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Sedgwick M, Brassolotto J, Manduca-Barone A. Rural healthcare professionals' participation in Medical Assistance in Dying (MAiD): beyond a binary decision. BMC Palliat Care 2024; 23:107. [PMID: 38664675 PMCID: PMC11044390 DOI: 10.1186/s12904-024-01440-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Medical Assistance in Dying (MAiD) was legalized in Canada in 2016 and amended in 2021. At the time that this study was conducted, the federal government was considering expanding the eligibility criteria to include patients whose death was not reasonably foreseeable. The purpose of this study was to better understand rural healthcare professionals' experiences with assisted dying set against the backdrop of legislative expansion. METHODS A qualitative exploratory study was undertaken with general rural practice physicians, nurse practitioners, registered nurses, ethicists, patients, and patient families in rural Southern Alberta, Canada. For this paper, data from 18 audio-recorded and transcribed semi-structured interviews with healthcare professionals were analyzed using thematic analysis. Categories and patterns of shared meaning that linked to an overarching theme were identified. RESULTS Between the binary positions of full support for and conscientious objection to assisted dying, rural healthcare professionals' decisions to participate in MAiD was based on their moral convictions, various contextual factors, and their participation thresholds. Factors including patient suffering; personal and professional values and beliefs; relationships with colleagues, patients and family, and community; and changing MAiD policy and legislation created nuances that informed their decision-making. CONCLUSIONS The interplay of multiple factors and their degree of influence on healthcare professionals' decision-making create multiple decision points between full support for and participation in MAiD processes and complete opposition and/or abstention. Moreover, our findings suggest evolving policy and legislation have the potential to increase rural healthcare professionals' uncertainty and level of discomfort in providing services. We propose that the binary language typically used in the MAiD discourse be reframed to reflect that decision-making processes and actions are often fluid and situational.
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Affiliation(s)
- Monique Sedgwick
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada.
| | - Julia Brassolotto
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada
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Odogwu S, Morris S, Addison S, Abbott S. Laparoscopic cholecystectomy performed by a surgical care practitioner: a review of outcomes. Ann R Coll Surg Engl 2024. [PMID: 38660827 DOI: 10.1308/rcsann.2023.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Surgical care practitioners (SCPs) are non-medical workers involved in various aspects of the management of surgical patients. The role includes assisting and performing surgical procedures. More than 60,000 laparoscopic cholecystectomies (LC) are performed annually in the UK. With ever-increasing pressure on waiting lists, it is important to look at fully utilising the skills of our entire workforce. We report what we believe is the first published series of LC performed by an SCP. METHODS A retrospective review of a prospectively collected database was performed. The primary outcome was any complication requiring intervention. Secondary outcomes were minor complications, operative time, length of stay, conversion and readmission. RESULTS In total, 170 patients were operated on. Indications were biliary colic in 127 (74.7%), cholecystitis in 30 (17.6%) and pancreatitis in 13 (7.6%). Mean operating time was 65min (range 35-152min). Fifty-three operations were assisted by a consultant, 110 by a specialist or associate specialist grade (SAS) doctor and 7 by a core trainee (CT2). Some 139 (81.7%) patients were discharged on the day of surgery and 24 (14.1%) stayed one night in hospital. There were no major complications. Five patients required readmission, three with pain and two with port site infections. There were no conversions or transfusions required. CONCLUSIONS There is a paucity of published data on surgical outcomes of procedures performed by SCPs. With a structured, supervised approach, SCPs could be trained to take on more complex procedures and further strengthen the surgical workforce. This study demonstrates that elective LC can be safely performed by an appropriately trained and supervised SCP.
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Affiliation(s)
- S Odogwu
- Walsall Healthcare NHS Trust, UK
| | - S Morris
- Walsall Healthcare NHS Trust, UK
| | - S Addison
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - S Abbott
- Walsall Healthcare NHS Trust, UK
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Geese F, Bryant-Lukosius D, Zwakhalen S, Hahn S. Advanced Practice Nurses and Their Roles in Swiss Cancer Care: A Cross-Sectional Study. Semin Oncol Nurs 2024:151626. [PMID: 38641521 DOI: 10.1016/j.soncn.2024.151626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/25/2024] [Accepted: 03/08/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES To examine the advanced practice nurse workforce in Swiss cancer care and how their roles are being implemented (eg, role structures, processes) to achieve optimal outcomes for patients and their families, care organizations, and the broader health care system. METHODS A cross-sectional study was conducted. The sample included master-prepared advanced practice nurses in cancer care, who completed an online questionnaire from December 2021 to January 2022. Thirty-nine items assessed structures (eg, role characteristics, utilization), processes (eg, role activities, interventions), and perceived outcomes (eg, for patients, the health care system) of advanced practice nurses in Swiss cancer care. Data from closed questions were analyzed using descriptive statistics. Data from open-ended questions were organized and summarized into categories related to domains of advanced practice nursing and its reported frequency by the advanced practice nurses. RESULTS The participating advanced practice nurses (n = 53), worked in half of the 26 Swiss cantons. Interventions were identified within nine categories, of which most were targeted to patients and their families (n = 7), followed by health care professionals (n = 2). Perceived positive outcomes were patient symptom management, length of hospital stay, and health care costs. Participants felt less confident in cancer care (eg, autonomous practice) and reported 15 professional development needs (eg, medical interventions, teaching). CONCLUSIONS This study provides a comprehensive examination of 53 advanced practice nurses, detailing the characteristics of their roles and utilization across various jurisdictions and health care settings. The results highlight the diverse dimensions of advanced practice nursing and its potential to enhance cancer services and outcomes in Switzerland. Opportunities for role development support and expansion are identified. IMPLICATIONS FOR NURSING PRACTICE More systematic health human resource planning is needed to expand the deployment of advanced practice nurses across jurisdictions, practice settings, and more diverse patient populations. Role development needs show the desire for specialized educational preparation in cancer care.
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Affiliation(s)
- Franziska Geese
- Academic Practice Partnership, School of Health Professions, Bern University of Applied Sciences, Switzerland; University Hospital Bern, Inselspital, Insel Gruppe, Freiburgstrasse, Switzerland.
| | - Denise Bryant-Lukosius
- School of Nursing and Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sandra Zwakhalen
- Department of Health Services Research, Maastricht University, Netherlands
| | - Sabine Hahn
- Division of Nursing, School of Health Professions, Bern University of Applied Sciences, Switzerland
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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 2024:151625. [PMID: 38556365 DOI: 10.1016/j.soncn.2024.151625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Dowling M, Pape E, Geese F, Van Hecke A, Bryant-Lukosius D, Cerón MC, Fernández-Ortega P, Marquez-Doren F, Ward A, Semple C, King T, Glarcher M, Drury A. Advanced Practice Nursing Titles and Roles in Cancer Care: A Scoping Review. Semin Oncol Nurs 2024:151627. [PMID: 38556366 DOI: 10.1016/j.soncn.2024.151627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES Advanced practice nursing roles in cancer care are diverse and exist across the cancer care continuum. However, the titles used and the scope of practice differ across countries. This diversity is likely to be misleading to patients and influence nurses' contribution to health care. An understanding of the current state of advanced practice nursing roles in cancer care internationally is needed to inform opportunities for future role development and enhance cancer nursing career pathways. METHODS This scoping review included a systematic search of four databases: MEDLINE, CINAHL, PsycINFO, and Academic Search Complete. Independent screening for papers meeting the review's inclusion criteria was undertaken using online screening software. Data extraction, coding, and mapping were undertaken in NVivo 12. RESULTS Of the 13,409 records identified, 108 met the review's inclusion criteria. A variety of roles in cancer care settings were described. The United States and the United Kingdom had the most titles for advanced practice nursing roles. Tumor-specific roles were described and integrated into different phases of the cancer care continuum. Trends in continuing professional development for advanced practice nurses in cancer care included the rise in Fellowship programs in the United States and practice-based education in the United Kingdom. CONCLUSIONS The differences in advanced practice nursing roles in cancer care allow regional and institutional variation to meet the needs of patient populations and health care system demands. However, a lack of clarity surrounding titles and roles results in confusion and underutilization of these nurses' highly specialized skill sets. IMPLICATIONS FOR NURSING PRACTICE Incongruence in titles and scope of practice internationally will ultimately result in a merging of roles. There is a need for international agreement on education requirements for advanced practice nursing roles to promote career pathways.
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Affiliation(s)
- Maura Dowling
- School of Nursing and Midwifery, University of Galway, Ireland.
| | - Eva Pape
- Cancer Center, Ghent University Hospital, Belgium; Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium and Ghent University Hospital, Centre for Nursing Expertise, Belgium
| | - Franziska Geese
- Department of Nursing, Clinical Practice Development and Digitalisation, Bern University Hospital, Inselspital, Insel Gruppe, Switzerland
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium and Ghent University Hospital, Centre for Nursing Expertise, Belgium; Nursing Department, Ghent University Hospital, Belgium
| | - Denise Bryant-Lukosius
- School of Nursing and Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - M Consuelo Cerón
- Escuela de Enfermería, Facultad de Enfermería y Obstetricia, Universidad de los Andes-Chile
| | - Paz Fernández-Ortega
- Catalan Institute of Oncology and Faculty of Nursing, University of Barcelona, Spain
| | - Francisca Marquez-Doren
- School of Nursing, PAHO Collaborating Center, Pontificia Universidad Católica de Chile and School of Nursing Pontificia Universidad Católica de Chile, PAHO Collaborating Center and Sigma Chapter Alfa Beta Ómicron
| | - Ashleigh Ward
- School of Medicine, Dentistry and Nursing College of Medicine, Veterinary and Life Sciences, University of Glasgow, Scotland; NHS Forth Valley, Stirling, UK
| | - Cherith Semple
- Institute of Nursing and Health Research, Ulster University / Cancer Services, South Eastern Health and Social Care Trust, Belfast, Northern Ireland
| | - Tracy King
- Cancer Care Research Unit (CCRU) Susan Wakil School of Nursing and Midwifery, The University of Sydney, Australia; Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Manela Glarcher
- Institute of Nursing Science, Paracelsus Medical University, Salzburg, Austria
| | - Amanda Drury
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Ireland
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Ord T, Metcalfe D, Greaves J, Hodgson P. Unmasking impostor phenomenon: a study of nurses in specialist roles. Br J Nurs 2024; 33:139-143. [PMID: 38335096 DOI: 10.12968/bjon.2024.33.3.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
This cross-sectional study aimed to explore the incidence of impostor phenomenon among 79 nurses in specialist roles in a single NHS trust in England, using an online anonymous questionnaire that included the Clance Imposter Phenomenon Scale and free-text responses. Results indicated a high prevalence of impostor phenomenon, with no specific variables predicting its occurrence. Four main themes emerged: self-doubt, role expectations, fear of exposure as an impostor, and factors leading to burnout. The study highlights the need for targeted support and training for this cohort, particularly as impostor phenomenon was found to be prevalent during career transitions and was not limited by gender. The findings have implications for nursing management and education, offering the opportunity to develop specific support mechanisms to alleviate impostor phenomenon and potentially reduce attrition rates in specialist nursing roles.
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Affiliation(s)
- Tracy Ord
- Assistant Professor in Nursing, Department of Nursing Midwifery and Health, Northumbria University
| | - Dale Metcalfe
- Lecturer in Psychology, Health and Life Sciences, Northumbria University
| | - Jane Greaves
- Associate Professor in Nursing, Strategic Lead-NMC Competence Test Centre, Health and Life Sciences, Northumbria University
| | - Philip Hodgson
- Assistant Professor in Nursing, Department of Nursing Midwifery and Health, Northumbria University
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D'Aoust R, Slone SE, Russell N, Budhathoki C, Ling C. PRIME- nurse practitioner competency model validation and criterion based OSCE rubric interrater reliability. BMC Med Educ 2024; 24:124. [PMID: 38326786 PMCID: PMC10851454 DOI: 10.1186/s12909-024-05056-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
The PRIME-NP (Professional-Reporter-Interpreter-Manager-Educator/Evaluation-Nurse Practitioner) Model is adapted from the RIME (Reporter-Interpreter-Manager-Educator) model used in medical education to guide medical student and resident education. The Delphi technique was used to validate the PRIME-NP Model. After two rounds of review by a group of experts in NP curriculum, the model was determined to be valid based on expert consensus. Agreement percent increase from the first round to the second round in all categories. Interrater reliability (IRR) was assessed using interclass correlation after instrument validation was completed for each of the five levels of the PRIME-NP model. Overall, the IRR of the instrument was found to be acceptable with some notable exceptions. No variance was noted in professional behaviors at any level. Variance was increased in management and educator/evaluator behaviors in higher/later course levels. The PRIME-NP Model and PRIME-NP OSCE Rubric is a valid and reliable instrument to assess NP student progression in objective structured clinical examinations. This instrument has the potential for adaptation for use in other types of health sciences education and settings.
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Affiliation(s)
- Rita D'Aoust
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sarah E Slone
- Johns Hopkins School of Nursing, Baltimore, MD, USA.
