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Ó Mír M, Casey MB, Smart KM. Physiotherapist managers views on advanced practice physiotherapy in Ireland. A qualitative study. Physiother Theory Pract 2024:1-10. [PMID: 39011854 DOI: 10.1080/09593985.2024.2370362] [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: 08/17/2023] [Accepted: 06/16/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION The introduction of physiotherapists working with advanced scope of practice has contributed to improvements in healthcare services. OBJECTIVE This qualitative study explores the views of physiotherapist managers on the Advanced Practice Physiotherapy role and the barriers and enablers to progression of this career pathway. METHODS A qualitative focus group study was conducted online with 10 purposefully sampled physiotherapist managers. The focus groups were audio-recorded, transcribed and thematically analyzed. RESULTS Three main themes were identified; 1) Physiotherapists working in advanced practice are recognized as experts and strong advocates for the physiotherapy profession; 2) Barriers to Advanced Practice Physiotherapy in Ireland include inconsistent role definition and protection, a lack of legislation and uncertainty concerning clinical governance; and 3) Physiotherapist managers can support Advanced Practice Physiotherapy through mentoring and resource provision, and implementation of the Advanced Practice Competency Framework. CONCLUSION Physiotherapist managers recognized the value of Advanced Practice Physiotherapy to the Irish health service but suggest that the role and reporting structures need to be clarified. They highlighted barriers preventing the full potential of this these roles being realized and provided suggestions to support the progression of this healthcare model.
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Affiliation(s)
- Marie Ó Mír
- Irish Society of Chartered Physiotherapists (ISCP), Irish Society of Chartered Physiotherapists, Royal College of Surgeons, Dublin, Ireland
| | - Máire-Bríd Casey
- Department of Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Keith M Smart
- UCD School of Public Health, Physiotherapy and Sports Science, Health Sciences Centre, University College Dublin, Belfield, Dublin, Ireland
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Alexander L, Cooper K, Peters MDJ, Tricco AC, Khalil H, Evans C, Munn Z, Pieper D, Godfrey CM, McInerney P, Pollock D. Large scoping reviews: managing volume and potential chaos in a pool of evidence sources. J Clin Epidemiol 2024; 170:111343. [PMID: 38582403 DOI: 10.1016/j.jclinepi.2024.111343] [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: 10/04/2023] [Revised: 03/06/2024] [Accepted: 03/27/2024] [Indexed: 04/08/2024]
Abstract
Scoping reviews can identify a large number of evidence sources. This commentary describes and provides guidance on planning, conducting, and reporting large scoping reviews. This guidance is informed by experts in scoping review methodology, including JBI (formerly Joanna Briggs Institute) Scoping Review Methodology group members, who have also conducted and reported large scoping reviews. We propose a working definition for large scoping reviews that includes approximately 100 sources of evidence but must also consider the volume of data to be extracted, the complexity of the analyses, and purpose. We pose 6 core questions for scoping review authors to consider when planning, developing, conducting, and reporting large scoping reviews. By considering and addressing these questions, scoping review authors might better streamline and manage the conduct and reporting of large scoping reviews from the planning to publishing stage.
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Affiliation(s)
- Lyndsay Alexander
- School of Health Sciences, Robert Gordon University, Aberdeen, UK; Scottish Centre for Evidence-based, Multi-professional Practice: a JBI Centre of Excellence, Robert Gordon University, Aberdeen, UK.
