Determinants in the development of advanced nursing practice: a case study of primary-care settings in Hong Kong

Contributions of Advanced Practice Nursing to Primary Health Care: A Scoping Review

Objective: To map the contributions and strategies to implement advanced practice nursing in primary health care. Materials and methods: This scoping review was carried out following the guidelines of the Joanna Briggs Institute in six databases, namely: LILACS, MEDLINE, WoS, Embase, CINAHL, and Scopus, in addition to a bibliographic repository. A total of 3,076 studies were found, from which 12 were selected. Results: The contributions mentioned by the studies regarding advanced practice nursing were divided into three subcategories, as follows: care, educational or management, and preventive practices. They concern autonomy, specialized clinical skills, therapeutic counseling, and patient-centered interaction. Some strategies to implement advanced practice are related to continuing education, practice management, self-care, and disease management. Conclusions: There is a need to improve strategies for advanced practice nursing, especially in primary care, to address gaps in specialized care, the development of indicators, and therapeutic objectives.

The impact on patient health and service outcomes of introducing nurse consultants: a historically matched controlled study

Background

The position of nurse consultant (NC) was introduced in Hong Kong by the Hospital Authority in January 2009. Seven NCs were appointed in five clinical specialties: diabetes, renal, wound and stoma care, psychiatrics, and continence. This was a pilot to explore the impact of the introduction of NCs on patient health and service outcomes.

Methods

The present paper describes a historically matched controlled study. A total of 280 patients, 140 in each cohort under NC or non-NC care, participated in the study. The patient health and service outcomes of both cohorts were evaluated and compared: accident and emergency visits, hospital admissions, length of hospital stays, number of acute complications, number of times of treatment or regimen altered by nurses according to patient’s condition, glycated haemoglobin A1c (HbA1c) levels, urea and urea-to-creatinine ratios, and number of wound dressings for patients in corresponding specialty units. A patient satisfaction instrument was also used to assess the NC cohort.

Results

The study showed that patients under NC care had favourable patient health and service outcomes compared with those under non-NC care. The NC cohort also reported a high level of patient satisfaction.

Conclusions

The study demonstrates that the introduction of NCs in specialty units may have a positive impact on patients’ health and service outcomes. The high level of patient satisfaction scores indicates that patients appreciate the care they are receiving with the introduction of NCs.

Role and working conditions of nurses in public health in Mexico and Peru: a binational qualitative study

AIM

This exploratory study conducted in Mexico and Peru investigated nurses' perceptions about their role in public health and working conditions.

BACKGROUND

Health reform efforts in many countries are redefining the role of health professionals in public health. Little is known about the role of nurses working in public health contexts in Latin America.

METHOD

Fourteen focus groups were conducted in Mexico and Peru with 82 nurses working in government-sponsored community health centres. Data were analysed using a content analysis technique.

FINDINGS

Themes identified were: nurses' job descriptions in public health settings; organisational factors influencing the nurses' work, and influence of academic and social image factors.

CONCLUSION

Management barriers and limited training influences the role and working conditions of public health nurses in Mexico and Peru.

IMPLICATIONS FOR NURSING MANAGEMENT

The professional role of nurses working in public health in Latin America is not well defined because of the health-care system infrastructure and the lack of a clear public health nurse job description. Further research is needed to better understand the role of public health nurses and strengthen their training, particularly in relation to nursing management encompassing abilities for decision-making processes and public health program planning and evaluation.

Perceptions of the benefits and challenges of the role of advanced practice nurses in nurse-led out-of-hours care in Hong Kong: a questionnaire study

AIMS AND OBJECTIVES

The aim of the study was to identify the factors that nurses perceive may facilitate or hinder the development of advanced practice nurse roles in Hong Kong.

BACKGROUND

Advanced practice nurses are increasingly prominent in nurse-led out-of-hours care in Hong Kong in response to changes to junior doctors' hours of work.

SETTING

Three five-day workshops for Hong Kong-based advanced practice nurses were offered in partnership with UK clinicians. The aim of the workshops was to share UK experiences of implementation of the 'Hospital at Night' model of care delivery. The questionnaire study undertaken was not part of the workshop programme. However, the workshops gave the authors a unique opportunity to access relatively large numbers of Hong Kong-based advanced practice nurses.

PARTICIPANTS

The workshops were attended by experienced nurses who had been or were about to be appointed as advanced practice nurses. All nurses who attended one of the three workshops (n=120) agreed to participate in the study.

METHODS

Responses to two open questions posed in the questionnaire were the subject of a content analysis.

RESULTS

A prominent finding of the study was that respondents viewed the benefits of introducing advanced practice nurse roles in Hong Kong as outweighing any challenges. One of the main features of the perceived benefits relates to improving the quality and safety of patient care. The greatest challenges associated with the role related to acceptance of the role by other healthcare professionals, and difficulties associated with the general public's traditional attitudes to healthcare provision in Hong Kong.

CONCLUSIONS

Education of the public concerning the implementation of such roles is of crucial importance.

RELEVANCE TO CLINICAL PRACTICE

Findings from this study enhance understanding of the factors that hinder or facilitate advanced practice roles in out-of-hours care in Hong Kong.

Exploring the scope of expanding advanced nursing practice in nurse-led clinics: a multiple-case study

AIM

This article is a report on a study to explore the development of expanding advanced nursing practice in nurse-led clinics in Hong Kong.

BACKGROUND

Nurse-led clinics serviced by advanced practice nurses, a common international practice, have been adopted in Hong Kong since 1990s. Evaluations consistently show that this practice has good clinical outcomes and contributes to containing healthcare cost. However, similar to the international literature, it remains unclear as to what the elements of good advanced nursing practice are, and which directions Hong Kong should adopt for further development of such practice.

METHODS

A multiple-case study design was adopted with six nurse-led clinics representing three specialties as six case studies, and including two clinics each from continence, diabetes and wound care. Each case had four embedded units of analysis. They included non-participant observation of nursing activities (9 days), nurse interviews (N = 6), doctor interviews (N = 6) and client interviews (N = 12). The data were collected in 2009. Within- and cross-case analyses were conducted.

RESULTS

The cross-case analysis demonstrated six elements of good advanced nursing practice in nurse-led clinics, and showed a great potential to expand the practice by reshaping four categories of current boundaries, including community-hospital, wellness-illness, public-private and professional-practice boundaries. From these findings, we suggest a model to advance the scope of advanced nursing practice in nurse-led clinics.

CONCLUSION

The six elements may be applied as audit criteria for evaluation of advanced nursing practice in nurse-led clinics, and the proposed model provides directions for expanding such practice in Hong Kong and beyond.

Nursing in Hong Kong: issues and challenges

This column provides a discussion of the issues and challenges facing nurses and nursing in Hong Kong. The author introduces the role of nurses in the special administrative region and focuses on workforce, educational and practice issues, as well as on leadership in nursing. He concludes that Hong Kong needs to have a strategic plan to determine sufficient numbers of properly educated nurses.