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Jezequel T, Cheron N, Ajazi Hub R, Brouillat C, Colonnese E, Desmedt C, Evard S, Hie S, Mourrut C, Vallade D, Bouhier I, Chauvel C, Gandemer V, Mercier L, Yakoub-Agha I. [Role of advanced practice nurse within a cellular therapy unit: Guidelines from the Francophone Society of Bone Marrow Transplantation and cellular therapy (SFGM-TC)]. Bull Cancer 2024; 111:S50-S66. [PMID: 36797127 DOI: 10.1016/j.bulcan.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 02/16/2023]
Abstract
Like the "nurse practitioner" in Anglo-Saxon countries, the French health authority validated on January 2016 the creation of an intermediate grade called advanced practice nurse (APN). They are authorized to carry out an assessment of the person's state of health, through a complete clinical examination. They can also prescribe additional examinations necessary for the monitoring of the pathology, and carry out certain acts for diagnostic and/or therapeutic purposes. Given the specificities of cellular therapy patients, the content of university professional training doesn't seem sufficient to assure an optimal management by the APN of these patients. The Francophone society of bone marrow transplantation and cellular therapy (SFGM-TC) had already published two works regarding what was initially called "the transfer of skills" between doctors and nurses in the follow-up of transplant patients. In the same way, this workshop attempts to address the question of the place of APNs in the management of patients undergoing cellular therapy treatment. Beyond a delegation of tasks as proposed by the cooperation protocols, this workshop produces recommendations to allow an autonomous activity of the IPA in the follow-up of these patients, in close collaboration with the medical team.
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Affiliation(s)
- Thomas Jezequel
- Service d'hématologie, oncologie, immunologie pédiatrique, CHU Nantes, 44093 Nantes cedex 1, France.
| | | | | | | | | | | | - Solène Evard
- Service d'oncohématologie pédiatrique, CHU Hôpital sud, 35000 Rennes, France
| | | | | | | | - Isabelle Bouhier
- CHU de Nantes, Service de santé publique, 44093 Nantes cedex 1, France
| | | | - Virginie Gandemer
- Service d'oncohématologie pédiatrique, CHU Hôpital sud, 35000 Rennes, France
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9
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Driscoll A, Watts JJ, Meagher S, Kennedy R, Mar R, Johnson D, Hare DL, Faourque O, Gao L. Cost-effectiveness of an inpatient nurse practitioner in heart failure. Eur J Cardiovasc Nurs 2024; 23:33-41. [PMID: 37067006 DOI: 10.1093/eurjcn/zvad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/18/2023]
Abstract
AIMS Heart failure (HF) nurse practitioners (NPs) are an important part of the HF specialist team, and their impact on the cost-effectiveness of their role is unknown. The aim of this study was to determine the cost-effectiveness of a HF NP inpatient service compared with current practice of no HF NP service from a health system perspective at 12 months and 3 years. METHODS AND RESULTS We developed a Markov model to estimate costs, effects, and cost-effectiveness for hospitalized HF patients and seen by a HF NP service compared with usual care at 12 months and 3 years. Costs and effects were taken from a retrospective observational cohort study. Transition probabilities and utilities were derived from published studies. A total of 500 patients were included (250 patients in the HF NP service vs. 250 patients in usual care). Average age was 77.7 ± 11 years, and 54% were male. At 12 months, the HF NP group was cheaper and more effective compared with no HF NP [$23 031 vs. $25 111 (AUD), respectively; quality-adjusted life years (QALYs) were 0.68 in HF NP group compared with 0.66 in usual care]. The incremental cost-effectiveness ratio showed a savings of $109 474 per QALY gained at 12 months and a savings of $270 667 per QALY gained at 3 years in favour of the HF NP service. CONCLUSION The HF NP service was cost-effective with lower costs and higher QALYs compared with no HF NP service. Economic evaluations alongside randomized controlled trials are warranted.
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Affiliation(s)
- Andrea Driscoll
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Jennifer J Watts
- School of Health Economics, Deakin University, Burwood, Australia
| | - Sharon Meagher
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Rhoda Kennedy
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Ronald Mar
- Clinical Costing Department, Austin Health, Melbourne, Australia
| | - Doug Johnson
- Department of General Medicine, Melbourne Health, Melbourne, Australia
- School of Medicine, University of Melbourne, Parkville, Australia
| | - David L Hare
- Department of Cardiology, Austin Health, Melbourne, Australia
- School of Medicine, University of Melbourne, Parkville, Australia
| | - Omar Faourque
- Department of Cardiology, Austin Health, Melbourne, Australia
- School of Medicine, University of Melbourne, Parkville, Australia
| | - Lan Gao
- School of Health Economics, Deakin University, Burwood, Australia
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Whitt KJ, Allen CL, Hogg CW, Pericak A, Beebe SL, Braungart C, Knestrick J, Harrod T, McNelis AM. The use of electronic health records in advanced practice nursing education: a scoping review. J Prof Nurs 2024; 50:83-94. [PMID: 38369377 DOI: 10.1016/j.profnurs.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 11/25/2023] [Accepted: 11/30/2023] [Indexed: 02/20/2024]
Abstract
Electronic health records are integral to the advanced practice registered nurse role, yet access and training during academic preparation are profoundly limited. Lack of exposure to electronic health records prevents students from becoming fully prepared for the responsibilities of clinical practice and potentially impacts quality of care, patient safety, and communication among patients and providers. This scoping review of 20 articles on electronic health record use in advanced practice registered nursing student education shows significant gaps in current research. Nine articles were classified as research. The remaining 11 were non-research reports of teaching innovations describing the use of simulated electronic health records in graduate nursing education or the use of an electronic health record in interprofessional education activities. Most of the limited research did not use valid and reliable instruments or robust designs, employed disparate approaches and tools to study the phenomenon, and measured low-level outcomes such as student navigation and confidence in using electronic health records. The non-research literature draws attention to the deficits in educational resources, including unaffordable electronic health records for academic use. Although rigorous evidence is lacking, a common theme throughout the reviewed literature was the benefit of simulation to develop electronic health record skills.
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Affiliation(s)
- Karen J Whitt
- George Washington University, School of Nursing, Washington, DC, USA.
| | - Cynthia L Allen
- George Washington University, School of Nursing, Washington, DC, USA
| | - Cameron W Hogg
- George Washington University, School of Nursing, Washington, DC, USA
| | - Arlene Pericak
- George Washington University, School of Nursing, Washington, DC, USA
| | - Sarah L Beebe
- Bayhealth Medical Center, PCOM Simulation Center at Bayhealth, Dover, DE, USA
| | - Carol Braungart
- George Washington University, School of Nursing, Washington, DC, USA
| | - Joyce Knestrick
- George Washington University, School of Nursing, Washington, DC, USA
| | - Thomas Harrod
- George Washington University, Himmelfarb Health Sciences Library, Washington, DC, USA
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11
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Horvath S, Visekruna S, Kilpatrick K, McCallum M, Carter N. Models of care with advanced practice nurses in the emergency department: A scoping review. Int J Nurs Stud 2023; 148:104608. [PMID: 37801938 DOI: 10.1016/j.ijnurstu.2023.104608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/31/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Emergency departments play a critical role in healthcare systems internationally. Visits for emergency care continue to increase, related to poor access to primary care, the COVID-19 pandemic, and health human resource issues. International literature shows similar stressors in the emergency department. Extended wait times to see health providers lead to poor outcomes, and innovative models of care are needed to address emergency department overcrowding and to meet the needs of patients. Advanced practice nurses have the expertise and scope of practice to optimize and address primary and acute care needs and could be further integrated into the emergency healthcare systems. It is unclear what and how advanced practice nurses are functioning in emergency departments to improve patient and organization outcomes. METHODS This scoping review was a comprehensive search of MEDLINE, EMCARE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and gray literature. Authors developed inclusion and exclusion criteria, performed title and abstract screening, and full text screening using review software. Data about models of care with advanced practice nurses were extracted and organized to understand patient, provider, and organizational outcomes. We also extracted information about the development and implementation of roles. RESULTS Of the 6780 records identified, 76 met inclusion criteria. Emergency department models of care, mainly using nurse practitioners, include fast-track, generalized emergency, minor injury, orthopedics, pediatrics, geriatrics, specific populations, and triage. Reported patient outcomes include improvement in key metrics specific to emergency departments, such as total length of stay, wait times to be seen by a provider, left without being seen rates, treatment for pain, costs, and resource use. When comparing nurse practitioners to other providers, outcomes were similar or better for patient and organizational outcomes. DISCUSSION Various models of care utilizing advanced practice nurses in emergency departments are present internationally and information about how they are developed, integrated, and utilized provides practical information to support and sustain new roles. There is an opportunity to expand the use of these roles into emergency departments as the nurse practitioner scope of practice grows. Given the current crisis across healthcare systems, there is need for innovation, and improving delivery of emergency services with these advanced practice nursing models of care can help to address important health policy priorities in Canada and other countries. TWEETABLE ABSTRACT Advanced Practice Nurse models of care in emergency - Improved outcomes for patients and organizations - A review of the literature. @SamanthaH_RN.
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Affiliation(s)
- Samantha Horvath
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.
| | - Sanja Visekruna
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | | | - Nancy Carter
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.
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Su JM, Wu CY, Hong WT, Chen PS, Hung KS, Wang CJ. Application of mobile-based web app to enhance simple suturing skills of nurse practitioners. Nurse Educ Today 2023; 131:105959. [PMID: 37713781 DOI: 10.1016/j.nedt.2023.105959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/11/2023] [Accepted: 09/03/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Suturing is a crucial clinical skill for nurse practitioners (NPs), but the effectiveness of traditional training methods (e.g., physical suture kits combined with video content) is low. OBJECTIVE This study compared the effectiveness and usability of a mobile-based web app (MoWa) developed for NPs to learn simple suturing skills with those of traditional instructional video-based training. METHODS The MoWa system utilizes mobile devices to simulate hands-on suturing and provides learning guidance and feedback to support self-learning with a physical suturing kit. Fifty-four suturing novices (NPs) were recruited as participants, divided into an experimental group (EG: 28 participants) and a control group (CG: 26 participants), and instructed to self-learn for 3 weeks. Learning effectiveness and system usability were evaluated through a pretest and posttest. RESULTS The EG exhibited significant improvements in learning outcomes, self-confidence, self-efficacy, and learning anxiety and expressed satisfaction with the MoWa system. Furthermore, the EG also considerably enhanced learning outcomes, self-efficacy, and learning anxiety compared to the CG, with no significant difference in self-confidence. CONCLUSION The MoWa system combined with deliberate practice is an effective strategy for supporting suturing skills training.
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Affiliation(s)
- Jun-Ming Su
- Department of Information and Learning Technology, National University of Tainan, Tainan 700301, Taiwan
| | - Chen-Yu Wu
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan 70428, Taiwan
| | - Wei-Ting Hong
- Department of Information and Learning Technology, National University of Tainan, Tainan 700301, Taiwan
| | - Pin-Shuo Chen
- National Cheng Kung University Hospital, Tainan 70428, Taiwan
| | - Kuo-Shu Hung
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, Tainan 70428, Taiwan
| | - Chih-Jung Wang
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, Tainan 70428, Taiwan.
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McGilton KS, Krassikova A, Wills A, Bethell J, Boscart V, Escrig-Pinol A, Iaboni A, Vellani S, Maxwell C, Keatings M, Stewart SC, Sidani S. Nurse practitioner led implementation of huddles for staff in long term care homes during the COVID-19 pandemic. BMC Geriatr 2023; 23:713. [PMID: 37919676 PMCID: PMC10623826 DOI: 10.1186/s12877-023-04382-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/05/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Staff working in long-term care (LTC) homes during COVID-19 frequently reported a lack of communication, collaboration, and teamwork, all of which are associated with staff dissatisfaction, health concerns, lack of support and moral distress. Our study introduced regular huddles to support LTC staff during COVID-19, led by a Nurse Practitioner (NP). The objectives were to evaluate the process of huddle implementation and to examine differences in outcomes between categories of staff (direct care staff, allied care and support staff, and management) who attended huddles and those who did not. METHODS All staff and management at one LTC home (< 150 beds) in Ontario, Canada were included in this pre-experimental design study. The process evaluation used a huddle observation tool and focused on the dose (duration, frequency) and fidelity (NP's adherence to the huddle guide) of implementation. The staff attending and non-attending huddles were compared on outcomes measured at post-test: job satisfaction, physical and mental health, perception of support received, and levels of moral distress. The outcomes were assessed with validated measures and compared between categories of staff using Bayesian models. RESULTS A total of 42 staff enrolled in the study (20 attending and 22 non-attending huddles). Forty-eight huddles were implemented by the NP over 15 weeks and lasted 15 min on average. Huddles were most commonly attended by direct care staff, followed by allied care/support, and management staff. All huddles adhered to the huddle guide as designed by the research team. Topics most often addressed during the huddles were related to resident care (46%) and staff well-being (34%). Differences were found between staff attending and non-attending huddles: direct care staff attending huddles reported lower levels of overall moral distress, and allied care and support staff attending huddles perceived higher levels of support from the NP. CONCLUSIONS NP-led huddles in LTC homes may positively influence staff outcomes. The process evaluation provided some understanding of why the huddles may have been beneficial: the NP addressed resident care issues which were important to staff, encouraged a collaborative approach to solving issues on the unit, and discussed their well-being. TRIAL REGISTRATION NUMBER NCT05387213, registered on 24/05/2022.
