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Bales G, Hasemann W, Kressig RW, Mayer H. Impact, scope of practice and competencies of Advanced Practice Nurses within APN-led models of care for young and middle-aged adult patients with multimorbidity and/or complex chronic conditions in hospital settings: a scoping review protocol. BMJ Open 2023; 13:e077335. [PMID: 37907288 PMCID: PMC10619075 DOI: 10.1136/bmjopen-2023-077335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION The increase of young and middle-aged adult patients with multimorbid and/or complex chronic conditions has created new challenges for healthcare systems and services. Advanced Practice Nurses (APNs) play an essential role in treating these patients because of their expertise and advanced nursing skills. Little is known about competencies, scope of practice and impact of APNs within APN-led care models for young and middle-aged adult patients with multimorbidity and/or complex chronic conditions in hospital settings. The objective of this scoping review is to describe the impact, scope of practice and competencies of APNs within APN-led care models for young and middle-aged adult patients in hospital settings. METHODS AND ANALYSIS This scoping review will be conducted using the methodological framework proffered by Arksey and O'Malley, incorporating the methodological enhancement of Levac et al. It will comply with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) for Scoping Reviews' guidelines of Tricco et al. Systematic research will be conducted in the databases MEDLINE (PubMed), CINAHL (EBSCO), EMBASE (Ovid), CENTRAL and PsycINFO (Ovid) using all recognised keywords, index terms and search strings. Grey literature will be scanned. Bibliography of all selected studies will be hand searched. Studies will be selected based on defined inclusion and exclusion criteria, screened by title and abstracts. Data from full-text articles meeting the inclusion criteria will be extracted independently by two authors. Disagreements in evaluation will be discussed and resolved by consensus. Results will be reported in the form of descriptive tables. Narrative summery is used to present the results of the review in the context of the study's objectives and questions. ETHICS AND DISSEMINATION This scoping review does not require ethics approval. The review will be handed in as part of a doctoral thesis and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER OSF 4PM38.
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Affiliation(s)
- Gabriele Bales
- University Department of Geriatric Medicine, FELIX PLATTER, Basel, Switzerland
- Faculty of Social Sciences, Department of Nursing Science, University of Vienna, Vienna, Austria
| | - Wolfgang Hasemann
- University Department of Geriatric Medicine, FELIX PLATTER, Basel, Switzerland
| | - Reto W Kressig
- University Department of Geriatric Medicine, FELIX PLATTER, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Hanna Mayer
- Department of General Health Studies, Division Nursing Science with focus on Person-Centered-Care-Research, Karl Landsteiner University of Health Sciences, Krems, Austria
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Raciti L, Corallo F, Manuli A, Calabrò RS. Nursing, Caregiving and Psychological support in Chronic Disorders of Consciousness: a scoping review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021013. [PMID: 33855992 PMCID: PMC8138815 DOI: 10.23750/abm.v92is2.11329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS The major disorders of consciousness include Coma, Vegetative State, and Minimally Conscious State. The care and the management of patients with Disorders of Consciousness (DOC) have raised several important ethical, social and medical issues. Aim of this review is to evaluate the role of nursing and psychological support in DOC management, in order to improve the quality of life of both patients and their caregivers. METHODS Studies dealing with DOC, nursing and caregiving pubblished in the last 20 years (from January 2000 to June 2020) were identified by searching on PubMed, Web of Science and Cochrane databases. RESULTS This review highlights the important role of DOC carevigers in the complex management of these frail patients, as well as the need for a specific support and counselling of caregivers. This psychological support may be given by nurses, as they are the healthcare professionals more involved in DOC care and cure. DISCUSSION Over the last years, specific recommendations for the assessment and rehabilitation of patients with DOC have been promulgated by neurorehabilitation organizations to provide some guidelines for the care and cure of such frail patients. Indeed, DOC patients need a multidisciplinary approach in which both caregivers and nurses have a pivotal role. CONCLUSIONS As the family is a critical and fundamental aspect in the management of DOC patients, it should be considered an integral part of care in the future guidelines.
