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Kilpatrick K, Savard I, Audet LA, Costanzo G, Khan M, Atallah R, Jabbour M, Zhou W, Wheeler K, Ladd E, Gray DC, Henderson C, Spies LA, McGrath H, Rogers M. A global perspective of advanced practice nursing research: A review of systematic reviews. PLoS One 2024; 19:e0305008. [PMID: 38954675 PMCID: PMC11218965 DOI: 10.1371/journal.pone.0305008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/21/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION The World Health Organization (WHO) called for the expansion of all nursing roles, including advanced practice nurses (APNs), nurse practitioners (NPs) and clinical nurse specialists (CNSs). A clearer understanding of the impact of these roles will inform global priorities for advanced practice nursing education, research, and policy. OBJECTIVE To identify gaps in advanced practice nursing research globally. MATERIALS AND METHODS A review of systematic reviews was conducted. We searched CINAHL, Embase, Global Health, Healthstar, PubMed, Medline, Cochrane Library, DARE, Joanna Briggs Institute EBP, and Web of Science from January 2011 onwards, with no restrictions on jurisdiction or language. Grey literature and hand searches of reference lists were undertaken. Review quality was assessed using the Critical Appraisal Skills Program (CASP). Study selection, data extraction and CASP assessments were done independently by two reviewers. We extracted study characteristics, country and outcome data. Data were summarized using narrative synthesis. RESULTS We screened 5840 articles and retained 117 systematic reviews, representing 38 countries. Most CASP criteria were met. However, study selection by two reviewers was done inconsistently and language and geographical restrictions were applied. We found highly consistent evidence that APN, NP and CNS care was equal or superior to the comparator (e.g., physicians) for 29 indicator categories across a wide range of clinical settings, patient populations and acuity levels. Mixed findings were noted for quality of life, consultations, costs, emergency room visits, and health care service delivery where some studies favoured the control groups. No indicator consistently favoured the control group. There is emerging research related to Artificial Intelligence (AI). CONCLUSION There is a large body of advanced practice nursing research globally, but several WHO regions are underrepresented. Identified research gaps include AI, interprofessional team functioning, workload, and patients and families as partners in healthcare. PROSPERO REGISTRATION NUMBER CRD42021278532.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS-EMTL), Montréal, Québec, Canada
| | - Isabelle Savard
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Li-Anne Audet
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Gina Costanzo
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Mariam Khan
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Renée Atallah
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Mira Jabbour
- Centre Intégré Universitaire de Santé et de Services sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS-EMTL), Montréal, Québec, Canada
| | - Wentao Zhou
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore; National University Health System, Singapore, Singapore
- Singapore National Neuroscience Institute, Singapore, Singapore
| | - Kathy Wheeler
- College of Nursing, University of Kentucky, Lexington, Kentucky, United States of America
| | - Elissa Ladd
- MGH Institute of Health Professions, School of Nursing, Boston, Massachusetts, United States of America
| | - Deborah C. Gray
- School of Nursing, Old Dominion University, Virginia Beach, Virginia, United States of America
| | - Colette Henderson
- School of Health Sciences, University of Dundee, Dundee, Scotland, United States of America
| | - Lori A. Spies
- Louise Herrington School of Nursing, Baylor University, Dallas, Texas, United States of America
| | - Heather McGrath
- St James Public Health Services, Montego Bay, St James, Jamaica
| | - Melanie Rogers
- Department of Nursing and Midwifery, University of Huddersfield, Queensgate, Huddersfield, United Kingdom
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Okhotin A, Osipov M, Osipov V, Barchuk A. Atrial fibrillation: real-life experience of a rhythm control with electrical cardioversion in a community hospital. BMC Cardiovasc Disord 2024; 24:213. [PMID: 38632510 PMCID: PMC11022487 DOI: 10.1186/s12872-024-03885-0] [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: 12/29/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Atrial fibrillation is the most prevalent sustained cardiac arrhythmia. Electrical cardioversion, a well-established part of the rhythm control strategy, is probably underused in community settings. Here, we describe its use, safety, and effectiveness in a cohort of patients with atrial fibrillation treated in rural settings. METHODS It is a retrospective cohort study. Data on all procedures from January 1, 2016, till December 1, 2022, in Tarusa Hospital, serving mostly a rural population of 15,000 people, were extracted from electronic health records. Data on the procedure's success, age, gender, body mass index, comorbidities, previous procedures, echocardiographic parameters, type and duration of arrhythmia, anticoagulation, antiarrhythmic drugs, transesophageal echocardiography, and settings were available. RESULTS Altogether, 1,272 procedures in 435 patients were performed during the study period. The overall effectiveness of the procedure was 92%. Effectiveness was similar across all prespecified subgroups. Electrical cardioversion was less effective in patients undergoing the procedure for the first time (86%, 95% CI: 82-90) compared to repeated procedures (95%, 95% CI: 93-96), OR 0.39 (95% CI: 0.26-0.59). Complications were encountered in 13 (1.02%) procedures but were not serious. CONCLUSIONS Electrical cardioversion is an immediately effective procedure that can be safely performed in community hospitals, both in inpatient and outpatient settings. Further studies with longer follow-up are needed to investigate the rate of sinus rhythm maintenance in these patients.