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Affiliation(s)
- Katherine S McGilton
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
| | - Alexandra Krassikova
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Aria Wills
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Jennifer Bethell
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Veronique Boscart
- School of Health and Life Sciences, Conestoga College, Kitchener, Canada
| | - Astrid Escrig-Pinol
- Mar School of Nursing, Universitat Pompeu Fabra, Barcelona, Spain
- Social Determinants and Health Education Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Shirin Vellani
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Colleen Maxwell
- Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Margaret Keatings
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Steven C Stewart
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Souraya Sidani
- Faculty of Nursing, Toronto Metropolitan University, Toronto, Canada
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Yang BK, Idzik S, Nelson HW, McSweeney-Feld MH. Nurse Practitioner Employment in Relation to Nursing Staff Turnover and Resident Care Outcomes in US Nursing Homes. J Am Med Dir Assoc 2023; 24:1767-1772. [PMID: 37634548 DOI: 10.1016/j.jamda.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES A growing number of nurse practitioners (NPs) are employed in nursing homes (NHs) through various NP staffing mechanisms. The purpose of this study was to examine if having NH-employed NPs was associated with nursing staff turnover and resident care outcomes measured as hospital utilization, infection control citations, and substantiated complaints in NHs in 2021-2022. DESIGN A cross-sectional, retrospective study. SETTING AND PARTICIPANTS A total of 13,966 NHs from payroll-based journal (PBJ) and claim-based quality measures published by the Centers for Medicare and Medicaid Services in 2021-2022. METHODS Facilities were identified as having NH-employed NPs if at least 1 employed NP with paid working hours ≥10 per week was reported through the PBJ. We examined if having NH-employed NPs was associated with nursing staff turnover rates, unplanned hospital utilization, infection control citations, and substantiated complaints using doubly robust estimation that combined inverse probability weight representing the NH's likelihood of employing NPs and outcome regression. RESULTS Approximately, 2.8% of NHs had employed NPs. Facilities with NH-employed NPs tended to be larger, hospital affiliated, and not for profit with greater medical and nursing staff availability. In addition, a significantly higher proportion of facilities with NH-employed NPs were in metropolitan areas or states with full NP practice independence. We found that facilities with NH-employed NPs had significantly lower registered nurse (adjusted β, -5.40; 95% CI, -9.50 to -1.30) and certified nursing assistant turnover rates (adjusted β, -3.35; 95% CI, -6.29 to -0.40). Facilities with NH-employed NPs also had significantly fewer long-stay resident hospitalizations, infection control citations, and substantial complaints compared with those with no NH-employed NPs. CONCLUSIONS AND IMPLICATIONS This study highlights the value of NH-employed NPs to improve registered nurse and certified nursing assistant staff retention and NH resident outcomes. NH stakeholders and policymakers may consider various strategies to incentivize NP employment in NHs such as removing regulatory barriers to NP practice.
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Affiliation(s)
- Bo Kyum Yang
- Department of Health Sciences, Towson University, Towson, MD, USA.
| | - Shannon Idzik
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - H Wayne Nelson
- Department of Health Sciences, Towson University, Towson, MD, USA
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O'Connor AW, Helfrich CD, Nelson KM, Sears JM, Jensen PK, Engstrom C, Wong ES. Full practice authority and burnout among primary care nurse practitioners. Nurs Outlook 2023; 71:102056. [PMID: 37856902 DOI: 10.1016/j.outlook.2023.102056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Full practice authority (FPA) improves clinical autonomy for nurse practitioners (NPs). Autonomy may reduce burnout. PURPOSE Estimate the effect of changing from reduced or restricted practice authority to FPA on NP burnout. METHODS In this quasi-experimental study, we compared NP burnout before (2016) and after (2018) a Veterans Health Administration (VHA) regulation authorized NP FPA. Burnout proportions were estimated for VHA facilities by aggregating responses to the VHA's All Employee Survey from 1,352 primary care NPs. DISCUSSION Seventy-seven percent of facilities changed to FPA postregulation. Burnout was six points lower among NPs in facilities that changed to FPA compared to facilities that had FPA prior to the regulation; however, this association was not statistically significant. CONCLUSION NPs are increasingly working under independent practice. While changing to FPA did not reduce NP burnout, this association may vary by health care setting or when burnout is measured for individuals or teams.
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Affiliation(s)
- Allyson W O'Connor
- Department of Health Systems and Population Health, University of Washington, Seattle, WA.
| | - Christian D Helfrich
- Department of Health Systems and Population Health, University of Washington, Seattle, WA; Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA
| | - Karin M Nelson
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA
| | - Jeanne M Sears
- Department of Health Systems and Population Health, University of Washington, Seattle, WA; Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
| | - Penny Kaye Jensen
- Office of Nursing Service, Department of Veterans Affairs, Washington, DC
| | - Christine Engstrom
- Office of Nursing Service, Department of Veterans Affairs, Washington, DC
| | - Edwin S Wong
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA
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Driscoll A, Meagher S, Kennedy R, Hare DL, Johnson DF, Asker K, Farouque O, Romaniuk H, Orellana L. Impact of a heart failure nurse practitioner service on rehospitalizations, emergency presentations, and survival in patients hospitalized with acute heart failure. Eur J Cardiovasc Nurs 2023; 22:701-708. [PMID: 36413653 DOI: 10.1093/eurjcn/zvac108] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/09/2022] [Accepted: 11/13/2022] [Indexed: 10/12/2023]
Abstract
AIMS Heart failure nurse practitioners (HF NPs) are an emerging component of the heart failure (HF) specialist workforce but their impact in an inpatient setting is untested. The aim of this paper is to explore the impact of an inpatient HF NP service on 12-month all-cause rehospitalizations, emergency department (ED) presentations, and mortality in patients hospitalized with HF compared with usual hospital care. METHODS AND RESULTS Retrospective, two-group comparative design involving patients (n = 408) admitted via ED with acute HF to a metropolitan quaternary hospital between January 2013 and August 2017. Doubly robust estimation with augmented inverse probability weighting (DR-AIPW) was used to account for the non-random allocation of patients to usual hospital care or the HF NP service in addition to usual in-hospital care. Among 408 patients (186 usual care and 222 HF NP service) admitted with acute HF, the mean age was 76.5 [standard deviation (SD) 12.0] years and 56.4% (n = 230) were male. After IPW adjustment, patients seen by the HF NP service had a lower risk of 12-month rehospitalization (61.3 vs. 78.3% usual care; difference -16.9%, 95% CI: -26.4%, -6.6%) and ED presentations (12.6 vs. 22.0%; difference -9.4%, 95% CI: -17.3%, -1.4%) with no difference in 6- or 12-month mortality. The HF NP service improved referrals to a home visiting programme that was available to HF patients (64.4 vs. 45.4%; difference 19%, 95% CI: 8.8%, 28.8%). CONCLUSION Additional support by an inpatient HF NP service has the potential to significantly reduce rehospitalizations and ED presentations over 12 months. Further evidence from a multicentre randomized control trial is warranted.
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Affiliation(s)
- Andrea Driscoll
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
| | - Sharon Meagher
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - Rhoda Kennedy
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - David L Hare
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | - Douglas F Johnson
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
- The Royal Melbourne Hospital, Department of General Medicine, Grattan St, Parkville, VIC 3050, Australia
| | - Kristina Asker
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
| | - Omar Farouque
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | - Helena Romaniuk
- Biostatistics Unit, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - Liliana Orellana
- Biostatistics Unit, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
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Silva A, Galica J, Woo K, Luctkar-Flude M. Using simulation to enhance primary care sexual health services for breast cancer survivors: a feasibility study. Support Care Cancer 2023; 31:576. [PMID: 37713111 DOI: 10.1007/s00520-023-08037-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE To evaluate the impact of a virtual simulation game (VSG) to improve primary care sexual health services for breast cancer survivors. METHODS We developed a VSG to help primary care providers (PCPs) address sexual health disturbances among breast cancer survivors. We used a pretest-posttest design with a series of validated tools to assess the feasibility and perceived impact of the VGS, including an open-ended question about participants' perceptions. Quantitative data was analyzed using descriptive and inferential statistics and qualitative data through an inductive content analysis approach. RESULTS Of the 60 participants, the majority were nurse practitioner students (n = 26; 43.3%), female (n = 48; 80%), and worked full-time (n = 35; 58.3%). Participants perceived the VSG as feasible and potentially effective. The intervention elicited an improvement in PCPs' perception of knowledge between pretest and posttest surveys (z = - 1.998, p = 0.046). Professional background and previous exposure to sexual health training were predictors of knowledge perception. Participants described the intervention as an engaging educational strategy where they felt safe to make mistakes and learn from that. CONCLUSIONS VSGs can be a potentially effective educational approach for PCPs. Our findings indicate that despite being an engaging interactive strategy, VSG interventions should be tailored for each professional group. IMPLICATIONS FOR CANCER SURVIVORS This intervention has potential to improve the knowledge and practice of PCPs related to breast cancer follow-up care to support comprehensive care for survivors, resulting in a better quality of life and patient outcomes.
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Affiliation(s)
- Amina Silva
- School of Nursing, Queen's University, Kingston, ON, Canada.
- Nursing Department, Brock University, St. Catherines, Canada.
| | | | - Kevin Woo
- School of Nursing, Queen's University, Kingston, ON, Canada
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Denke NJ, Switzer DF, Davis WD, Gibbons-Hallman M, House DT. Supporting Emergency Care Delivery Through Updated Emergency Nurse Practitioner Competencies. J Emerg Nurs 2023; 49:654-660. [PMID: 37648367 DOI: 10.1016/j.jen.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 09/01/2023]
Abstract
As multidisciplinary emergency care becomes increasingly complex, all team members must be aware of their respective roles and responsibilities. In the emergency department, nurse practitioners are integral members of the team. They possess a wide range of clinical and leadership competencies that allow them to perform specific and differentiated tasks within the emergency department. A well-defined competency not only contributes to the promotion of a positive work culture but also clarifies performance expectations, identifies skill gaps, and supports team development. Furthermore, it allows the nurse practitioner to adapt to changing conditions while maintaining patient safety. The competencies of emergency nurse practitioners have evolved over the past 2 decades. The authors discuss the importance of establishing clear expectations for emergency nurse practitioner practice in this article and the alignment of competencies with organizational culture and objectives.
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Justice L, Florez AR, Diller C, Moellinger A, Ellis M, Riley C, Dugan E, Heichel J, Williams B, Dykton TI, Foerster LA, Callow L. Development and implementation of a paediatric cardiac intensive care advanced practice provider curriculum. Cardiol Young 2023; 33:1288-1295. [PMID: 35929440 DOI: 10.1017/s1047951122002542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Education of paediatric advanced practice providers takes a generalist approach which lacks in-depth exposure to subspecialties like paediatric cardiac intensive care. This translates into a knowledge gap related to congenital cardiac physiology and management for APPs transitioning to the paediatric cardiac ICU. METHODS A specialised interprofessional peer-reviewed curriculum was created and distributed through the Pediatric Cardiac Intensive Care Society. This curriculum includes a textbook which is complemented by a didactic and simulation review course. Course evaluations were collected following each course, and feedback from participants was incorporated into subsequent courses. Pediatric Cardiac Intensive Care Society partnered with the Pediatric Nursing Certification Board to develop a 200-question post-assessment (exam) bank. RESULTS From December 2017 to January 2022, 12 review courses were taught at various host sites (n = 314 participants). Feedback revealed that courses improved preparedness for practice, contributed to advanced practice provider empowerment, and emphasised the importance of professional networking. 97% of attendees agreed/strongly agreed that the course improved clinical knowledge, 97% agreed/strongly agreed that the course improved ability to care for patients, and 88% agreed/strongly agreed that the course improved confidence to practice. 49% of participants rated the course as extremely effective, 42% very effective, 6% moderately effective, and 3% as only slightly effective. CONCLUSIONS A standardised subspecialty curriculum dedicated to advanced practice provider practice in cardiac intensive care was needed to improve knowledge, advance practice, and empower APPs managing critically ill patients in the cardiac ICU. The developed curriculum provides standardised learning, increasing advanced practice provider knowledge acquisition, and confidence to practice.
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Affiliation(s)
- Lindsey Justice
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Amy R Florez
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christin Diller
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ashley Moellinger
- Department of Cardiology, Children's of Alabama, Birmingham, AL, USA
| | - Misty Ellis
- Department of Critical Care, Kentucky Children's Hospital, Lexington, KY, USA
| | - Christine Riley
- Division of Cardiac Critical Care, Children's National Medical Center, Washington, DC, USA
| | - Erin Dugan
- Department of Cardiology, Levine Children's Hospital at Atrium Health, Charlotte, NC, USA
| | - Jenna Heichel
- Department of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brenda Williams
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Louise Callow
- Department of Pediatric Cardiac Surgery, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
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Faraz Covelli A, Barnes H. Novice nurse practitioners' employment decisions and role transition experiences during COVID-19. J Prof Nurs 2023; 47:81-87. [PMID: 37295916 DOI: 10.1016/j.profnurs.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND While it is known how the COVID-19 pandemic affected providers already employed and working in health care settings, there is little data about the effect it may have had on novice nurse practitioners (NPs). PURPOSE The purpose of this study was to describe novice NPs' employment decisions and role transition experiences during the COVID-19 pandemic. METHOD Via an online survey, novice NPs were asked open-ended questions about how the pandemic influenced the decision to take their first position and their role transition experience, as well as what employers did well or could have done better to facilitate this transition. FINDINGS Participants described employment challenges that included a difficult job market with limited employment opportunities, decreased pay and benefits, fewer onboarding and mentorship opportunities, and less primary care experience. However, NPs reported the pandemic positively influenced their role transition experiences with decreased patient workload and greater use of telehealth. CONCLUSION Novice NPs were impacted by the COVID-19 pandemic in making employment decisions and transitioning into the NP role.