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Taylor C, Wiseman T. Review of a nurse consultant's role: Identifying the contribution made to people living with and beyond cancer. Nurs Open 2020; 7:68-77. [PMID: 31871692 PMCID: PMC6917967 DOI: 10.1002/nop2.407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/08/2019] [Indexed: 11/07/2022] Open
Abstract
Aim To evaluate a new nurse consultant (NC) role, four specific objectives were set including examining the NC's contribution to the local implementation over a 30-month time period of the Recovery Package and assessing changes at a patient/professional/system level. Methods An evaluative process was agreed using Donabedian's (2005) model for measuring the quality of care provided. It focused on the NC's contribution to the Trust's LWBC agenda including a review of Recovery Package metrics, analysis of the NC template recording activity across different domains, 360-degree feedback and personal reflections. Results The evaluation demonstrated the NC's influence on individual patient care with an increase in three of the four Recovery Package metrics to the Trust; improvements in delivery of services and a higher level of participation in activities aimed at raising awareness to LWBC at a regional and national level. Broader influences of this role were also evident.
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Affiliation(s)
- Claire Taylor
- London North West University Healthcare NHS TrustHarrowUK
| | - Theresa Wiseman
- Applied Health ResearchThe Royal Marsden NHS Foundation TrustLondonUK
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Halliday S, Hunter DJ, McMillan L. Ward staff perceptions of the role of the advanced nurse practitioner in a 'hospital at day' setting. ACTA ACUST UNITED AC 2019; 27:92-97. [PMID: 29368566 DOI: 10.12968/bjon.2018.27.2.92] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM to examine ward staff perceptions on the role of the 'hospital at day' advanced nurse practitioner (ANP). This term is used locally to refer to a model first introduced into 'hospital at night' teams, in response to changes in working patterns of junior doctors, where an advanced nurse practitioner is based on the ward-the model was subsequently rolled out to daytime teams. METHODS a qualitative descriptive phenomenological approach was adopted to carry out this study with a purposive sample of ten participants. Participants were interviewed individually using semi-structured interviews to gain insights into their perceptions on the role of the ANP, following Colaizzi's analytical model of data analysis. FINDINGS four major themes were identified. The first overarching theme was effectiveness of the ANP role. There was evidence that the role was not only clinically effective in the ward but also in relation to organisational priorities such as impact on patient flow. Secondly it was acknowledged that having an ANP based on the ward and as a 'constant' in the ward area, when medical teams rotate, provides team stability and improves the functioning of the ward area. Despite the positivity recognised, the third theme identified that having a ward-based ANP may affect skill acquisition and development and may lead to the 'de-skilling' of staff. Lastly it was acknowledged that there remains an overall confusion about the role of the ANP. CONCLUSION the themes identified reflect what is already known about the wider perceived role of the ANP. Moreover, this study adds to the limited literature available specifically on the benefits of the ANP within 'hospital at day' roles.
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Affiliation(s)
- Stuart Halliday
- Advanced Nurse Practitioner-Cardiology, Crosshouse Hospital, Kilmarnock
| | - David J Hunter
- Lecturer in Adult Health/Deputy Programme Leader, BSc Adult Nursing, University of the West of Scotland, Paisley Campus
| | - Laura McMillan
- Lecturer, MSc Health Studies, University of the West of Scotland, Paisley Campus
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Doody O, Slevin E, Taggart L. A survey of nursing and multidisciplinary team members' perspectives on the perceived contribution of intellectual disability clinical nurse specialists. J Clin Nurs 2019; 28:3879-3889. [DOI: 10.1111/jocn.14990] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/11/2019] [Accepted: 06/30/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Owen Doody
- Health Research Institute, Department of Nursing and Midwifery University of Limerick Limerick Ireland
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Vaughan K, McMurray A, Sidebotham M, Gamble J. Factors Influencing International Board Certified Lactation Consultants to Continue Advancing Practice Beyond Certification: A Multinational Study. INTERNATIONAL JOURNAL OF CHILDBIRTH 2018. [DOI: 10.1891/2156-5287.7.4.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background:Certification as a lactation consultant is based on practitioners having achieved a standard of knowledge indicative of their competence to practice by passing a psychometric examination. The underpinning principle of recertification programs is to support clinicians to become lifelong learners by progressively enhancing and advancing their knowledge and skills in line with contemporary evidence. The aim of this study was to investigate the factors that influence International Board Certified Lactation Consultants (IBCLCs) to advance their practice.Method:A mixed-methods study was conducted in two phases. Phase 1 included focus groups, interviews, and participants’ demographic data. Phase 2 comprised of an online questionnaire to IBCLCs. This approach was designed to provide a comprehensive qualitative understanding of the IBCLCs’ experiences, which was then triangulated with quantitative data from a significantly larger population of IBCLCs in Phase 2.Results:The findings are described in themes and subthemes. Participants in phase 2 (n = 3,946) reported being intrinsically motivated (93.3%, n = 3,631) and committed to providing evidence-based guidance and optimal care to support breastfeeding mothers. They identified various sources of continuing education, although attendance at conferences, peer support, and reflective sessions were the most common approaches to enhancing knowledge. They recognized that it was through extension of knowledge that they were able to advance their practice.Conclusion:This article identifies strategies that the managers, educators, and certification bodies can adopt to support the IBCLCs in continuing to advance their practice, which will ultimately improve breastfeeding outcomes for mothers.
