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Forbes MF, Carter N, MacKenzie KL, Kouroukis CT, Balonjan KS, Bryant-Lukosius DE. The Nurse Practitioner Role in Complex Malignant Hematology: A Qualitative Descriptive Study. Semin Oncol Nurs 2024; 40:151625. [PMID: 38556365 DOI: 10.1016/j.soncn.2024.151625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/16/2024] [Accepted: 03/08/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES Internationally, there is limited evidence about the role and impact of nurse practitioners (NPs) in complex malignant hematology (CMH). In one Canadian CMH program, NPs have existed for 20 years but not been evaluated. This study aimed to understand stakeholder perceptions of CMH NP role structures, processes, and outcomes and the extent to which the role meets patient and health service needs. METHODS A qualitative descriptive study was conducted, guided by the PEPPA-Plus framework. Purposive sampling was used to recruit stakeholders who participated in focus groups and interviews. Content analysis was used to analyze the data. RESULTS Participants included patients (n = 8) and healthcare professionals (n = 27). Themes about structures related to evolution of the CMH Program, model of care, and need for strategic vision. Process themes related to provision of accessible, comprehensive, and holistic care and NP workload. Positive and negative outcomes and lack of outcome measurement were identified. CONCLUSION Structures related to patient and NP characteristics, organizational change, staffing, and how NP work is organized impacts on NP role implementation and outcomes. Organizational structures can be strengthened to improve the model of care and NP role implementation and workload. Value-added NP contributions related to providing comprehensive care with attention to safety and social determinants of health. Research is needed to evaluate NP role outcomes in CMH. IMPLICATIONS FOR NURSING PRACTICE The results can inform role design and organization policies and strategies to promote the recruitment, retention, and optimization of NP roles in CMH settings. Priorities for future research are also identified.
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Affiliation(s)
- Margaret F Forbes
- Nurse Practitioner and Nurse Practitioner Lead for Hematology, Juravinski Hospital and Cancer Center at Hamilton Health Sciences and Assistant Clinical Professor, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nancy Carter
- Associate Professor and Assistant Dean Graduate Nursing Programs, Department Education Coordinator, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kristi L MacKenzie
- Director, Regional Cancer Program and Hematology, Juravinski Hospital and Cancer Centre at Hamilton Health Sciences, Hamilton, Ontario. Canada
| | - C Tom Kouroukis
- Hematologist, Juravinski Hospital and Cancer Centre at Hamilton Health Sciences and Associate Professor, Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kerry S Balonjan
- Registered Nurse and Graduate Student, School of Nursing, Faculty of Health Sciences, McMaster University Hamilton, Ontario, Canada
| | - Denise E Bryant-Lukosius
- Professor and Alba DiCenso Chair in Advanced Practice Nursing, School of Nursing, Faculty of Health Sciences, McMaster University; Scientist, Escarpment Cancer Research Institute; Clinician Scientist, Juravinksi Hospital and Cancer Centre at Hamilton Health Sciences, Hamilton, Ontario, Canada.
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Lockwood C, Tricco AC. Preparing scoping reviews for publication using methodological guides and reporting standards. Nurs Health Sci 2020; 22:1-4. [PMID: 32115893 DOI: 10.1111/nhs.12673] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/10/2019] [Accepted: 11/12/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Craig Lockwood
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Epidemiology Division, Dalla Lana School of Public Health and the Institute for Health, Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Queen's Collaboration for Health Care Quality, Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Ontario, Canada
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Winter SG, Duderstadt K, Chan GK, Spetz J, Stephan LM, Matsuda E, Chapman SA. Service Value Activities by Nurse Practitioners in Ambulatory Specialty Care. Policy Polit Nurs Pract 2020; 21:95-104. [PMID: 32486957 DOI: 10.1177/1527154420927689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The increase in nurse practitioners (NPs) in ambulatory medical and surgical specialty settings has prompted inquiry into their role and contribution to patient care. We explored the role and contribution of NPs in ambulatory specialty care through their activities outside of direct care and billable visits (referred to as service value activities), and how NPs perceive these activities enhance quality and efficiency of care, for both patients and the health care institution. This qualitative thematic analysis examined interviews from 16 NPs at a large academic medical center about their role and contribution to patient care quality and departmental efficiency beyond billable visits. Five categories of NP contribution were identified: promoting patient care continuity, promoting departmental continuity, promoting institutional historical and insider knowledge, addressing time-sensitive issues, and participating in leadership and quality improvement activities. As the role of NPs in specialty care grows and health care systems emphasize quality of care, it is appropriate to explore the quality- and efficiency-enhancing activities NPs perform in specialty care beyond direct patient care.