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Affiliation(s)
- Artemiy Okhotin
- ITMO University, Kronverkskiy Prospekt, 49, 197101, St. Petersburg, Russia.
- Tarusa Hospital, K. Libknekhta ulitsa, 16, 249100, Tarusa, Russia.
| | - Maxim Osipov
- Tarusa Hospital, K. Libknekhta ulitsa, 16, 249100, Tarusa, Russia
| | - Vasilij Osipov
- Tarusa Hospital, K. Libknekhta ulitsa, 16, 249100, Tarusa, Russia
| | - Anton Barchuk
- ITMO University, Kronverkskiy Prospekt, 49, 197101, St. Petersburg, Russia
- Institute for Interdisciplinary Health Research, European University at St. Petersburg, Shpalernaya Ulitsa 1, 191187, St. Petersburg, Russia
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Zaher W, Pannone L, Thayse K, Ebinger KR, Tran-Ngoc E, de Asmundis C, Chierchia GB, Sorgente A. Safety and efficacy of a nurse-led elective cardioversion with etomidate for atrial arrhythmia in a tertiary hospital. Heliyon 2023; 9:e15158. [PMID: 37089358 PMCID: PMC10113848 DOI: 10.1016/j.heliyon.2023.e15158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
Management of cardiac arrhythmias often requires direct current cardioversion (DCC) to restore sinus rhythm. This intervention varies greatly between countries and hospitals, mostly regarding the organization of an elective DCC, and the choice of the sedation. The aim of this study is to assess the safety and efficacy of an elective DCC performed in a cardiology day hospital, led by trained nurses, and using intravenous Etomidate as sedation. We performed a retrospective cohort study at a single tertiary hospital in Belgium. Data were collected from January 2017 to October 2020. A total of 788 electrical cardioversions were performed on 574 patients from 2017 to 2020. Age was 70.9 ± 10 years. Restoration of sinus rhythm was obtained in 89.5% of the patients. One (0.1%) patient experienced ischemic stroke within 24 h, despite adequate anticoagulation. There were 4 (0.5%) cases of transient sinus arrest requiring atropine. Three patients (0.4%) experienced respiratory depression, requiring bag-mask ventilation but not oro-tracheal intubation. There were no cases of hypotension. No periprocedural death was reported. In conclusion, an elective electrical cardioversion performed and led by trained nurses, using Etomidate as sedation, appears to be both safe and effective.
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Affiliation(s)
- Wael Zaher
- Department of Cardiology, Centre Hospitalier EpiCURA, Hornu, Belgium
- Corresponding author. Department of Cardiology, Centre Hospitalier EpiCURA, Route de Mons 63 - 7301, Hornu, Belgium.
