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Vlerick I, Kinnaer LM, Delbaere B, Coolbrandt A, Decoene E, Thomas L, Vanderlinde R, Van Hecke A. Characteristics and effectiveness of mentoring programmes for specialized and advanced practice nurses: A systematic review. J Adv Nurs 2024; 80:2690-2714. [PMID: 38093489 DOI: 10.1111/jan.16023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/09/2023] [Accepted: 11/30/2023] [Indexed: 06/13/2024]
Abstract
AIMS (1) To identify, evaluate and summarize evidence about the objectives and characteristics of mentoring programmes for specialized nurses (SNs) or nurse navigators (NNs) and advanced practice nurses (APNs) and (2) to identify the effectiveness of these programmes. DESIGN A systematic review based on PRISMA guidelines. DATA SOURCES From November 2022 until 7 December 2022, four databases were searched: PubMed, EMBASE, CINAHL and The Cochrane Library. REVIEW METHODS Study selection was performed independently by two researchers. Disagreements were discussed until consensus was reached. Data extraction was undertaken for included studies. Data synthesis was conducted using narrative analysis. Quality appraisal was performed using the Critical Appraisal Skill Programme (CASP) and Mixed Methods Appraisal Tool (MMAT). RESULTS Twelve articles were included, all of which focused on mentoring programmes for APNs. Different forms of mentorship (e.g. (in)formal mentorship, work shadowing, workshops) were reported. Studies reported positive outcomes on job retention (n = 5), job satisfaction (n = 6), skills improvement (n = 7), satisfaction with the programme (n = 7) and confidence improvement (n = 4) among participants of mentoring programmes. CONCLUSION There is a lack of uniformity and consistency in various elements of mentoring programmes. Further research is needed to develop mentoring programmes for both APNs and SNs/NNs in a systematic and theoretically underpinned manner. It is necessary to establish a thorough evaluation methodology, preferably using a mixed methods design that includes both a qualitative process evaluation and a comprehensive outcome evaluation using validated questionnaires, taking into account the NN/APN, the interprofessional team and organizational level. IMPACT The synthesis of evidence may be useful to organizations developing and implementing mentoring programmes for both SN/NN and APN. The development of a mentoring programme for nursing experts should be considered a complex intervention that requires theoretical frameworks and contextual considerations. NO PATIENT OR PUBLIC CONTRIBUTION Not applicable, as no patients or public were involved.
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Affiliation(s)
- Isabel Vlerick
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Lise-Marie Kinnaer
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Ben Delbaere
- Faculty of Medicine and Health Sciences, Department of Family Medicine and Population Health, Chair Care and the Natural Living Environment, University of Antwerp, Antwerp, Belgium
| | - Annemarie Coolbrandt
- Department of Oncology Nursing, University Hospitals Leuven, Leuven, Belgium
- Department of Public Health and Primary Care, KU Leuven, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Elsie Decoene
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Laura Thomas
- Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Ruben Vanderlinde
- Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Faculty of Medicine and Health Sciences, 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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Van Hecke A, Decoene E, Courtens A, Coolbrandt A, Decadt I, Pape E. The Role of Researcher for Advanced Practice Nurses in Oncology: Challenges and Lessons Learned. Semin Oncol Nurs 2024; 40:151634. [PMID: 38604927 DOI: 10.1016/j.soncn.2024.151634] [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: 12/18/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES To reflect on current practice analyses regarding the role of advanced practice nurse (APN) researcher in oncology, and report on the challenges that were faced and lessons we have learned when intensively working with APNs on doing research within the domain of oncology. METHODS Discussions with APNs supervised by or who collaborated with academics in nursing science during the past 10 years on doing research within the domain of oncology. RESULTS Several misconceptions exist regarding the role of APNs as researchers. During the research process, APNs are confronted with a wide range of topics based on evidence gaps and unmet needs, challenges linked to specific research designs, and ethical issues. APNs also face challenges related to the dissemination of research. This step in the research process is often overlooked due to APNs' lack of time, limited financial resources, insufficient support for academic writing, or lower priority for APNs and other healthcare providers. CONCLUSION The APN role of researcher in oncology is fundamental for the advancement of oncology nursing care, implementation of evidence-based practice and innovations in oncology patient care, and further development of the nursing profession and nursing science. Participation in research is considered a main function that differentiates APNs from nurses in other clinical roles, such as specialized nurses. By embracing the role of researcher, oncology APNs can achieve professional growth that will stimulate them as an APN, open new opportunities, and keep them challenged. IMPLICATIONS FOR NURSING PRACTICE In addition to APN, organizational and structural related factors, support by relevant stakeholders, partnering with (nursing) research units and professional and patient organizations, and dedicated time for research can positively influence uptake of the APN researcher role.
