1
|
Serra-Barril MA, Ferro-Garcia T, Fernandez-Ortega P, Sanchez-Lopez C, Martinez-Momblan MA, Benito-Aracil L, Romero-Garcia M. The role experience of advanced practice nurses in oncology: An interpretative phenomenological study. J Adv Nurs 2024; 80:2512-2524. [PMID: 38054402 DOI: 10.1111/jan.15997] [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: 08/05/2023] [Revised: 11/06/2023] [Accepted: 11/19/2023] [Indexed: 12/07/2023]
Abstract
AIM(S) To understand the experiences of advanced practice nurses working in cancer care. DESIGN Phenomenological qualitative study. METHODS Three focus groups were held to collect qualitative data. Participants were recruited through theoretical non-probabilistic sampling of maximum variation, based on 12 profiles. Data saturation was achieved with a final sample of 21 oncology advanced practice nurses who were performing advanced clinical practice roles in the four centers from December 2021 to March 2022. An interpretative phenomenological analysis was performed following Guba and Lincoln's criteria of trustworthiness. The centers' ethics committee approved the study, and all participants gave written informed consent. Data analysis was undertaken with NVivo 12 software. RESULTS Three broad themes emerged from the data analysis: the role performed, facilitators and barriers in the development of the role and nurses' lived experience of the role. CONCLUSION Advanced practice nurses are aware that they do not perform their role to its full potential, and they describe different facilitators and barriers. Despite the difficulties, they present a positive attitude as well as a capacity for leadership, which has allowed them to consolidate the advanced practice nursing role in unfavourable environments. IMPLICATIONS FOR THE PROFESSION These results will enable institutions to establish strategies at different levels in the implementation and development of advanced practice nursing roles. REPORTING METHOD Reporting complied with COREQ criteria for qualitative research. PATIENT OR PUBLIC CONTRIBUTIONS No patient or public contribution.
Collapse
Affiliation(s)
- M Antònia Serra-Barril
- Innovation and Quality Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, L'Hospitalet, Spain
| | - Tàrsila Ferro-Garcia
- Innovation and Quality Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, L'Hospitalet, Spain
| | - Paz Fernandez-Ortega
- Department of Public Health, Mental Health and Maternal Care, Faculty of Medicine and Health Sciences, University of Barcelona, Campus Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Sanchez-Lopez
- Catalan Institute of Oncology, Oncology Hospitalization/Inpatient Unit, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Antonia Martinez-Momblan
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, L'Hospitalet, Spain
| | - Llúcia Benito-Aracil
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, L'Hospitalet, Spain
- IDIBELL, Institute of Biomedical Research, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Romero-Garcia
- Department of Fundamental and Clinical Nursing, Faculty of Nursing, University of Barcelona, L'Hospitalet, Spain
| |
Collapse
|
2
|
Nightingale J, Ali N, Lewis R, Ibbotson R, Monks H, Urquhart-Kelly T, Saunders L. Transforming nursing care for children with serious long-term conditions: A mixed methods exploration of the impact of Roald Dahl Specialist Nurses in the United Kingdom. J Pediatr Nurs 2023; 70:90-102. [PMID: 36848741 DOI: 10.1016/j.pedn.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/15/2023] [Accepted: 02/09/2023] [Indexed: 02/27/2023]
Abstract
PURPOSE A new model of paediatric nursing, funded initially by a charitable organisation working in partnership with UK healthcare providers, was implemented to support children living with serious long-term conditions. This study explored, from the perspective of multiple stakeholders, the impact of services provided by 21 'Roald Dahl Specialist Nurses' (RDSN) within 14 NHS Trust hospitals. DESIGN AND METHODS A Mixed Methods Exploratory design commenced with interviews with RDSNs (n = 21) and their managers (n = 15), alongside a medical clinician questionnaire (n = 17). Initial themes (constructivist grounded theory) were validated through four RDSN focus groups, and informed development of an online survey of parents (n = 159) and children (n = 32). Findings related to impact were integrated using a six-step triangulation protocol. RESULTS Zones of significant impact included: Improving quality and experience of care; Improved efficiencies and cost-effectiveness; Provision of holistic family-centred care; and Impactful leadership and innovation. The RDSNs forged networks across inter-agency boundaries to safeguard the child and enhance the family experience of care. RDSNs delivered improvements across a range of metrics, and were valued for their emotional support, care navigation and advocacy. CONCLUSIONS Children living with serious long-term conditions have complex needs. Regardless of the specialty, location, organisation or service focus, this new model of care crosses organisational and inter-agency boundaries to ensure that the healthcare delivered has maximum impact. It has a profoundly positive impact on families. PRACTICE IMPLICATIONS This integrated and family-centred model of care is strongly recommended for children with complex needs crossing organisational divides.
