Professional issues facing nurse practitioners and nursing

A realist review protocol of the role and contribution of the advanced nurse practitioner (ANP) in gastroenterology nursing

Background: The role and contribution of advanced nurse practitioners (ANP) has been well researched and found to be of great value for improving quality patient care and enhancing patient outcomes through education and health promotion. However, the role and the contribution of the ANP to gastroenterology nursing have not been evaluated either nationally or internationally. A review to determine the role and contribution of the ANP in gastroenterology nursing will inform on the contribution of the role and whether the role makes a difference to patient outcomes and cost effectiveness of patient care. Objective: This review aims to investigate the nursing role and contribution of the advanced nurse practitioner in gastroenterology. Furthermore, improved understanding of the underlying causal mechanisms explaining how the ANP role in gastroenterology nursing works, will provide a deeper understanding of how, why, for whom and in what contexts the role and contribution of the ANP to gastroenterology nursing are most successful. Methods: A realist review will consolidate evidence on how, when why and where the ANP role in gastroenterology works or fails through identifying programme theories underlying to the role’s introduction. The following steps will be operationalised; locating existing theories, searching the literature, documenting literature selection, engaging in data extraction and synthesis and refining programme theory. As an iterative approach, review cycles will uncover explanatory and contingent theories through context-mechanism-outcome configurations (CMOCc). Due to the variation in context and mechanisms, different outcomes will be likely across different clinical settings although similar patterns may be identified. Conclusions: Due to the theory-oriented approach of realist reviews, the pragmatic consequences of the review, will lend itself to deeper understanding of how the role and contribution of the ANP in gastroenterology nursing works in practice.

A Model of Consultation in Prostate Cancer Care: Evidence From a Systematic Review

BACKGROUND

There has been an evolution of various consultation models in the literature. Men affected by prostate cancer can experience a range of unmet supportive care needs. Thus, effective consultations are paramount in the delivery of supportive care to optimize tailored self-management plans at the individual level of need.

OBJECTIVE

The aim of this study is to critically appraise existing models of consultation and make recommendations for a model of consultation within the scope of clinical practice for prostate cancer care.

METHODS

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement Guidelines. Electronic databases were searched using a wide range of keywords and free text items to increase the sensitivity and inclusiveness of the searches. Findings were integrated in a narrative synthesis.

RESULTS

A total of 1829 articles were retrieved and 17 papers were included. Beneficial features ranged across a number of models that included a person-centered consultation, shared management plans, and safety netting. None of the reviewed models of consultation are suitable for use in prostate cancer care because of a range of limitations and the clinical context in which models were developed. A Cancer Care Consultation Model was informed from critical appraisal of the evidence and expert clinical and service user comment.

CONCLUSION

Further research is needed to empirically test consultation models in routine clinical practice, specifically for advanced cancer specialist nurses.

IMPLICATIONS FOR PRACTICE

The Prostate Cancer Model of Consultation can be used to structure clinical consultations to target self-management care plans at the individual level of need over the cancer care continuum.

A model of succession planning for mental health nurse practitioners

This paper reviews current literature on succession planning for mental health nurse practitioners (NPs) and discusses a model of succession planning that is underpinned by principals of leadership development, workforce participation and client engagement. The paper identifies succession planning as a means of managing a present and future workforce, while simultaneously addressing individual and organizational learning and practice development needs. A discussion of the processes attendant upon sustainable succession planning - collegial support, career planning and development, information exchange, capacity building, and mentoring is framed within the potential interrelationships between existing NP, developing NP and service directors and/or team managers. Done effectively and in partnership with wider clinical services, succession planning has the potential to build NP leadership development and leadership transition more broadly within mental health services.

Exploring the nurse endoscopist role: a qualitative approach

BACKGROUND

Previously, gastrointestinal endoscopy was undertaken only by medical staff. The nurse endoscopist role has recently been developed and is now in great demand. Barriers and facilitators are identified in similar nursing roles, though little research has been undertaken on the nurse endoscopist role.