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Presenting the primary care team to the public: a qualitative exploration of general practice websites. Br J Gen Pract 2018; 68:e178-e186. [PMID: 29440014 DOI: 10.3399/bjgp18x695009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/31/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Increasing demand and expanded primary care provision, coupled with a reduced GP workforce, present challenges for primary care. New workforce models aim to reduce GP workload by directing patients to a variety of alternative clinicians. Concurrently, the principle of patient choice in relation to healthcare providers has gained prominence. It is, therefore, necessary to provide patients with sufficient information to negotiate access to appropriate primary healthcare professionals. AIM To explore how practice websites present three exemplar healthcare professional groups (GPs, advanced nurse practitioners [ANPs], and practice nurses [PNs]) to patients and the implications for informing appropriate consultation choices. DESIGN AND SETTING Qualitative thematic analysis of a sample of general practice websites. METHOD In total, 79 accessible websites from a metropolitan district in the north of England were thematically analysed in relation to professional representation and signposting of the three identified professional groups. RESULTS Information about each group was incomplete, inconsistent, and sometimes inaccurate across the majority of general practice websites. There was a lack of coherence and strategy in representation and direction of website users towards appropriate primary healthcare practitioners. CONCLUSION Limited and unclear representation of professional groups on general practice websites may have implications for the direction of patients to the wider clinical healthcare team. Patients may not have appropriate information to make choices about consulting with different healthcare practitioners. This constitutes a missed opportunity to signpost patients to appropriate clinicians and enhance understanding of different professional roles. The potential for websites to disseminate information to the public is not being maximised.
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Carryer J, Wilkinson J, Towers A, Gardner G. Delineating advanced practice nursing in New Zealand: a national survey. Int Nurs Rev 2017; 65:24-32. [DOI: 10.1111/inr.12427] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J. Carryer
- School of Nursing College of Health Massey University Palmerston North New Zealand
| | - J. Wilkinson
- School of Public Health College of Health Massey University Palmerston North New Zealand
| | - A. Towers
- School of Nursing College of Health Massey University Wellington New Zealand
| | - G. Gardner
- Faculty of Health School of Nursing Queensland University of Technology Brisbane QLD Australia
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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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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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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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Giles M, Parker V, Mitchell R. Examining Nurse Consultant connectivity: An Australian mixed method study. Nurs Health Sci 2015; 18:154-62. [PMID: 26305104 DOI: 10.1111/nhs.12235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/03/2015] [Indexed: 11/27/2022]
Abstract
The nurse consultant (NC) role in Australia is a senior classification of advanced practice nurse has been described as enhancing health care outcomes largely through extensive collaboration with consumers, nurses, and other health professionals. However, little is known about the actual nature, amount, and quality of NC interactions. This study examines the connectivity of the NC role across metropolitan and rural contexts, using a mixed method sequential design with an online survey and focus groups with NCs and other stakeholders. Results demonstrated that NCs most commonly have high density connectivity patterns with other nursing colleagues, medical staff, patients/clients, and administrative staff. Position grade (1, 2 or 3) influences density of connectivity, as does location, with those based in metropolitan roles engaging significantly less with other clinicians. Findings demonstrate that many NCs are highly collaborative and predominantly embedded into interprofessional practice models. This study provides valuable insight into the diverse and often complex NC role and the way in which NC expertise and influence is deployed and integrated across a large local health district.
