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Metersky K, Tan V, Al-Hamad A, Catallo C, Koller D, Patel K. Exploration of the advanced preparation nurse-mother role in care of children with chronic disease: A narrative inquiry. J Clin Nurs 2024; 33:1533-1549. [PMID: 38156701 DOI: 10.1111/jocn.16981] [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: 06/02/2023] [Revised: 11/20/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
AIM To explore the lived experience of advanced preparation nurses (APNs) who are mothers (APN-mothers) as they seek care in the Emergency Department for a child with a chronic disease. DESIGN Qualitative, Narrative Inquiry. METHODS Narrative Inquiry was used to examine critical self-reflections of four (n = 4) APN-mothers. Directed by a question guide, participants engaged in the Narrative Reflective Process through metaphoric and artistic means. RESULTS Participants identified salient challenges associated with their experiences. Narrative threads that emerged include feelings around being discovered, unfair expectations by healthcare providers, feelings of guilt and the tension from competing roles: APN and mother. CONCLUSION APN-mothers represent a unique population with enhanced knowledge, skills and judgement; however, they indicate that there is insufficient communication and interprofessional collaboration between parents and Emergency Department staff. Further research is needed to foster and improve therapeutic relationships between APN-mothers and healthcare providers. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Findings can inform the development of family centred care guidelines for healthcare professional parents and their children. IMPACT This study explores the experiences of an understudied population. This research will impact APN-mothers, healthcare professionals in the Emergency Department as well as nursing students and researchers. REPORTING METHOD EQUATOR guidelines and SRQR reporting method used. PATIENT OR PUBLIC CONTRIBUTION APN-mothers, caregivers and support persons of children with chronic disease enacted investigator-participant roles and were involved in each step of the study process. In addition, some patients (participants' children with chronic diseases) were included in data collected.
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Affiliation(s)
- Kateryna Metersky
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Valerie Tan
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Areej Al-Hamad
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Cristina Catallo
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Donna Koller
- School of Early Childhood Studies, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Kiran Patel
- North Lambton Community Health Centre, Lambton Shores, Ontario, Canada
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De Rosis C, Teixeira M, Jovic L. Nursing boundaries and work identity construction among nurses exercising an advanced role: A qualitative study. Heliyon 2023; 9:e18590. [PMID: 37560657 PMCID: PMC10407137 DOI: 10.1016/j.heliyon.2023.e18590] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
Research on the deployment of advanced practice nurses (APNs) in healthcare settings highlights significant challenges for APNs transitioning to a broader, less well-defined nursing role in negotiating professional boundaries and a new work identity with other health workers. However, theories of boundary-work and professional identity have been rarely applied to APNs relationships with general nurses and colleagues in lower professional position such as nursing-assistants. APNs relationships with these colleagues remain poorly understood. This article aims to contribute to addressing this gap. It is based on qualitative research on a pilot-project prefiguring the introduction of APN (pre-APN) in the French Health system entitled the Prefiguration of Clinical Nurse Specialists (PrefICS). Data were collected through field observations and interviews with pre-APNs, general nurses, nursing-assistants, doctors and nursing hierarchy, to assess the implementation of PrefICS project in four hospitals, one health centre and one cancer control centre. The analysis shows that facing the risk of their role being limited to collaborations with doctors, pre-APNs engaged in different forms of boundary-work with general nurses and nursing-assistants, to negotiate new professional relationships with these colleagues. Some pre-APNs presented themselves as resource persons and led activities aimed at developing and sharing nursing knowledges and competencies with general nurses and nursing-assistants. Other pre-APNs shaped their work identity around a reformist role in terms of both the nursing profession and work environments. Pre-APNs boundary work with general nurses and nursing-assistants produced work spaces in which pre-APNs interwove their work identity with these colleagues by negotiating new professional ties and brokering knowledges between different professional worlds. Changes in levels of pre-APN self-categorization reflected different views of the nursing and nursing-assistant professions, from which pre-APNs started building new alliances for a shared reflective work on their practice and about caring.