| | - Luigi Pannone
- Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Kathleen Thayse
- Department of Cardiology, Centre Hospitalier EpiCURA, Hornu, Belgium
| | | | | | - Carlo de Asmundis
- Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Antonio Sorgente
- Department of Cardiology, Centre Hospitalier EpiCURA, Hornu, Belgium
- Heart Rhythm Management Centre, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Uhm D, Jung GH. Clinical Nurses' Intention to Use Defibrillators in South Korea: A Path Analysis. Healthcare (Basel) 2022; 11:healthcare11010061. [PMID: 36611521 PMCID: PMC9818537 DOI: 10.3390/healthcare11010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
This study aimed to investigate factors affecting behavioral intentions to use defibrillators among clinical nurses in South Korea, using a modified predictive technology acceptance model 2 (TAM 2) that facilitates understanding of what prompts apparent spontaneous actions. This descriptive, cross-sectional study included 467 clinical nurses with more than 6 months of clinical experience. The path analysis results showed that the variables directly affecting the intention to use a defibrillator among clinical nurses were the image, organizational support, perceived ease of use, and perceived usefulness. Moreover, job autonomy and total career indirectly affected the intention to use a defibrillator. Clinical nurses need to know how to use defibrillators and be able to act promptly on patients with in-hospital cardiac arrest (IHCA). Organizational managers need to improve the work environments of clinical nurses accordingly. Additionally, it is necessary to establish a policy foundation to ensure the development of competence and job autonomy that can lead to the use of defibrillators by improving various factors, including anxiety or reluctance of nurses to use defibrillators in acute cardiac arrest.
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Affiliation(s)
- Dongchoon Uhm
- Department of Emergency Medical Technology, Daejeon University, 62 Daehak-ro, Dong-gu, Daejeon 300-716, Republic of Korea
| | - Gye-Hyun Jung
- Department of Nursing, Jeonbuk Science College, Jeonbuk 56204, Republic of Korea
- Correspondence: or ; Tel.: +82-63-530-9262
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Health care utilization in a nurse practitioner–led atrial fibrillation clinic. J Am Assoc Nurse Pract 2022; 34:1139-1148. [DOI: 10.1097/jxx.0000000000000779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/09/2022] [Indexed: 11/07/2022]
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Connolly C, Cotter P. Effectiveness of nurse-led clinics on healthcare delivery: An umbrella review. J Clin Nurs 2021; 32:1760-1767. [PMID: 34970816 DOI: 10.1111/jocn.16186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Healthcare provision remains challenging leading to a focus on health service redesign including the development of nurse-led clinics. While there is a belief that nurse-led services positively impact on healthcare delivery, it is necessary to inform development through examination of the evidence. METHODS A search was conducted of Cumulative Index of Nursing and Allied Health Literature, MEDLINE, EMBASE, Scopus and the Cochrane Library for systematic reviews evaluating the effectiveness of nurse-led clinics when compared with usual care published between 2015 and 2020. Outcomes of interest were clinical outcomes, patient satisfaction and patient access to health care. Study quality was appraised using the AMSTAR 2 tool (A MeaSurement tool to Assess Systematic Reviews). A narrative analysis was conducted. RESULTS From 681 identified studies, nine were included, with reporting quality rated from very low to high quality. Patient clinical outcomes were reported as equal to or better than usual care across all studies included. There was evidence of high levels of patient satisfaction with nurse-led clinics across the included systematic reviews. While access to health care was the least reported variable, there were reports that access to health care increased or patient reliance on other healthcare providers reduced due to nurse-led clinics. CONCLUSIONS Despite the heterogeneous nature of the systematic reviews, along with some quality issues in reporting, there was evidence that nurse-led services provided comparable or superior care to usual care with high levels of patient satisfaction. There was a lack of reporting on the impact of nurse-led clinics on patient access to health care; further research is required on this area. Health service managers should consider nurse-led clinics an effective innovation in health service provision.