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Affiliation(s)
- Michelle Giles
- Clinical Nurse Consultant Research, Hunter New England Local Health District, James Fletcher Campus, Newcastle, NSW, Australia.,School of Health, University of New England, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Vicki Parker
- Clinical Nurse Consultant Research, Hunter New England Local Health District, James Fletcher Campus, Newcastle, NSW, Australia.,School of Health, University of New England, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Rebecca Mitchell
- School of Business and Law, University of Newcastle, Newcastle, NSW, Australia
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The Perioperative Nurse Surgeon's Assistant: Issues and challenges associated with this emerging advanced practice nursing role in Australia. Collegian 2015; 22:109-15. [DOI: 10.1016/j.colegn.2013.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Affiliation(s)
- Abby Barnwell
- Lead Colorectal/Stoma Nurse Specialist, University Hospitals, Coventry, England
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McDonnell A, Goodwin E, Kennedy F, Hawley K, Gerrish K, Smith C. An evaluation of the implementation of Advanced Nurse Practitioner (ANP) roles in an acute hospital setting. J Adv Nurs 2014; 71:789-99. [DOI: 10.1111/jan.12558] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Kay Hawley
- TRI Clinical Research Facility; Princess Alexandra Hospital; Woolloongabba Queensland Australia
| | - Kate Gerrish
- Sheffield University and Sheffield Teaching Hospitals NHS Foundation Trust; UK
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Giles M, Parker V, Mitchell R. Recognising the differences in the nurse consultant role across context: a study protocol. BMC Nurs 2014; 13:30. [PMID: 25320563 PMCID: PMC4198326 DOI: 10.1186/1472-6955-13-30] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 09/08/2014] [Indexed: 12/01/2022] Open
Abstract
Background The advanced practice role of the Nurse Consultant is unique in its capacity to provide clinical leadership across a range of contexts. However, the Nurse Consultant role has been plagued with confusion due to lack of clarity over function and appropriateness for purpose within health organisations across contexts. Changing health service delivery models are driving the emergence of new nursing roles, further clouding the waters related to role positioning and purpose. There is an urgent need for evidence of impact and demonstration of how Nurse Consultants contribute to health care outcomes. This study aims to gain a clearer understanding of the Nurse Consultant role and its impact in metropolitan and rural New South Wales (NSW) Australia. Design The proposed study employs a sequential mixed method design, underpinned by Realistic Evaluation, to explore how Nurse Consultants contribute to organisational outcomes. The ‘context – mechanism – outcome’ approach of realistic evaluation provides a sound framework to examine the complex, diverse and multifaceted nature of the Nurse Consultant’s role. Method Participants will be stakeholders, recruited across a large Local Health District in NSW, comprising rural and metropolitan services. A modified and previously validated survey will be used providing information related to role characteristics, patterns and differences across health context. Focus groups with Nurse Consultant’s explore issues highlighted in the survey data. Focus groups with other clinicians, policy makers and managers will help to achieve understanding of how the role is viewed and enacted across a range of groups and contexts. Discussion Lack of role clarity is highlighted extensively in international and Australian studies examining the role of the Nurse Consultant. Previous studies failed to adequately examine the role in the context of integrated and complex health services or to examine the role in detail. Such examination is critical in order to understand the significance of the role and to ascertain how Nurse Consultants can be most effective as members of the health care team. This is the first Australian study to include extensive stakeholder perspectives in order to understand the relational and integrated nature and impact of the role across metropolitan and rural context.
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Affiliation(s)
- Michelle Giles
- Hunter New England Local Health District, James Fletcher Campus, 72 Watt Street Newcastle, Newcastle, NSW 2300, Australia
| | - Vicki Parker
- School of Health, University of New England, Armidale, NSW, Australia
| | - Rebecca Mitchell
- School of Business and Law, University of Newcastle, Callaghan, NSW 2308, Australia
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East L, Knowles K, Pettman M, Fisher L. Advanced level nursing in England: organisational challenges and opportunities. J Nurs Manag 2014; 23:1011-9. [DOI: 10.1111/jonm.12247] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Linda East
- The University of Nottingham; Nottingham UK
| | - Kate Knowles
- Nottingham University Hospitals NHS Trust; Nottingham UK
| | - Maria Pettman
- Nottingham University Hospitals NHS Trust; Nottingham UK
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Wilson-Miller R, Stanley H. Nurse-led intravitreal injection clinics: defining the ophthalmic nurse's scope of practice and educational needs. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/ijop.2014.5.4.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Helen Stanley
- Assistant Head of School and Postgraduate Academic Programme Lead, School of Health Sciences, University of Brighton, UK
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Franks H. The contribution of nurse consultants in England to the public health leadership agenda. J Clin Nurs 2014; 23:3434-48. [DOI: 10.1111/jocn.12593] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Helen Franks