| | - Kay Cooper
- School of Health Sciences, Robert Gordon University, Aberdeen, UK; Scottish Centre for Evidence-based, Multi-professional Practice: a JBI Centre of Excellence, Robert Gordon University, Aberdeen, UK
| | - Micah D J Peters
- Clinical and Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, Adelaide Nursing School, University of Adelaide, Adelaide, Australia; The Centre for Evidence-based Practice South Australia (CEPSA): A Joanna Briggs Institute Centre of Excellence, Adelaide, Australia
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Dalla Lana School of Public Health & Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University School of Nursing, Kingston, Ontario, Canada
| | - Hanan Khalil
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Catrin Evans
- The Nottingham Centre for Evidence Based Healthcare: a JBI Centre of Excellence, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Zachary Munn
- Health Evidence Synthesis, Recommendations and Impact (HESRI), Faculty of Health and Medical Sciences, School of Public Health, University of Adelaide, Adelaide, Australia
| | - Dawid Pieper
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health System Research, Rüdersdorf bei Berlin, Germany; Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf bei Berlin, Germany
| | - Christina M Godfrey
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University School of Nursing, Kingston, Ontario, Canada
| | - Patricia McInerney
- Wits-JBI Centre for evidence-based practice: A JBI Centre of Excellence, University of the Witwatersrand, Johannesburg, South Africa
| | - Danielle Pollock
- Health Evidence Synthesis, Recommendations and Impact (HESRI), Faculty of Health and Medical Sciences, School of Public Health, University of Adelaide, Adelaide, Australia
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Oliveira C, Barbosa B, Couto JG, Bravo I, Hughes C, McFadden S, Khine R, McNair HA. Advanced practice in radiotherapy across Europe: stakeholders' perceptions of implementation and evolution. Radiography (Lond) 2024; 30:896-907. [PMID: 38608565 DOI: 10.1016/j.radi.2024.03.013] [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: 11/03/2023] [Revised: 03/09/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Adapting radiotherapy services with workforce innovation using skills-mix or task-shifting optimises resources, supporting current and future demands. Advanced practitioners (APs) work at a different level of practice (beyond initial registration) across four pillars: clinical practice, leadership and management, education, and research. There is limited cross-country research on the advanced therapeutic radiographers/radiation therapists (TR/RTTs), particularly in Europe. This study aimed to investigate European radiotherapy stakeholders' perceptions regarding current and future advanced practice (AP). METHODS From June to September 2022, one-to-one online semi-structured interviews were conducted in English, and audio and video were recorded. Full verbatim audio files were independently transcribed and checked by interviewer and interviewees. Braun and Clarke's seven steps guided the thematic analysis (using NVivo). RESULTS Thirty-three interviewees working or studying in 16 European countries represented practitioners (n=14), managers (n=6), educators (n=4), professional bodies (n=4), students (n=3), and regulators (n=2). Four overarching themes emerged: "AP drivers and outcomes", "AP challenges vs enablers", "Current vs future AP", "Becoming and being advanced practitioner". Participants identified research as the neglected AP pillar due to a lack of protected time, limited staff skills, no research culture, no funding, workload, and clinical priorities. Interviewees highlighted the importance of consistency in job titles, harmonisation of education models and curricula, definition of AP requirements, and support for all AP pillars through job plans and workforce planning. CONCLUSION Neither the profession nor education of TR/RTTs are harmonised across Europe, which is highly reflected in advanced-level practice. Advanced TR/RTTs should work across all pillars, including research, and these should be embedded in master's programmes, including leadership. IMPLICATIONS FOR PRACTICE This study highlights a policy gap in the education and practice of APs in radiotherapy.
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Affiliation(s)
- C Oliveira
- Radiotherapy Department, Instituto Português de Oncologia do Porto (IPO Porto), Portugal; Escola Internacional de Doutoramento, Universidad de Vigo, Spain.
| | - B Barbosa
- Radiotherapy Department, Instituto Português de Oncologia do Porto (IPO Porto), Portugal; Escola Internacional de Doutoramento, Universidad de Vigo, Spain; Medical Physics, Radiobiology Group and Radiation Protection Group, IPO Porto Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO Porto), Portugal.
| | - J G Couto
- Radiography Department, Faculty of Health Sciences, University of Malta, Malta.
| | - I Bravo
- Medical Physics, Radiobiology Group and Radiation Protection Group, IPO Porto Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO Porto), Portugal.
| | - C Hughes
- School of Health Sciences, Ulster University, United Kingdom.
| | - S McFadden
- School of Health Sciences, Ulster University, United Kingdom.
| | - R Khine
- European Federation of Radiographer Societies, Utrecht, Netherlands; Institute of Health Sciences Education, Faculty of Medicine & Dentistry, Queen Mary, University of London, United Kingdom.
| | - H A McNair
- European Federation of Radiographer Societies, Utrecht, Netherlands; The Royal Marsden NHS Foundation Trust, Radiotherapy and the Institute of Cancer Research, Surrey, United Kingdom.