Collapse
Affiliation(s)
- Julie Nightingale
- Centre for Applied Health and Social Care Research (CARe), Sheffield Hallam University, United Kingdom.
| | - Nancy Ali
- Centre for Applied Health and Social Care Research (CARe), Sheffield Hallam University, United Kingdom
| | - Robin Lewis
- Centre for Applied Health and Social Care Research (CARe), Sheffield Hallam University, United Kingdom
| | - Rachel Ibbotson
- Centre for Applied Health and Social Care Research (CARe), Sheffield Hallam University, United Kingdom
| | - Helen Monks
- Centre for Applied Health and Social Care Research (CARe), Sheffield Hallam University, United Kingdom
| | - Tanya Urquhart-Kelly
- Centre for Applied Health and Social Care Research (CARe), Sheffield Hallam University, United Kingdom
| | - Lesley Saunders
- Centre for Applied Health and Social Care Research (CARe), Sheffield Hallam University, United Kingdom
| |
Collapse
|
3
|
Woodman H, Spencer S. Advanced clinical practice in paediatric haematology and oncology: developing a capability document. Nurs Child Young People 2023; 35:27-33. [PMID: 35875922 DOI: 10.7748/ncyp.2022.e1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 01/06/2023]
Abstract
Specialist roles have been developed to provide holistic care to children and young people with cancer, one of which is the advanced clinical practitioner (ACP) in paediatric oncology and haematology. A survey showed that paediatric oncology and haematology ACPs in the UK work in a wide variety of roles and that their numbers vary greatly between treatment centres. The survey also confirmed the need for a national standardised framework delineating the knowledge, skills and expertise required of ACPs working in paediatric oncology and haematology. This article describes the development of a capability document to support and standardise advanced practice in paediatric oncology and haematology. The document reflects the advanced level of critical thinking, autonomy and decision-making required of ACPs and has been endorsed by the Children's Cancer and Leukaemia Group and by the Royal College of Nursing. It is hoped that it will support ACPs to consistently deliver high-quality, safe care for the benefit of children and young people with cancer and their families.
Collapse
Affiliation(s)
- Helen Woodman
- oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, England
| | - Sally Spencer
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, England
| |
Collapse
|
4
|
Wang H, English M, Chakma S, Namedre M, Hill E, Nagraj S. The roles of physician associates and advanced nurse practitioners in the National Health Service in the UK: a scoping review and narrative synthesis. HUMAN RESOURCES FOR HEALTH 2022; 20:69. [PMID: 36109746 PMCID: PMC9479410 DOI: 10.1186/s12960-022-00766-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 09/07/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Mid-level practitioners (MLPs), including physician associates (PAs) and advanced nurse practitioners (ANPs), have emerged to address workforce shortages in the UK and perform specific roles in relation to population needs. This has resulted in new ways of working and changes to established professional hierarchies. We conducted a study to investigate the career development, competencies, effectiveness, perceptions, and regulation of PAs and ANPs, with the aim of understanding ways to effectively integrate MLPs into the NHS workforce. METHODS We conducted a systematic scoping review following PRISMA guidelines. Embase, Medline, the Cochrane database, Pubmed, and CINAHL databases were searched, using terms relating to PAs and ANPs in the UK. A total of 128 studies (60 on PAs and 68 on ANPs) were included in the final analysis. A narrative synthesis, guided by the pre-defined themes and emerging themes, was conducted to bring together the findings. RESULTS PAs are educated on a medical model with basic medical skills but lack formal professional regulation and do not have prescribing rights. ANPs are educated on a nurse model with enhanced skills that depend on roles within specific specialities, and their governance is mostly employer-led. PAs are primarily employed in secondary care. ANPs are employed widely in both primary and secondary care. No defined career progression exists for PAs. In contrast, becoming an ANP is a form of career progression within nursing. Both roles were regarded as cost-effective in comparison to doctors performing simple tasks. PAs were less understood compared to ANPs and received a mixed reception from colleagues, which sometimes undermined their professional identity, whereas ANPs were mostly welcomed by colleagues. CONCLUSIONS Potential ways to better integrate PAs and ANPs into the NHS workforce include further initiatives by regulatory bodies and the NHS to create more awareness and clearer role definitions for MLPs, outline potential for career progression, offer transparency with regard to remuneration, and introduction of prescribing rights. Future research might include more cadres of MLPs and explore the international literature.
