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Søndergaard SF, Andersen AB, Frederiksen K. APN nurses' core competencies for general clinical health assessment in primary health care. A scoping review. Scand J Caring Sci 2024; 38:258-272. [PMID: 38246856 DOI: 10.1111/scs.13235] [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: 08/06/2023] [Revised: 11/28/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND The field of Advanced Practice Nursing (APN) has developed over the past six decades. However, the definition of roles and responsibilities of APN nurses seem to be contested due to both a lack of a clear definition of the concept and to institutional and cultural barriers that restrict the nurses' opportunities to practise to the full extent of their competencies. AIM The objective of this scoping review was to identify, examine and conceptually map the available literature on APN nurses' core competencies for general health assessment in primary health care. METHOD We performed a scoping review, following the methodological guidance for reporting as it is described by the Joanna Briggs Institute (JBI). Furthermore, the PRISMA-ScR statement and checklist for reporting scoping reviews were followed. Guiding the initial process for the search, we used the Population, Concept and Context mnemonic (PCC) to clarify the focus and context of the review. RESULTS We found three areas of core competencies on which APN nurse draw in performing general health assessments in primary health care: (1) 'Collaborative, leadership and management skills' (2) 'Person-centred nursing care skills' and (3) 'Academic and educational skills'. Furthermore, we found that the three areas are interrelated, because it is crucial that APN nurses draw on collaborative competencies related to leadership and management to meet the service users' needs and deliver high-quality and person-centred care. CONCLUSION There is a need for a more specific investigation into how APN nurses' core competencies play a role during general health assessments of patients in primary care. We suggest an evaluation of what works for whom in what circumstances looking into the interrelation between competencies, skills and knowledge when an APN nurse performs a general health assessment in a primary healthcare setting.
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Affiliation(s)
- Susanne Friis Søndergaard
- Section for Nursing and Health Care, Institute for Public Health, Aarhus University, Aarhus, Denmark
| | - Anne Bendix Andersen
- VIA University College, School of Nursing and Research Centre for Health and Welfare Technology, Viborg, Denmark
| | - Kirsten Frederiksen
- Section for Nursing and Health Care, Institute for Public Health, Aarhus University, Aarhus, Denmark
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Levy-Malmberg R, Boman E, Lehwaldt D, Fagerström L, Lockwood EB. Clinical decision-making processes among graduate nurses, specialist nurses and nurse practitioners A collaborative international study. Int Nurs Rev 2024; 71:224-231. [PMID: 38450783 DOI: 10.1111/inr.12951] [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: 01/15/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024]
Abstract
AIM To explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland. BACKGROUND Clinical decision-making in an emergency department environment is a complex process often occurring in times of crisis. It is an important aspect contributing to the quality of care. However, empirical research is limited regarding the decision-making process in different nursing roles. METHODS In accordance with the consolidated criteria for reporting qualitative research, a qualitative and observational study was conducted to explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland. Six Registered Nurses, six Nurse Specialists and six Nurse Practitioners were observed. A total of 40 hours of observation was made at each setting according to a structured observation guideline, followed by clarifying questions. The data material was analysed by means of a qualitative manifest and latent content analysis. RESULTS Three themes arose: acting in accordance with routines, previous experience and intuition; considering patient experience; and facilitating new alternatives based on critical thinking. The Registered Nurses mainly used the first approach, the Nurse Specialists used the first and the second approaches, and the Nurse Practitioners used all three approaches. CONCLUSIONS The results highlight the differences in decision-making processes between these groups. Nurse Practitioners were the only group that facilitated and evaluated new alternatives using their clinical autonomy, such as stepping up and making independent and collaborative decision-making. IMPLICATION The results can be used in countries developing advanced practice nursing education and defining their scope of practice to inform stakeholders.