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Kuczawski M, Ablard S, Sampson F, Croft S, Sutton-Klein J, Mason S. Exploring advanced clinical practitioner perspectives on training, role identity and competence: a qualitative study. BMC Nurs 2024; 23:185. [PMID: 38500131 PMCID: PMC10946138 DOI: 10.1186/s12912-024-01843-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Advanced Clinical Practitioners (ACPs) are a new role that have been established to address gaps and support the existing medical workforce in an effort to help reduce increasing pressures on NHS services. ACPs have the potential to practice at a similar level to mid-grade medical staff, for example independently undertaking assessments, requesting and interpreting investigations, and diagnosing and discharging patients. These roles have been shown to improve both service outcomes and quality of patient care. However, there is currently no widespread formalised standard of training within the UK resulting in variations in the training experiences and clinical capabilities of ACPs. We sought to explore the training experiences of ACPs as well as their views on role identity and future development of the role. METHODS Five online focus groups were conducted between March and May 2021 with trainee and qualified advanced clinical practitioners working in a range of healthcare settings, in the North of England. The focus groups aimed to explore the experiences of undertaking ACP training including supervision, gaining competence, role identity and career progression. Thematic analysis of the focus group transcripts was performed, informed by grounded theory principles. RESULTS Fourteen advanced clinical practitioners participated. Analysis revealed that training was influenced by internal and external perceptions of the role, often acting as barriers, with structural aspects being significant contributory factors. Key themes identified (1) clinical training lacked structure and support, negatively impacting progress, (2) existing knowledge and experience acted as both an enabler and inhibitor, with implications for confidence, (3) the role and responsibilities are poorly understood by both advanced clinical practitioners and the wider medical profession and (4) advanced clinical practitioners recognised the value and importance of the role but felt changes were necessary, to provide security and sustainability. CONCLUSIONS Appropriate structure and support are crucial throughout the training process to enable staff to have a smooth transition to advanced level, ensuring they obtain the necessary confidence and competence. Structural changes and knowledge brokering are essential, particularly in relation to role clarity and its responsibilities, sufficient allocated time to learn and practice, role accreditation and continuous appropriate supervision.
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Affiliation(s)
- Maxine Kuczawski
- Centre for Urgent and Emergency Care Research (CURE), Sheffield Centre for Health and Related Research (ScHARR), The University of Sheffield, S1 4DA, Sheffield, UK.
| | - Suzanne Ablard
- Centre for Urgent and Emergency Care Research (CURE), Sheffield Centre for Health and Related Research (ScHARR), The University of Sheffield, S1 4DA, Sheffield, UK
| | - Fiona Sampson
- Centre for Urgent and Emergency Care Research (CURE), Sheffield Centre for Health and Related Research (ScHARR), The University of Sheffield, S1 4DA, Sheffield, UK
| | - Susan Croft
- Centre for Urgent and Emergency Care Research (CURE), Sheffield Centre for Health and Related Research (ScHARR), The University of Sheffield, S1 4DA, Sheffield, UK
- Emergency Department, Northern General Hospital, S5 7AU, Sheffield, UK
| | - Joanna Sutton-Klein
- Centre for Urgent and Emergency Care Research (CURE), Sheffield Centre for Health and Related Research (ScHARR), The University of Sheffield, S1 4DA, Sheffield, UK
- Manchester Royal Infirmary, Oxford Rd, M13 9WL, Manchester, UK
| | - Suzanne Mason
- Centre for Urgent and Emergency Care Research (CURE), Sheffield Centre for Health and Related Research (ScHARR), The University of Sheffield, S1 4DA, Sheffield, UK
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Drennan VM, Halter M, Taylor F, Gabe J, Jarman H. Non-medical practitioners in the staffing of emergency departments and urgent treatment centres in England: a mixed qualitative methods study of policy implementation. BMC Health Serv Res 2023; 23:1221. [PMID: 37936220 PMCID: PMC10631061 DOI: 10.1186/s12913-023-10220-4] [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: 07/09/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Patient demand, internationally, on emergency departments and urgent care treatment centres has grown. Shortages of staff, particularly of emergency medicine doctors, have compounded problems. Some countries are pursuing solutions of including non-medical practitioners e.g., nurse practitioners and physician associates/assistants in their emergency department workforces. This study investigated at the macro and meso level of the health system in England: what the rationale was and the factors influencing the current and future employment, or otherwise, of non-medical practitioners in emergency departments and urgent treatment centres. METHODS Mixed qualitative methods in the interpretative tradition were employed. We undertook, in 2021-2022, a documentary analysis of national, regional and subregional policy (2017-2021), followed by semi-structured interviews of a purposive sample (n = 18) of stakeholders from national, regional and subregional levels. The data were thematically analysed and then synthesised. RESULTS There was general national policy support for increasing the presence of non-medical practitioners as part of the solution to shortages of emergency medicine doctors. However, evidence of policy support dissipated at regional and subregional levels. There were no published numbers for non-medical practitioners in emergency departments, but stakeholders suggested they were relatively small in number, unevenly distributed and faced uncertain growth. While the experience of the COVID-19 pandemic and its aftermath were said to have made senior decision makers more receptive to workforce innovation, many factors contributed to the uncertain growth. These factors included: limited evidence on the relative advantage of including non-medical practitioners; variation in the models of service being pursued to address patient demand on emergency departments and the place of non-medical practitioners within them; the lack of a national workforce plan with clear directives; and the variation in training for non-medical practitioner roles, combined with the lack of regulation of that level of practice. CONCLUSIONS We identified many features of a system ready to introduce non-medical practitioners in emergency departments and urgent treatment centres but there were uncertainties and the potential for conflict with other professional groups. One area of uncertainty was evidence of relative advantage in including non-medical practitioners in staffing. This requires urgent attention to inform decision making for short- and long-term workforce planning. Further investigation is required to consider whether these findings are generalisable to other specialties, and to similar health systems in other countries.