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Affiliation(s)
- Carolina De Rosis
- Researcher University of Paris cité, INSERM ECEVE UMR1123, Paris, France
- Université Paris Cité, Inserm, ECEVE, F-75010 Paris, France
| | - Maria Teixeira
- Researcher University of Paris cité, INSERM ECEVE UMR1123, Paris, France
- Université Paris Cité, Inserm, ECEVE, F-75010 Paris, France
| | - Ljiljana Jovic
- Researcher University of Paris cité, INSERM ECEVE UMR1123, Paris, France
- Université Paris Cité, Inserm, ECEVE, F-75010 Paris, France
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Barrott L, Wiseman T, Tsianakas V, Czuber-Dochan W. Nurse and pharmacist systemic anti-cancer therapy review clinics and their impact on patient experience and care: A systematic review. J Adv Nurs 2023; 79:442-453. [PMID: 36448339 PMCID: PMC10100432 DOI: 10.1111/jan.15512] [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: 05/22/2022] [Revised: 10/25/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022]
Abstract
AIM To review the evidence of how nurse and pharmacist roles have been incorporated into the management of patients undergoing systemic anti-cancer therapy (SACT) services and their impact on patient experience and care provision. DESIGN Systematic Review. DATA SOURCES Seven databases were searched on 10 April 2022. REVIEW METHODS Research studies that met defined inclusion criteria were included. Quantitative findings were converted into textual descriptions and combined with qualitative results for thematic analysis. Data were categorized and aggregated into themes. Heterogeneity of studies meant meta-analysis was not possible. RESULTS Fifteen papers were included. Three main themes were identified: advanced clinical practice (ACP) SACT service development; ACP skills and qualifications; and the impact of ACP SACT services on patient care and outcomes. There is a variation in tasks undertaken by nurses and pharmacists and role integration is restricted by limited physician engagement. Role titles used and skills and qualifications acquired differ and professional autonomy is variable. Qualitative studies were limited. CONCLUSION Evidence of how nursing and pharmacist ACP roles are implemented, what skills are essential and how roles are impacting patient experience and outcomes is limited. More research is required to explore patient and physician experience of, and satisfaction with multi-professional care, alongside further evaluation of clinical delivery models.
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Affiliation(s)
- Lisa Barrott
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK.,Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Theresa Wiseman
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,The Royal Marsden NHS Foundation Trust, London, UK
| | - Vicki Tsianakas
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Lake S, Rudge T, West S. Braided identities in acute care nurses' practices of work: professional, clinician, employee. JOURNAL OF ORGANIZATIONAL ETHNOGRAPHY 2022. [DOI: 10.1108/joe-04-2022-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PurposeThis paper aims to explore how dispositions of nursing habitus carry shift handover into practice in acute care.Design/methodology/approachHandover (the exchange of information by nurses between shifts) is more recently purported to be a procedure that transfers the responsibility of and accountability for care to maintain patient safety. Using Bourdieu's theory of practice as lens, this paper examines data from an ethnographic study of nurses' work in acute care to reveal what happens in and around nurses' practices of handover.FindingsExploring handover as a practice enables identification of nurses' responsibilities of work as professional, clinician and employee. These responsibilities are not practised separately, rather, as braided identities they are embodied into nurses' practices of work. Nurses' clinician and employee identities address the clinical and organisationally relevant material contained in handover, but it is in the ways that nurses embody their responses that their professional identity becomes evident.Research limitations/implicationsViewing handover as a procedure suggests that nurses are rule followers and/or sole players and conceptualises nurses as individualised professionals only. This received knowledge as doxa misrecognises the centrality of connectedness between nurses in their work in the acute care setting.Originality/valueRecognising nurses' braided workplace identities as being professional, clinician and employee upends the doxa of nurses work as tasks and roles in the delivery of healthcare in the acute care setting.
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Lewis R. The evolution of advanced nursing practice: Gender, identity, power and patriarchy. Nurs Inq 2022; 29:e12489. [PMID: 35279899 PMCID: PMC9787357 DOI: 10.1111/nin.12489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 12/30/2022]
Abstract
To address longstanding workforce shortages, increase efficiency and control the costs associated with the modern health-care provision, there has been a worldwide policy to promote increased flexibility within the health-care workforce. This is being done primarily by extending the 'scope of practice' of existing occupational roles into what is referred to as 'advanced' practice. The development of the advanced practice nurse (APN) has occurred within the context of a shortage of medical staff, and the need to control cost. However, the means by which substantially repurposed occupational groups such as these, are incorporated into complex, hierarchical organisations such as the UK national health service (NHS) remains poorly understood. Using modern sociological theory, the development of the APN role has been examined in terms of power, control, professional identity and gender relations. Each of the theoretical approaches used adds to the quality of the discussion, although none provide a comprehensive picture. However, when synthesised, they do provide an enhanced insight into the evolution of the role. It is argued here that by critically examining the development of the APN role, this will enable both a better understanding of, and the means to influence, its future direction of travel.