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Affiliation(s)
- Ann Van Hecke
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care - University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium; Staff member Center of Expertise in Nursing, Ghent University Hospital, Ghent, Belgium.
| | - Elsie Decoene
- Staff member Center of Expertise in Nursing, Ghent University Hospital, Ghent, Belgium
| | - Annelies Courtens
- Advanced Practice Nurse in Oncology, AZ Groeninge Hospital, Kortrijk, Belgium
| | - Annemarie Coolbrandt
- Advanced Practice Nurse in Oncology, University Hospitals Leuven, Leuven, Belgium; Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Ine Decadt
- Advanced Practice Nurse in Oncology, AZ Groeninge Hospital, Kortrijk, Belgium
| | - Eva Pape
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care - University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium; Advanced Practice Nurse Digestive Oncology, Ghent University Hospital, Ghent, Belgium
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Van Hecke A, Vlerick I, Akhayad S, Daem M, Decoene E, Kinnaer LM. Dynamics and processes influencing role integration of advanced practice nurses and nurse navigators in oncology teams. Eur J Oncol Nurs 2023; 62:102257. [PMID: 36634592 DOI: 10.1016/j.ejon.2022.102257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE Exploring the persisting presence of underlying processes, dynamics, experienced barriers and facilitators of Advanced Practice Nurses (APN) in oncology and Oncology Nurse Navigators (ONN) during their role integration in an interprofessional team over a research period of seven years. METHODS A qualitative study based on the principles of Grounded Theory, in which individual semi-structured interviews and focus groups were conducted with 51 ONN and APN from 11 university and local hospitals in Belgium between 2011-2018. Data were analyzed to develop a framework that consists of different themes. RESULTS ONN and APN experienced a lonely journey during role integration. They were searching for partners, medical knowledge and acknowledgement from the interprofessional team. ONN and APN had a watchful attitude and tried to make themselves visible to ensure they were involved in the team and to preserve their role and responsibilities. An unclear role description to the interprofessional team, and a lack of coaching and guidance were influencing factors in the experience of ONN and APN. CONCLUSION ONN and APN in oncology feel difficulties to integrate their role in existing interprofessional teams. A lack of role clarity, the interprofessional team environment and a desire for coaching and guidance are influencing factors to implement APN roles. Coaching and mentorship of novice ONN/APN and their interprofessional team and healthcare managers are needed to address these issues. These findings could form the basis for a mentorship program for ONN/APN and their interprofessional team to enhance role integration.
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Affiliation(s)
- Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium; Staff Member Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Isabel Vlerick
- Nursing Department, Ghent University Hospital, Ghent, Belgium.
| | - Soumaya Akhayad
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Michiel Daem
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Elsie Decoene
- Staff Member Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Lise-Marie Kinnaer
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
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Nurses' Perceptions of the Clinical Nurse Specialist Role Implemented in a Highly Specialized University Hospital in Spain: A Qualitative Study. CLIN NURSE SPEC 2022; 36:317-326. [PMID: 36279493 DOI: 10.1097/nur.0000000000000703] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/AIMS To explore nurses' perceptions of clinical nurse specialist practice as implemented in a highly specialized university hospital in Spain. DESIGN A descriptive qualitative study was carried out in 3 inpatient wards, with a clinical nurse specialist within the team, at a high specialized university hospital in Spain. METHOD Semistructured interviews were conducted by purposive sampling with 17 selected nurses with at least 2 years of professional experience who voluntarily agreed to participate and signed the informed consent form. Analysis of the qualitative data was conducted according to Burnard's method of content analysis. The Consolidated Criteria for Reporting Qualitative Research checklist was used. RESULTS Four main categories emerged from the analysis of the data: "qualities of the role-holder," "role competencies in practice," "integration with the team," and "impact of the role" on nursing, the patient, and the organization. CONCLUSIONS The findings of this study have interesting implications for the development and implementation of clinical nurse specialist practice in healthcare organizations. They also provide evidence of the benefit of implementing clinical nurse specialist practice for improving the quality of care, patient outcomes, and healthcare efficiency.