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Affiliation(s)
- Vari M Drennan
- Centre for Applied Health and Social Care Research, Kingston University, Kingston Upon Thames, UK.
| | - Mary Halter
- Centre for Applied Health and Social Care Research, Kingston University, Kingston Upon Thames, UK
| | - Francesca Taylor
- Centre for Applied Health and Social Care Research, Kingston University, Kingston Upon Thames, UK
| | | | - Heather Jarman
- St George's University Hospitals NHS Foundation Trust, London, UK
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Dean S, Barratt J. What is the existing evidence base for adult medical same day emergency care in UK NHS hospitals? A scoping review protocol. BMJ Open 2023; 13:e071890. [PMID: 37793937 PMCID: PMC10551928 DOI: 10.1136/bmjopen-2023-071890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVES Same day emergency care (SDEC) is a new model of care, which has emerged over the past 5 years, building on prior ambulatory care services. The National Health Service (NHS) England National Strategy for SDEC suggests SDEC can meet local health needs by providing alternatives to emergency department attendance or hospital admission, for people with an urgent healthcare need, beyond the limited scope of an urgent treatment centre. This review focuses on acute medical SDEC, as medical patients represent a significant proportion of emergency admissions. The planned scoping review aims to map the existing evidence base. METHODS AND ANALYSIS This is a protocol for a scoping review to be conducted in accordance with the format of the Joanna Briggs Institute (JBI) methodology for scoping reviews. The databases to be searched will include EMBASE, MEDLINE and CINAHL, via EBSCOhost. Sources of unpublished studies, policies and grey literature will include Google Scholar, the Cochrane Library, TRIP database, ProQuest Dissertations and Theses Open, and the Health Management Information Consortium. Papers relating to acute medicine adult patients attending NHS SDEC services in the UK will be included. International papers will be excluded, as will those over 5 years old, and those where full text is not available. The results of the search and study inclusion/exclusion process will be reported and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram. Data will be extracted from papers included in the scoping review by two reviewers, using a JBI data extraction tool. Any differences of opinion will be discussed until consensus is reached. If needed, a third reviewer will be asked to join the review team to achieve consensus. Data and themes extracted will be summarised and presented in tables. A narrative thematic summary will accompany the presented results, describing how the results relate to the review objective. Literature gaps will be identified and recommendations for future research made. ETHICS AND DISSEMINATION There is no requirement for ethical approval for this scoping review. On completion, it will be published in a peer-reviewed academic journal and presented at a conference.
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Affiliation(s)
- Sue Dean
- Same Day Emergency Care, United Lincolnshire Hospitals NHS Trust, Boston, UK
| | - Julian Barratt
- The Centre for Advancing Practice, Health Education England - East Midlands, Nottingham, UK
- The Institute of Health, University of Wolverhampton, Wolverhampton, UK
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Hepburn J. Advanced practice physiotherapists in Scottish primary care: Axial Spondyloarthropathy epidemiology, time to diagnosis, and referrals to rheumatology. Musculoskeletal Care 2023; 21:958-967. [PMID: 37186356 DOI: 10.1002/msc.1769] [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: 03/28/2023] [Revised: 03/29/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES (1) Generate empirical knowledge of a Musculoskeletal (MSK) Advanced Practice Physiotherapist (APP) Service in Scottish Primary Care; (2) Identify the incidence and baseline time to diagnosis of Axial Spondyloarthropathy (AxSpA); (3) Identify APP Rheumatology referral fulfilment of the NICE 2017 Guidelines and Spondylarthritis Diagnosis Evaluation (SPADE) Tool; (4) Calculate APP Rheumatology referral conversion rates for AxSpA diagnosis and further investigation; (5) Contribute towards the current body of literature for informing analysis of MSK APP services within Scottish Primary Care. METHODS An audit and evaluation approach was undertaken over a 3-year period (May 2019-April 2022). Relevant clinical cases from the whole-service data-set were identified and analysed, using retrospective electronic healthcare record review and descriptive statistical techniques. RESULTS A total of 37,656 primary care MSK APP consultations took place, with N = 19 suspected AxSpA referrals made to Rheumatology. N = 6 cases of AxSpA were diagnosed by a Rheumatologist (31.6%). The mean age of individuals diagnosed with AxSpA was 39.6 ± 8.8, and 66.7% (4/6) were female. Mean time to diagnosis was 3.4 years, and incidence per-10,000 person-years was 1.6. Compliance of referrals with the NICE 2017 Guidelines and SPADE Tool Criteria was 78.9%. Of those diagnosed with AxSpA, 66.7% met both referral criterion sets. CONCLUSION Those referred by an MSK APP from primary care had a 5.1 year shorter time to diagnosis than the previous reported UK average of 8.5 years. APPs identified relevant AxSpA features in referring to Rheumatology, and supported effective implementation of the local secondary care pathway.