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Affiliation(s)
- Shira G Winter
- VA Palo Alto Health Care System, Center for Innovation to Implementation, Menlo Park, California
- Center for Health Policy, Primary Care and Outcomes Research, Stanford University School of Medicine
| | - Karen Duderstadt
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco
| | - Garrett K Chan
- Department of Physiological Nursing, University of California, San Francisco
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Linda M Stephan
- Department of Family Health Care Nursing, University of California, San Francisco
| | - Erin Matsuda
- Benioff Children's Hospitals, University of California, San Francisco
| | - Susan A Chapman
- Department of Social and Behavioral Sciences, University of California, San Francisco
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Thompson S, Metcalfe K, Boncey K, Merriman C, Flynn LC, Alg GS, Bothwell H, Forde-Johnston C, Puffett E, Hardy C, Wright L, Beale J. Interprofessional education in geriatric medicine: towards best practice. A controlled before-after study of medical and nursing students. BMJ Open 2020; 10:e018041. [PMID: 31964659 PMCID: PMC7045260 DOI: 10.1136/bmjopen-2017-018041] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/31/2019] [Accepted: 08/23/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate nursing and medical students' readiness for interprofessional learning before and after implementing geriatric interprofessional education (IPE), based on problem-based learning (PBL) case scenarios. To define the optimal number of geriatric IPE sessions, the size and the ratio of participants from each profession in the learner groups, the outcomes related to the Kirkpatrick four-level typology of learning evaluation, students' concerns about joint learning and impact of geriatric IPE on these concerns. The study looked at the perception of roles and expertise of the 'other' profession in interprofessional teams, and students' choice of topics for future sessions. Students' expectations, experience, learning points and the influence on the understanding of IP collaboration, as well as their readiness to participate in such education again were investigated. DESIGN A controlled before-after study (2014/2015, 2015/2016) with data collected immediately before and after the intervention period. Study includes additional comparison of the results from the intervention with a control group of students. Outcomes were determined with a validated 'Readiness for Interprofessional Learning' questionnaire, to which we added questions with free comments, combining quantitative and qualitative research methods. The teaching sessions were facilitated by experienced practitioners/educators, so each group had both, a clinician (either geratology consultant or registrar) and a senior nurse. PARTICIPANTS 300 medical, 150 nursing students. SETTING Tertiary care university teaching hospital. RESULTS Analysis of the returned forms in the intervention group had shown that nursing students scored higher on teamwork and collaboration post-IPE (M=40.78, SD=4.05) than pre-IPE (M=34.59, SD=10.36)-statistically significant. On negative professional identity, they scored lower post-IPE (M=7.21, SD=4.2) than pre-IPE (M=8.46, SD=4.1)-statistically significant. The higher score on positive professional identity post-IPE (M=16.43, SD=2.76) than pre-IPE (M=14.32, SD=4.59) was also statistically significant. Likewise, the lower score on roles and responsibilities post-IPE (M=5.41, SD=1.63) than pre-IPE (M=6.84, SD=2.75).Medical students scored higher on teamwork and collaboration post-IPE (M=36.66, SD=5.1) than pre-IPE (M=32.68, SD=7.4)-statistically significant. Higher positive professional identity post-IPE (M=14.3, SD=3.2) than pre-IPE (M=13.1, SD=4.31)-statistically significant. The lower negative professional identity post-IPE (M=7.6, SD=3.17) than pre-IPE (M=8.36, SD=2.91) was not statistically significant. Nor was the post-IPE difference over roles and responsibilities (M=7.4, SD=1.85), pre-IPE (M=7.85, SD=2.1).In the control group, medical students scored higher for teamwork and collaboration post-IPE (M=36.07, SD=3.8) than pre-IPE (M=33.95, SD=3.37)-statistically significant, same for positive professional identity post-IPE (M=13.74, SD=2.64), pre-IPE (M=12.8, SD=2.29), while negative professional identity post-IPE (M=8.48, SD=2.52), pre-IPE (M=9, SD=2.07), and roles and responsibilities post-IPE (M=7.89, SD=1.69), pre-IPE (M=7.91, SD=1.51) shown no statistically significant differences. Student concerns, enhanced understanding of collaboration and readiness for future joint work were addressed, but not understanding of roles. CONCLUSIONS Educators with nursing and medical backgrounds delivered geriatric IPE through case-based PBL. The optimal learner group size was determined. The equal numbers of participants from each profession for successful IPE are not necessary. The IPE delivered by clinicians and senior nurses had an overall positive impact on all participants, but more markedly on nursing students. Surprisingly, it had the same impact on medical students regardless if it was delivered to the mixed groups with nursing students, or to medical students alone. Teaching successfully addressed students' concerns about joint learning and communication and ethics were most commonly suggested topics for the future.