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Affiliation(s)
- Rika Levy-Malmberg
- University of South-Eastern Norway, Kongsberg, Norway
- Novia University of Applied Sciences, Vaasa, Finland
| | - Erika Boman
- University of South-Eastern Norway, Kongsberg, Norway
- Åland University of Applied Sciences, Mariehamn, Finland
| | - Daniela Lehwaldt
- Dublin City University, School of Nursing, Psychotherapy & Community Health, Dublin, Ireland
| | - Lisbeth Fagerström
- University of South-Eastern Norway, Kongsberg, Norway
- Åbo Akademi University, Vaasa, Finland
| | - Emily B Lockwood
- University College Cork, School of Nursing and Midwifery, Cork, Ireland
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Lockwood EB, Schober M. Factors Influencing the impact of nurse practitioners' clinical autonomy: a self determining perspective. Int Nurs Rev 2024; 71:375-395. [PMID: 38651183 DOI: 10.1111/inr.12948] [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: 07/29/2023] [Accepted: 02/08/2024] [Indexed: 04/25/2024]
Abstract
AIM To explore factors that influence the impact of nurse practitioners' clinical autonomy with a self-determining perspective. BACKGROUND Worldwide, there is a significant demand for healthcare professionals such as the nurse practitioner in meeting some healthcare needs across patients' lifespans. Factors influencing nurse practitioners clinical autonomy can impact the full utilisation of the role in practice. INTRODUCTION Limited evidence exists that describes or researches nurse practitioner clinical autonomy. Instead, there is a focus in the literature on strategic debates, role confusion and nurse practitioners reporting the straddling between nursing, allied heath professionals and medicine in the provision of healthcare services. DESIGN A cross-sectional study design was used in a purposive sample in a national sample of nurse practitioners in Ireland across a full range of healthcare settings. Additionally, the survey included open comments sections to capture qualitative comments by the nurse practitioners themselves. METHODS Self-determination theory is rooted in an organismic dialectical stance. This study used a convenience sample of n = 148 from a total sample of n = 448 (33%) of the population. The Dempster Practice Behavioural Scale and an initially validated advanced nursing practice clinical autonomy scale were used. Open comments were analysed by thematic analysis. STROBE Standards guidelines for cross-sectional studies were followed, and COREQ guidelines were followed for writing qualitative research. RESULTS The study findings demonstrated that the more clinical experience the nurse practitioner had, the higher their levels of clinical autonomy. The previous length of nursing experience did not impact nurse practitioner clinical autonomy levels. However, average experience of nurse practitioner' in this study was 3-10 years. No significant differences existed between the reported gender, nurse practitioners' clinical autonomy and decision-making. 1:40 female and 1:9 male nurse practitioners undertook a doctorate or PhD-level education. No advanced nurse practitioner identified as non-binary. Gender and organisational culture considerations can influence nurse practitioners clinical autonomy. IMPLICATIONS FOR NURSING AND HEALTH POLICY This study highlights intrinsic motivators that support nurse practitioners in providing innovative healthcare: competence, relatedness and clinical autonomy. Countries credentialing, regulations professional standards and healthcare policy positively influence nurse practitioner clinical autonomy. Nurse practitioners' clinical autonomy is championed when health policy and organisational stakeholders intrinsically collaborate. A disconnect between health policy organisational culture extrinsically influences lower levels of nurse practitioners' clinical autonomy. CONCLUSION The findings underline the positive impact of nurse practitioner clinical autonomy. A recommendation of this study is to continue to measure impact of clinical autonomy and develop nurse practitioners' self-determination strategies around the role and integrity of their levels of intrinsic clinical autonomy.
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Affiliation(s)
- Emily B Lockwood
- University Lecturer, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Madrean Schober
- Schober Global Healthcare Consulting International Healthcare Consultants, Indianapolis, Indiana, USA
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Vitale E, Mea R, Chang YC. The effect of sex, age, work experience, education, shift, and ward on nursing autonomy perceptions. Work 2024:WOR230740. [PMID: 38669509 DOI: 10.3233/wor-230740] [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: 04/28/2024] Open
Abstract
BACKGROUND In Italy, cultural and professional nursing improvements are reached thanks to the university-based education which marks the clinical competency and the professional autonomy in nursing decision-making. OBJECTIVE To highlight how Italian nurses perceived their nursing autonomy level in the main action-points highlighted in the Italian regulation law according to sex, age, work experience, education, shift and ward. METHODS A cohort explorative study was carried out from September 2022 to January 2023 to highlight how Italian nurses perceived their nursing autonomy levels in the main action-points highlighted in the Italian regulation law for the nursing profession according to demographic characteristics, like: gender, age, work of experience, education, shift, ward employment. RESULTS A total of 403 nurses were enrolled. Significant differences were recorded in: decision-making authority in patient care and shift (p≤0.001) and ward employment (p = 0.045); ability to initiate nursing interventions and education (p < 0.001) and ward employment (p = 0.011); collaboration and communication with healthcare team members and education (p < 0.001) and ward employment (p = 0.010); independence in clinical judgment and critical thinking and shift (p < 0.001); responsibility for the planning and evaluation of nursing care and education (p = 0.005) and shift (p = 0.002) and ward employment (p = 0.013); autonomy in professional development and continuing education and shift (p < 0.001) and ward employment (p < 0.001). CONCLUSIONS The results highlighted the intricate world both of the healthcare surrounding and the abilities to act autonomously within the multiprofessional staff. Future studies will develop qualitative and phenomenological designs in order to better define in which fields nurses will act their professional autonomy.