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Jokiniemi K, Kärkkäinen A, Korhonen K, Pekkarinen T, Pietilä A. Outcomes and challenges of successful clinical nurse specialist role implementation: Participatory action research. Nurs Open 2022; 10:704-713. [PMID: 36065161 PMCID: PMC9834530 DOI: 10.1002/nop2.1336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 01/16/2023] Open
Abstract
AIM To describe the clinical nurse specialist role and its outcomes and challenges. DESIGN Participatory Action Research conducted in Finland between the fall of 2017 and the end of 2018. METHODS A core participatory action research team (n = 10) led the design, implementation and evaluation of the research. Multiple data collection methods were used. The study is reported using the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) guidelines for participatory action research. RESULTS The clinical nurse specialist used most of the time in clinical patient care followed by clinical nursing leadership and scholarship activities. Outcomes of successful implementation led to increased visibility of nursing expertise, development, integration and quality assurance of nursing processes and practice, and promotion of knowledge translation and unit and collaborator cooperation. Furthermore, role challenges were also recognized.
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Affiliation(s)
- Krista Jokiniemi
- Department of Nursing Science, Faculty of Health SciencesUniversity of Eastern FinlandKuopioFinland
| | - Anne Kärkkäinen
- Department of PsychiatryUniversity Hospital of KuopioKuopioFinland,Department of Nursing ScienceUniversity of Eastern FinlandKuopioFinland
| | | | | | - Anna‐Maija Pietilä
- Department of Nursing Science, Faculty of Health SciencesUniversity of Eastern FinlandKuopioFinland
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Avery P, Cleaver N. Managing capability in specialist nursing practice. Nurs Manag (Harrow) 2021; 28:29-32. [PMID: 33650345 DOI: 10.7748/nm.2021.e1963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
Raising concerns over another nurse's clinical practice and capability presents significant challenges, particularly in specialist clinical nursing roles. However, the support provided to nurses who raise such concerns is not always optimal. While compassionate leadership in healthcare has been stated as a priority to develop safer workplaces for staff, it must be balanced against the need to manage staff undergoing capability management processes. This article discusses how enhanced training and support for both line managers and staff can improve the capability management processes.
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Affiliation(s)
- Pearl Avery
- Dorset County Hospital NHS Foundation Trust, Dorchester, England
| | - Neal Cleaver
- Dorset County Hospital NHS Foundation Trust, Dorchester, England
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Boman E, Levy‐Malmberg R, Fagerström L. Differences and similarities in scope of practice between registered nurses and nurse specialists in emergency care: an interview study. Scand J Caring Sci 2019; 34:492-500. [DOI: 10.1111/scs.12753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Erika Boman
- Department of Nursing and Health Sciences Faculty of Health and Social Sciences University of South‐Eastern Norway Drammen Norway
- Department of Nursing Åland University of Applied Sciences Mariehamn Finland
| | - Rika Levy‐Malmberg
- Department of Nursing and Health Sciences Faculty of Health and Social Sciences University of South‐Eastern Norway Drammen Norway
- Department of Health Care Novia University of Applied Sciences Vaasa Finland
| | - Lisbeth Fagerström
- Department of Nursing and Health Sciences Faculty of Health and Social Sciences University of South‐Eastern Norway Drammen Norway
- Department of Caring Science Faculty of Education and Welfare Studies Åbo Akademi University Vaasa Finland
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Dover N, Lee GA, Raleigh M, Baker EJ, Starodub R, Bench S, Garry B. A rapid review of educational preparedness of advanced clinical practitioners. J Adv Nurs 2019; 75:3210-3218. [DOI: 10.1111/jan.14105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 03/29/2019] [Accepted: 04/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Nicola Dover
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care King's College London London UK
- North Middlesex University Hospital London UK
| | - Geraldine A. Lee
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care King's College London London UK
| | - Mary Raleigh
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care King's College London London UK
| | - Edward J. Baker
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care King's College London London UK
| | - Roksolana Starodub
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care King's College London London UK
| | - Suzanne Bench
- Royal National Orthopaedic Hospital, South Bank University London UK
| | - Brendan Garry
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care King's College London London UK
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Birks M, Davis J, Smithson J, Lindsay D. Enablers and Barriers to Registered Nurses Expanding Their Scope of Practice in Australia: A Cross-Sectional Study. Policy Polit Nurs Pract 2019; 20:145-152. [PMID: 31390303 DOI: 10.1177/1527154419864176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A number of resources exist to assist registered nurses in Australia to determine their scope of practice; however, the ability of a professional nurse to expand his or her practice is highly context dependent. This article reports on barriers and enablers to expanding scope of practice, as identified by registered nurses across Australia. A cross-sectional survey administered online in 2016 returned 1,205 useable submissions. Results indicated that nurses wishing to expand their practice felt supported to do so by nursing colleagues and were aware of professional and regulatory documents relating to expanding scope of practice. Less support for this process was evident from other health professionals or employers. Respondents also indicated that they were motivated to expand their scope by professional satisfaction, potential for career advancement, and the desire to meet health service user's needs. The majority of respondents identified barriers to expanding scope of practice, including lack of remuneration and the absence of supportive guidelines. Respondents in the early stage of their careers were more likely to perceive organizational support for expanding their scope of practice. When required to expand their role, the majority of respondents indicated that they had undertaken additional training or accessed various resources to guide them in this process. Barriers to expanding nursing scope of practice can result in underutilization of the one of the greatest resources in the health care system. This article identifies a number of strategies that can facilitate role expansion to ensure that nursing continues to make a significant contribution to positive health service outcomes in Australia.