- College of Health & Social Care; School of Nursing, Midwifery & Social Work; University of Salford; Salford UK
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Ramis MA, Wu CJ, Pearson A. Experience of being an advanced practice nurse within Australian acute care settings: a systematic review of qualitative evidence. INT J EVID-BASED HEA 2013. [DOI: 10.1111/1744-1609.12029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Linga S, Curtis J, Brightond R, Dunlopb A. An examination of barriers to nurse practitioner endorsement in senior rural drug and alcohol nurses in New South Wales. Collegian 2013; 20:79-86. [PMID: 23898595 DOI: 10.1016/j.colegn.2012.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND AIMS To examine barriers senior rural nurses in New South Wales drug and alcohol clinical settings perceive when considering endorsement to Nurse Practitioner (NP). DESIGN AND METHODS A survey was designed to record views of senior alcohol and drug nurses in rural New South Wales about becoming a NP. Participants were identified by Area Health Service Directors of Drug and Alcohol Services for each Area Health Service in NSW excluding metropolitan Sydney. Forty eight surveys were distributed, with 17 (35%) completed surveys included in the results. RESULTS Of the 17 participants, 12 (70.6%) expressed interest in becoming a NP. The majority (12, 70.6%) were unaware or unsure of endorsement processes. Lack of clarity about the NP role and processes and benefits to becoming a NP was found to be of most concern to all participants. Only 6 participants (35%) indicated they would consider seeking endorsement to NP. DISCUSSION AND CONCLUSION Despite agreeing that NP positions in alcohol and drug settings would improve patient access to treatment and care, senior nurses working in these settings in regional areas are unfamiliar with pathways to becoming endorsed. Barriers, such as a lack of internal support from management and colleagues, as well as the fact that respondents reported no foreseeable financial gain in endorsement, also need to be addressed, before more nurses will consider endorsement. Further evaluation of the views of senior nurses in metropolitan alcohol and other drug settings in the process to NP endorsement is needed before clients will benefit from the expertise and enhanced care that NP's may provide.
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Affiliation(s)
- Stephen Linga
- Drug and Alcohol, John Hunter Hospital, Hunter New England Area Health Service, New South Wales, Australia.
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Dowling M, Beauchesne M, Farrelly F, Murphy K. Advanced practice nursing: A concept analysis. Int J Nurs Pract 2013; 19:131-40. [DOI: 10.1111/ijn.12050] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Maura Dowling
- School of Nursing and MidwiferyNational University of Ireland Galway Ireland
| | - Michelle Beauchesne
- School of NursingBouve College of Health ScienceNortheastern University Boston Massachusetts USA
| | - Frances Farrelly
- School of Nursing and MidwiferyNational University of Ireland Galway Ireland
| | - Kathy Murphy
- School of Nursing and MidwiferyNational University of Ireland Galway Ireland
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Begley C, Murphy K, Higgins A, Cooney A. Policy-makers' views on impact of specialist and advanced practitioner roles in Ireland: the SCAPE study. J Nurs Manag 2012; 22:410-22. [DOI: 10.1111/jonm.12018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Cecily Begley
- School of Nursing and Midwifery; Trinity College Dublin; Dublin
| | - Kathy Murphy
- School of Nursing and Midwifery; National University of Ireland; Galway Galway
| | - Agnes Higgins
- School of Nursing and Midwifery; Mental Health Nursing; Trinity College Dublin; Dublin
| | - Adeline Cooney
- School of Nursing and Midwifery; National University of Ireland Galway; Galway Ireland
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Clark S, Paul F. The role of the nurse practitioner within the Hospital at Night service. ACTA ACUST UNITED AC 2012; 21:1132-7. [DOI: 10.12968/bjon.2012.21.19.1132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Fiona Paul
- School of Nursing and Midwifery, University of Dundee, Dundee
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Neville L, Swift J. Measuring the impact of the advanced practitioner role: a practical approach. J Nurs Manag 2012; 20:382-9. [PMID: 22519616 DOI: 10.1111/j.1365-2834.2012.01356.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM This paper aims to illuminate difficulties in evaluating the advanced practitioner role and to offer a practical solution. BACKGROUND The advanced practice role has been part of the workforce strategy in the Northwest of England since 2005. However capturing hard evidence of the impact of this role has been problematic. Current restrictions on resources require the provision of evidence of the value of roles and services. EVALUATION Critical analysis of literature has identified challenges in evaluating the advanced practice role. The case study design takes account of current policy initiatives, notably QIPP. KEY ISSUES There is no common approach to evaluating the role of advanced practitioners. The case study has the potential to be a useful tool to organise evidence of the impact of advanced practitioner roles. CONCLUSIONS Advanced practitioners need to have appropriate knowledge and skills to provide evidence of the impact of their role. There is potential for this work to be applied to other roles across the NHS. IMPLICATIONS FOR NURSING MANAGEMENT Managers need to work in partnership with workforce planners and educationalists to support advanced practitioners to utilise their skills in methods of providing evidence that they do work of value. Clear strategic direction for advanced practitioners is advised as part of the workforce strategy.