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Affiliation(s)
- Asefeh Faraz Covelli
- The George Washington University School of Nursing, 1919 Pennsylvania Avenue NW, Suite 500, Washington, DC 20006, USA.
| | - Hilary Barnes
- Widener University School of Nursing, One University Place, Chester, PA 19013, USA.
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21
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Reilly GR, Russell NG, McIltrot K, Sisson SD, Scott AW. Nurse Practitioner Students' Knowledge Assessment and Perceived Preparedness to Triage Ophthalmology Complaints in a Primary Care Setting: An Educational Intervention. J Acad Ophthalmol (2017) 2023; 15:e232-e236. [PMID: 37795384 PMCID: PMC10547544 DOI: 10.1055/s-0043-1771355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/28/2023] [Indexed: 10/06/2023]
Abstract
Purpose In this proof-of-concept pilot study, we aimed to increase nurse practitioner (NP) student knowledge of ophthalmology to prepare NPs for encounters in primary care settings. The Association of University Professors of Ophthalmology (AUPO) and the American Academy of Ophthalmology (AAO) endorse core knowledge that medical students should achieve. We assess the effectiveness of an innovative ophthalmologist-led curriculum based on these competencies tailored to issues NPs encounter in primary care. Methods Johns Hopkins University NP students enrolled in a pre-post-cohort study and educational intervention. The didactic program was developed according to AUPO and AAO core ophthalmology content for medical students and was taught in-person by an ophthalmologist. Pre-post-assessments evaluated students' perceived readiness to encounter ophthalmic issues in the clinic and baseline knowledge of core competencies of ophthalmology. Results A total of 42 NP students were included in the analysis. NP students improved in core knowledge and readiness to encounter ophthalmology issues. After the educational event, there was a statistically significant improvement in students' ratings of preparedness to obtain a focused history, exam, perform initial management and decide the urgency of a referral for acute painless vision loss ( p < 0.001), chronic vision loss ( p < 0.001), or a patient with a red/painful eye ( p < 0.001). Students showed a statistically significant improvement in postdidactic event core ophthalmology knowledge assessment scores ( p = 0.002). Conclusion Primary care NPs are increasingly the initial point of contact for patients with ophthalmic complaints, and thus, high-quality and thorough education regarding ophthalmology triage and referral for NPs is necessary. NP student comfort with and knowledge of ophthalmic complaints and triage may be improved by a brief educational intervention taught by an ophthalmologist early in the NP curriculum.
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Affiliation(s)
- Grace R. Reilly
- Drexel University College of Medicine, Philadelphia, Pennsylvania
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Stephen D. Sisson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adrienne W. Scott
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Zhou Y, Wang S, Liu M, Gan G, Qin N, Luo X, Zhang C, Xie J, Wang K, Cheng AS. The role of sleep quality and perceived stress on depressive symptoms among tertiary hospital nurses: a cross-sectional study. BMC Psychiatry 2023; 23:416. [PMID: 37308915 DOI: 10.1186/s12888-023-04936-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Nurses in tertiary hospitals are at high risk for depression. Understanding sleep quality and perceived stress may contribute to nurses' mental health and health-related nursing productivity. The aim of this study was to investigate the role of sleep quality and perceived stress on depressive symptoms among nurses in tertiary hospitals. METHODS A total of 2,780 nurses (overall response rate = 91.1%) were recruited through a cross-sectional survey in 23 tertiary hospitals in China. Questionnaires included the Self-Rating Depression Scale, the Pittsburgh Sleep Quality Index, and the Chinese Perceived Stress Scale. Variables that were significant in Chi-square tests were further entered into binary logistic stepwise regression. RESULTS The prevalence of depressive symptoms was 60.3% (n = 1,676), of which 97.4% (n = 1,633) were female, and 77.8% were younger than 35 years (n = 1,304). Nurses who had moderate, poor, severe sleep quality and poor perceived pressure were more likely to be depressed. Master's degree, 6-10 years of work, and physical activity were protective factors, while the opposite was the case for shift work and high dissatisfaction. CONCLUSIONS More than half of nurses working in tertiary care hospitals reported depressive symptoms, and lower sleep quality and higher perceived stress were more associated with this. Perceived stress is an interesting concept, which may provide a new entry point for the well-known idea that there is a relationship between poor sleep quality and depression. It is possible to reduce depressive symptoms among public hospital nurses by providing information on sleep health and stress relief.
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Affiliation(s)
- Yi Zhou
- Nursing Department, The Third Xiangya Hospital, Xiangya School of Nursing, Central South University, Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Sha Wang
- Nursing Department, The Third Xiangya Hospital, Xiangya School of Nursing, Central South University, Central South University, Changsha, Hunan, China
| | - Min Liu
- Nursing Department, The Third Xiangya Hospital, Xiangya School of Nursing, Central South University, Central South University, Changsha, Hunan, China
| | - Gang Gan
- Nursing Department, The Third Xiangya Hospital, Xiangya School of Nursing, Central South University, Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Ning Qin
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Xiaofei Luo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Chun Zhang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jianfei Xie
- Nursing Department, The Third Xiangya Hospital, Xiangya School of Nursing, Central South University, Central South University, Changsha, Hunan, China.
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
| | - Kewei Wang
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, Hunan, China.
| | - Andy Sk Cheng
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
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Wills A, Krassikova A, Keatings M, Escrig-Pinol A, Bethell J, McGilton KS. Assessing the implementation of nurse practitioner-led huddles in long-term care using the Consolidated Framework for Implementation Research (CFIR). BMC Nurs 2023; 22:193. [PMID: 37286987 DOI: 10.1186/s12912-023-01354-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic created major challenges in long-term care (LTC) homes across Canada and globally. A nurse practitioner-led interdisciplinary huddle intervention was developed to support staff wellbeing in two LTC homes in Ontario, Canada. The objective of this study was to identify the constructs strongly influencing the process of implementation of huddles across both sites, capturing the overall barriers and facilitators and the intervention's intrinsic properties. METHODS Nineteen participants were interviewed about their experiences, pre-, post-, and during huddle implementation. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection and analysis. CFIR rating rules and a cross-comparison analysis was used to identify differentiating factors between sites. A novel extension to the CFIR analysis process was designed to assess commonly influential factors across both sites. RESULTS Nineteen of twenty selected CFIR constructs were coded in interviews from both sites. Five constructs were determined to be strongly influential across both implementation sites and a detailed description is provided: evidence strength and quality; needs and resources of those served by the organization; leadership engagement; relative priority; and champions. A summary of ratings and an illustrative quote are provided for each construct. CONCLUSION Successful huddles require long-term care leaders to consider their involvement, the inclusion all team members to help build relationships and foster cohesion, and the integration of nurse practitioners as full-time staff members within LTC homes to support staff and facilitate initiatives for wellbeing. This research provides an example of a novel approach using the CFIR methodology, extending its use to identify significant factors for implementation when it is not possible to compare differences in success.
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Affiliation(s)
- Aria Wills
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 500 University Avenue, Toronto, ON, Canada
- Bruyère Research Institute, 43 Bruyère Street, Ottawa, ON, Canada
| | - Alexandra Krassikova
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 500 University Avenue, Toronto, ON, Canada
| | - Margaret Keatings
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 500 University Avenue, Toronto, ON, Canada
| | - Astrid Escrig-Pinol
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 500 University Avenue, Toronto, ON, Canada
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra-affiliated, Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jennifer Bethell
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 500 University Avenue, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, Canada
| | - Katherine S McGilton
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 500 University Avenue, Toronto, ON, Canada.
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada.
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Martsolf G, Turi E, Liu J, Chen J, Poghosyan L. DNP preparation of primary care nurse practitioners and clinical outcomes for patients with chronic conditions. Nurs Outlook 2023; 71:101951. [PMID: 36947974 PMCID: PMC10683711 DOI: 10.1016/j.outlook.2023.101951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Many professional nursing organizations have proposed that the Doctor of Nursing Practice (DNP) is the most appropriate entry-level degree for nurse practitioners (NPs). There have been no studies to date examining the impact of DNP preparation on quality of care or patient outcomes. PURPOSE To examine differences in emergency department utilization and hospitalizations among patients with chronic conditions cared for by Master of Science in Nursing (MSN)- and DNP-prepared primary care NPs. METHODS We use survey data from over 1,000 primary care NPs in 6 states linked to Medicare claims data. Using regression models, we controlled for various patient, NP, and practice characteristics that might confound the relationship. RESULS We find that patient outcomes are not statistically different between patients attributed to MSN- and DNP-prepared primary care NPs. DISCUSSION These findings suggest that there remains little evidence that DNP education has led to significant improvements in patient outcomes. CONCLUSIONS Further empirical analysis related to the clinical outcomes other than health care utilization of the DNP degree is warranted. Future studies might consider examining (a) NPs in settings other than primary care, (b) practice-wide or system-wide outcomes, (c) other measures of care quality, and (d) impact of DNP program content.
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Affiliation(s)
- Grant Martsolf
- School of Nursing, University of Pittsburgh, Pittsburgh, PA.
| | - Eleanor Turi
- School of Nursing, Columbia University, New York, NY
| | - Jianfang Liu
- School of Nursing, Columbia University, New York, NY
| | - Julius Chen
- Mailman School of Public Health, Columbia University, New York, NY
| | - Lusine Poghosyan
- School of Nursing, Columbia University, New York, NY; Mailman School of Public Health, Columbia University, New York, NY
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Abstract
BACKGROUND AND OBJECTIVES Primary care providers (PCPs) report decreased job satisfaction and high levels of burnout, yet little is known about their experience of moral distress. The aim of this study was to gain insight into the experiences of PCPs regarding moral distress including causative factors and proposed mitigation strategies. METHODS This qualitative pilot study used semi-structured interviews to identify causes of moral distress in PCPs in an academic family medicine department. Interviews were analyzed using conventional content analysis. RESULTS Of 35 eligible participants, 12 completed the study (34% participation rate). Most were white, female, and had practiced for less than 10 years. Four PCPs had considered leaving their position due to moral distress. Participants identified five causes of moral distress: policies and procedures that conflict with patient needs, the unpredictable nature of primary care, need to "bend the rules," lack of accountability, and lack of support staff. Six internal conflicts made resolving morally distressing situations difficult: perceived powerlessness, sense of responsibility, socialization to follow orders, emotional toll of the job, competing obligations, and fear of mistakes. CONCLUSIONS These findings matched themes in the current literature and identified an unbending infrastructure. This, coupled with the chaotic nature of primary care, resulted in frequent moral distress. Participants offered solutions to reduce and mitigate moral distress (also similar with current literature) and suggested moral distress and burnout are closely linked.
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Affiliation(s)
- Dawn Worsham Bourne
- Department of Student Health & Wellness, University of Virginia, PO Box 800760, Charlottesville, VA, 22908, USA.
| | - Elizabeth Epstein
- University of Virginia School of Nursing, Charlottesville, VA, 22908, USA
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Newlon JL, Murphy EM, Ahmed R, Illingworth KS. Determining and regulating scope of practice for health care professionals: A participatory, multiple stakeholder approach. Res Social Adm Pharm 2023; 19:457-467. [PMID: 36517405 DOI: 10.1016/j.sapharm.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Scope of practice varies between health professions and states. OBJECTIVE To explore stakeholders' preferences for determining and regulating health care professionals' scopes of practice. METHODS Stakeholders in medicine, nursing, and pharmacy, including practitioners, leaders of professional associations, regulatory board members, and healthcare executives, were recruited via professional organizations, social media, and snowball sampling. Stakeholder preferences were collected using concept mapping, an integrated mixed methods approach which includes 1) brainstorming of statements and 2) sorting and rating of statements. Multidimensional scaling, hierarchical cluster analysis, and Mann Whitney-U tests were used for analysis. RESULTS Thirty participants generated and sorted statements regarding preferences for scope of practice, creating eight clusters: 1) accountability to prioritize patient safety, 2) standardization, 3) collaborative regulation, 4) intra-professional regulation, 5) federal versus state, 6) role of non-health care professionals, 7) prioritization of patient outcomes, and 8) health care professional training and education. Fifty-seven participants rated statements in terms of importance and feasibility. Physicians and non-physicians held similar views on 68.5% (n = 37) and 81.5% (n = 44) of statements, respectively for importance and feasibility. The statements in the standardization and health care professional training and education clusters were perceived as the most important and feasible across stakeholder types.