Collapse
Affiliation(s)
- Hanyu Wang
- Nuffield Department of Medicine, Oxford Centre for Global Health Research, University of Oxford, Oxford, UK.
| | - Mike English
- Nuffield Department of Medicine, Oxford Centre for Global Health Research, University of Oxford, Oxford, UK
- KEMRI-Wellcome Trust Research Programme, KEMRI-Wellcome Trust, Nairobi, Kenya
| | - Samprita Chakma
- Nuffield Department of Medicine, Oxford Centre for Global Health Research, University of Oxford, Oxford, UK
| | | | - Elaine Hill
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Shobhana Nagraj
- Nuffield Department of Medicine, Oxford Centre for Global Health Research, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Fothergill LJ, Al-Oraibi A, Houdmont J, Conway J, Evans C, Timmons S, Pearce R, Blake H. Nationwide evaluation of the advanced clinical practitioner role in England: a cross-sectional survey. BMJ Open 2022; 12:e055475. [PMID: 34987045 PMCID: PMC8734004 DOI: 10.1136/bmjopen-2021-055475] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND STUDY OBJECTIVE In response to growing pressures on healthcare systems, the advanced clinical practice (ACP) role has been implemented widely in the UK and internationally. In England, ACP is a level of practice applicable across various healthcare professions, who exercise a level of autonomy across four domains, referred to as the four pillars of practice (education, leadership, research and clinical practice). A national framework for ACP was established in 2017 to ensure consistency across the ACP role, however current ACP governance, education and support is yet to be evaluated. This study aimed to analyse data from a national survey of the ACP role to inform the development and improvement of policies relating to ACP in the National Health Service (NHS) in England. DESIGN A cross-sectional survey with free-text comments. SETTING The survey was distributed across primary and secondary levels of care to three distinct groups in England, including individual ACPs, NHS provider organisations and Trusts and primary care settings. PARTICIPANTS A total of 4365 surveys were returned, from ACP staff (n=4013), NHS provider organisations and Trusts (n=166) and primary care organisations (n=186). RESULTS Considerable variation was found in role titles, scope of practice, job descriptions and educational backgrounds of ACPs. Differing approaches to governance were noted, which led to inconsistent ACP frameworks in some organisations. A further challenge highlighted included committing time to work across the four pillars of advanced practice, particularly the research pillar. ACPs called for improvements in supervision and continuing professional development alongside further support in navigating career pathways. CONCLUSIONS A standardised approach may support ACP workforce development in England and enable ACPs to work across the four pillars of practice. Due to the wide uptake of ACP roles internationally, this study has relevance across professions for global healthcare workforce transformation.
Collapse
Affiliation(s)
| | - Amani Al-Oraibi
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Joy Conway
- Centre for Health, Medicine and Life Sciences, Brunel University London, Uxbridge, Middlesex, UK
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Stephen Timmons
- University of Nottingham Business School, Nottingham, Nottingham, UK
| | - Ruth Pearce
- School of Nursing, AHPs and Midwifery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Holly Blake
- NIHR Nottingham Biomedical Research Centre, Nottingham, Nottinghamshire, UK
- University of Nottingham School of Health Sciences, Nottingham, Nottinghamshire, UK
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Wood E, King R, Robertson S, Allmark P, Senek M, Tod A, Ryan T. Advanced practice nurses' experiences and well-being: Baseline demographics from a cohort study. J Nurs Manag 2021; 28:959-967. [PMID: 32501626 DOI: 10.1111/jonm.13030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 11/27/2022]
Abstract
AIMS To create a cohort of advanced practice nurses from across the UK and to report the initial questionnaire including demographics, work experiences and well-being. BACKGROUND In the UK, advanced nursing practice is not regulated. This has led to the concern that advanced nurses are working in very different ways with different levels of autonomy and support. METHODS Participants were recruited via university and Royal College of Nursing mailing lists, and social media adverts. They completed the initial questionnaire about their background and workplace, work experiences, credentialing and well-being. RESULTS A total of 143 nurses were recruited to the cohort and 86 completed the survey. Over 40 job titles were reported, across five pay bands. Job title was not correlated with pay band (p = .988). Participant well-being was not significantly different from the UK general population, but they reported high rates of work-related stress (44.2%) compared with the National Health Service national average (37.9%). CONCLUSION There is a wide disparity in pay, which is not reflected in title or setting. The high levels of work-related stress require further exploration. IMPLICATIONS FOR NURSING MANAGEMENT The range of experiences reported here should encourage managers to evaluate whether title, pay and support mechanisms for Advanced Practice Nurses in their organisations align with suggested national standards set by Royal Colleges and government departments.