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Affiliation(s)
- Jordan Hepburn
- General Practice, Primary Care, Edinburgh Health & Social Care Partnership, NHS Lothian, Edinburgh, UK
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Male I, Farr W, Bremner S, Gage H, Williams P, Gowling E, Honey E, Gain A, Parr J. An observational study of individual child journeys through autism diagnostic pathways, and associated costs, in the UK National Health Service. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1119288. [PMID: 37350848 PMCID: PMC10283036 DOI: 10.3389/fresc.2023.1119288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/02/2023] [Indexed: 06/24/2023]
Abstract
Background Demand for diagnostic assessment in children with possible autism has recently increased significantly. Services are under pressure to deliver timely and high-quality diagnosis, following National Institute and Care Excellence multidisciplinary assessment guidelines. This UK National Health Service study aimed to answer: how many hours of health professional time are required to deliver autism diagnostic assessment, and how much does this cost?. Method Case notes of 20 children (1-16 yrs.) from 27 NHS trusts, assessed through an autism diagnostic pathway in the previous year, were examined retrospectively. Data included: hours of professional time, diagnostic outcome. Assessment costs calculated using standardised NHS tariffs. Results 488 children (aged 21-195 months, mean 82.9 months, SD 39.36) from 22 Child Development Services (CDS), four Child and Adolescent Mental Health Services (CAMHS) and one tertiary centre; 87% were either under 5 (36%) or 5 to 11 years (51%). Children seen by CDS were younger than CAMHS (mean (SD) 6.10 (2.72) vs. 10.39 (2.97) years, p < 0.001). Mean days to diagnosis were 375 (SD 235), with large variation (range 41-1553 days). Mean hours of professional time per child was 11.50 (SD 7.03) and varied substantially between services and individuals. Mean cost of assessment was £846.00 (SD 536.31). 339 (70.0%) children received autism diagnosis with or without comorbidity; 54 (11%) received no neurodevelopmental diagnosis; 91 (19%) received alternative neurodevelopmental diagnoses. Children with one or more coexisting conditions took longer to diagnose, and assessment was more costly, on average 117 days longer, costing £180 more than a child with no neurodevelopmental diagnosis. Age did not predict days to diagnosis or assessment costs. Conclusion Typical assessment took 11 h of professional time and over 12-months to complete, costing GB£850 per child. Variation between centres and children reflect differences in practice and complexity of diagnostic presentation. These results give information to those delivering/planning autism assessments using multi-disciplinary team approach, in publicly funded health systems. Planning of future diagnostic services needs to consider growing demand, the need for streamlining, enabling context appropriate services, and child/family complexity.
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Affiliation(s)
- Ian Male
- Research Department, Sussex Community NHS Foundation Trust, West Sussex, United Kingdom
- Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - William Farr
- Research Department, Sussex Community NHS Foundation Trust, West Sussex, United Kingdom
- Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
- Faculty of Education, University of Cambridge, Cambridge, United Kingdom
| | - Stephen Bremner
- Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Heather Gage
- School of Biosciences and Medicine, University of Surrey, Guildford, United Kingdom
| | - Peter Williams
- School of Mathematics, University of Surrey, Guildford, United Kingdom
| | - Emma Gowling
- Geriatrics, Queen Alexandra Hospital, Cosham, United Kingdom
| | - Emma Honey
- Paediatrics, Northumberland Tyne and Wear National Health Service, Newcastle Upon Tyne, United Kingdom
| | - Aaron Gain
- Public Health, University of Brighton, Brighton, UK
| | - Jeremy Parr
- Paediatrics, Northumberland Tyne and Wear National Health Service, Newcastle Upon Tyne, United Kingdom
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Faculty of Medical Sciences, Great North Children's Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
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Evidence of expert clinical practice among nuclear medicine non-medical staff: a scoping review. Nucl Med Commun 2023; 44:169-177. [PMID: 36729427 DOI: 10.1097/mnm.0000000000001650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This scoping review concerns expertclinical practice (ECP) by nuclear medicine practitioners (NMP), encompassing radiographers, technologists and nurses. ECP is typically demonstrated by clinical skills with higher levels of autonomy and responsibility traditionally fulfilled by physicians. The Advanced Clinical Practice (ACP) framework by Health Education England (2017) specifies ECP as one aspect of advanced role progression. This scoping review aims to identify and categorise the extent and type of the existing NMP ECP evidence to support the establishment of Nuclear Medicine ACP. METHODS PubMed, Cumulative Index to Nursing and Allied Health Literature, and Ovid Medline were searched for peer-reviewed literature published between 2001 and 2021 using extended and advanced practice as key terms alongside nuclear medicine and each NMP profession. Due to the sparsity of results, conference abstracts from prominent international societies were also searched. Studies were independently reviewed and graded for inclusion by four NMP. RESULTS Of the 36 studies that met the inclusion criteria, 80.6% were conference abstracts and 66.7% were single-centres studies. Commonly reported NM ECP activities included image interpretation, cardiac stressing and therapies. Less reported activities include ordering complementary diagnostic procedures, invasive procedures and physical examinations. The United Kingdom presented itself at the forefront of NMP ECP publications. CONCLUSION This study demonstrates evidence of NMP ECP across a variety of clinical roles. The dominance of conference abstracts highlights NMP ECP as an emerging area of role extension and a potential preference for information dissemination by NMP. Greater research into specific NMP ECP activities is required particularly studies of greater sample size and robusticity.