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Affiliation(s)
- Jenny L Newlon
- Birth Control Pharmacist, USA; Purdue University - College of Pharmacy, USA
| | | | - Rami Ahmed
- Indiana University - School of Medicine, USA
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McGilton KS, Haslam-Larmer L, Wills A, Krassikova A, Babineau J, Robert B, Heer C, McAiney C, Dobell G, Bethell J, Kay K, Keatings M, Kaasalainen S, Feldman S, Sidani S, Martin-Misener R. Nurse practitioner/physician collaborative models of care: a scoping review protocol. BMC Geriatr 2023; 23:98. [PMID: 36797669 PMCID: PMC9934505 DOI: 10.1186/s12877-023-03798-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Before the COVID-19 pandemic, many long-term care (LTC) homes experienced difficulties in providing residents with access to primary care, typically delivered by community-based family physicians or nurse practitioners (NPs). During the pandemic, legislative changes in Ontario, Canada enabled NPs to act in the role of Medical Directors thereby empowering NPs to work to their full scope of practice. Emerging from this new context, it remains unclear how NPs and physicians will best work together as primary care providers. NP/physician collaborative models appear key to achieving optimal resident outcomes. This scoping review aims to map available evidence on existing collaborative models of care between NPs and physicians within LTC homes. METHODS The review will be guided by the research question, "What are the structures, processes and outcomes of collaborative models of care involving NPs and Physicians in LTC homes?" This scoping review will be conducted according to the methods framework for scoping reviews outlined by Arksey and O'Malley and refined by Levac et al., Colquhoun et al., and Daudt et al., as well as the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Statement. Electronic databases (MEDLINE, Embase + Embase Classic, APA PsycInfo, Cochrane Central Register of Controlled Trials, AMED, CINAHL, Ageline, and Scopus), grey literature, and reference lists of included articles will be searched. English language studies that describe NP and physician collaborative models within the LTC setting will be included. DISCUSSION This scoping review will consolidate what is known about existing NP/physician collaborative models of care in LTC homes. Results will be used to inform the development of a collaborative practice framework for long-term care clinical leadership.
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Affiliation(s)
- Katherine S. McGilton
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8 Canada
| | - Lynn Haslam-Larmer
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8 Canada
| | - Aria Wills
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8 Canada
| | - Alexandra Krassikova
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada
| | - Jessica Babineau
- grid.231844.80000 0004 0474 0428Library & Information Services, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.231844.80000 0004 0474 0428The Institute for Education Research, University Health Network, Toronto, Canada
| | - Ben Robert
- Perley Health, 1750 Russell Road, Ottawa, ON K1G 5Z6 Canada ,grid.28046.380000 0001 2182 2255Faculty of Medicine, University of Ottawa, 451 Smyth Road #2044, Ottawa, ON K1H 8M5 Canada
| | - Carrie Heer
- Brant Community Healthcare System, 200 Terrace Hill Street, Brantford, ON N3R 1G9 Canada ,grid.418792.10000 0000 9064 3333Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1 Canada
| | - Carrie McAiney
- grid.498777.2Schlegel-UW Research Institute for Aging, Waterloo, ON N2J 0E2 Canada ,grid.46078.3d0000 0000 8644 1405School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Gail Dobell
- Ontario Health, 130 Bloor Street West, Toronto, ON M5S 1N5 Canada
| | - Jennifer Bethell
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON M5T 3M7 Canada
| | - Kelly Kay
- Provincial Geriatrics Leadership Ontario, Toronto, Canada ,grid.17063.330000 0001 2157 2938Ontario Institute for Studies in Education and the Institute for Life Course and Aging, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4 Canada
| | - Margaret Keatings
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Sharon Kaasalainen
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Sid Feldman
- Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON M6A2E1 Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, Temerty Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8 Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, 250 Victoria Street, Toronto, ON M5B 2K9 Canada
| | - Ruth Martin-Misener
- grid.55602.340000 0004 1936 8200School of Nursing, Dalhousie University, Room G26, Forrest Bldg., 5869 University Avenue, Halifax, NS B3H 4R2 Canada
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Li Y, Howell JR, Cimiotti JP. Nurse practitioner job preference: A discrete choice experiment. Int J Nurs Stud 2023; 138:104407. [PMID: 36481595 PMCID: PMC9671868 DOI: 10.1016/j.ijnurstu.2022.104407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nurse practitioners play a critical role in improving the access to care and in meeting the needs for health care. However, prior to the COVID-19 pandemic, the average turnover rate of nurse practitioners was 10 % with associated total direct cost that ranged from $85,832 to $114,919 for each episode of turnover in the United States. Little is known about the job preference of nurse practitioners and the cost savings to an organization that provides jobs with characteristics attractive to nurse practitioners. OBJECTIVE The aim of this study was to identify the preferred job characteristics that are associated with nurse practitioners' job choices; and to determine the extent to which nurse practitioners would need to be compensated for practicing without these characteristics. DESIGN A two-stage design using a mixed method approach. SETTING(S) The state of Georgia in the United States. PARTICIPANTS 2757 nurse practitioners who were actively licensed were invited to participate. Of the 412 participants, 372 actively employed in Georgia were included in the analysis. METHODS A 2-stage discrete choice experiment was designed. Stage-1 was a qualitative design using a focus group to identify nurse practitioners' preferred job characteristics. Stage-2 was a quantitative design using survey distribution and analysis. A mixed logit model was used for ranking nurse practitioners' preferred job characteristics and the extent to which they would need to be compensated. RESULTS On average nurse practitioners were 47.4 years of age; the majority were female (90 %), white (75.3 %), and educated at the master's level (88.7 %). Participants did not value teams that were not very cohesive (β = -1.50); administration that was not very responsive and supportive (β = -1.04); being supervised by a physician (β = -0.58); not having their own panel of patients (β = -0.42); and not billing under their own National Provider Identifier (β = -0.18). Participants would need an increase in annual income of USD$21,780 for practicing in a not very cohesive team; USD$15,280 for practicing with a not very responsive administration; and USD$21,450 for being supervised by a physician. CONCLUSIONS A cohesive, responsive, and supportive working environment and being able to practice independently are important characteristics for nurse practitioners when choosing a job. Healthcare managers should provide a workplace culture that reflects these preferred job characteristics to attract and retain nurse practitioners. Policymakers should consider reforming the scope of practice legislation to promote the independent practice of nurse practitioners.
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Affiliation(s)
- Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA,Corresponding author at: Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd NE, Atlanta, GA 30324, USA
| | - John R. Howell
- Department of Marketing and Global Supply Chain, Brigham Young University, Provo, UT, USA
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Yamada T, Ehara J, Funakoshi H, Endo K, Kitano Y. Effectiveness of point of care ultrasound (POCUS) simulation course and skills retention for Japanese nurse practitioners. BMC Nurs 2023; 22:21. [PMID: 36691022 PMCID: PMC9872333 DOI: 10.1186/s12912-023-01183-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In Japan, the nurse practitioner (NP) system has only been in place for a short time, and there is no ultrasound (US) simulation course for NPs. Therefore, NPs may have to attend US simulation courses for physicians. We evaluated whether US simulation course for physicians lead to improved image acquisition and interpretation amongst NPs and, if so, if these changes would be maintained over time. METHODS A 2-day point-of-care ultrasound (POCUS) course designed for physicians in cardiac US, lung US, lower extremity deep vein thrombosis (DVT) US, and abdominal US was held for Japanese nurse practitioners (JNP) and JNP trainees in 2018 and 2019. Participants kept a record of the number of US examinations they performed for 3 months before and 3 months after the course. The number of US exams performed was grouped into six categories. All participants underwent pre-course, immediate post-course, and 4-month post-course testing to assess image interpretation skills, image acquisition skills, and confidence. RESULTS Thirty-three participants from 21 facilities completed the program. Before and immediately after the course, test scores of the image interpretation test, image acquisition test, and confidence increased significantly (37.1, 72.6: P < 0.001), (13.7, 53.6: P < 0.001), and (15.8, 35.7: P < 0.001), respectively. Comparing the follow-up tests immediately after the course and 4 months later, there was no decrease in scores on the image interpretation test, the image acquisition test, or confidence (72.6, 71.8: P = 1.00) (53.6, 52.9: p = 1.00) (35.7, 33.0: P = 0.34). There was a statistically significant increase (P < 0.001) in both the total number of ultrasound examinations and in the number of ultrasound examinations by category (cardiac, lung, lower extremity DVT, and abdominal) in the 3 months before and 3 months after the course. CONCLUSIONS The POCUS simulation course for physicians is useful for JNPs to acquire US examination skills even if it is not arranged for JNPs. Image interpretation skill, image acquisition skill, and confidence improved significantly and were maintained even after 4 months of the course. It leads to behavioral changes such as increasing the number of US examinations in daily practice after the course.
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Affiliation(s)
- Toru Yamada
- grid.265073.50000 0001 1014 9130Department of General Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-Ku, Tokyo, 113-8510 Japan
| | - Jun Ehara
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba Japan
| | - Hiraku Funakoshi
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba Japan
| | - Keita Endo
- Department of Nephrology, Endocrinology and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba Japan
| | - Yuka Kitano
- grid.412764.20000 0004 0372 3116Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa Japan
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Huang SS, Chen CY, Kau K, Tsai JM, Tsay SL. Key determinates of job satisfaction for acute care nurse practitioners in Taiwan. BMC Nurs 2023; 22:6. [PMID: 36604678 PMCID: PMC9814220 DOI: 10.1186/s12912-022-01156-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Taiwan is a super-aged society, and the shortage of hospital doctors; nurse practitioners (NPs) became vital healthcare providers to fulfill the healthcare demands of the population. The purpose of this study was to explore the key determinates of job satisfaction for NPs in acute care practices using significant practice variables, such as empowerment and burnout. METHODS Participants of this descriptive survey study were recruited from a national sample of NPs with membership in the Taiwan Association of Nurse Practitioners. The data were collected utilizing an online questionnaire based on demographic and practice variables, the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS), the Condition for Work Effectiveness Questionnaire II (CWEQ II), and the Copenhagen Burnout Inventory (CBI). A total of 1,211 NPs completed the online survey. A multiple regression model with the stepwise selection was used to explore job satisfaction. RESULTS The mean overall satisfaction score indicated that the level of satisfaction was between slightly dissatisfied and slightly satisfied. Regression results indicated that formal power, work-related burnout, access to information, and needed resources were critical components of job satisfaction, and accounted for 63% of the variance. Moreover, NPs who were married, had a higher annual salary, worked only during the day shift, and had lower patients-related burnout showed better job satisfaction. CONCLUSIONS This study provides evidence for healthcare organizations to formulate policies to strengthen NP job satisfaction. Empowerment and burnout are vital factors in NPs' job satisfaction. Healthcare organizations have an obligation to implement policies to empower NPs in practice and provide interventions to mitigate burnout. Implementing these changes will improve job satisfaction and with it the quality of patient care.
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Affiliation(s)
- Sheng-Shiung Huang
- grid.445025.20000 0004 0532 2244College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| | - Cheng-Yuan Chen
- grid.412094.a0000 0004 0572 7815National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Kevin Kau
- grid.19188.390000 0004 0546 0241Academic Writing Education Center, National Taiwan University, Taipei, Taiwan
| | - Jung-Mei Tsai
- grid.413593.90000 0004 0573 007XDepartment of Nursing, Mackay Memorial Hospital, Taipei, Taiwan ,grid.445025.20000 0004 0532 2244Department of Nursing, Da-Yeh University, Changhua, Taiwan
| | - Shiow-Luan Tsay
- grid.445025.20000 0004 0532 2244College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
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Suh L, Renno MS, Bolin EH, Eble BK, Collins RT, Pye S, Daily JA. Referring Provider Opinions of Pediatric Cardiology Evaluations Performed by Nurse Practitioners. Pediatr Cardiol 2023; 44:34-43. [PMID: 35779122 DOI: 10.1007/s00246-022-02959-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/22/2022] [Indexed: 01/24/2023]
Abstract
In the setting of physician shortages, nurse practitioner (NP) roles have evolved, with increasing independence across most healthcare settings. We sought to characterize referring clinician perceptions of NP-performed outpatient pediatric cardiology consultations. We electronically distributed to pediatric and family medicine physicians and NPs in Arkansas our 11-item survey assessing the acceptability of pediatric cardiology consultations being completed by an NP under varying circumstances. Circumstances included seven common referral indications, and the scale offered five answer choices ranging from "definitely unacceptable" to "definitely acceptable". A total of 292 of 1756 (16.6% response rate) referring clinicians responded to the survey. Overall, 57% of responses indicated that NP-completed pediatric cardiology evaluations were either definitely or probably unacceptable. Acceptability was varied by referral indication and referring clinician characteristics. Unacceptability of NP-completed pediatric cardiology evaluations was greatest among family medicine physicians (81%), pediatricians (66%), and clinicians working in solo or two-physician practices (77%) or community hospitals/clinics (71%). If NP evaluation of a murmur included required review with a cardiologist, the unacceptability rate dropped from 50 to 24% (p < 0.0001). Unacceptability was higher in physicians who do not work with NPs (69%) compared to those who do (60%) (pp < 0.0001). Many referring physicians were willing to send patients ≥ 100 miles to ensure evaluation by a pediatric cardiologist. Most referring physicians find pediatric cardiology evaluations performed by NPs to be unacceptable. Requisite review with a cardiologist improved acceptability of NP evaluations. Many referring physicians would send patients much farther to guarantee evaluation by a cardiologist.