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Affiliation(s)
- Robin Lewis
- Applied Health and Social Care Research Centre, College of Health, Wellbeing and LifesciencesSheffield Hallam UniversitySheffieldUK
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Alqahtani FM, Salvador JT, Dorgham SR, Al-Garni R, Alvarez MOC, Rosario AB, Easow RJ, Reyes LD, Cabonce SG, Sanchez KB. A phenomenological exploration of nurse educators' roles in Saudi Arabia's Vision 2030. J Nurs Manag 2022; 30:3102-3112. [PMID: 35696553 DOI: 10.1111/jonm.13718] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/08/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022]
Abstract
AIM The purpose of this study is to examine the roles of nurse educators through the eyes of undergraduate and graduate students at selected Saudi Arabian universities in the context of Vision 2030, an initiative to transform the socio-economic reform plan that is opening Saudi Arabia worldwide based on the following three pillars: a vital society, a thriving economy and an ambitious nation. BACKGROUND Nursing education in Saudi Arabia has faced numerous obstacles due to cultural, educational, organizational and work-related factors, discouraging registered nurses and students enrolled in undergraduate and graduate programmes from pursuing career paths in nursing education. METHODS Descriptive phenomenology was used as the method. Twenty-two nursing students from selected government and private universities in Saudi Arabia's Eastern Region were recruited through purposive sampling and semi-structured in-depth interviews. The COREQ criteria list was adapted to report the study's findings. RESULTS Four themes emerged regarding how nursing students perceived nurse educators' roles, including philanthropists of learning, advocates for patient safety and quality service, proponents of individual transformation and beacons of hope for nursing's future. CONCLUSION Despite rapidly changing images, ideologies and perceptions of modernization and worldwide freedom of expression and speech, students continue to have positive perspectives on nurse educators' roles. IMPLICATIONS FOR NURSING MANAGEMENT The study's findings will provide an initiative for nurse managers and leaders to revisit the roles of nurse educators in moulding future generations of registered nurses and realign these roles towards the goals and objectives of Saudi Vision 2030.
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Affiliation(s)
- Friyal M Alqahtani
- Department of Community Health Nursing, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Jordan T Salvador
- Department of Nursing Education, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sherien R Dorgham
- Department of Nursing Education, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rima Al-Garni
- Department of Fundamentals of Nursing, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Marc Oneel C Alvarez
- Department of Fundamentals of Nursing, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahrjaynes B Rosario
- Department of Nursing Education, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Robin J Easow
- Department of Community Health Nursing, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Lilibeth D Reyes
- Department of Nursing Education, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Suzette G Cabonce
- Department of Fundamentals of Nursing, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Kathlynn B Sanchez
- Department of Nursing Education, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Cheng J, Cui J, Yu W, Kang H, Tian Y, Jiang X. Factors influencing nurses' behavioral intention toward caring for COVID-19 patients on mechanical ventilation: A cross-sectional study. PLoS One 2021; 16:e0259658. [PMID: 34739532 PMCID: PMC8570482 DOI: 10.1371/journal.pone.0259658] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/23/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To investigate nurses' behavioral intention toward caring for COVID-19 patients on mechanical ventilation, as well as the factors affecting their intention. BACKGROUND COVID-19 patients undergoing mechanical ventilation have many care needs and pose more challenges for nurses, which might adversely affect nurses' intention toward caring behavior. METHODS A cross-sectional study was conducted by using simple random sampling to recruit 598 nurses from five tertiary hospitals in Sichuan Province, China. The participants responded to an online questionnaire that included questions on demographic characteristics; the Attitude, Subjective Norms, and Behavioral Intention of Nurses toward Mechanically Ventilated Patients (ASIMP) questionnaire; the Nursing Professional Identity Scale (NPIS); and the Compassion Fatigue-Short Scale (CF-Short Scale). ANOVA, Spearman correlation analysis, and multiple linear regression were performed to analyze the data. RESULTS The mean total behavioral intention score was 179.46 (± 14.83) out of a total score of 189.00, which represented a high level of intention toward caring for patients on mechanical ventilation. Multiple linear regression revealed that subjective norms (β = 0.390, P<0.001), perceived behavioral control (β = 0.149, P<0.001), professional identity (β = 0.101, P = 0.009), and compassion fatigue (β = 0.088 P = 0.024) were significant predictors of nurses' behavioral intention. CONCLUSIONS Most nurses have a positive behavioral intention to care for COVID-19 patients undergoing mechanical ventilation. The findings in this study provide some insight for developing effective and tailored strategies to promote nurses' behavioral intention toward caring for ventilated patients under the pandemic situation.