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Affiliation(s)
- Sanja Thompson
- Geratology department, John Radcliffe Hospital, Oxford, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
| | | | - Katy Boncey
- Geratology department, John Radcliffe Hospital, Oxford, UK
| | - Clair Merriman
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | | | | | | | | | - Elizabeth Puffett
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Caroline Hardy
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Liz Wright
- Geratology department, John Radcliffe Hospital, Oxford, UK
| | - James Beale
- Geratology department, John Radcliffe Hospital, Oxford, UK
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Glegg SMN, Jenkins E, Kothari A. How the study of networks informs knowledge translation and implementation: a scoping review. Implement Sci 2019; 14:34. [PMID: 30917844 PMCID: PMC6437864 DOI: 10.1186/s13012-019-0879-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 03/11/2019] [Indexed: 11/17/2022] Open
Abstract
Background To date, implementation science has focused largely on identifying the individual and organizational barriers, processes, and outcomes of knowledge translation (KT) (including implementation efforts). Social network analysis (SNA) has the potential to augment our understanding of KT success by applying a network lens that examines the influence of relationships and social structures on research use and intervention acceptability by health professionals. The purpose of this review was to comprehensively map the ways in which SNA methodologies have been applied to the study of KT with respect to health professional networks. Methods Systematic scoping review methodology involved searching five academic databases for primary research on KT that employed quantitative SNA methods, and inclusion screening using predetermined criteria. Data extraction included information on study aim, population, variables, network properties, theory use, and data collection methods. Descriptive statistics and chronology charting preceded theoretical analysis of findings. Results Twenty-seven retained articles describing 19 cross-sectional and 2 longitudinal studies reported on 28 structural properties, with degree centrality, tie characteristics (e.g., homophily, reciprocity), and whole network density being most frequent. Eleven studies examined physician-only networks, 9 focused on interprofessional networks, and 1 reported on a nurse practitioner network. Diffusion of innovation, social contagion, and social influence theories were most commonly applied. Conclusions Emerging interest in SNA for KT- and implementation-related research is evident. The included articles focused on individual level evidence-based decision-making: we recommend also applying SNA to meso- or macro-level KT activities. SNA research that expands the range of professions under study, examines network dynamics over time, extends the depth of analysis of the role of network structure on KT processes and outcomes, and employs mixed methods to triangulate findings, is needed to advance the field. SNA is a valuable approach for evaluating key network characteristics, structures and positions of relevance to KT, implementation, and evidence informed practice. Examining how network structure influences connections and the implications of those holding prominent network positions can provide insights to improve network-based KT processes.
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Affiliation(s)
- Stephanie M N Glegg
- Rehabilitation Sciences, The University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Therapy Department, Sunny Hill Health Centre for Children, 3644 Slocan Street, Vancouver, BC, V5M 3E8, Canada. .,BC Children's Hospital Research Institute, 938 West 28th Ave, Vancouver, BC, V5Z 4H4, Canada.