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Affiliation(s)
- Carmel Connolly
- Catherine McAuley School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Patrick Cotter
- Catherine McAuley School of Nursing & Midwifery, University College Cork, Cork, Ireland
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Carney M, Kearns T, Greene K. Collaborative strategic initiative between a university and hospital network group: Advanced nurse/midwife practice forum. J Nurs Manag 2020; 28:1457-1460. [PMID: 32667682 DOI: 10.1111/jonm.13099] [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: 04/14/2020] [Revised: 06/03/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Faculty of Nursing and Midwifery, one of a few nursing and midwifery faculties worldwide, was established in 1974 by Ms Mary Frances Crowley, for postgraduate nursing education, and is situated within the Royal College of Surgeons in Ireland, University of Medicine and Health Sciences. The RCSI operates through a network group of university hospitals: Beaumont, Connolly, Drogheda, Cavan, Monaghan and the Rotunda. Combined these hospitals have 120 registered and candidate ANP/AMPs and caters for general, psychiatric, children and maternity patients/clients. The drive to establish the forum between the faculty and the six Dublin hospitals was to build capacity among advanced nurse practitioners and advanced midwife practitioners (ANP/AMPs) who are seen as intelligent consumers of evidence-based research and safe practice. The SCAPE report identified research as the single domain that was underdeveloped within the ANP role, in the study exploring the role of ANPs and CNSs. Latterly, the Nursing and Midwifery Board of Ireland highlighted research as a vital component of the ANP/AMP role in its standards for advanced nurse and midwife practice. The faculty acted collaboratively to introduce an ANP/AMP forum to support advanced practitioners working in the university hospital group in their education and professional development, support the expansion of their knowledge base through practice-based enquiry and research and act as a conduit for interactions between ANPs/AMPs by keeping them up to date with practice and research. METHODS The Initiation phase was undertaken through a survey of needs; Implementation phase by extensive literature review and research-based newsletters sent to individuals by the forum coordinator; and the Evaluation phase through focus groups.
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Affiliation(s)
- Marie Carney
- Faculty of Nursing and Midwifery, RCSI Network Group Hospitals, Dublin, Ireland
| | - Thomas Kearns
- Faculty of Nursing and Midwifery, RCSI, Dublin, Ireland
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Scott N, O'Sullivan J, Asgeirsson K, Macmillan D, Wilson E. Changing practice: moving to a specialist nurse-led service for BRCA gene testing. ACTA ACUST UNITED AC 2020; 29:S6-S13. [DOI: 10.12968/bjon.2020.29.10.s6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Some 5–10% of all breast cancers are associated with a pathogenic variant in a breast cancer-associated gene (BRCA1/BRCA2). Historically, with referral to the Nottingham University Hospitals NHS Trust's clinical genetics department for genetic testing, waiting times were on average 12–14 weeks for an initial appointment and 4–6 months to obtain results from the date of testing. A specialist, nurse-led mainstreaming cancer genetics (MCG) service was set up in the trust's Nottingham Breast Institute (NBI) to: reduce waiting times for the initial consultation, counselling, consent and obtaining results for BRCA1/BRCA2 gene testing; and to ensure appropriate patients with breast cancer were offered genetic testing. Two breast clinical nurse specialists were trained so they could counsel, consent and give results for the BRCA1/BRCA2 gene testing directly to patients. Average waiting times for results from the time of testing were reduced to 35.8 days under the nurse-led service, which enabled oncologists and patients to consider individual treatment options at an earlier time. The MCG service reduced waiting times, resulting in an improved, more streamlined service for patients undergoing genetic testing. The MCG service extended the scope of practice of the breast nurse clinical specialists, embedded an expert advanced nursing role in the breast multidisciplinary team and developed nurse mentoring opportunities.
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Affiliation(s)
- Nicola Scott
- Breast Clinical Nurse Specialist and Specialist in Breast Family History, Nottingham Breast Institute, Nottingham University Hospitals NHS Trust
| | - Jackie O'Sullivan
- Breast Clinical Nurse Specialist and Specialist in Breast Family History, Nottingham Breast Institute, Nottingham University Hospitals NHS Trust
| | - Kristjan Asgeirsson
- Consultant Oncoplastic Breast Surgeon, Nottingham Breast Institute, Nottingham University Hospitals NHS Trust
| | - Douglas Macmillan
- Consultant Oncoplastic Breast Surgeon, Nottingham Breast Institute, Nottingham University Hospitals NHS Trust
| | - Emma Wilson
- Associate Professor in Public Health, University of Nottingham
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Fournier J. Current state of knowledge around nurse-led cardioversion: a launchpad for future projects. Evid Based Nurs 2020; 24:61. [PMID: 32033975 DOI: 10.1136/ebnurs-2019-103151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2020] [Indexed: 11/04/2022]
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