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Affiliation(s)
- Jingxia Cheng
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Sichuan, China
| | - Jinbo Cui
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Sichuan, China
| | - Wenwen Yu
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Sichuan, China
| | - Hua Kang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Yongming Tian
- West China Hospital, Sichuan University, Sichuan, China
| | - Xiaolian Jiang
- West China School of Nursing, Sichuan University/West China Hospital, Sichuan University, Sichuan, China
- * E-mail:
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Experiences of out-of-hours task-shifting from GPs: a systematic review of qualitative studies. BJGP Open 2021; 5:BJGPO.2021.0043. [PMID: 34158369 PMCID: PMC8450886 DOI: 10.3399/bjgpo.2021.0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background The current GP workforce is insufficient to manage rising demand in patient care within out-of-hours (OOH) primary care services. To meet this challenge, non-medical practitioners (NMPs) are employed to fulfil tasks traditionally carried out by GPs. It is important to learn from experiences of task-shifting in this setting to inform optimal delivery of care. Aim To synthesise qualitative evidence of experiences of task-shifting in the OOH primary care setting. Design & setting Systematic review of qualitative studies and thematic synthesis. Method Electronic searches were conducted across CINAHL (Cumulative Index of Nursing and Allied Health Literature), PsychINFO, Cochrane, MEDLINE, Embase, and OpenGrey for qualitative studies of urgent or OOH primary care services, utilising task-shifting or role delegation. Included articles were quality appraised and key findings collated through thematic synthesis. Results A total of 2497 studies were screened, of which six met the inclusion criteria. These included interviews with 15 advanced nurse practitioners (ANPs), three physician assistants (PAs), two paramedics, and a focus group of 22 GPs, and focus groups with 33 nurses. Key findings highlight the importance of clearly defining and communicating the scope of practice of NMPs, and of building their confidence by appropriate training, support, and mentoring. Conclusion While NMPs may have the potential to make a substantial contribution to OOH primary care services, there has been very little research on experiences of task-shifting. Evidence to date highlights the need for further training specific to OOH services. Mentorship and support to manage the sometimes challenging cases presenting to OOH could enable more effective OOH services and better patient care.