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Affiliation(s)
- Lillian Neville
- University of Salford School of Nursing and Midwifery, Frederick Road Campus, Salford M60 6PU, UK.
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Christiansen A, Vernon V, Jinks A. 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. J Clin Nurs 2012; 22:1173-81. [PMID: 22861053 DOI: 10.1111/j.1365-2702.2012.04139.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Ramis MA, Pearson A, Jo Wu CJ. The experience of being an advanced practice nurse in Australian acute care settings: A systematic review of qualitative evidence. ACTA ACUST UNITED AC 2012; 10:3960-4018. [PMID: 27820520 DOI: 10.11124/jbisrir-2012-404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND There is a vast amount of international literature which, although agreeing on the need for advanced practice nurse roles, simultaneously debates and discusses the difficulties with nomenclature, definition and subsequent implementation of such roles. Due to this ambiguity it is difficult to equally compare evidence in this field across different countries. A context-specific systematic review on the qualitative evidence of the experience of being an advanced practice nurse in Australia has not been undertaken previously, however it is imperative for nursing managers and leaders to understand the complexities of advanced nursing roles in order to effectively utilise and retain these experienced and valuable nurses. With the creation of a national nursing regulating authority in 2010, it is timely to explore in-depth the experience of being an advanced practice nurse from a national perspective. OBJECTIVE To identify the experience of being an advanced practice nurse working in Australian acute care settings. INCLUSION CRITERIA Registered nurses working in advanced practice roles in acute care settings throughout Australia.The experience of being an advanced practice registered nurse working in an Australian acute care setting, as reported by the nurses themselves.Interpretive qualitative studies including designs such as phenomenology, grounded theory and ethnography. SEARCH STRATEGY A three step search strategy was used to identify published and unpublished studies. The search process was conducted from August to October 2011 and considered published and unpublished studies from 1990 to October 2011. METHODOLOGICAL QUALITY Studies were appraised for methodological quality by two independent reviewers using the Joanna Briggs Qualitative Assessment and Review Instrument. DATA EXTRACTION Data was extracted from the papers included in the review using the standardised Joanna Briggs Institute Qualitative Assessment and Review Instrument data extraction tool. DATA SYNTHESIS Research findings were pooled using the Joanna Briggs Institute Qualitative Data and Review Instrument. RESULTS Three published studies and one unpublished dissertation were included in the review. From these four studies, 216 findings were extracted, forming 18 categories which were then analysed to create six synthesised findings. Six meta-syntheses under the headings of expert knowledge, confidence, education, relationships, negative experiences and patient centred experience were formed from the findings. CONCLUSIONS The synthesised findings confirm that the experience of advanced practice nurses in Australian acute care settings is complex and greatly influenced personally and professionally by the organisation as well as the unpredictable nature of working with people. IMPLICATIONS FOR PRACTICE A deeper understanding of the essence of being an advanced practice nurse may be of benefit for recruitment and retention planning. Health care organisations must also be aware of the impact they have on the nurse's experience if they are to commit to retention of nurses and to patient safety. IMPLICATIONS FOR RESEARCH If the topic of advanced practice is to remain current in the Australian nursing profession then ongoing research must be conducted to identify if the title is being used more frequently within the nursing research. Nurses must be supported in publishing quality research if they are to improve articulation of their experiences.
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Affiliation(s)
- Mary-Anne Ramis
- 1. The Joanna Briggs Institute, Faculty of Health Sciences, The University of Adelaide, South Australia, 5005. 2. Queensland University of Technology, School of Nursing, Kelvin Grove Campus, Brisbane 4059
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Cant R, Birks M, Porter J, Jacob E, Cooper S. Developing advanced rural nursing practice: A whole new scope of responsibility. Collegian 2011; 18:177-82. [DOI: 10.1016/j.colegn.2011.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Chang AM, Gardner GE, Duffield C, Ramis MA. Advanced practice nursing role development: factor analysis of a modified role delineation tool. J Adv Nurs 2011; 68:1369-79. [DOI: 10.1111/j.1365-2648.2011.05850.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lowe G, Plummer V, O’Brien AP, Boyd L. Time to clarify - the value of advanced practice nursing roles in health care. J Adv Nurs 2011; 68:677-85. [DOI: 10.1111/j.1365-2648.2011.05790.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Advanced practice nursing and specialty practice are terms that are often used interchangeably in nursing discourse. This column explores the inextricable link, as well as the differences between these two types of practice. Drawing differing conclusions about their specific and cooperative value enables nurses to construct innovative and creative approaches to their continued development that illuminates a path for disciplinary expansion. Congruent programs of education prepare nurses to communicate the distinctiveness of their many and varied contributions to the public with greater clarity and emphatic certainty.