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Affiliation(s)
- Elsa Vitale
- Centre of Mental Health Modugno, Local Healthcare Company Bari, Italy
| | | | - Yun-Chen Chang
- School of Nursing and Graduate Institute of Nursing, China Medical University, Taichung, Taiwan
- Nursing Department, China Medical University Hospital, Taichung, Taiwan
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Van Hecke A, Decoene E, Embo M, Beeckman D, Bergs J, Courtens A, Dancot J, Dobbels F, Goossens GA, Jacobs N, Van Achterberg T, Van Bogaert P, Van Durme T, Verhaeghe S, Vlaeyen E, Goossens E. Development of a competency framework for advanced practice nurses: A co-design process. J Adv Nurs 2024. [PMID: 38586883 DOI: 10.1111/jan.16174] [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: 08/14/2023] [Revised: 02/23/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
AIMS The aim of the study was to develop a comprehensive competency framework for advanced practice nurses in Belgium. DESIGN A co-design development process was conducted. METHODS This study consisted of two consecutive stages (November 2020-December 2021): (1) developing a competency framework for advanced practice nurses in Belgium by the research team, based on literature and (2) group discussions or interviews with and written feedback from key stakeholders. 11 group discussions and seven individual interviews were conducted with various stakeholder groups with a total of 117 participants. RESULTS A comprehensive competency framework containing 31 key competencies and 120 enabling competencies was developed based on the Canadian Medical Education Directions for Specialists Competency Framework. These competencies were grouped into seven roles: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator and health promoter. CONCLUSION The developed competency framework has resemblance to other international frameworks. This framework emphasized the independent role of the advanced practice nurse and provided guidance in a clear task division and delegation to other professionals. It can provide a solid foundation for delivering high-quality, patient-centred care by advanced practice nurses in the years to come. IMPLICATIONS FOR THE PROFESSION This competency framework can guide further development of advanced practice nursing education in Belgium and represents a starting point for future evaluation of its feasibility and usability in education and clinical practice. Advanced practice nurses and healthcare managers can also use the framework as an instrument for personal and professional development, performance appraisal, and further alignment of these function profiles in clinical practice. Finally, this framework can inform and guide policymakers towards legal recognition of advanced practice nursing in Belgium and inspire the development of advanced practice nursing profiles in countries where these profiles are still emerging. IMPACT What problem did the study address? The absence of a detailed competency framework for advanced practice nurses complicates legal recognition, role clarification and implementation in practice in Belgium. A rigorously developed competency framework could clarify which competencies to integrate in future advanced practice nursing education, mentorship programs and practice. What were the main findings? The competency framework outlined seven roles for advanced practice nurses: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator, and health promoter. Differentiation from other expert nursing profiles and clinical autonomy of advanced practice nurses were pivotal. Where and on whom will the research have impact? The comprehensive competency framework for advanced practice nurses and the collaborative methodology used can inspire other countries where these profiles are still emerging. The competency framework can be used as an instrument for role clarification, performance appraisals, continuous professional development, and professional (e-)portfolios. The competency framework can guide policymakers when establishing Belgian's legal framework for advanced practice nurses. REPORTING METHOD The authors have adhered to CONFERD-HP: recommendations for reporting COmpeteNcy FramEwoRk Development in health professions. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution in the design of the study. A patient advisory panel commented on the developed competency framework.
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Affiliation(s)
- Ann Van Hecke
- Department of Public Health and Primary Care, University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Staff Member Centre of Expertise in Nursing, Ghent University Hospital, Ghent, Belgium
| | - Elsie Decoene
- Staff Member Centre of Expertise in Nursing, Ghent University Hospital, Ghent, Belgium
| | - Mieke Embo
- Department of Educational Studies, Faculty of Psychology and Educational Sciences and Expertise Network Health and Care, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Swedish Center for Skin and Wound Research (SCENTR), Nursing Science Unit, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Jochen Bergs
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
- Department of PXL-Healthcare, Center for Healthcare Innovation, PXL University of Applied Sciences and Arts, Hasselt, Belgium
| | | | - Jacinthe Dancot
- Nursing Department, Haute École Robert Schuman, Libramont, Belgium
- Public Health Sciences Department, University of Liège, Liège, Belgium
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Goddelieve Alice Goossens
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Nursing Center of Excellence, University Hospitals, Leuven, Belgium
| | - Noortje Jacobs
- Research Unit Health Promotion, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Theo Van Achterberg
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Peter Van Bogaert
- Center for Research and Innovation in Care, Department of Midwifery and Nursing Sciences, Antwerp University, Antwerp, Belgium
| | - Thérèse Van Durme
- Institute of Health and Society, UC Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Ellen Vlaeyen
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Eva Goossens
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Center for Research and Innovation in Care, Department of Midwifery and Nursing Sciences, Antwerp University, Antwerp, Belgium
- Department of Patient Care, Antwerp University Hospital, Antwerp, Belgium
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BAYER N, ŞİMŞEK D, BULUT ÖÜ, GÖLBAŞI Z. Effect of Nurses’ Autonomy Levels and Problem-Solving Skills on Job Satisfaction. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.1119340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Objective: This study aimed to determine the effect of nurses’ autonomy levels and problem-solving skills on job satisfaction and was conducted in public, private and university hospital between July and September 2021.
Methods: This descriptive and relational – screening study was conducted with 278 nurses. Data were collected through the Socio-demographic Form, the Problem-Solving Inventory, the Sociotrophy-Autonomy Scale, and the Minnesota Job Satisfaction Questionnaire (MJSQ). Data were analyzed using SPSS 26 and AMOS 24 programs using numbers, percentages, minimum/maximum values, means, and standard deviation values.
Results: Modern mediation analysis findings performed using the Bootstrap method showed that the indirect effect of the autonomy score on the overall satisfaction score with the mediation of the problem-solving skills was significant (p< .05).
Conclusion: Problem-solving skills were found to have a partial mediating role in the effect of nurses’ autonomy levels on their job satisfaction.
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