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Van Hecke A, Vlerick I, Akhayad S, Daem M, Decoene E, Kinnaer LM. Dynamics and processes influencing role integration of advanced practice nurses and nurse navigators in oncology teams. Eur J Oncol Nurs 2023; 62:102257. [PMID: 36634592 DOI: 10.1016/j.ejon.2022.102257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE Exploring the persisting presence of underlying processes, dynamics, experienced barriers and facilitators of Advanced Practice Nurses (APN) in oncology and Oncology Nurse Navigators (ONN) during their role integration in an interprofessional team over a research period of seven years. METHODS A qualitative study based on the principles of Grounded Theory, in which individual semi-structured interviews and focus groups were conducted with 51 ONN and APN from 11 university and local hospitals in Belgium between 2011-2018. Data were analyzed to develop a framework that consists of different themes. RESULTS ONN and APN experienced a lonely journey during role integration. They were searching for partners, medical knowledge and acknowledgement from the interprofessional team. ONN and APN had a watchful attitude and tried to make themselves visible to ensure they were involved in the team and to preserve their role and responsibilities. An unclear role description to the interprofessional team, and a lack of coaching and guidance were influencing factors in the experience of ONN and APN. CONCLUSION ONN and APN in oncology feel difficulties to integrate their role in existing interprofessional teams. A lack of role clarity, the interprofessional team environment and a desire for coaching and guidance are influencing factors to implement APN roles. Coaching and mentorship of novice ONN/APN and their interprofessional team and healthcare managers are needed to address these issues. These findings could form the basis for a mentorship program for ONN/APN and their interprofessional team to enhance role integration.
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Affiliation(s)
- Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium; Staff Member Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Isabel Vlerick
- Nursing Department, Ghent University Hospital, Ghent, Belgium.
| | - Soumaya Akhayad
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Michiel Daem
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Elsie Decoene
- Staff Member Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Lise-Marie Kinnaer
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
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Mann C, Timmons S, Evans C, Pearce R, Overton C, Hinsliff-Smith K, Conway J. Exploring the role of advanced clinical practitioners (ACPs) and their contribution to health services in England: A qualitative exploratory study. Nurse Educ Pract 2023; 67:103546. [PMID: 36739736 PMCID: PMC9872859 DOI: 10.1016/j.nepr.2023.103546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/06/2022] [Accepted: 12/17/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND An extended role being explored globally is the advanced clinical practitioner (ACP). In England this is an extended role for allied health professions, nurses and midwives in a range of settings. OBJECTIVES This paper focuses on three research questions: 1) What is the role of ACPs in England? 2) What are the barriers and facilitators to implementing the role? and 3) What is the contribution of ACPs to health services in England? DESIGN/SETTING A qualitative, exploratory study to explore perspectives on the ACP role in a range of clinical settings. PARTICIPANTS We recruited 63 stakeholders, including 34 nurses, working in a ACP role or ACP education. A purposive snowball sampling technique identified participants meeting inclusion criteria. METHODS One-to-one semi-structured interviews throughout 2020, recorded and transcribed verbatim, anonymised and thematically analysed. RESULTS The ACP role in England was undertaken in a broad range of clinical contexts. In England 'advanced clinical practitioner' was not a protected title. There were high levels of variability and ambiguity of understanding and deployment of the ACP role in England. Facilitators to the implementation process included training and education, clinical supervision and organisational support. Lack of protection for the role and variances in experience were barriers. Employer support facilitated development of the ACP role, however where support was limited, at either an individual or organisation level, this was a barrier. Our study highlighted the wide range of ways the ACP role benefitted patient outcomes and workforce development. CONCLUSIONS This study outlines the contribution that ACPs can make to health services, contributing factors and key barriers and facilitators to implementing this role. The work showed the positive contribution ACPs can make to service redesign, workforce development and patient outcomes, whilst accepting there is much work to do to ensure protected status and parity across all professions and clinical contexts.