Collapse
Affiliation(s)
- Emily Wood
- Health Sciences School, Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Rachel King
- Health Sciences School, Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Steve Robertson
- Health Sciences School, Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK.,Leeds Beckett University, Leeds, UK.,Waterford Institute of Technology, Waterford City, Ireland
| | - Peter Allmark
- Health Sciences School, Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Michaela Senek
- Health Sciences School, Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Angela Tod
- Health Sciences School, Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Tony Ryan
- Health Sciences School, Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| |
Collapse
|
8
|
Kerr H, Donovan M, McSorley O. Evaluation of the role of the clinical Nurse Specialist in cancer care: an integrative literature review. Eur J Cancer Care (Engl) 2021; 30:e13415. [PMID: 33501707 DOI: 10.1111/ecc.13415] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/18/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although there is growing evidence the Clinical Nurse Specialist role makes a difference to patient care, the full value of this service may not be always appreciated with current models not meeting the needs of those with cancer. The primary aim of this integrative literature review was to evaluate outcomes associated with the role of the Clinical Nurse Specialist in cancer care. The secondary aim was to identify the components of the Clinical Nurse Specialist role in cancer care from the included papers in the literature review. METHODS An integrative literature review using a systematic approach was adopted. Literature searches were undertaken in four databases and supplemented with a search in the grey literature and reference lists of included papers. Searches were limited to January 2009-July 2019 and those written in the English language. Three reviewers independently completed the searches and reviewed the papers before reaching a consensus. RESULTS Fourteen eligible research papers were identified. Evaluations were predominately positive with the role contributing to improving patient outcomes with regards psychological support, information provision, symptom management, service coordination and patient satisfaction. CONCLUSION The findings of this literature review firmly establish the Clinical Nurse Specialist as a valuable member of the multidisciplinary team in enhancing cancer care services.
Collapse
Affiliation(s)
- Helen Kerr
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University, Belfast, UK
| | - Monica Donovan
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University, Belfast, UK
| | - Oonagh McSorley
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University, Belfast, UK
| |
Collapse
|
9
|
Nigenda López GH, Aristizábal Hoyos GP. El liderazgo silencioso de la enfermería en México: reflexiones sobre su transformación. REVISTA CUIDARTE 2020. [DOI: 10.22201/fesi.23958979e.2020.9.18.1.77574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
<p><strong>Introducción. </strong>El objetivo del documento es argumentar que el liderazgo de enfermería en México tiene un enorme potencial por desarrollar y que en gran medida es silencioso. Se exponen casos para mostrar el liderazgo de la enfermería en el sistema de salud de México que no son reconocidos debidamente por los actores sociales y el Estado. <strong>Desarrollo. </strong>Se discuten un conjunto de características del liderazgo que la enfermería podría incorporar en su desarrollo y lograr avanzar hacia nuevas etapas de su estatus profesional, sus niveles de entrenamiento y su papel en la producción de servicios de salud. Particularmente, se hace énfasis en el desarrollo de un liderazgo colectivo que permita a la enfermería apoyar el alcance de objetivos sistémicos por encima objetivos grupales o individuales. A diferencia de otros grupos profesionales, la enfermería es entrenada sobre bases humanistas las cuáles han sido obliteradas por los cambios que las reformas de los sistemas de salud han traído consigo en las últimas dos décadas. <strong>Conclusión. </strong>Un liderazgo conspicuo de la enfermería debe basarse en preservar su formación humanista, en la capacidad de establecerse como par en las decisiones clínicas y gerenciales, en articular un plan consistente para el desarrollo de la enfermería en práctica avanzada y, finalmente, para fungir como un motor del cambio del sistema hacia el modelo de atención primaria a la salud.<strong></strong></p>
Collapse
|
10
|
Evans C, Pearce R, Greaves S, Blake H. Advanced Clinical Practitioners in Primary Care in the UK: A Qualitative Study of Workforce Transformation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124500. [PMID: 32585866 PMCID: PMC7344450 DOI: 10.3390/ijerph17124500] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 01/02/2023]
Abstract