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Evans C, Poku B, Pearce R, Eldridge J, Hendrick P, Knaggs R, Blake H, Yogeswaran G, McLuskey J, Tomczak P, Thow R, Harris P, Conway J, Collier R. Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review. BMJ Open 2021; 11:e048171. [PMID: 34353799 PMCID: PMC8344309 DOI: 10.1136/bmjopen-2020-048171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/23/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES In response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the UK. This review was undertaken to establish a baseline of evidence on ACP roles and their outcomes, impacts and implementation challenges across the UK. DESIGN A scoping review was undertaken following JBI methodological guidance. METHODS 13 online databases (Medline, CINAHL, ASSIA, Embase, HMIC, AMED, Amber, OT seeker, PsycINFO, PEDro, SportDiscus, Osteopathic Research and PenNutrition) and grey literature sources were searched from 2005 to 2020. Data extraction, charting and summary was guided by the PEPPA-Plus framework. The review was undertaken by a multi-professional team that included an expert lay representative. RESULTS 191 papers met the inclusion criteria (any type of UK evidence, any sector/setting and any profession meeting the Health Education England definition of ACP). Most papers were small-scale descriptive studies, service evaluations or audits. The papers reported mainly on clinical aspects of the ACP role. Most papers related to nursing, pharmacy, physiotherapy and radiography roles and these were referred to by a plethora of different titles. ACP roles were reported to be achieving beneficial impacts across a range of clinical and health system outcomes. They were highly acceptable to patients and staff. No significant adverse events were reported. There was a lack of cost-effectiveness evidence. Implementation challenges included a lack of role clarity and an ambivalent role identity, lack of mentorship, lack of continuing professional development and an unclear career pathway. CONCLUSION This review suggests a need for educational and role standardisation and a supported career pathway for advanced clinical practitioners (ACPs) in the UK. Future research should: (i) adopt more robust study designs, (ii) investigate the full scope of the ACP role and (iii) include a wider range of professions and sectors.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Brenda Poku
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Ruth Pearce
- School of Education, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jeanette Eldridge
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Roger Knaggs
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Gowsika Yogeswaran
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - John McLuskey
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Philippa Tomczak
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Ruaridh Thow
- Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter Harris
- Health Education England East Midlands, Leicester, UK
| | - Joy Conway
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Richard Collier
- Centre for Advancing Practice, Health Education England, Leeds, UK
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Aguayo-González M, Weise C. Career Transition and Identity Development in Academic Nurses: A Qualitative Study. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2021. [DOI: 10.1080/10720537.2021.1936711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Crista Weise
- Department of Basic Psychology and Education, Universitat Autónoma de Barcelona, Bellaterra, Spain
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Lockwood EB, Lehwaldt D, Sweeney MR, Matthews A. 'An exploration of the levels of clinical autonomy of advanced nurse practitioners': A narrative literature review. Int J Nurs Pract 2021; 28:e12978. [PMID: 34109706 DOI: 10.1111/ijn.12978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/30/2021] [Accepted: 05/12/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The aims of the review are to synthesise current evidence about advanced nurse practitioner clinical autonomy and consider how this may inform clinical practice and research. BACKGROUND Clinical autonomy is one of the cornerstones of advanced nursing practice globally, yet there is limited synthesis of clinical autonomy in the literature. DESIGN This is a narrative literature review. DATA SOURCES The databases Cumulative Index to Nursing and Allied Health Literature, EBSCO host, Cochrane Library, CINAHL and MEDLINE were searched for publications between 2005 and 2020 inclusive. REVIEW METHODS A systematic approach was used to analyse the literature reviewed. Two reviewers undertook quality appraisal. RESULTS Nineteen articles were selected. Four major themes emerged: (1) 'ANP Stepping Up'-moving into and accepting advanced nursing practice roles and clinical responsibilities; (2) 'ANP Living It'-ANPs' ability to act independently including an understanding of task mastery and self-determination; (3) 'ANP Bounce-back ability'-depicted in challenges that threaten their ability to practice clinically autonomously; (4) 'ANP Setting in Motion'-indirect care activities and service-level improvements. CONCLUSION A clearer understanding of advanced nurse practitioner clinical autonomy could help develop more in-depth knowledge. Research of advanced nurse practitioners' clinical autonomy would improve full utilisation in clinical practice.