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Affiliation(s)
- Melanie Birks
- Nursing and Midwifery, College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Jenny Davis
- School of Nursing and Midwifery, College of Science, Engineering and Health, Latrobe University, Bundoora, Victoria, Australia
| | - John Smithson
- Nursing and Midwifery, College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Daniel Lindsay
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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Irajpour A, Khorasani P, Bagheri M, Eshaghian A, Ziaee ES, Saberi Z, Afshari A. The framework for developing nursing specialist roles in the health care system of Iran. Nurs Outlook 2019; 68:45-54. [PMID: 31445752 DOI: 10.1016/j.outlook.2019.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/13/2019] [Accepted: 06/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND A key step to the development of a roadmap for developing nursing specialist roles is to create its framework based on the immediate context. PURPOSE This study aimed to create the framework for developing nursing specialist roles in the health care system of Iran. METHODS This was a descriptive qualitative study. A purposeful sample of 81 nursing and nonnursing experts was recruited. The directed content analysis approach was used for data analysis. FINDINGS The framework for developing nursing specialist roles in the health care system include eight main categories. These categories are role titles, prioritization of the necessary specialties, the necessary competencies of nurses at specialist level, the scope of nursing specialist practice, expected authorizations, requirements for role development, and its barriers and facilitators. DISCUSSION Creating a context-based framework for nursing specialist role development based on the characteristics of each country is recommended.
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Affiliation(s)
- Alireza Irajpour
- Department of Critical Care Nursing, School of Nursing And Midwifery, Nursing Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvaneh Khorasani
- Department Of Community Health Nursing, School of Nursing And Midwifery, Nursing Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Bagheri
- Department of Adult Health Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azam Eshaghian
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elaheh Sadat Ziaee
- School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Saberi
- School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atefeh Afshari
- Department Of Community Health Nursing, School of Nursing And Midwifery, Nursing Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Karimi‐Shahanjarini A, Shakibazadeh E, Rashidian A, Hajimiri K, Glenton C, Noyes J, Lewin S, Laurant M, Colvin CJ. Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 4:CD010412. [PMID: 30982950 PMCID: PMC6462850 DOI: 10.1002/14651858.cd010412.pub2] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Having nurses take on tasks that are typically conducted by doctors (doctor-nurse substitution, a form of 'task-shifting') may help to address doctor shortages and reduce doctors' workload and human resource costs. A Cochrane Review of effectiveness studies suggested that nurse-led care probably leads to similar healthcare outcomes as care delivered by doctors. This finding highlights the need to explore the factors that affect the implementation of strategies to substitute doctors with nurses in primary care. In our qualitative evidence synthesis (QES), we focused on studies of nurses taking on tasks that are typically conducted by doctors working in primary care, including substituting doctors with nurses or expanding nurses' roles. OBJECTIVES (1) To identify factors influencing implementation of interventions to substitute doctors with nurses in primary care. (2) To explore how our synthesis findings related to, and helped to explain, the findings of the Cochrane intervention review of the effectiveness of substituting doctors with nurses. (3) To identify hypotheses for subgroup analyses for future updates of the Cochrane intervention review. SEARCH METHODS We searched CINAHL and PubMed, contacted experts in the field, scanned the reference lists of relevant studies