Escalating costs and changing population demographics are putting pressure on primary care systems to meet ever more complex healthcare needs. Non-medical ‘advanced clinical practitioner’ (ACP) roles are increasingly being introduced to support service transformation. This paper reports the findings of a qualitative evaluation of nursing ACP roles across General Practices in one region of the UK. Data collection involved telephone interviews with 26 participants from 3 different stakeholder groups based in 9 practice sites: ACPs (n = 9), general practitioners (n = 8) and practice managers (n = 9). The data was analysed thematically. The study found a high degree of acceptance of the ACP role and affirmation of the important contribution of ACPs to patient care. However, significant variations in ACP education, skills and experience led to a bespoke approach to their deployment, impeding system-wide innovation and creating challenges for recruitment and ongoing professional development. In addition, a context of high workforce pressures and high service demand were causing stress and there was a need for greater mentorship and workplace support. System wide changes to ACP education and support are required to enable ACPs to realise their full potential in primary care in the UK.
Collapse
Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (R.P.); (S.G.); (H.B.)
- Correspondence:
| | - Ruth Pearce
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (R.P.); (S.G.); (H.B.)
| | - Sarah Greaves
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (R.P.); (S.G.); (H.B.)
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (R.P.); (S.G.); (H.B.)
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2HA, UK
| |
Collapse
|
11
|
Thompson J, Tiplady S, Hodgson P, Proud C. Scoping the application of primary care advanced clinical practice roles in England. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2020. [DOI: 10.1108/ijhg-03-2020-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study aims to scope the profile and application of an advanced clinical practitioner (ACP) roles in primary care in the North of England and how these roles meet the requirements of Health Education England's (HEE’s) ACP workforce capability framework.Design/methodology/approachA two-stage design was used. Stage 1 analysed health and social care workforce intelligence reports to inform scoping of numbers of ACPs working in primary care. Stage 2 used two surveys. Survey 1 targeted ACP leads and collected strategic-level data about ACP application. Survey 2 targeted staff who perceived themselves to be working as ACPs. Survey 2 was in three parts. Part 1 collected demographic data. Part 2 required participants to record their perceived competence against each of the HEE ACP framework capability criteria. Part 3 required respondents to identify facilitators and barriers to ACP practice.FindingsDespite the introduction of HEE's ACP capability framework, there is inconsistency and confusion about the ACP role. The results indicated a need for standardisation of role definition and educational and practice requirements. The results also suggested that some ACPs are not working to their full potential, while some staff who are employed as “gap-fillers” to provide routine clinical services perceive themselves as ACPs despite not working at the ACP level.Originality/valueAlthough previous research has explored the application of ACP practice in primary care, few studies have considered ACP application in the light of the introduction of workforce capability frameworks aimed at standardising ACP practice.
Collapse
|
12
|
Evans C, Poku B, Pearce R, Eldridge J, Hendrick P, Knaggs R, McLuskey J, Tomczak P, Thow R, Harris P, Conway J, Collier R. Characterising the evidence base for advanced clinical practice in the UK: a scoping review protocol. BMJ Open 2020; 10:e036192. [PMID: 32439696 PMCID: PMC7247387 DOI: 10.1136/bmjopen-2019-036192] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION A global health workforce crisis, coupled with ageing populations, wars and the rise of non-communicable diseases is prompting all countries to consider the optimal skill mix within their health workforce. The development of advanced clinical practice (ACP) roles for existing non-medical cadres is one potential strategy that is being pursued. In the UK, National Health Service (NHS) workforce transformation programmes are actively promoting the development of ACP roles across a wide range of non-medical professions. These efforts are currently hampered by a high level of variation in ACP role development, deployment, nomenclature, definition, governance and educational preparation across the professions and across different settings. This scoping review aims to support a more consistent approach to workforce development in the UK, by identifying and mapping the current evidence base underpinning multiprofessional advanced level practice in the UK from a workforce, clinical, service and patient perspective. METHODS AND ANALYSIS This scoping review is registered with the Open Science Framework (https://osf.io/tzpe5). The review will follow Joanna Briggs Institute guidance and involves a multidisciplinary and multiprofessional team, including a public representative. A wide range of electronic databases and grey literature sources will be searched from 2005 to the present. The review will include primary data from any relevant research, audit or evaluation studies. All review steps will involve two or more reviewers. Data extraction, charting and summary will be guided by a template derived from an established framework used internationally to evaluate ACP (the Participatory Evidence-Informed Patient-Centred Process-Plus framework). DISSEMINATION The review will produce important new information on existing activity, outcomes, implementation challenges and key areas for future research around ACP in the UK, which, in the context of global workforce transformations, will be of international, as well as local, significance. The findings will be disseminated through professional and NHS bodies, employer organisations, conferences and research papers.