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Affiliation(s)
- Lily Suh
- Division of Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, USA
- Department of Pediatrics, Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72205, USA
| | - Markus S Renno
- Division of Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, USA
- Department of Pediatrics, Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72205, USA
| | - Elijah H Bolin
- Division of Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, USA
- Department of Pediatrics, Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72205, USA
| | - Brian K Eble
- Division of Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, USA
- Department of Pediatrics, Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72205, USA
| | - R Thomas Collins
- Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, USA
- Lucile Packard Children's Hospital, Palo Alto, USA
| | - Sherry Pye
- Division of Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, USA
- Department of Pediatrics, Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72205, USA
| | - Joshua A Daily
- Division of Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, USA.
- Department of Pediatrics, Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72205, USA.
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Webb S, Butler J, Williams E, Harbour K, Hammond N, Delaney A. Intensive care nurse practitioners in Australia: A description of a service model in an adult tertiary intensive care unit. Aust Crit Care 2023; 36:133-137. [PMID: 36470778 DOI: 10.1016/j.aucc.2022.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/13/2022] [Accepted: 10/30/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Although well-established internationally, nurse practitioners (NPs) in Australian adult intensive care units (ICUs) are rare. Australian literature clearly highlights the importance of creating ICU NP roles to meet emerging demands. An ICU NP model of care at a metropolitan hospital in Sydney provides care in four core practice areas: complex case management, vascular access, tracheostomy management, and intrahospital transport of critically ill patients. The ICU NPs also provide training and assessment for ICU nurses and medical officers in these same core practice areas and can efficiently meet service gaps in crisis such as the most recent COVID-19 pandemic. RESULTS The ICU NP program described is an innovative model of care that has demonstrated potential benefits to patients and their families. Potential benefits to the healthcare system including supporting advanced practice nursing development in regional and rural Australia and in addressing future ICU workforce issues are also identified. This model of care provides a clear role and structure for the integration of NPs in the adult ICU. Research to evaluate the impact of the role is required and is underway. CONCLUSIONS This model is being used to develop a national adult ICU NP fellowship training program for ICU transitional NPs preparing for endorsement or endorsed NPs who require additional ICU-specific training. This immersive clinical training program combined with didactic learning modules offers a framework to support the implementation of the adult ICU NP role as well as a framework for NP fellowship programs in other specialties.
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Affiliation(s)
- Sarah Webb
- Royal North Shore Hospital Intensive Care Unit, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia.
| | - Jessica Butler
- Royal North Shore Hospital Intensive Care Unit, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia.
| | - Elliot Williams
- Royal North Shore Hospital Intensive Care Unit, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Kelly Harbour
- Royal North Shore Hospital Intensive Care Unit, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia.
| | - Naomi Hammond
- Royal North Shore Hospital Intensive Care Unit, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia; Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia.
| | - Anthony Delaney
- Royal North Shore Hospital Intensive Care Unit, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Division of Critical Care, The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia.
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Denton G, Davies V, Whyman E, Arora N. A narrative review of the training structure, role, and safety profile of advanced critical care practitioners in adult intensive services in the United Kingdom. Aust Crit Care 2023; 36:145-150. [PMID: 36577616 DOI: 10.1016/j.aucc.2022.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/15/2022] [Accepted: 12/05/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Advanced clinical practitioners are a growing part of the National Health Service workforce in the United Kingdom (UK). The concept stems from the progression of skills, knowledge, and experience of healthcare professionals (including nursing, physiotherapists, paramedics, and pharmacists) to a higher level of practice. The addition of advanced critical care practitioners (ACCPs) to the multidisciplinary team of the UK adult critical care is recent; they form part of the fabric of the advanced clinical practitioner workforce. This is a narrative review of the role of ACCPs, considering the evolution of the role, training, accreditation, and evidence supporting the safety profile in adult intensive care in the UK. METHOD This is a narrative review. CONCLUSION ACCPs have evolved from an ad hoc and local training structure, to a UK-wide competency standard and training developed within the Faculty of Intensive Care Medicine. This formed in concert with the advanced clinical practitioner concept. As advanced practice is very much multiprofessional in the UK, a single regulator for multiple base professions is likely neither feasible nor realistic. Over the last 5 years, the UK picture of advanced practice has slowly standardised; an ACCP securely fits under the advanced clinical practitioner umbrella. The ACCP workforce has moved from a handful of early adopters, regional hubs, to a position across most critical care units now have or are developing a team of practitioners. The evidence base for the safety profile of ACCPs is evolving and shows parity in outcomes in the areas currently investigated. The ACCP role provides a vision of a multiprofessional workforce for the future of staffing of critical care services that is diverse and inclusive, not with the intention of competing with our medical colleagues.
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Affiliation(s)
- Gavin Denton
- Sandwell and West Birmingham Hospitals, Intensive Care, City Hospital, Dudley Road Birmingham West Midlands B18 7QH, UK.
| | - Vicki Davies
- Sandwell and West Birmingham Hospitals, Intensive Care, City Hospital, Dudley Road Birmingham West Midlands B18 7QH, UK
| | - Emma Whyman
- Sandwell and West Birmingham Hospitals, Intensive Care, City Hospital, Dudley Road Birmingham West Midlands B18 7QH, UK
| | - Nitin Arora
- University Hospital of Birmingham, Intensive Care, Heartlands Hospital, Bordesley Green East, West Midlands, Birmingham, B9 5SS, UK
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Sears A, Davis J, Zuber K. Postgraduate Education and Training for the Nephrology Physician Assistants and Nurse Practitioners. Adv Chronic Kidney Dis 2022; 29:534-538. [PMID: 36371118 DOI: 10.1053/j.ackd.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/14/2022] [Accepted: 03/29/2022] [Indexed: 11/10/2022]
Abstract
There is no consistent educational model to introduce the physician assistant and/or nurse practitioner to nephrology. The job descriptions of the nephrology physician assistant/nurse practitioner may be similar, but the training, state and federal licensing, background, and recertification are different for the 2 professions adding a level of complexity to the training of the physician assistant/nurse practitioner new to nephrology. On-the-job training is the most common modality, but formats, content, mentors, and practices vary from organization to organization and even within organizations. The advantage of on-the-job training is its flexibility while the disadvantage is its nonspecific outcomes. As nephrology practices vary widely and range from single provider private practices to multiprovider academic practices, it is difficult if not impossible to develop a generic orientation model. This article outlines the history and present state of postgraduate educational offerings for the physician assistant/nurse practitioner and provides insight into components of an ideal training program.
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Affiliation(s)
- Amy Sears
- University of Cincinnati, Department of Internal Medicine, Nephrology and Hypertension, Cincinnati, OH, USA.
| | - Jane Davis
- University of Alabama at Birmingham, Division of Nephrology, Birmingham, AL, USA
| | - Kim Zuber
- Executive Director, American Academy of Nephrology PAs, St Petersburg, FL, USA
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Gonna N, Tran T, Bassett RL, Farris DP, Nelson KC. Sensitivity and Specificity for Skin Cancer Diagnosis in Primary Care Providers: a Systematic Literature Review and Meta-analysis of Educational Interventions and Diagnostic Algorithms. J Cancer Educ 2022; 37:1563-1572. [PMID: 35834156 DOI: 10.1007/s13187-022-02194-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In areas without convenient access to dermatology care, primary care providers (PCPs) serve as an important patient resource for early skin cancer detection. To determine the most effective strategy for skin cancer detection training in PCPs, we conducted a systematic review of educational interventions and performed a meta-analysis on sensitivity and specificity outcomes in PCPs. OBJECTIVES To summarize data on skin cancer sensitivity and specificity outcomes for PCP-targeted training programs and diagnostic algorithms. Our PCP cohort included practicing physicians, trainee physicians, and advanced practice practitioners. METHODS A literature search was performed in MEDLINE, Embase, Web of Science, and the Cochrane Library for relevant English-language articles published worldwide from 2000 onward. Results were screened for eligibility, and overlapping datasets were reconciled. Data extracted included the educational intervention, diagnostic algorithm, and outcomes of interest (sensitivity and specificity). Outcomes were pooled across interventions that taught the same diagnostic algorithm. A bivariate model was fit to compare different interventions/algorithms. This review followed the PRISMA guidelines. RESULTS In total, 21 articles were included in this review, encompassing over 58,610 assessments of skin lesions by about 1529 participants worldwide. Training programs that implemented the triage-amalgamated dermoscopic algorithm (TADA) demonstrated high pooled sensitivity (91.7%) and high pooled specificity (81.4%) among PCPs. CONCLUSIONS AND RELEVANCE Overall, this systematic review and meta-analysis showed that dermoscopy training in PCPs was generally associated with gains in skin cancer sensitivity without loss of specificity. Clinically, this correlates with fewer skin cancers overlooked by PCPs and fewer excisions of benign lesions.
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Affiliation(s)
- Nadeen Gonna
- John P. and Kathrine G. McGovern Medical School, Houston, TX, USA
| | - Tiffaney Tran
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1452, Houston, TX, 77030, USA
| | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David P Farris
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1452, Houston, TX, 77030, USA.
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Mallidou AA, Tschanz C, Antifeau E, Lee KY, Mtambo JK, Heckl H. The Medical Orders for Scope of Treatment (MOST) form completion: a retrospective study. BMC Health Serv Res 2022; 22:1186. [PMID: 36131303 PMCID: PMC9492459 DOI: 10.1186/s12913-022-08542-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background Advance care planning (ACP) involves discussions about patient and families’ wishes and preferences for future healthcare respecting autonomy, improving quality of care, and reducing overtreatment. The Medical Orders for Scope of Treatment (MOST) form records person preferred level and types of treatment and intervention. Purpose To examine the MOST form use in inpatient units within a British Columbia (Canada) hospital, estimate and compare its completion rate, and inform health policies for continuous, quality and individualized patient care. Methods About 5,000 patients admitted to the participating tertiary acute care hospital during October 2020. Data from 780 eligible participants in medical, surgical, or psychiatry unit were analyzed with descriptive statistics, the chi-square test for group comparisons, and logistic regression to assess predictors of the MOST form completion. Results Participants’ (54% men) age ranged from 20–97 years (mean = 59.53, SD = 19.54). Mainly physicians (99.1%) completed the MOST form for about 60% of them. A statistically significant difference of MOST completion found among the units [Pearson χ2(df=2, n=780) = 79.53, p < .001, φ = .319]. Multivariate logistic regression analysis demonstrated that age (OR = 1.05, 95% CI 1.04 to 1.06) and unit admission (OR = .60, 95% CI 0.36 to 0.99 in psychiatry; and OR = .21, 95% CI 0.14 to 0.31 in surgery) were independently associated with the MOST form completion. Conclusion Our findings demonstrate a need for consistent and broad completion of the MOST form across all jurisdictions using, desirably, advanced electronic systems. Healthcare providers need to raise awareness of the MOST completion benefits and be prepared to discuss topics relevant to end-of-life. Further research is required on the MOST form completion.
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Affiliation(s)
- Anastasia A Mallidou
- School of Nursing, University of Victoria, B236 - HSD Building, 3800 Finnerty (Ring) Road, Victoria, BC, V8P 5C2, Canada.
| | - Coby Tschanz
- School of Nursing, University of Victoria, B236 - HSD Building, 3800 Finnerty (Ring) Road, Victoria, BC, V8P 5C2, Canada
| | - Elisabeth Antifeau
- Palliative Care and End of Life Services, Interior Health, Vancouver, VIC, Canada
| | | | | | - Holly Heckl
- School of Nursing, University of Victoria, B236 - HSD Building, 3800 Finnerty (Ring) Road, Victoria, BC, V8P 5C2, Canada
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Kathuria H, Gunawan A, Spring M, Aijaz S, Cobb V, Fitzgerald C, Wakeman C, Howard J, Clancy M, Foreman AG, Truong V, Wong C, Steiling K, Lasser KE, Bulekova K, Wiener RS. Hospitalization as an opportunity to engage underserved individuals in shared decision-making for lung cancer screening: results from two randomized pilot trials. Cancer Causes Control 2022. [PMID: 35997854 DOI: 10.1007/s10552-022-01620-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 08/09/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Medicare requires tobacco dependence counseling and shared decision-making (SDM) for lung cancer screening (LCS) reimbursement. We hypothesized that initiating SDM during inpatient tobacco treatment visits would increase LCS among patients with barriers to proactively seeking outpatient preventive care. METHODS We collected baseline assessments and performed two pilot randomized trials at our safety-net hospital. Pilot 1 tested feasibility, acceptability, and preliminary efficacy of a nurse practitioner initiating SDM for LCS during hospitalization (Inpatient SDM). We collected qualitative data on barriers encountered during Pilot 1. Pilot 2 added a community health worker (CHW) to address barriers to LCS completion (Inpatient SDM + CHW-navigation). For both studies, preliminary efficacy was an intention-to-treat analysis of LCS completion at 3 months between intervention and comparator (furnishing of LCS decision aid only) groups. RESULTS Baseline assessments showed that patients preferred in-person LCS discussions versus self-reviewing materials; overall 20% had difficulty understanding written information. In Pilot 1, 4% (2/52) in Inpatient SDM versus 2% (1/48, comparator) completed LCS (p = 0.6), despite 89% (89/100) desiring LCS. Primary care providers noted that competing priorities and patient factors (e.g., social barriers to keeping appointments) prevented the intervention from working as intended. In Pilot 2, 50% (5/10) in Inpatient SDM + CHW-navigation versus 9% (1/11, comparator) completed LCS (p < 0.05). Many patients were ineligible due to recent diagnostic chest CT (Pilot 1: 255/659; Pilot 2: 239/527). CONCLUSIONS Inpatient SDM + CHW-navigation shows promise to improve LCS rates among underserved patients who smoke, but feasibility is limited by recent diagnostic chest CT among inpatients. Implementing CHW-navigation in other clinical settings may facilitate LCS for underserved patients. TRAIL REGISTRATION ClinicalTrials.gov Identifier: NCT03276806 (8 September 2017); NCT03793894 (4 January 2019).