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Affiliation(s)
- Emily B Lockwood
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland.,Emergency Department, University Hospital Waterford, Waterford, Ireland
| | - Daniela Lehwaldt
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Mary Rose Sweeney
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Anne Matthews
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
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Scantlebury A, Brant H, Anderson H, Leggett H, Salisbury C, Cowlishaw S, Voss S, Benger JR, Adamson J. Potential impacts of general practitioners working in or alongside emergency departments in England: initial qualitative findings from a national mixed-methods evaluation. BMJ Open 2021; 11:e045453. [PMID: 34031113 PMCID: PMC8149439 DOI: 10.1136/bmjopen-2020-045453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the potential impacts of introducing General Practitioners into Emergency Departments (GPED) from the perspectives of service leaders, health professionals and patients. These 'expectations of impact' can be used to generate hypotheses that will inform future implementations and evaluations of GPED. DESIGN Qualitative study consisting of 228 semistructured interviews. SETTING 10 acute National Health Service (NHS) hospitals and the wider healthcare system in England. Interviews were undertaken face to face or via telephone. Data were analysed thematically. PARTICIPANTS 124 health professionals and 94 patients and carers. 10 service leaders representing a range of national organisations and government departments across England (eg, NHS England and Department of Health) were also interviewed. RESULTS A range of GPED models are being implemented across the NHS due to different interpretations of national policy and variation in local context. This has resulted in stakeholders and organisations interpreting the aims of GPED differently and anticipating a range of potential impacts. Participants expected GPED to affect the following areas: ED performance indicators; patient outcome and experience; service access; staffing and workforce experience; and resources. Across these 'domains of influence', arguments for positive, negative and no effect of GPED were proposed. CONCLUSIONS Evaluating whether GPED has been successful will be challenging. However, despite uncertainty surrounding the direction of effect, there was agreement across all stakeholder groups on the areas that GPED would influence. As a result, we propose eight domains of influence that will inform our subsequent mixed-methods evaluation of GPED. TRIAL REGISTRATION NUMBER ISRCTN51780222.
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Affiliation(s)
- Arabella Scantlebury
- York Trials Unit, Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Heather Brant
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | - Helen Anderson
- York Trials Unit, Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Heather Leggett
- York Trials Unit, Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Chris Salisbury
- School of Social and community medicine, University of Bristol, Bristol, UK
| | - Sean Cowlishaw
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Voss
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | - Jonathan Richard Benger
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
- Academic Department of Emergency Care, NHS Bristol North Somerset and South Gloucestershire Clinical Commissioning Group, Bristol, UK
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, North Yorkshire, UK
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Mateo-Martínez G, Sellán-Soto MC, Vázquez-Sellán A. The construction of contemporary nursing identity from narrative accounts of practice and professional life. Heliyon 2021. [DOI: 10.1016/j.heliyon.2021.e06942
expr 851849274 + 851121935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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Mateo-Martínez G, Sellán-Soto MC, Vázquez-Sellán A. The construction of contemporary nursing identity from narrative accounts of practice and professional life. Heliyon 2021; 7:e06942. [PMID: 34007932 PMCID: PMC8111597 DOI: 10.1016/j.heliyon.2021.e06942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/11/2021] [Accepted: 04/23/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To explore the contemporary narrative of nursing identity in Spain. METHOD This qualitative study was conducted between 2018 and 2020. Eleven registered nurses were interviewed. The conversations were recorded in audio, were semistructured, and held in a mental health clinic affiliated with a Catholic institution. Narrative analysis of the data was carried out. FINDINGS Two themes were identified: How do I construct my professional life?, with the subthemes 'Training and initiation in care practice', 'Ways of living the professional care experience', 'The sculpting of care' and 'Self-image and future projection'; and What do I know about my practice?, with the subthemes 'Nursing experience: shift, days, years', 'Strategy in the field of nursing care', 'Some foundations of caregiving practice', 'The specificity of the gesture of care' and 'Voice and recognition of nursing within the institution'. CONCLUSION Contemporary nursing identity is built in reflections on the epistemology of care, confronting the weight of tradition and breaking into new modes of self-image where the profession is legitimized and projected from historical consciousness. This claim can be used to support reflective practice in academic and healthcare settings as well as to promote a paradigm shift.
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Affiliation(s)
- Ginés Mateo-Martínez
- Faculty of Medicine of Autonomous University of Madrid (Doctoral Student), Spain
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Bell B. Towards abandoning the master's tools: The politics of a universal nursing identity. Nurs Inq 2020; 28:e12395. [PMID: 33332732 DOI: 10.1111/nin.12395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 11/28/2022]
Abstract
Healthcare environments continue to prove discriminatory and marginalizing towards patients and healthcare workers themselves, which contributes to inequitable health outcomes across lines of socially constructed difference. This content and discourse analysis of nursing identity scholarship asks whether there is a connection between nursing identity and oppressive behaviour by examining the construction of nursing identity and the foundational discourses, sometimes in absentia, that support such a construction. Bourdieu's concepts of social fields and Audre Lorde's concept of the master's house are applied as a framework towards understanding the constructs of power and status in healthcare. The analysis identifies a gap in nursing identity literature where social constructs of difference are not considered. In the reviewed literature, nursing identity has been co-opted by the professionalization project in effort to stabilize a conceptualization of nursing's contribution to healthcare towards gaining professional and societal status. This leads to a monolithic, apolitical representation of nursing identity that erases difference, denies historical influence, universalizes nursing work and further marginalizes marginalized identities. The oppressive and hegemonic nature of a universal nursing identity may contribute to a lack of disciplinary reflexivity about the ongoing influences of foundational discursive constructs of gender, epistemology, power and professional status.