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Affiliation(s)
- Claire Mann
- Centre for Health Improvement, Leadership and Learning, Nottingham University Business School, University of Nottingham, Jubilee Campus, Nottingham, NG8 1BB , UK.
| | - Stephen Timmons
- Centre for Health Improvement, Leadership and Learning, Nottingham University Business School, University of Nottingham, NG7 2RD, UK.
| | - Catrin Evans
- Health Sciences, QMC University of Nottingham, NG7 2RD, UK.
| | - Ruth Pearce
- Allied Health Professions and Midwifery University Hospitals, Birmingham NHS Foundation Trust, UK.
| | | | | | - Joy Conway
- Centre for Health, Medicine and Life Sciences Brunel University London, UK.
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12
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Gyldenvang HH, Christiansen MG, Jarden M, Piil K. Experiences and perspectives of patients and clinicians in nurse-led clinics in an oncological setting: A sequential multi-methods study. Eur J Oncol Nurs 2022; 61:102203. [DOI: 10.1016/j.ejon.2022.102203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/26/2022] [Accepted: 09/19/2022] [Indexed: 11/29/2022]
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Gutiérrez-Rodríguez L, García-Mayor S, León-Campos Á, Gómez-González AJ, Pérez-Ardanaz B, Rodríguez-Gómez S, Fajardo-Samper M, Morilla-Herrera JC, Morales-Asencio JM. Competency Gradients in Advanced Practice Nurses, Specialist Nurses, and Registered Nurses: A Multicentre Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148415. [PMID: 35886267 PMCID: PMC9323129 DOI: 10.3390/ijerph19148415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 02/04/2023]
Abstract
(1) Background: Identifying differences in the competencies of different areas of nursing is a crucial aspect for determining the scope of practice. This would facilitate the creation of a formal structure for clinical practice in advanced and specialised services. The aims of this study are to analyse the distribution of advanced competencies in registered, specialist and advanced practice nurses in Spain, and to determine the level of complexity of the patients attended by these nurses. (2) Methods: A cross-sectional study was developed on registered, specialist and advanced practice nurses, all of whom completed an online survey on their perceived level of advanced competencies and their professional characteristics. (3) Results: In total, 1270 nurses completed the survey. Advanced practice nurses recorded the highest self-perceived level of competency, especially for the dimensions of evidence-based practice, autonomy, leadership and care management. (4) Conclusions: Among registered, specialist and advanced practice nurses, there are significant differences in the level of self-perceived competencies. Patients attended by advanced practice nurses presented the highest levels of complexity. Understanding these differences could facilitate the creation of a regulatory framework for clinical practice in advanced and specialized services.
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Affiliation(s)
- Laura Gutiérrez-Rodríguez
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Silvia García-Mayor
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Álvaro León-Campos
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
- Correspondence: ; Tel.: +34-951-952-879
| | - Alberto José Gómez-González
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Bibiana Pérez-Ardanaz
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | | | | | - Juan Carlos Morilla-Herrera
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - José Miguel Morales-Asencio
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
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Oliveira C, Barbosa B, Couto JG, Bravo I, Khine R, McNair H. Advanced practice roles of therapeutic radiographers/radiation therapists: A systematic literature review. Radiography (Lond) 2022; 28:605-619. [PMID: 35550932 DOI: 10.1016/j.radi.2022.04.009] [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: 02/09/2022] [Revised: 04/06/2022] [Accepted: 04/19/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Advances in Radiotherapy (RT) technology and increase of complexity in cancer care have enabled the implementation of new treatment techniques. Subsequently, a greater level of autonomy, responsibility, and accountability in the practice of Therapeutic Radiographers/Radiation Therapists (TR/RTTs) has led to Advanced Practice (AP) roles. The published evidence of this role is scattered with confusing terminology and divergence regarding the perception of whether a specific role represents AP internationally. This study aims to establish an international baseline of evidence on AP roles in RT to identify roles and activities performed by TR/RTTs at advanced level practice and to summarise the impact. METHODS A systematic PRISMA review of the literature was undertaken. Thematic analysis was used to synthesise the roles and associated activities. Six RT external experts validated the list. The impact was scrutinised in terms of clinical, organisational, and professional outcomes. RESULTS Studies (n = 87) were included and categorised into four groups. AP roles were listed by clinical area, site-specific, and scope of practice, and advanced activities were organised into seven dimensions and 27 sub-dimensions. Three most-reported outcomes were: enhanced service capacity, higher patient satisfaction, and safety maintenance. CONCLUSION Evidence-based AP amongst TR/RTTs show how AP roles were conceptualised, implemented, and evaluated. Congruence studies have shown that TR/RTTs are at par with the gold-standard across the various AP roles. IMPLICATIONS FOR PRACTICE This is the first systematic literature review synthetisising AP roles and activities of TR/RTTs. This study also identified the main areas of AP that can be used to develop professional frameworks and education guiding policy by professional bodies, educators and other stakeholders.