and conducted forward citation searches for key articles in the Social Science Citation Index and Science Citation Index databases, and 'related article' searches in PubMed. SELECTION CRITERIA We constructed a maximum variation sample (exploring variables such as country level of development, aspects of care covered and the types of participants) from studies that had collected and analysed qualitative data related to the factors influencing implementation of doctor-nurse substitution and the expansion of nurses' tasks in community or primary care worldwide. We included perspectives of doctors, nurses, patients and their families/carers, policymakers, programme managers, other health workers and any others directly involved in or affected by the substitution. We excluded studies that collected data using qualitative methods but did not analyse the data qualitatively. DATA COLLECTION AND ANALYSIS We identified factors influencing implementation of doctor-nurse substitution strategies using a framework thematic synthesis approach. Two review authors independently assessed the methodological strengths and limitations of included studies using a modified Critical Appraisal Skills Programme (CASP) tool. We assessed confidence in the evidence for the QES findings using the GRADE-CERQual approach. We integrated our findings with the evidence from the effectiveness review of doctor-nurse substitution using a matrix model. Finally, we identified hypotheses for subgroup analyses for updates of the review of effectiveness. MAIN RESULTS We included 66 studies (69 papers), 11 from low- or middle-income countries and 55 from high-income countries. These studies found several factors that appeared to influence the implementation of doctor-nurse substitution strategies. The following factors were based on findings that we assessed as moderate or high confidence.Patients in many studies knew little about nurses' roles and the difference between nurse-led and doctor-led care. They also had mixed views about the type of tasks that nurses should deliver. They preferred doctors when the tasks were more 'medical' but accepted nurses for preventive care and follow-ups. Doctors in most studies also preferred that nurses performed only 'non-medical' tasks. Nurses were comfortable with, and believed they were competent to deliver a wide range of tasks, but particularly emphasised tasks that were more health promotive/preventive in nature.Patients in most studies thought that nurses were more easily accessible than doctors. Doctors and nurses also saw nurse-doctor substitution and collaboration as a way of increasing people's access to care, and improving the quality and continuity of care.Nurses thought that close doctor-nurse relationships and doctor's trust in and acceptance of nurses was important for shaping their roles. But nurses working alone sometimes found it difficult to communicate with doctors.Nurses felt they had gained new skills when taking on new tasks. But nurses wanted more and better training. They thought this would increase their skills, job satisfaction and motivation, and would make them more independent.Nurses taking on doctors' tasks saw this as an opportunity to develop personally, to gain more respect and to improve the quality of care they could offer to patients. Better working conditions and financial incentives also motivated nurses to take on new tasks. Doctors valued collaborating with nurses when this reduced their own workload.Doctors and nurses pointed to the importance of having access to resources, such as enough staff, equipment and supplies; good referral systems; experienced leaders; clear roles; and adequate training and supervision. But they often had problems with these issues. They also pointed to the huge number of documents they needed to complete when tasks were moved from doctors to nurses. AUTHORS' CONCLUSIONS Patients, doctors and nurses may accept the use of nurses to deliver services that are usually delivered by doctors. But this is likely to depend on the type of services. Nurses taking on extra tasks want respect and collaboration from doctors; as well as proper resources; good referral systems; experienced leaders; clear roles; and adequate incentives, training and supervision. However, these needs are not always met.
