventions focused on multimorbid patients, or focused on a specific disease). RESULTS Fifteen studies were included. In long-term settings, integrative, multi-component and continuous advanced practice nursing care, reduced readmissions, and increased patients' and caregivers' satisfaction. Advanced practice nurses were integrated within multidisciplinary teams and the main interventions deployed were patient education, multidimensional assessments and coordination of multiple providers. CONCLUSION Positive results have been found in older people in long-term care settings, although it is difficult to discern the specific effect attributable to them because they are inserted in multidisciplinary teams. Further investigations are needed to evaluate the cost-effectiveness of the two modalities detected and to compare internationally the interventions developed by advanced practice nurses.
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Affiliation(s)
- Juan Carlos Morilla-Herrera
- Primary Health Care District of Málaga, Spain; Department of Nursing, Faculty of Health Sciences, University of Málaga, Spain
| | - Silvia Garcia-Mayor
- Department of Nursing, Faculty of Health Sciences, University of Málaga, Spain
| | - Francisco Javier Martín-Santos
- Primary Health Care District of Málaga, Spain; Department of Nursing, Faculty of Health Sciences, University of Málaga, Spain
| | | | - Álvaro Leon Campos
- Department of Nursing, Faculty of Health Sciences, University of Málaga, Spain
| | - Jorge Caro Bautista
- Health Care Centre El Limonar, Primary Health Care District of Málaga, Spain
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