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Affiliation(s)
- C Oliveira
- Radiotherapy Department, Instituto Português de Oncologia do Porto (IPO Porto), R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal; Escola Internacional de Doutoramento, Universidad de Vigo, Circunvalación Ao Campus Universitario, 36310, Vigo, Pontevedra, Spain.
| | - B Barbosa
- Radiotherapy Department, Instituto Português de Oncologia do Porto (IPO Porto), R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal; Escola Internacional de Doutoramento, Universidad de Vigo, Circunvalación Ao Campus Universitario, 36310, Vigo, Pontevedra, Spain; Medical Physics, Radiobiology Group and Radiation Protection Group, IPO Porto Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO Porto), R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal.
| | - J G Couto
- Radiography Department, Faculty of Health Sciences, University of Malta, Msida, MSD2080, Malta.
| | - I Bravo
- Medical Physics, Radiobiology Group and Radiation Protection Group, IPO Porto Research Centre (CI-IPOP), Instituto Português de Oncologia do Porto (IPO Porto), R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal.
| | - R Khine
- European Federation of Radiographer Societies, PO Box 30511, Utrecht, 3503, AH, Netherlands; School of Health Care and Social Work, Buckinghamshire New University, Buckinghamshire, United Kingdom.
| | - H McNair
- European Federation of Radiographer Societies, PO Box 30511, Utrecht, 3503, AH, Netherlands; The Royal Marsden NHS Foundation Trust, Radiotherapy and the Institute of Cancer Research, Surrey, SM2 5PT, United Kingdom.
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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.
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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
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Zhang M, Chen H, Wang N, Li Y, Li X, Liu Y. The mediating role of job satisfaction between psychological capital and work engagement among Chinese nurses during COVID-19 outbreak: A comparative study between nurse specialists and general nurses. Front Psychiatry 2022; 13:990216. [PMID: 36713893 PMCID: PMC9878697 DOI: 10.3389/fpsyt.2022.990216] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 12/15/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The outbreak of COVID-19 has become a global public health emergency, causing great psychological distress to nurses. It is unknown whether the pandemic will affect the work engagement of nurses, the relationship between psychological capital, job satisfaction, and work engagement among nurses, and whether there are differences between nurse specialists and general nurses during the pandemic. OBJECTIVES The purpose of this study was to compare psychological capital, job satisfaction, and work engagement among nurse specialists and general nurses during the pandemic, as well as to test the role of job satisfaction as a mediator in the association between psychological capital and work engagement among nurses, and to examine whether the underlying mechanism of the relationship between psychological capital and job satisfaction differs between nurse specialists and general nurses. MATERIALS AND METHODS A convenience sampling was used to assess a sample of 372 nurse specialists and 318 general nurses from nine provincial general hospitals in China to participate in the online survey. Data were collected using self-report questionnaires, including the following tools: self-designed socio-demographic questionnaire, psychological capital scale, job satisfaction scale, and work engagement scale. RESULTS Compared with general nurses, the nurse specialists had higher psychological capital, job satisfaction, and work engagement. Job satisfaction partially mediated the positive association between psychological capital and work engagement and the indirect effect was stronger in nurse specialists in comparison to general nurses during the COVID-19 pandemic. CONCLUSION The findings provide important practical implications for future intervention programs aimed at enhancing nurses' work engagement, which may be realized through strengthening psychological capital and job satisfaction during the pandemic. Moreover, considering the cost-effectiveness of limited health care spending, nursing managers should pay more attention to the continuing professional development of young general nurses.
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Affiliation(s)
- Minyi Zhang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, China
| | - Hongyu Chen
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, China
| | - Ning Wang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, China
| | - Yao Li
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, China
| | - Xiaofei Li
- Department of Transplantation/Hepatobiliary Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Yan Liu
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, China
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