AIM

To examine perceptions of UK nurse endoscopists regarding their experience of the role. This qualitative study involved semi-structured interviews with eight UK nurse endoscopists. Data gained were analyzed qualitatively. The following categories emerged: role structure, collaboration, experience, and education and training.

RESULTS

The 'role structure' category showed that patient services were better where the nurse endoscopist role encompassed a more holistic approach. In the 'collaboration' category, the importance of relations with medical, nursing and management colleagues was observed. It was found that nurse endoscopists may be providing an inferior service due to being given lower priority than medical endoscopists. The 'experience' category showed nurse endoscopists valued their nursing experience, while specific endoscopy nursing experience prior to becoming an endoscopist was also useful. The 'education' category showed that degree-level education and training were important when accessed, in addition to prescribing courses.

CONCLUSION

Nurses undertaking endoscopy have potentially satisfying roles, which allow them to perform effectively. The roles should be planned adequately and practitioners should receive appropriate degree-level education. Furthermore, patients should receive equitable treatment regardless of which profession undertakes the endoscopy.

Point counterpoint: the function of contradictions on an interdisciplinary health care team

In this qualitative study we used Dialectical Theory to analyze contradictions occurring between medical doctors (MDs) and nurse practitioners (NPs) working collaboratively on a health care team. The analysis of interview data revealed contradictions in two areas: (1) NPs espouse a need for heightened autonomy in their working associations with medical doctors, whereas conversely, MDs emphasize a need for ongoing connection, and (2) MDs argue that NPs should be more proactive problem solvers and frame their working relationships as educational. However, NPs argue that MDs enact patterns of behavior that limit proactive problem solving and curtail the educational potential of those relationships, thus reinforcing predictable work routines. Both areas of contradiction constitute what dialectical theorist Leslie Baxter refers to as "oppositions." Examples of these oppositions are provided in the analysis. The study concludes with an assessment of how such contradictions might constitute developmental opportunities for NPs and MDs working in collaboration.

The core role of the nurse practitioner: practice, professionalism and clinical leadership

AIM

To draw on empirical evidence to illustrate the core role of nurse practitioners in Australia and New Zealand.

BACKGROUND

Enacted legislation provides for mutual recognition of qualifications, including nursing, between New Zealand and Australia. As the nurse practitioner role is relatively new in both countries, there is no consistency in role expectation and hence mutual recognition has not yet been applied to nurse practitioners. A study jointly commissioned by both countries' Regulatory Boards developed information on the core role of the nurse practitioner, to develop shared competency and educational standards. Reporting on this study's process and outcomes provides insights that are relevant both locally and internationally.

METHOD

This interpretive study used multiple data sources, including published and grey literature, policy documents, nurse practitioner program curricula and interviews with 15 nurse practitioners from the two countries. Data were analysed according to the appropriate standard for each data type and included both deductive and inductive methods. The data were aggregated thematically according to patterns within and across the interview and material data.

FINDINGS

The core role of the nurse practitioner was identified as having three components: dynamic practice, professional efficacy and clinical leadership. Nurse practitioner practice is dynamic and involves the application of high level clinical knowledge and skills in a wide range of contexts. The nurse practitioner demonstrates professional efficacy, enhanced by an extended range of autonomy that includes legislated privileges. The nurse practitioner is a clinical leader with a readiness and an obligation to advocate for their client base and their profession at the systems level of health care.

CONCLUSION

A clearly articulated and research informed description of the core role of the nurse practitioner provides the basis for development of educational and practice competency standards. These research findings provide new perspectives to inform the international debate about this extended level of nursing practice.

RELEVANCE TO CLINICAL PRACTICE

The findings from this research have the potential to achieve a standardised approach and internationally consistent nomenclature for the nurse practitioner role.

Advanced nursing practice – the influences and accountabilities

The past two decades have seen a proliferation of new, advanced clinical roles for nurses in the UK which has resulted in much debate about the nature of advanced practice as these new roles involve many tasks that were traditionally considered the remit of doctors. This article critically analyses the professional accountabilities of working at an advanced level and the influences which are driving the NHS modernization agenda with particular reference to the role of the Community Matron. It concludes that advanced nursing practice presents an opportunity for the combination of the art of nursing and advanced tasks, but emphasizes that new roles must develop within a recognized framework which takes account of the educational, ethical and legal accountability issues and clarifies the scope and remit of roles for health professionals, patients and indemnifying agents.