Collapse
Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Brenda Poku
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Ruth Pearce
- School of 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, Nottinghamshire, 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, Nottingham, UK
| | - Joy Conway
- College of Health and Life Sciences, Brunel University, Uxbridge, UK
| | | |
Collapse
|
13
|
Abstract
Purpose
The purpose of this paper is to ascertain primary care advanced clinical practitioners’ (ACP) perceptions and experiences of what factors influence the development and identity of ACP roles, and how development of ACP roles that align with Health Education England’s capability framework for advanced clinical practice can be facilitated in primary care.
Design/methodology/approach
The study was located in the North of England. A qualitative approach was used in which 22 staff working in primary care who perceived themselves to be working as ACPs were interviewed. Data analysis was guided by Braun and Clarke’s (2006) six phase method.
Findings
Five themes emerged from the data – the need for: a standardised role definition and inclusive localised registration; access to/availability of quality accredited educational programmes relevant to primary care and professional development opportunities at the appropriate level; access to/availability of support and supervision for ACPs and trainee ACPs; a supportive organisational infrastructure and culture; and a clear career pathway.
Originality/value
Findings have led to the generation of the Whole System Workforce Framework of INfluencing FACTors (IN FACT), which lays out the issues that need to be addressed if ACP capability is to be maximised in primary care. This paper offers suggestions about how IN FACT can be addressed.
Collapse
|
14
|
Doyle-Cox C, Nicholson G, Stewart T, Gin-Sing W. Current organization of specialist pulmonary hypertension clinics: results of an international survey. Pulm Circ 2019; 9:2045894019855611. [PMID: 31106660 PMCID: PMC6557030 DOI: 10.1177/2045894019855611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Optimal pulmonary hypertension (PH) management relies on a timely, accurate diagnosis and follow-up in specialized clinics by multidisciplinary teams that have clearly defined responsibilities and protocols. Internationally agreed criteria for expert center staff are lacking, particularly with respect to nurses, who often act as a central component of the team. This survey aimed to evaluate the current organization of PH clinics and the role of nurses. The survey (35 questions) was online February-December 2015 and was advertised at international PH nurse meetings and through international PH organizations to their corresponding clinics. In total, 126 healthcare professionals from 32 countries responded. According to respondents, 54% of clinics managed >200 patients, of whom 49% had a pulmonary arterial hypertension (PAH) diagnosis, on average. In terms of staff, 66% had a dedicated program administrator, 35% had one full-time nurse coordinator/practitioner/specialist, and 57% had a nurse attend outpatient clinic alongside a physician. Crucially, not all centers had a nurse in their team. The role of a nurse coordinator/practitioner/specialist varied with 51% taking patient histories/examinations and 66% managing outpatients. In 34% of clinics, nurses were involved in their own research. Protocols were available for PH therapies (81%), management of heart failure (37%) and pain (26%), and referring patients who did not have PAH/chronic thromboembolic PH back to their specialist (62%). Not all clinics are meeting all of the standards outlined in the latest guidelines with key areas of improvement being level of support from/for nurses, clear protocols, and referral pathways.