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Abstract
AIMS This review was designed to evaluate the evidence relating to pain management interventions for patients having bone marrow biopsy. BACKGROUND Bone marrow biopsy is an invasive procedure causing considerable pain and anxiety for adult patients, yet there are no guidelines to inform effective nursing care. Although this is an under-researched area, a range of pain interventions have been tested on this patient group, but this evidence has not been synthesised. DESIGN Structured evidence review. METHOD The Cochrane Library and databases Medline, Scopus and Cinahl were searched for original research reports. Reference lists of retrieved papers were hand-searched and researchers in the field were contacted. Retrieved papers were analysed using the CASP framework. A narrative data synthesis considered the strengths and limitations of included studies and findings were collated and interpreted. RESULTS No systematic reviews of evidence have been undertaken and the search strategy identified twelve research studies eligible for inclusion in the review. Hand-searching did not identify any additional studies, and emails to researchers confirmed this is an under-researched field. Analysis shows three main interventions, intravenous midazolam, premedication with analgesia and/or anxiolysis and the use of Entonox™ are used to manage the pain experience for patients undergoing a bone marrow biopsy. CONCLUSIONS Evidence is inconclusive and provides little guidance for practice. There is an urgent need for research into effective interventions for pain management in bone marrow biopsy and in understanding the patient experience. RELEVANCE TO CLINICAL PRACTICE Nurses have a central role to play in the assessment and management of the pain and anxiety associated with bone marrow biopsy. There is little evidence to guide this aspect of care, but it is important that nurses involved with bone marrow biopsy are aware of the best evidence to facilitate the most effective management of their patients' pain.
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Affiliation(s)
- Sarah Watmough
- NIHR Postgraduate Student, School of Health Sciences, University of Liverpool, Liverpool, UK.
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Christensen M. Advancing nursing practice: redefining the theoretical and practical integration of knowledge. J Clin Nurs 2011; 20:873-81. [PMID: 21320209 DOI: 10.1111/j.1365-2702.2010.03392.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The aim of this paper is to offer an alternative knowing-how knowing-that framework of nursing knowledge, which in the past has been accepted as the provenance of advanced practice. BACKGROUND The concept of advancing practice is central to the development of nursing practice and has been seen to take on many different forms depending on its use in context. To many it has become synonymous with the work of the advanced or expert practitioner; others have viewed it as a process of continuing professional development and skills acquisition. Moreover, it is becoming closely linked with practice development. However, there is much discussion as to what constitutes the knowledge necessary for advancing and advanced practice, and it has been suggested that theoretical and practical knowledge form the cornerstone of advanced knowledge. DESIGN The design of this article takes a discursive approach as to the meaning and integration of knowledge within the context of advancing nursing practice. METHOD A thematic analysis of the current discourse relating to knowledge integration models in an advancing and advanced practice arena was used to identify concurrent themes relating to the knowing-how knowing-that framework which commonly used to classify the knowledge necessary for advanced nursing practice. CONCLUSION There is a dichotomy as to what constitutes knowledge for advanced and advancing practice. Several authors have offered a variety of differing models, yet it is the application and integration of theoretical and practical knowledge that defines and develops the advancement of nursing practice. An alternative framework offered here may allow differences in the way that nursing knowledge important for advancing practice is perceived, developed and coordinated. RELEVANCE TO CLINICAL PRACTICE What has inevitably been neglected is that there are various other variables which when transposed into the existing knowing-how knowing-that framework allows for advanced knowledge to be better defined. One of the more notable variables is pattern recognition, which became the focus of Benner's work on expert practice. Therefore, if this is included into the knowing-how knowing-that framework, the knowing-how becomes the knowledge that contributes to advancing and advanced practice and the knowing-that becomes the governing action based on a deeper understanding of the problem or issue.
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Kelly M, Crotty G, Perera K, Dowling M. Evaluation of bone marrow examinations performed by an advanced nurse practitioner: an extended role within a haematology service. Eur J Oncol Nurs 2010; 15:335-8. [PMID: 20952253 DOI: 10.1016/j.ejon.2010.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 09/23/2010] [Accepted: 09/27/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Traditionally, medical personnel have undertaken bone marrow (BM) examination. However, specially trained nurses in advanced practice roles are increasingly undertaking this role. This paper presents the findings from an audit of BM examinations undertaken by an advanced nurse practitioner (ANP) at a regional haematology specialist centre. METHODS The audit evaluated the quality of BM examinations performed by the ANP over the past two years (September 2007-September 2009). Over the two year period, 324 BM examinations were performed at the centre of which 156 (48.1%) were performed by the ANP. A random sample of 30 BM examinations undertaken by the ANP were analysed by the consultant haematologist. RESULTS All 30 BM examinations undertaken by the ANP were sufficient for diagnosis. CONCLUSIONS The ANP is capable and competent to obtain BM samples which are of a sufficient quality to permit diagnosis.