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Affiliation(s)
- Akram Karimi‐Shahanjarini
- Hamadan University of Medical SciencesDepartment of Public HealthMahdeieh Ave. Hamadan, IranHamadanHamadanIran
- Hamadan University of Medical SciencesSocial Determinants of Health Research CenterHamadanIran
| | - Elham Shakibazadeh
- Tehran University of Medical SciencesDepartment of Health Education and Health PromotionTehranTehranIran
| | - Arash Rashidian
- Tehran University of Medical SciencesDepartment of Health Management and Economics, School of Public HealthPoursina AveTehranIran1417613191
| | - Khadijeh Hajimiri
- School of Public Health, Zanjan University of Medical SciencesDepartment of Health Education and Health PromotionZanjanIran
| | - Claire Glenton
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
| | - Jane Noyes
- Bangor UniversityCentre for Health‐Related Research, Fron HeulogBangorWalesUKLL57 2EF
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Miranda Laurant
- Radboud Institute for Health Sciences, IQ healthcareRadboud University Medical CenterPO Box 9101NijmegenNetherlands6500 HB
- Institute of Nursing StudiesHAN University of Applied SciencesNijmegenNetherlands
| | - Christopher J Colvin
- School of Public Health and Family Medicine, University of Cape TownDivision of Social and Behavioural SciencesCape TownSouth Africa
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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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Boman E, Ösp Egilsdottir H, Levy-Malmberg R, Fagerström L. Nurses’ understanding of a developing nurse practitioner role in the Norwegian emergency care context: A qualitative study. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2057158518783166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Norway the nurse practitioner (NP) role is still in its infancy. To succeed with implementation of this new role stakeholder involvement is important, and there should be an explicit need for change. The aim of this study was to explore registered nurses’ understanding of how the NP role could contribute to meeting patients’ needs for care in the emergency care context, and nurses’ perceptions about the implementation process. The study is a qualitative interview study. The interviews were analysed by means of qualitative content analysis. Two themes presented themselves: the NP role being an autonomous role suitable for non-urgent patients, and the NP role being diffuse as well as a threat to colleagues and organizational structures. The results indicate that the NP role can make a valuable contribution to meet current challenges in the emergency care context. However, for successful implementation, the management team plays an important role in leading change and engaging co-workers to be part of the process. In further research, it is recommended to evaluate the forthcoming implementation process and, later on, to evaluate the outcomes of NP practice in the emergency care context in Norway.
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Affiliation(s)
- Erika Boman
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway
- Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
| | - H. Ösp Egilsdottir
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Rika Levy-Malmberg
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway
- Department of Nursing, University of Applied Sciences, Novia, Vaasa, Finland
| | - Lisbeth Fagerström
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
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14
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Jokiniemi K, Meretoja R, Pietilä AM. Constructing content validity of clinical nurse specialist core competencies: exploratory sequential mixed-method study. Scand J Caring Sci 2018; 32:1428-1436. [PMID: 29963720 DOI: 10.1111/scs.12588] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 05/13/2018] [Indexed: 11/29/2022]
Abstract
RATIONAL The demand to increase nursing competence is brought on by the requirement of safe, accessible and more effective use of healthcare provider expertise. Clinical nurse specialist competency development dates back to the late 20th century; however, an examination of the literature reveals a lack of research and discussion to support the competency development. OBJECTIVES To describe the formulation and validation process of the clinical nurse specialist core competencies. DESIGN Exploratory sequential mixed-method design. METHODS This mixed-method study, conducted between 2013 and 2017 in Finland, involved four phases: I) a Policy Delphi study (n = 25, n = 22, n = 19); II) cross-mapping of preliminary competency criteria against international competency sets; III) content validity study of expanded competency criteria (n = 7, n = 10); and IV) verification of competency criteria with practicing CNSs (n = 16). Data were analysed by both qualitative and quantitative analysis methods. RESULTS Seventy-four preliminary clinical nurse competency criteria were formulated in the first phase of the study. Through cross-mapping the competencies against the US and Canadian clinical nurse specialist competency sets, they were further concised to 61 criteria. The examination of Content Validity Indexes and experts' comments led to the clarification and consequent inclusion of 50 criteria to the final scale, with Scale Content Validity Index Average of 0.94. The competency criteria were evaluated to be a solid set with potential to clarify and uniform the clinical nurse specialist roles. CONCLUSIONS Through a rigorous research process, validated clinical nurse specialist competency criteria were formed with a high Scale Content Validity Index Average. The results allude to the potential of formulating international competency criteria to support global role clarity and understanding. However, further research is needed to validate the content and construct of the formulated competencies with a larger population across countries.