Collapse
Affiliation(s)
| | | | - Traci Stewart
- 3 Heart and Vascular Center, University of Iowa, Iowa City, IA, USA
| | - Wendy Gin-Sing
- 4 Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
15
|
Nascimento WGD, Uchôa SADC, Coêlho AA, Clementino FDS, Cosme MVB, Rosa RB, Brandão ICA, Martiniano CS. Medication and test prescription by nurses: contributions to advanced practice and transformation of care. Rev Lat Am Enfermagem 2018; 26:e3062. [PMID: 30379247 PMCID: PMC6206830 DOI: 10.1590/1518-8345.2423-3062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 08/02/2018] [Indexed: 12/03/2022] Open
Abstract
Objective: To carry out a documentary study on the rules, guidelines, policies and
institutional support for the nurse to prescribe medicines and request tests
with a view to the advanced practice in the scope of Primary Health Care.
Methods: Documentary research using open-access institutional documents - Federal
Nursing Council (COFEN), its regional representations in the respective
Brazilian states (COREN) and the Brazilian Nursing Association (ABEN). Results: Most of the news/notices were issued by the Regional Nursing Councils in the
different Federative Units. The argumentation regarding the prescription of
medicines and request for tests by nurses is based on three categories:
Autonomy and competencies for the prescription of medicines and/or request
of tests; Corporate policies that undermine the full exercise of nursing;
and Transformation of health and nursing care in Primary Health Care. Conclusion: The prescriptive practice by nurses integrates health care and has been
defended by the institutions that represent the category. It emerges as an
important element of advanced practice and in the transformation of care in
the context of health teams.
Collapse
Affiliation(s)
| | | | | | | | | | - Rayone Bastos Rosa
- Universidade Estadual da Paraíba, Departamento de Enfermagem, Campina Grande, PB, Brazil
| | | | | |
Collapse
|
16
|
Ladd E, Schober M. Nurse Prescribing From the Global Vantage Point: The Intersection Between Role and Policy. Policy Polit Nurs Pract 2018; 19:40-49. [PMID: 30231768 DOI: 10.1177/1527154418797726] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nurses around the world are increasingly prescribing and managing pharmaceutical agents. Prescribing by nurses is currently based on varying nursing roles, depending on national and regional norms and practices. Prescribing occurs within the advance practice, advanced level, and task-sharing roles, depending on the country. It is evolving both within and outside of traditional regulatory frameworks. Therefore, the purpose of this article is to describe the nurse prescribing globally among various nursing roles that support and facilitate the practice. We gathered practice, statutory, and regulatory information from gray and peer-reviewed literature, Google search and Google scholar, government websites, PubMed, and CINAHL electronic databases. In contrast to previous global policy reviews that focus primarily on high-income nations, our findings suggest that nurse prescribing occurs extensively in all six continents. Nurse prescribing within the context of advanced practice nursing occurs mostly in high-income countries. However, the predominant model of nurse prescribing from the global context occurs within the advanced level role by postbasic or postprofessional nurses. Additional nurse prescribing occurs through less formal task-sharing arrangements, primarily in low- to middle-income countries. In general, nurse prescribing is evolving rapidly around the world but within highly variable roles and regulatory frameworks. Codifying these roles by strengthening of educational and regulatory standards may serve to enhance the health system capacity, especially in low- to middle-income countries.
Collapse
Affiliation(s)
- Elissa Ladd
- 1 School of Nursing, MGH Institute of Health Professions, Boston, MA, USA
| | - Madrean Schober
- 2 Schober Global Healthcare Consulting, International Healthcare Consultants, Indianapolis, IN, USA
| |
Collapse
|
17
|
Hyde R. An advanced nurse practitioner service for neonates, children and young people. Nurs Child Young People 2018; 29:36-41. [PMID: 29115771 DOI: 10.7748/ncyp.2017.e938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 11/09/2022]
Abstract
The NHS continues to face unprecedented demands and reform which necessitates a move away from traditional modes of delivery. Over the past ten years economic austerity, changes to legislation and professional career developments have led to healthcare service redesign and innovations in nursing roles, including the development of the advanced nurse practitioner (ANP) role. This article explores how one organisation created an ANP service for out-of-hours neonatal and paediatric care in a district general hospital setting. It was found that ANPs help to provide continuity of care, support learning, inspire continued professional development and lead on healthcare agendas. However, the ANP service faced factors not exclusive to local context including an ageing workforce, difficulties in recruiting and retaining suitably qualified staff and economic pressures. The future of the service depends on it overcoming these factors while demonstrating that the shift from traditional models of care can lead to a positive outcome.
Collapse
Affiliation(s)
- Robin Hyde
- Edinburgh Napier University, Edinburgh, Scotland
| |
Collapse
|
18
|
|