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Affiliation(s)
- Mary Kelly
- Department of Haematology, Tullamore General Hospital, Co.Offaly, Ireland.
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Chang AM, Gardner GE, Duffield C, Ramis MA. A Delphi study to validate an Advanced Practice Nursing tool. J Adv Nurs 2010; 66:2320-30. [DOI: 10.1111/j.1365-2648.2010.05367.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Alexandrov AWW, Brethour M, Cudlip F, Swatzell V, Biby S, Reiner D, Kiernan TE, Handler D, Tocco S, Yang J. Postgraduate fellowship education and training for nurses: the NET SMART experience. Crit Care Nurs Clin North Am 2010; 21:435-49. [PMID: 19951762 DOI: 10.1016/j.ccell.2009.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Neurovascular Education and Training in Stroke Management and Acute Reperfusion Therapy (NET SMART) program for advanced practice nursing (APN) offers a first-of-its-kind, academic, postgraduate, fellowship program for APNs that is modeled after physician academic fellowship programs but supported by a flexible Internet-based platform. This article details the rationale, methods, and preliminary results of the NET SMART APN experience, which serves as a unique template for the development of academic postgraduate nursing fellowship programs across a variety of specialty practices.
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Affiliation(s)
- Anne W Wojner Alexandrov
- University of Alabama at Birmingham, Comprehensive Stroke Center, 1813 6th Avenue South, UAB Hospital Russell Wing, Suite 226, Birmingham, AL 35249, USA.
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Abstract
This literature review was conducted to identify the attributes of an expert nurse and the direct and indirect impact they have on patient care, health-care organisations and nursing. Given the loss of expert nursing posts as a result of NHS deficits, there is an urgent need to differentiate between a range of expert nursing roles and how these contribute to positive patient and health outcomes and organisational efficiency. The focus of the literature search was on developments in the UK and the results indicated that ambiguity and confusion exist around the terminology and definitions associated with expert nurses. Research shows that expert nurses have a positive impact on patient care and organisational efficiency. However, a lack of clarity leads to a dilution of expert nursing roles and nurse expertise. There is a need for national guidance on the skills required of expert nurses and the necessity of considering the formal protection of nursing titles.
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LIVESLEY JOAN, WATERS KAREN, TARBUCK PAUL. The management of advanced practitioner preparation: a work-based challenge. J Nurs Manag 2009; 17:584-93. [DOI: 10.1111/j.1365-2834.2009.00967.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
AIM The aim of this paper was to discuss the potential development of a conceptual model of knowledge integration pertinent to critical care nursing practice. A review of the literature identified that reflective practice appeared to be at the forefront of professional development. BACKGROUND It could be argued that advancing practice in critical care has been superseded by the advanced practice agenda. Some would suggest that advancing practice is focused on the core attributes of an individual's practice, which then leads onto advanced practice status. However, advancing practice is more of a process than identifiable skills and as such is often negated when viewing the development of practitioners to the advanced practice level. For example, practice development initiatives can be seen as advancing practice for the masses, which ensures that practitioners are following the same level and practice of care. The question here is, are they developing individually? RELEVANCE TO CLINICAL PRACTICE What this paper presents is that reflection may not be best suited to advancing practice if the individual practitioner does not have a sound knowledge base both theoretically and experientially. The knowledge integration model presented in this study uses multiple learning strategies that are focused in practice to develop practice, e.g. the use of work-based learning and clinical supervision. To demonstrate the models application, an exemplar of an issue from practice shows its relevance from a practical perspective. CONCLUSIONS In conclusion, further knowledge acquisition and its relationship with previously held theory and experience will enable individual practitioners to advance their own practice as well as being a resource for others.
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Affiliation(s)
- Martin Christensen
- School of Health & Social Care, Bournemouth University, Bournemouth, UK.
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Abstract
This paper is a personal journey through nurse training and perioperative practice. Nurse education is also explored alongside some of the social, academic and political changes that have influenced healthcare in the United Kingdom between 1966 and 2008. The views expressed are those of the author only, and the anecdotal descriptions are anonymous.
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