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Affiliation(s)
- Krista Jokiniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Riitta Meretoja
- University of Turku, Turku, Finland.,Helsinki University Hospital, Helsinki, Finland
| | - Anna-Maija Pietilä
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Social and Health Care Services, Kuopio, Finland
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15
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Backhaus R, Verbeek H, van Rossum E, Capezuti E, Hamers JP. Baccalaureate-educated Registered Nurses in nursing homes: Experiences and opinions of administrators and nursing staff. J Adv Nurs 2017; 74:75-88. [DOI: 10.1111/jan.13391] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Ramona Backhaus
- Department of Health Services Research; CAPHRI; Care and Public Health Research Institute; Maastricht University; Maastricht The Netherlands
| | - Hilde Verbeek
- Department of Health Services Research; CAPHRI; Care and Public Health Research Institute; Maastricht University; Maastricht The Netherlands
| | - Erik van Rossum
- Department of Health Services Research; CAPHRI; Care and Public Health Research Institute; Maastricht University; Maastricht The Netherlands
- Research Centre for Community Care; Zuyd University of Applied Sciences; Heerlen The Netherlands
| | - Elizabeth Capezuti
- Hunter College and the Graduate Center; City University of New York; New York NY USA
| | - Jan P.H. Hamers
- Department of Health Services Research; CAPHRI; Care and Public Health Research Institute; Maastricht University; Maastricht The Netherlands
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16
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Sibbern T, Bull Sellevold V, Steindal SA, Dale C, Watt-Watson J, Dihle A. Patients’ experiences of enhanced recovery after surgery: a systematic review of qualitative studies. J Clin Nurs 2017; 26:1172-1188. [DOI: 10.1111/jocn.13456] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Tonje Sibbern
- Diakonhjemmet University College; Institute of Nursing and Health; Oslo Norway
| | | | - Simen A Steindal
- Diakonhjemmet University College; Institute of Nursing and Health; Oslo Norway
- Lovisenberg Diaconal University College; Oslo Norway
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
| | - Judy Watt-Watson
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
| | - Alfhild Dihle
- Diakonhjemmet University College; Institute of Nursing and Health; Oslo Norway
- Oslo and Akershus University College of Applied Sciences; Oslo Norway
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17
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Wisur-Hokkanen C, Glasberg AL, Mäkelä C, Fagerström L. Experiences of working as an advanced practice nurse in Finland--the substance of advanced nursing practice and promoting and inhibiting factors. Scand J Caring Sci 2015; 29:793-802. [PMID: 25656095 DOI: 10.1111/scs.12211] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 11/19/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evaluation of new advanced practice nursing roles, from different angles, is strongly recommended in the literature. New nurses' experiences of working in an advanced role may highlight problems and/or factors that promote or inhibit a successful implementation of new advanced nursing roles. AIM To explore advanced practice nurses' experiences of the content of their nursing care and to describe promoting or inhibiting factors for working with a full scope of advanced nursing practice. METHODS The study design was explorative and descriptive. A total of 24 advanced practice nurses participated in focus group interviews (two were interviewed individually) about the processes, structure and outcome of working as advanced practice nurses. Qualitative manifest content analysis was used for data analysis. FINDINGS The substance of advanced practice nursing can be described with three main themes: a broader and deeper holistic view of patients' state of health, an independent and responsible manner of working and knowing own limits. Promoting factors were an identity as a nurse with advanced competency, feedback from satisfied patients and fruitful teamwork is a necessity. Inhibiting factors were a lack of organisational understanding for advanced nursing practice, poor planning leads to unsatisfactory advanced practice nursing models and advanced practice nurses' lack of courage in adopting new advanced roles. CONCLUSION The participants experienced both a personal inner transition and a role transition that were either supported or opposed. Vague or nonexistent definitions and concepts, insufficient knowledge, insufficient support and undefined roles hindered participants' role transition. Two main strategies should be employed. The first is the realisation of more strategic leadership and support from organisations on all management levels, including nursing organisations/unions, while the second is to more realistically prepare future advanced practice nurses for the challenges they will face, through mentorship programmes and continuous further training.
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Affiliation(s)
| | | | | | - Lisbeth Fagerström
- Buskerud and Vestfold University College, Drammen, Norway.,Åbo Akademi University, Vaasa, Finland
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18
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Jokiniemi K, Haatainen K, Meretoja R, Pietilä AM. The Future of the Clinical Nurse Specialist Role in Finland. J Nurs Scholarsh 2014; 47:78-86. [DOI: 10.1111/jnu.12109] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 01/19/2023]
Affiliation(s)
- Krista Jokiniemi
- Doctoral student; University of Eastern Finland; Faculty of Health Sciences; Department of Nursing Science, and Assistant Head Nurse; Kuopio Finland
| | - Kaisa Haatainen
- Docent; University of Eastern Finland; and Patient Safety Manager; Kuopio University Hospital; Kuopio Finland
| | - Riitta Meretoja
- Docent; Universtity of Turku; and Development Manager; Corporate Headquarters; Hospital District of Helsinki; Uusimaa Helsinki Finland
| | - Anna-Maija Pietilä
- Professor; University of Eastern Finland; Faculty of Health Sciences; Department of Nursing Science; Social and Health Care Services; Kuopio Finland
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