[Practice and Niches of Advanced Practice Nurses (APNs) in Psychiatric and Mental Health Care]

The current expansion in role responsibilities of advanced practice nurses (APNs) stems from the current change in public health needs. Advanced nursing education enables APNs to respond promptly to current health needs while expanding the scope of nursing practice. As a result, APNs have obtained recognition and acceptance from the public. The "clinical nurse specialist" in psychiatric care was a pioneering example of APNs in the United States. These specialists not only led the vigorous development of contemporary psychiatric nursing but also advanced the nursing profession as a whole. This article aims to elucidate the role practice of and future opportunities for advanced psychiatric mental health nurses. Using examples of "applying evidence-based care to solve complex practice issues", this article demonstrates the role functions of advanced psychiatric mental health nursing and outlines potential niche opportunities for this field.

Skill-Mix Changes Targeting Health Promotion and Prevention Interventions and Effects on Outcomes in all Settings (Except Hospitals): Overview of Reviews

Objectives: Skill-mix changes to step up health promotion and prevention are increasing, but there is limited evidence on their effects. Methods: Overview of reviews, based on a protocol. The search was carried out in six databases, screening was performed ensuring high interrater reliability. All countries, health professions and lay workers in all settings (except hospitals) were included, quality appraisals performed. Results: A total of 31 systematic reviews were included. Expanded roles performing outreach (e.g., home visits) had mostly positive effects on access and health outcomes, primarily for hard-to-reach groups. Task-shifting in colorectal or skin cancer screenings (performed by advanced practice nurses) were suggested effective; supporting roles (by community health workers) increased uptake in screenings, but based on limited evidence. Expanded roles of various professions focusing on lifestyle modification showed promising effects in most reviews, including weight, diet, smoking cessation and physical activity. Reviews on cost-effectiveness were based on limited evidence. Conclusion: Promising skill-mix changes included expanded roles providing lifestyle modifying interventions, task-shifting, and outreach roles for hard-to-reach groups, whereas evidence on costs was limited.

The expansion of the role of nurse prescribing in intensive care units in the healthcare system of Iran: a qualitative content analysis

Intensive Care Unit (ICU) nurses prescribe medication for patients in many countries. However, there is still no evidence on the legitimacy of nurse prescribing roles in the healthcare system of Iran. This qualitative study with 30 experts was conducted to explore the experiences regarding the expanding role of prescribing medication by the ICU nurses. Data were collected through 31 individual semi-structured interviews and analyzed using the conventional content analysis method by MAXQDA 10. One major theme, "applicability of prescribing medication by ICU nurses", together with three sub-themes of "facilitators", "potential risks of nurse prescribing" and "the professional pathway", emerged. The use of successful global experiences, patient-oriented healthcare system policies, current culture and positive professional position of nurses, physician shortage, and high capacity of ICU nurses appeared as facilitators to perform the new role in our context. For the expansion of the new role, different professional pathways such as discussion with physicians and special groups with conflicts of interests, training qualified nurses in this area, and gradual development were proposed by the participants. The next step of the research is to prepare a set of standards for the prescription of medication by the ICU nurses in our context.

The people's army “enemising” the people: The COVID-19 case of Israel

The Israel Defense Forces (IDF) were deployed extensively relative to other democracies’ militaries to combat the coronavirus during 2020–1. Ostensibly, the military's engagements are instrumental in addressing the pandemic due to its resources and hierarchical discipline, and especially in light of its centrality in Israel. However, problems remain concerning this deployment, the most prominent and relevant to the case of Israel being the high legitimacy that the Israeli public afforded this policy, especially given the alternative options available to the government. Motivated by this conundrum, I present a circular argument: securitisation legitimised the deployment of the military and in turn, this deployment, constitutive of the discourse of securitisation, further legitimised securitisation. Consequently, Israel could legitimately adopt an enemy-oriented approach to deal with the crisis, an approach that ‘enemises’ the population.

Exploring self-perception of community pharmacists of their professional identity, capabilities, and role expansion

Objective:

The principal aim of this study was to explore the self-perception of community pharmacists of their professional identity and roles and how they think patients and doctors perceive them. The study also aimed at exploring their opinions regarding role expansion and how they assess their capabilities.

Methods:

This is an exploratory study that employed qualitative method. Individual, in-depth interviews were conducted with a purposive sample of 50 community pharmacists working in Khartoum State, Sudan, from October to November 2015. Each interview was recorded, transcribed, and coded into themes. Thematic analysis was carried out.

Findings:

The study revealed nine different identities of community pharmacists including supplier of medicines, medicines maker, dispenser, patient counselor, medicines expert, clinical practitioner, health promoter, monitor of medicines use, and family practice identity. Participants described that most of the patients value their professional role while doctors perceive them as merely dispensers. Most of participants believe that they are capable to fulfill their roles; however, they identified the need for continuous education. The study revealed that community pharmacists are thirst to role expansion.

Conclusion:

The study concluded that community pharmacists are aware of the different identities of their profession. The good recognition of their role by patients reflects good service provided while lack of integrated primary health care system that join doctors and pharmacists resulted in lack of pharmacists’ recognition by doctors. Continuous educational program is needed for community pharmacists, and role expansion will allow for better self-perception and better profession contribution in healthcare.

[Centennial retrospective on the role expansion of the nursing profession in Taiwan]

Advanced practice nurses were introduced in Taiwan to address increasingly complex public healthcare needs, reimbursement reform in the National Health Care Insurance system, and healthcare organization changes and to ensure high-quality care for patients. This article discusses the role and the function of nurses; the expansion and extension of nursing responsibilities; the specific roles of the advanced practice nurse, the nurse practitioner, the case manager, and the care manager; the affect of advanced practice on nursing identity and effectiveness; and key current issues in advanced practice. Suggestions are provided to improve the professional development of nurses in the future.

The evolving role of health care aides in the long-term care and home and community care sectors in Canada

Health Care Aides (HCAs) provide up to 80% of the direct care to older Canadians living in long-term care facilities, or in their homes. They are an understudied workforce, and calls for health human resources strategies relating to these workers are, we feel, precipitous. First, we need a better understanding of the nature and scope of their work, and of the factors that shape it. Here, we discuss the evolving role of HCAs and the factors that impact how and where they work. The work of HCAs includes role-required behaviors, an increasing array of delegated acts, and extra-role behaviors like emotional support. Role boundaries, particularly instances where some workers over-invest in care beyond expected levels, are identified as one of the biggest concerns among employers of HCAs in the current cost-containment environment. A number of factors significantly impact what these workers do and where they work, including market-level differences, job mobility, and work structure. In Canada, entry into this 'profession' is increasingly constrained to the Home and Community Care sector, while market-level and work structure differences constrain job mobility to transitions of only the most experienced workers, to the long-term care sector. We note that this is in direct opposition to recent policy initiatives designed to encourage aging at home. Work structure influences what these workers do, and how they work; many HCAs work for three or four different agencies in order to sustain themselves and their families. Expectations with regard to HCA preparation have changed over the past decade in Canada, and training is emerging as a high priority health human resource issue. An increasing emphasis on improving quality of care and measuring performance, and on integrated team-based care delivery, has considerable implications for worker training. New models of care delivery foreshadow a need for management and leadership expertise--these workers have not historically been prepared for leadership roles. We conclude with a brief discussion of the next steps necessary to generating evidence necessary to informing a health human resource strategy relating to the provision of care to older Canadians.