Advancing the clinical perspective: a practice development project to develop the nurse practitioner role in an acute hospital trust

AIMS

The aims of this project were to investigate awareness and foster understanding of the concept of the nurse practitioner and to facilitate and support the development of nurse practitioner roles within an acute hospital trust.

BACKGROUND

A limited understanding of and minimal support for the development of the nurse practitioner (NP) role were identified within an acute hospital trust in the south of England. This was the impetus for pursuing the project outlined in this paper. THEORETICAL PERSPECTIVE: The project used practice development theory synonymously with action research methodology comprising of four action research cycles.

METHOD

Data were collected in a variety of ways within the four overlapping cycles using formal and informal methods, which were analysed concurrently during the project. Techniques included questionnaires, semi-structured interviews, meetings, discussions and the project leader's field notes' diary.

OUTCOMES

A better understanding of the concept and support for NP posts were enhanced across the trust. A Nurse Practitioner Development Group (NPDG) was established, which helped to facilitate the development of NP posts. An example of such a post was established within a NP-led gynaecology pre-operative assessment clinic, which was a pilot project and constituted Action Research cycle 3.

CONCLUSION

It is concluded that the development of NP roles, with the support of a NPDG, within an agreed strategy offers a robust process for NP development within an acute hospital setting.

RELEVANCE TO CLINICAL PRACTICE

This project demonstrated how practice development and action research might be used together as a systematic process for developing and supporting professional roles that aim to improve the quality of patient care and the effectiveness of health care services.

The safety and effectiveness of a nurse-led anticoagulant service

AIM

The aim of this study was to compare the safety and effectiveness of anticoagulant nurses and a consultant haematologist in managing anticoagulant patients in a hospital outpatient setting.

BACKGROUND

Nurses are increasingly developing roles traditionally undertaken by medical staff. As a result nurse-led practice has expanded in many areas including anticoagulant services. Previous studies have attempted to demonstrate the effectiveness of using other professionals to manage anticoagulant clinics over short periods of time. This research evaluates the safety and effectiveness of a consultant-led and a nurse-led service over two sequential 18-month periods.

RESEARCH METHODS

A nonexperimental design was adopted. Data were collected retrospectively, from a random sample of 197 patients, who had been managed by both the consultant-led and nurse-led service. Two main outcome measures were selected: anticoagulant control between professional groups and interval between outpatient clinic appointments.

RESULTS

No statistically significant difference in anticoagulant control was found between professional groups (P=0.137). There was evidence that patients attended anticoagulant clinics on significantly fewer occasions with nurse-led management (P < 0.0005).

CONCLUSION

At the department within which this research was conducted, anticoagulant nurses were found to be at least as safe and effective as the consultant haematologist in managing outpatient anticoagulant patients over the study period. These findings are of importance in both shaping the future provision of anticoagulant care and also contributing to the wider area in evaluating the impact of nurse-led practice within health care.

Education for a new role: a review of neonatal nurse practitioner programmes

A comparison was made of the different educational programmes developed to train Neonatal Nurse Practitioners (ENB A19) in the UK. The structure and character of the programmes were examined in relation to course aims and philosophies, learning outcomes, content, teaching strategies and methods of assessment. Documentation provided by course leaders included hand-books, timetables, teaching staff details and documents concerning supervision and assessment. When viewed closely there are differences between the programmes that are evident in design and curriculum content and which present a quality assurance issue to the institutions validating and running these programmes. The issue of parity and standards is also a critical one for those supporting the development regionally and nationally. Viewed within the broader perspective of post-registration nurse education, these relatively new programmes could be regarded as experiments in which professionals, as teachers and learners, are trying to address the changing boundaries of expertise and professional identities. It is suggested that the nurse practitioner programmes developed for neonatal care could provide a model for similar programmes in other specialties and argued that the experience gained in planning and running these courses could contribute positively to the development of other comparable educational programmes for established and experienced nurses.