| | - Emily Jenkins
- School of Nursing, The University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Anita Kothari
- School of Health Studies, Western University, Arthur and Sonia Labatt Health Sciences Building, Room 222, London, ON, V6A 5B9, Canada
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Southcott AM, Holdsworth C, Malcolm L, Muruganandan S, Skinner E. Evaluation of the implementation of a Tracheostomy Review Services (TRS): an observational cohort study. J Interprof Care 2019; 33:697-705. [DOI: 10.1080/13561820.2019.1566216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
| | - Clare Holdsworth
- Department of Physiotherapy, Western Health, Footscray, Australia
| | - Louise Malcolm
- Department of Speech Pathology, Western Health, Footscray, Australia
| | | | - Elizabeth Skinner
- Department of Physiotherapy, Western Health, Footscray, Australia
- School of Physiotherapy, Faculty of Medicine Nursing and Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Physiotherapy, Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, Australia
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Implementing Posthospital Interprofessional Care Team Visits to Improve Care Transitions and Decrease Hospital Readmission Rates. Prof Case Manag 2018; 23:264-271. [DOI: 10.1097/ncm.0000000000000284] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Perceptions of the effectiveness of Advanced Practice Nurses on a neurosurgery unit in a Canadian Tertiary Care Centre: A pre-and-post implementation design. Int J Nurs Sci 2018; 5:138-143. [PMID: 31406815 PMCID: PMC6626254 DOI: 10.1016/j.ijnss.2018.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/31/2018] [Accepted: 03/27/2018] [Indexed: 11/30/2022] Open
Abstract
Objectives A framework for the advanced practice nurse (APN) role was developed in our Canadian Tertiary Care Centre, delineating five domains of advanced nursing practice: clinical practice, consultation, research, education and leadership. The goal of this study was to evaluate perceptions of the effectiveness of the implementation of an innovative APN role on an in-patient Neurosurgery unit. Methods A pre-and-post implementation design, incorporating both qualitative and quantitative data, was utilized. An innovative APN role was implemented within the Neurosurgery program focusing on the clinical domain and required the successful candidates to be NP prepared. This APN role was designed to improve patient flow, documentation, communication and patient and staff satisfaction. Three primary outcomes were measured: pre-implementation questionnaire (nurses), post-implementation questionnaire (nurses and residents) and number of pages to the on-call resident. Results Survey scores by nurses and residents indicated improvement across all aspects studied. Average scores increased from 1.1 to 2.6, reflecting an overall statistically significant increase. The number of pages to the on-call resident also showed a decrease. Conclusion Perceptions of patient care delivery and professional collaboration improved following implementation of the APN role. Responses indicated that APNs significantly impacted patient care and improved nurses and residents' job satisfaction.
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Lutze M, Fry M, Mullen G, O’Connell J, Coates D. Highlighting the Invisible Work of Emergency Nurse Practitioners. J Nurse Pract 2018. [DOI: 10.1016/j.nurpra.2017.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Stahlke Wall S, Rawson K. The Nurse Practitioner Role in Oncology: Advancing Patient Care. Oncol Nurs Forum 2017; 43:489-96. [PMID: 27314191 DOI: 10.1188/16.onf.489-496] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To explore and describe the characteristics of the nurse practitioner (NP) role in cancer care in a Canadian province, identify the ways in which NPs add value to cancer care, and suggest ways in which organizations can better support the NP role.
. RESEARCH APPROACH Exploratory, qualitative design.
. SETTING Three cancer care facilities in a western Canadian province.
. PARTICIPANTS 12 NPs in cancer care, 12 physicians working with NPs, and 5 administrators responsible for implementing the role.
. METHODOLOGIC APPROACH Interpretive description, a qualitative method aimed at systematically exploring and analyzing a topic and applying the findings back into practice.
. FINDINGS Each group had a different perspective on the role and its value. Physicians regarded these high-level practitioners as "help" within their own practices. Administrators tended to use NPs to manage patient workload within the traditional physician-focused system, but they could see value in NP-led innovation. The NPs themselves envisioned a nontraditional, holistic, patient-centered approach to care that challenged the interventionist focus of the medical model. Suggestions for enhancing the potential of the role were offered by all groups.
. CONCLUSIONS Lack of clarity about the NP role persists. Traditional professional hierarchies and expectations about care delivery continue to affect role implementation.
. INTERPRETATION Nursing leaders must be proactive about NP role implementation to maximize its potential. Additional research is needed about the outcomes of the role and the process of implementation.
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