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Affiliation(s)
- Blythe Bell
- Leadership Studies, University of Victoria, Victoria, BC, Canada
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Luo Q, Dor A, Pittman P. Optimal staffing in community health centers to improve quality of care. Health Serv Res 2020; 56:112-122. [PMID: 33090467 DOI: 10.1111/1475-6773.13566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To explore optimal workforce configurations in the production of care quality in community health centers (CHCs), accounting for interactions among occupational categories, as well as contributions to the volume of services. DATA SOURCES We linked the Uniform Data System from 2014 to 2016 with Internal Revenue Service nonprofit tax return data. The final database contained 3139 center-year observations from 1178 CHCs. STUDY DESIGN We estimated a system of two generalized linear production functions, with quality of care and volume of services as outputs, using the average percent of diabetic patients with controlled A1C level and hypertensive patients with controlled blood pressure as quality measures. To explore the substitutability and complementarity between staffing categories, we estimated a revenue function. FINDINGS Primary care physicians and advanced practice clinicians achieve similar quality outcomes (3.2 percent and 3.0 percent improvement in chronic condition management per full-time equivalent (FTE), respectively). Advanced practice clinicians generate less revenue per FTE but are generally less costly to employ. CONCLUSION As quality incentives are further integrated into payment systems, CHCs will need to optimize their workforce configuration to improve quality. Given the relative efficiency of advanced practice clinicians in producing quality, further hiring of these professionals is a cost-effective investment for CHCs.
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Affiliation(s)
- Qian Luo
- The Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, Department of Health Policy and Management, The George Washington University, Washington, District of Columbia, USA
| | - Avi Dor
- Milken Institute School of Public Health, Department of Health Policy and Management, The George Washington University, Washington, District of Columbia, USA.,National Bureau of Economic Research, Cambridge, Massachusetts, USA
| | - Patricia Pittman
- The Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, Department of Health Policy and Management, The George Washington University, Washington, District of Columbia, USA
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Li Z, Zuo Q, Cheng J, Zhou Y, Li Y, Zhu L, Jiang X. Coronavirus disease 2019 pandemic promotes the sense of professional identity among nurses. Nurs Outlook 2020; 69:389-398. [PMID: 33077203 PMCID: PMC7538146 DOI: 10.1016/j.outlook.2020.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/13/2020] [Accepted: 09/20/2020] [Indexed: 02/08/2023]
Abstract
Background Under the COVID-19 pandemic, nurses are the mainstay in the fight against the pandemic. Purpose To evaluate potential impact of the pandemic on nurses’ professional identity. Method Self-report questionnaires were distributed online. Data collected were compared with available norms. Multivariate logistic regression analyses were employed to calculate the OR of frontline vs. nonfrontline nurses. Findings The mean of the total score of the scale was 121.12 out of 150. Both the total score and scores on the five dimensions were significantly higher than norms. Frontline nurses had a significantly higher professional identity than non-frontline nurses (total score: odds ratio [OR], 1.19; professional identity evaluation: OR, 1.27; professional social support: OR, 1.18; professional social proficiency: OR, 1.33; and dealing with professional frustration: OR, 1.19). The most frequently mentioned tags were Hope, Frontline, Protection, Outbreak, Work, Situation. Discussion COVID-19 outbreak was associated with an enhancement in the professional identity of nurses.
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Affiliation(s)
- Zhuyue Li
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Qiantao Zuo
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Jingxia Cheng
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Yu Zhou
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Yingying Li
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Longling Zhu
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Xiaolian Jiang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China.
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Carryer J. Pride, power and professional trust in each other are essential if we are to move forward in this year of the nurse. J Clin Nurs 2020; 29:3577-3579. [DOI: 10.1111/jocn.15377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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