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Kidd VD, Spisak JM, Vanderlinden S, Kayingo G. A survey of implicit bias training in physician assistant and nurse practitioner postgraduate fellowship/residency programs. BMC Med Educ 2022; 22:598. [PMID: 35922854 PMCID: PMC9351247 DOI: 10.1186/s12909-022-03664-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND There has been renewed focus on advancing inclusivity within organized medicine to reduce health disparities and achieve health equity by addressing the deleterious effects of implicit bias in healthcare and clinical outcomes. It is well documented that negative implicit attitudes and stereotypes perpetuate inequity in healthcare. The aim of this study is to investigate implicit bias training in postgraduate physician assistant (PA) and nurse practitioner (NP) education; describe delivery of content to trainees; and detail program directors' attitudes toward this type of training. Although there is research examining implicit bias training in physician residency education, there are no published studies on implicit bias training in postgraduate PA and NP postgraduate residency/fellowship programs. METHOD A non-experimental, descriptive study was designed to obtain information via survey from members of the Association of Postgraduate Physician Assistant Programs (APPAP). RESULTS The response rate was 41%. The majority of respondents (76%) felt that PA and NP postgraduate programs should include implicit bias instruction. Educational strategies used by PA and joint PA/NP postgraduate programs or their sponsoring institution to deliver implicit bias content to trainees include: implicit bias training modules (50%), facilitated group discussions (36%), invited speaker on implicit bias (33%), case studies on implicit bias (16%), and implicit association test (10%); however, 30% of postgraduate programs do not provide implicit bias training to PA and/or NP trainees. Barriers to implementing implicit bias training expressed by some postgraduate programs include: uncertainty in how to incorporate implicit bias training (16%); lack of strategic alignment with training program or sponsoring institution (13%); time constraints (10%); financial constraints (6%); lack of access to content experts (6%); and unfamiliarity with evidence supporting implicit bias training (6%). CONCLUSION The present study sheds some light on the current state of implicit bias training in PA and joint PA/NP postgraduate residency/fellowship programs. While the majority of programs offer some sort of implicit bias training, there is a need to standardize this training in PA and joint PA/NP postgraduate education curricula using an actionable framework.
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Affiliation(s)
- Vasco Deon Kidd
- School of Medicine, Department of Orthopaedic Surgery, University of California Irvine (UCI Health), 101 The City Dr S, Orange, CA, 92868, USA.
| | - Jennifer M Spisak
- Ronald O. Perelman Department of Emergency Medicine, NYU Langone Health, 545 First Avenue, Greenberg Hall Suite 6B, New York, NY, 10016, USA
| | - Sarah Vanderlinden
- Department of Surgery, Trauma and Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gerald Kayingo
- Graduate School, University of Maryland Baltimore, Baltimore, MD, USA
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Schesser M, Naderi S, Fananapazir G. Utilizing advanced practice providers in the paracentesis/thoracentesis clinic. Abdom Radiol (NY) 2022; 47:2712-2716. [PMID: 35258668 DOI: 10.1007/s00261-022-03469-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 01/18/2023]
Abstract
In an era of increasing radiology volumes, including image-guided procedures, as well as decreased reimbursements, radiology practices are seeking ways to become more efficient to prevent radiologist burnout. One such strategy involves the employment of advanced practice providers to perform certain procedures. We describe steps departments can pursue to involve advanced practice providers within the radiology workforce, specifically in implementing an advance practice provider-driven paracentesis and thoracentesis clinic.
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Affiliation(s)
- Mandy Schesser
- Advanced Practice Supervisor for Radiology, Acute Infection Management Service, and Trauma, UCDMC, Sacramento, CA, USA
| | - Sima Naderi
- Department of Radiology, UCDMC, Sacramento, CA, USA
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Chiang YH, Yu HC, Chung HC, Chen JW. Implementing an entrustable professional activities programmatic assessments for nurse practitioner training in emergency care: A pilot study. Nurse Educ Today 2022; 115:105409. [PMID: 35636245 DOI: 10.1016/j.nedt.2022.105409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Entrustable professional activities (EPAs), as new methods used to operationalize competency-based education, are gaining acceptance in medical professions. However, no EPA-based framework exists to evaluate emergency care nurse practitioners' competencies in clinical practice. OBJECTIVES To develop, implement, and evaluate an EPA-based framework for emergency care nurse practitioners. DESIGN Prospective observational study. SETTING An accredited nurse practitioner training program in the emergency department of a University-affiliated Hospital. PARTICIPANTS Eight novice nurse practitioners and eighteen clinical instructors. METHODS A working group of academic educators, nurse practitioner leaders, and clinical instructors developed a set of EPAs using a participatory design method. We scheduled weekly ad hoc evaluations for the nurse practitioners in emergency care, and we collected several observations from multiple assessors for analysis. RESULTS Four nested EPAs were developed that adopted a 1-5 supervision-entrustment scale to measure performance. The results of the 20-month assessments illustrated that the average scores of EPA1, which measured the assessment and management of patients with acute medical presentations in the emergency department, differed significantly but were not positively correlated with the nurse practitioners' increasing subspecialty and department seniority levels (Kruskal-Wallis test P = .011 and 0.006, respectively). In addition, the most time required for the nurse practitioners to achieve a stable level 5 entrustability score for all EPAs for at least 3 consecutive months was 18 months. Clinical instructors noted that recognizing limits is a skill that is essential for a nurse practitioner to earn clinical instructors' trust. CONCLUSIONS Entrustability scores may not correlate with nurse practitioners' increasing seniority, and patient care requires the longest training time (18 months) for emergency care nurse practitioners to achieve autonomy. Program directors should adjust the supervision-entrustment level expected at various stages of training according to the complexity of individual EPAs. An EPA-based assessment framework in a nurse practitioner training program may assist in overseeing the development of competencies for emergency care nurse practitioners.
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Affiliation(s)
- Yi-Hui Chiang
- Department of Nursing, Cardinal Tien Hospital An Kang District, New Taipei City, Taiwan; Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, New Taipei City, Taiwan
| | - Hsiang-Chu Yu
- Department of Emergency, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Hung-Chun Chung
- Department of Emergency, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Jeng-Wen Chen
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Otolaryngology-Head and Neck Surgery, National Taiwan University Hospital, Taipei, Taiwan; Master Program of Big Data in Biomedicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Medical Education and Research, Cardinal Tien Hospital, New Taipei City, Taiwan; Department of Research and Development, Cardinal Tien Junior College of Healthcare and Management, New Taipei City, Taiwan.
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Kidd VD, Liu JH, Reamer-Yu A, Wang JH, Deng M. The development of a visual dashboard report to assess physician assistant and nurse practitioner financial and clinical productivity. BMC Health Serv Res 2022; 22:882. [PMID: 35804364 DOI: 10.1186/s12913-022-08216-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
The evolving COVID-19 pandemic has unevenly affected academic medical centers (AMCs), which are experiencing resource-constraints and liquidity challenges while at the same time facing high pressures to improve patient access and clinical outcomes. Technological advancements in the field of data analytics can enable AMCs to achieve operational efficiencies and improve bottom-line expectations. While there are vetted analytical tools available to track physician productivity, there is a significant paucity of analytical instruments described in the literature to adequately track clinical and financial productivity of physician assistants (PAs) and nurse practitioners (NPs) employed at AMCs. Moreover, there is no general guidance on the development of a dashboard to track PA/NP clinical and financial productivity at the individual, department, or enterprise level. At our institution, there was insufficient tracking of PA/NP productivity across many clinical areas within the enterprise. Thus, the aim of the project is to leverage our institution's existing visualization tools coupled with the right analytics to track PA/NP productivity trends using a dashboard report.MethodsWe created an intuitive and customizable highly visual clinical/financial analytical dashboard to track productivity of PAs/NPs employed at our AMC.ResultsThe APP financial and clinical dashboard is organized into two main components. The volume-based key performance indicators (KPIs) included work relative value units (wRVUs), gross charges, collections (payments), and payer-mix. The session utilization (KPIs) included (e.g., new versus return patient ratios, encounter type, visit volume, and visits per session by provider). After successful piloting, the dashboard was deployed across multiple specialty areas and results showed improved data transparency and reliable tracking of PAs/NPs productivity across the enterprise. The dashboard analytics were also helpful in assessing PA/NP recruitment requests, independent practice sessions, and performance expectations.ConclusionTo our knowledge, this is the first paper to highlight steps AMCs can take in developing, validating, and deploying a financial/clinical dashboard specific to PAs/NPs. However, empirical research is needed to assess the impact of qualitative and quantitative dashboards on provider engagement, revenue, and quality of care.
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Vinck TAM, Deneer R, Verstappen C, Kok WE, Salah K, Scharnhorst V, Otterspoor LC. Validation of the ELAN-HF Score and self-care behaviour on the nurse-led heart failure clinic after admission for heart failure. BMC Nurs 2022; 21:158. [PMID: 35729554 PMCID: PMC9210612 DOI: 10.1186/s12912-022-00914-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
AIM To validate the predictive value of the European coLlaboration on Acute decompeNsated Heart Failure (ELAN-HF) score, and to assess the effect of self-care behaviour on readmission and mortality in patients after admission with acute decompensated heart failure (ADHF). DESIGN Quantitative, prospective, single centre, cohort study. METHODS N-Terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured on admission and discharge, and were used together with clinical and laboratory parameters to calculate the ELAN-HF score. Patients were stratified into four risk groups (low, intermediate, high, very high) according to their ELAN-HF score. The performance of the ELAN-HF score was evaluated and compared to the original study. Self-care behaviour was assessed by the European Heart Failure Self-care Behaviour Scale (EHFScBS-9). Survival analysis was used to estimate the association between both scores and re-admission for HF and/or all-cause mortality within 180 days. RESULTS 88 patients were included. The median age of the study population was 75 years (IQR 69-83), 43% was female. NYHA III/IV functional class was present at discharge in 68 patients (85%) and 27 patients (34%) had a left ventricular ejection fraction < 40%. Complete data and 180 day follow up was available for 80 patients. 55% reached the endpoint of readmission and/or all-cause mortality. There was a significant association between the ELAN-HF score and re-admission and/or mortality < 180 days (HR = 1.25, 95% CI 1.08-1.45, p = 0.003). The median EHFScBS-9 score was 68.1 (IQR 58.3 - 77.8). There was no significant association between the EHFScBS-9 score and readmission and/or mortality < 180 days (HR = 1.01, 95% CI 0.99-1.03, p = 0.174). CONCLUSION This study confirms the validity and therefore the potential of the ELAN-HF score to triage patients with ADHF before discharge. Using this score may optimize the follow-up treatment on the nurse-led heart failure clinic in order to decrease readmission and mortality. Self-care behaviour was non-significantly associated with readmission and/or mortality in our study population. TRIAL REGISTRATION This study has been registered with the ethics committee MEC-U (Nieuwegein, The Netherlands), registration nr: V.160999/W18.208/HG/mk.
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Affiliation(s)
- T A M Vinck
- Department of Cardiology Catharina Hospital, Eindhoven, the Netherlands.
| | - R Deneer
- Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands.,Eindhoven University of Technology, Eindhoven, the Netherlands.,Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
| | - Ccag Verstappen
- Department of Cardiology Catharina Hospital, Eindhoven, the Netherlands.,Eindhoven University of Technology, Eindhoven, the Netherlands
| | - W E Kok
- Amsterdam UMC, University of Amsterdam, Heart Center; department of Clinical and Experimental Cardiology, Amsterdam, the Netherlands
| | - K Salah
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands
| | - V Scharnhorst
- Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands.,Eindhoven University of Technology, Eindhoven, the Netherlands.,Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
| | - L C Otterspoor
- Department of Cardiology Catharina Hospital, Eindhoven, the Netherlands
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Wright MA. Septic arthritis of the wrist and the hand: - An Emergency department case study. Int Emerg Nurs 2022; 62:101150. [PMID: 35240452 DOI: 10.1016/j.ienj.2022.101150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 01/07/2022] [Accepted: 01/29/2022] [Indexed: 11/19/2022]
Abstract
Joint pain is a common presentation in the Emergency department. There are countless potential causes for pain and swelling in a joint. Septic arthritis is a true joint emergency as it can lead to rapid, irreversible destruction of the joint. If not diagnosed early this infection can lead to considerable functional deficit. Our case is unique in that our patient presented to the Emergency department requesting referral to the fracture clinic for continued management of a suspected scaphoid bone fracture but was found to have Neisseria gonorrhoea causing septic arthritis of the joint. This case highlights the importance of accurate history taking, clinical examination and assessment of the patients presenting with joint pain.
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Affiliation(s)
- Mary A Wright
- Emergency Department, Redcliffe Hospital, Redcliffe, Queensland, Australia.
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O'Reilly-Jacob M, Perloff J, Sherafat-Kazemzadeh R, Flanagan J. Nurse practitioners' perception of temporary full practice authority during a COVID-19 surge: A qualitative study. Int J Nurs Stud 2022; 126:104141. [PMID: 34923317 PMCID: PMC8609748 DOI: 10.1016/j.ijnurstu.2021.104141] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND At the beginning of the COVID-19 pandemic in the United States, 22 state governors temporarily waived physician supervision of nurse practitioners to expand access to health care during the state of emergency. OBJECTIVE We examined the nurse practitioner perception of the simultaneous scope of practice changes and the exigent pandemic demands during the initial COVID-19 surge in Massachusetts. METHODS Qualitative descriptive design using content analysis of open-ended responses to a web-based survey of Massachusetts nurse practitioners conducted in May & June 2020. RESULTS Survey response rate was 40.6 percent (N = 389). Content analysis identified four themes including: 1) State waivers enabled more control over practice and more expedited care, 2) State waiver did not change practice either because of pre-established independence or employers not changing policy, 3) Perception of nurse practitioner role as both versatile and disposable and 4) Telehealth increased access to care and created an autonomous setting. CONCLUSIONS Although findings suggest fewer barriers in some areas, the temporary removal of state-level restrictions alone is not sufficient to achieve immediate full scope of practice for nurse practitioners. There is a need for regulatory frameworks that optimize the capacity of the advanced practice nursing workforce to respond to global health emergencies. US-based policymakers and healthcare organizations should revise outdated scope of practice policies and capitalize on telehealth technology to utilize the full extent of nurse practitioners. Likewise, nursing leaders should be a voice for nurse practitioners to more effectively and safely maximize the nurse practitioner contribution during emergency responses. In countries where the role is under development, regulators can leverage these findings to establish modernized nurse practitioner scope of practice policies from the outset.
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Affiliation(s)
- Monica O'Reilly-Jacob
- Boston College, Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA,Corresponding author
| | - Jennifer Perloff
- Brandeis University, The Heller School for Social Policy and Management, 415 South Street, Waltham, MA, 02454, USA
| | - Roya Sherafat-Kazemzadeh
- Brandeis University, The Heller School for Social Policy and Management, 415 South Street, Waltham, MA, 02454, USA
| | - Jane Flanagan
- Boston College, Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
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King-Dailey K, Frazier S, Bressler S, King-Wilson J. The Role of Nurse Practitioners in the Management of Heart Failure Patients and Programs. Curr Cardiol Rep 2022; 24:1945-1956. [PMID: 36434405 PMCID: PMC9702908 DOI: 10.1007/s11886-022-01796-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper is to highlight the multifaceted approach heart failure (HF) nurse practitioners (NPs) use to manage patients. We were seeking to answer if NPs have the scope of clinical skills to manage the complexity of HF patients. RECENT FINDINGS NP care in HF has been shown to reduce readmissions, improve timeliness of visits, decrease cost, and improve quality outcomes in small heterogeneous studies. The evidence supports that NPs provide multifaceted, patient-centered care for at all stages on the continuum of HF. Our goals as NPs are to reduce the healthcare financial strain and improve access to high quality care. Telehealth is an emerging technology that shows promise in HF management by improving access and decreasing readmissions. Telehealth use and recognition increased with the COVID-19 pandemic. Future research should focus on NP run clinics, cost effectiveness, and quality of care.
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Affiliation(s)
- Kathaleen King-Dailey
- Division of Cardiology, Penn State Health Heart and Vascular Institute, Mail Code H047, 500 University Dr., P.O. Box 850, Hershey, PA 17033 USA
| | - Suzanne Frazier
- Division of Cardiology, Penn State Health Heart and Vascular Institute, Mail Code H047, 500 University Dr., P.O. Box 850, Hershey, PA 17033 USA
| | - Sonya Bressler
- Division of Cardiology, Penn State Health Heart and Vascular Institute, Mail Code H047, 500 University Dr., P.O. Box 850, Hershey, PA 17033 USA
| | - Jennifer King-Wilson
- Division of Cardiology, Penn State Health Heart and Vascular Institute, Mail Code H047, 500 University Dr., P.O. Box 850, Hershey, PA 17033 USA
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Poghosyan L, Pulcini J, Chan GK, Dunphy L, Martsolf GR, Greco K, Todd BA, Brown SC, Fitzgerald M, McMenamin AL, Solari-Twadell PA. State responses to COVID-19: Potential benefits of continuing full practice authority for primary care nurse practitioners. Nurs Outlook 2022; 70:28-35. [PMID: 34763899 PMCID: PMC8346350 DOI: 10.1016/j.outlook.2021.07.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, federal and state governments removed the scope of practice restrictions on nurse practitioners (NPs), allowing them to deliver care to patients without restrictions. PURPOSE To support policy makers' efforts to grant full practice authority to NPs beyond the COVID-19 pandemic, this manuscript summarizes the existing evidence on the benefits of permanently removing state-level scope of practice barriers and outline recommendations for policy, practice, and research. METHODS We have conducted a thorough review of the existing literature. FINDINGS NP full scope of practice improves access and quality of care and leads to better patient outcomes. It also has the potential to reduce health care cost. DISCUSSION The changes to support full practice authority enacted to address COVID-19 are temporary. NP full practice authority could be part of a longer-term plan to address healthcare inequities and deficiencies rather than merely a crisis measure.
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Affiliation(s)
| | - Joyce Pulcini
- George Washington University School of Nursing, Ashburn, VA
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Dempsey CM, Serino-Cipoletta JM, Marinaccio BD, O'Malley KA, Goldberg NE, Dolan CM, Parker-Hartigan L, Williams LS, Vessey JA. Determining factors that influence parents' perceptions of telehealth provided in a pediatric gastroenterological practice: A quality improvement project. J Pediatr Nurs 2022; 62:36-42. [PMID: 34894421 DOI: 10.1016/j.pedn.2021.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND In response to the COVID-19 pandemic, local and institutional guidelines restricted non-emergent, in-person visits in outpatient specialty clinics. Nurse practitioners (NPs) in pediatric gastroenterology clinics immediately shifted their practice to telehealth (TH). LOCAL PROBLEM The shift to TH necessitated a change in practice. This quality improvement project was designed to define factors influencing family's perceptions of TH and secure feedback on the TH experience. TH is remaining an option for accessing care even as restrictions are being lifted. Feedback is necessary to ensure that quality of care and high patient satisfaction are maintained in a virtual environment. METHODS The Unified Theory of Acceptance and Use of Technology was used to frame the project. Surveys were collected from NPs related to services provided and complexities of each encounter. Post-visit surveys were conducted with families to assess their perceptions of the visit. Findings were discussed to identify and address gaps in service. RESULTS Parent/family surveys were consistent with NP feedback. Results indicated that parents were satisfied with care provided via TH, but that these visits were limited by incomplete assessments, lacked the intimacy of in-person encounters and were often difficult to access due to technological issues. CONCLUSIONS It is anticipated that TH will be used in the post pandemic era to provide routine and non-emergent acute care. Institutions and providers need to consider factors influencing the patient experience learned during the pandemic and implement evidenced-based strategies that ensure quality care that meets patients' needs.
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Piersma FR, Neefs J, Berger WR, van den Berg NWE, Wesselink R, Krul SPJ, de Groot JR. Care and referral patterns in a large, dedicated nurse-led atrial fibrillation outpatient clinic. Neth Heart J 2021; 30:370-376. [PMID: 34919210 PMCID: PMC9270511 DOI: 10.1007/s12471-021-01651-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Atrial fibrillation (AF) is the most common arrhythmia and imposes a high burden on the healthcare system. A nurse-led AF outpatient clinic may alleviate the burden on the cardiology outpatient clinic by triaging patients who need care by a cardiologist or general practitioner (GP). However, care and referral patterns after initial assessment in a nurse-led AF outpatient clinic are unknown. We examined the proportion of AF patients assessed in a nurse-led clinic without outpatient follow-up by a cardiologist. Methods All patients with AF referred to our tertiary medical centre underwent cardiac work-up in the nurse-led AF outpatient clinic and were prospectively followed. Data on patient characteristics, rhythm monitoring and echocardiography were collected and described. Odds ratio (OR) for continuing care in the nurse-led AF outpatient clinic was calculated. Results From 2014 to 2018, 478 consecutive individual patients were referred to the nurse-led AF outpatient clinic. After the initial cardiac work-up, 139 patients (29.1%) remained under nurse-led care and 121 (25.3%) were referred to a cardiologist and 218 (45.6%) to a GP. Patients who remained under nurse-led care were significantly younger, were more symptomatic, more often had paroxysmal AF and had less comorbidities than the other two groups. After multivariable testing, CHA2DS2-VASc score ≥ 2 was associated with discontinued nurse-led care (OR 0.57, 95% confidence interval 0.34–0.95). Conclusion After initial cardiac assessment in the nurse-led outpatient clinic, about half of the newly referred AF patients were referred back to their GP. This strategy may reduce the burden of AF patients on secondary or tertiary cardiology outpatient clinics. Supplementary Information The online version of this article (10.1007/s12471-021-01651-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F R Piersma
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - J Neefs
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - W R Berger
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - N W E van den Berg
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - R Wesselink
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - S P J Krul
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - J R de Groot
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.
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Kidd VD, Vanderlinden S, Spisak JM. An analysis of the selection criteria for postgraduate physician assistant residency and fellowship programs in the United States. BMC Med Educ 2021; 21:621. [PMID: 34915879 PMCID: PMC8675298 DOI: 10.1186/s12909-021-03059-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study aims to investigate the admission criteria used by physician assistant postgraduate education programs in selecting licensed PA applicants for postgraduate training in the United States. To our knowledge, there have been no previously published reports on selection criteria and/or other factors influencing postgraduate PA admission decisions. METHOD A non-experimental, descriptive research study was designed to obtain information from members of the Association of Postgraduate Physician Assistant Programs (APPAP). RESULTS Twenty-three out of 73 postgraduate programs (35%) responded to the survey. The study reported that applicant PAs and NPs are largely selected on the basis of several factors. The most heavily weighted factor is the interview itself; other selection criteria perceived to be extremely/very important included board certification/eligibility, letters of recommendation, advanced degree, and personal essay. Survey data suggest that publications, undergraduate transcripts, and class rankings are not considered to be of high importance in applicant selection. The number of PA applicants applying to each postgraduate training program averages around 26 and total number of enrollees is about 3.6 per program. Additionally, some programs reported furloughing of trainees (temporary suspension of didactic and clinical training) during the pandemic, whereas the vast majority of postgraduate PA programs remained operational and some even experienced an increase in application volume. The total cost of training a PA resident or fellow in postgraduate programs is currently $93,000 whereas the average cost of training a categorical physician resident is estimated at $150,000 per year when considering both salary and benefits. CONCLUSIONS This novel study examined criteria and other factors used by postgraduate PA programs in selecting candidates for admission. Results can be used by postgraduate programs to improve or modify current selection criteria to enhance the quality of trainee selection. Further research is needed to examine correlations between applicant attributes, selection criteria, and trainee success in completing postgraduate training.
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Affiliation(s)
- Vasco Deon Kidd
- School of Medicine, Department of Orthopaedic Surgery, University of California Irvine (UCI Health), 101 The City Dr S, Orange, CA, 92868, USA.
| | - Sarah Vanderlinden
- Department of Surgery, Trauma and Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer M Spisak
- Ronald O. Perelman Department of Emergency Medicine, NYU Langone Health, 545 First Avenue, Greenberg Hall Suite 6B, New York, NY, 10016, USA
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50
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D'Aoust RF, Brown KM, McIltrot K, Adamji JMD, Johnson H, Seibert DC, Ling CG. A competency roadmap for advanced practice nursing education using PRIME-NP. Nurs Outlook 2021; 70:337-346. [PMID: 34911643 DOI: 10.1016/j.outlook.2021.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 10/05/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Clinical competency validation is essential for nurse practitioner (NP) education and public accountability. While there has been robust discussion around what constitutes clinical competency and assessment, clear and consistent definitions and measurements remain elusive. PURPOSE This article describes the PRIME-NP clinical competency model that is scalable, reproducible and accurately documents NP student competency across clinical courses. METHODS To develop the model, work in 5 discrete domains was necessary: (a) model development, (b) assessment tool to be used in Objective Structured Clinical Exams (OSCE), (c) rubrics to accompany the OSCE exam, (d) faculty education, and (e) evaluating the model use. FINDINGS Faculty and student outcomes reveal that the model and assessment tool acceptability and effectiveness of the model, especially for early identification for at risk students. CONCLUSION The PRIME-NP offered faculty the opportunity to identify at-risk students, identify a more nuanced remediation plan, and assess student competency in simulated environments.
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Affiliation(s)
| | | | | | | | - Heather Johnson
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University, Bethesda, MD
| | - Diane C Seibert
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University, Bethesda, MD
| | - Catherine G Ling
- Johns Hopkins School of Nursing, Baltimore, MD; Family Nurse Practitioner Track Coordinator, Baltimore, MD
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