An Advanced Practice Nurse Coordinated Multidisciplinary Intervention for Patients with Late-Stage Cancer: A Cluster Randomized Trial

BACKGROUND

Early palliative care provided through a palliative care consultative service is effective in enhancing patient outcomes. However, it is unknown whether the integration of palliative care as part of routine comprehensive cancer care improves patients' self-reported clinical outcomes.

OBJECTIVE

The objective of this study was to evaluate the effects of a multidisciplinary coordinated intervention by advanced practice nurses at the clinic level on outcomes with patients newly diagnosed with late-stage cancer.

METHODS

A clustered, randomized, controlled trial design was used. Four disease-specific multidisciplinary clinics were randomized to the 10-week intervention (gynecologic and lung clinics) or to enhanced usual care (head and neck and gastrointestinal clinics). Patient primary outcomes (symptoms, health distress, depression, functional status, self-reported health) were collected at baseline and one and three months, and secondary outcomes were collected one and three months postbaseline. General linear mixed model analyses with a covariance structure of within-subject correlation was used to examine the intervention's effect.

RESULTS

The sample included 146 patients with newly diagnosed late-stage cancers. We found no differences between the two groups on the primary patient-reported outcomes at one and three months postbaseline; however, physical and emotional symptoms remained stable or significantly improved from baseline for both groups. Overall, secondary outcomes remained stable within the groups.

CONCLUSION

In this translational study, we demonstrated that if patients newly diagnosed with late-stage cancer were managed by disease-specific multidisciplinary teams who palliated their symptoms, providing whole-patient care, patient outcomes remained stable or improved.

A historical overview of the development of advanced practice nursing roles in Canada

Advanced practice nursing has evolved over the years to become recognized today as an important and growing trend among healthcare systems worldwide. To understand the development and current status of advanced practice nursing within a Canadian context, it is important to explore its historical roots and influences. The purpose of this paper is to provide a historical overview of the major influences on the development of advanced practice nursing roles that exist in Canada today, those roles being the nurse practitioner and the clinical nurse specialist. Using a scoping review and qualitative interviews, data were summarized according to three distinct time periods related to the development of advanced practice nursing. They are the early beginnings; the first formal wave, between the mid 1960s and mid 1980s; and the second wave, beginning in the late 1980s and continuing to the present. This paper highlights how advanced practice nursing roles have evolved over the years to meet emerging needs within the Canadian healthcare system. A number of influential factors have both facilitated and hindered the development of the roles, despite strong evidence to support their effectiveness. Given the progress over the past few decades, the future of advanced practice nursing within the Canadian healthcare system is promising.

Assessing and addressing practitioner burnout: Results from an advanced practice registered nurse health and well-being study

BACKGROUND

Numerous nursing and physician studies have reported the effects of workload, environment, and life circumstances contributing to burnout. Effects may include job dissatisfaction, poor quality of life, and associated negative patient outcomes. Although assessing clinician burnout to determine effective interventions has become a topic of great importance, there are minimal studies specific to advanced practice registered nurses (APRNs).

PURPOSE

This single-center study was conducted to assess the prevalence and impact of APRN burnout and to recommend targeted interventions toward improvement of overall health and well-being.

METHODS

A cross-sectional, mixed methods design was used. The voluntary, anonymous survey examined perceptions of wellness, inclusion, social support, personal coping mechanisms, and status of burnout.

RESULTS

The 78-question survey was sent to 1,014 APRNs (94%) and PAs (6%), with a 43.6% response rate (n = 433); 76.4% were nurse practitioners. Participants were identified as currently experiencing burnout, formerly burned out, or never having experienced burnout. Profiles were developed, and similarities and differences between each group were compared. Of 433 respondents, 40.4% (n = 175) reported having never experienced burnout, 33.3% (n = 144) reported they had formerly experienced burnout, and 26.3% (n = 114) reported they were currently experiencing burnout.

IMPLICATIONS FOR PRACTICE

The results of the study identified that some APRNs report experiencing burnout at different times in their careers. Recommendations by participants to mitigate burnout included self-care, organizational promotion of health and well-being, career development, and leadership support. This study is one of the first to report on burnout among APRNs and potential interventions to build resilience; however, additional research is warranted.

A survey of oncology advanced practice providers' knowledge and attitudes towards sexual and gender minorities with cancer

AIMS AND OBJECTIVES

To evaluate the knowledge and attitudes towards sexual and gender minority (SGM) oncology patients' needs among advanced practice providers (APPs).

BACKGROUND

SGM individuals experience health disparities, in part due to lack of access to knowledgeable providers. Despite the important role of APPs in cancer care, less is known about their attitudes and knowledge towards SGM cancer patients.

DESIGN

Cross-sectional study.

METHODS

A survey of APPs at a National Cancer Institute-Designated Comprehensive Cancer Center assessed self-reported demographics, attitudes, knowledge and postsurvey confidence in knowledge of SGM oncology patient needs. Reporting of this study adheres to STROBE guidelines.

RESULTS

Knowledge of health needs was low with an average of 2.56 (SD = 1.27) items answered correctly out of 6. The majority of APPs self-reported being comfortable treating SGM patients (93.6% and 87.2%, respectively), but less confident in knowledge of their health needs (68.0% and 53.8%, respectively). Although less than half of APPs believed education should be mandatory (44.9%), 79.5% were interested in education about SGMs' unique health needs. Political affiliation, medical specialty, licensure, and having SGM friends or family were associated with various attitude items, but not knowledge. Moderation analyses indicated that APPs who had greater overall knowledge scores were more likely to agree, on average, that knowing sexual orientation, gender identity and sex assigned at birth are important to providing quality oncology care.

CONCLUSION

APPs report being comfortable providing care for SGMs with cancer, but knowledge gaps remain that may inhibit the quality of care provided. Given the interest in education, results would support the development of SGM-related healthcare training for oncology APPs.

RELEVANCE TO CLINICAL PRACTICE

Targeted education for providers during training and continuing education is likely to improve the provision of quality care for SGMs with cancer.

Coping skills training in a telephone health coaching program for youth at risk for type 2 diabetes

INTRODUCTION

The purpose of this article is to describe components of a health coaching intervention based on coping skills training delivered via telephone. This intervention was provided to urban adolescents at risk for type 2 diabetes mellitus (T2DM), reinforcing a school-based curriculum designed to promote a healthy lifestyle and prevent T2DM.

METHOD

Health coaching via telephone was provided to at-risk urban youth enrolled in a study of an intervention to reduce risk for T2DM. Vignettes are used to describe the use of several coping skills in this high-risk youth population.

RESULTS

A variety of vignettes illustrate how telephone health coaching reinforced lifestyle changes in students by incorporating coping skills training.

DISCUSSION

Given the benefits and the challenges of the telephone health coaching intervention, several suggestions for others who plan to use a similar method are described.

"I can just be me": advanced practice nursing with families experiencing grief

Nurses have a key role to play in therapeutic interventions for bereaved and grieving families. In this article, hermeneutic inquiry is used to uncover what families found helpful or useful with respect to therapeutic conversations with advanced practice registered nurses. The findings show that nursing expertise is important in family nursing practice. Expertise in the relationship allowed the family to find healing and hope by addressing core constraining beliefs. Clinical judgment, or sense, was significant in guiding the therapeutic conversation. Lastly, how problems are framed and how families are positioned have implications for outcomes and therapeutic change.

The gift of listening: JUST listening strategies

The purpose of this paper is to examine how the simple act of listening deeply to patients serves as a potentially powerful tool in determining treatment plans, improving patient compliance, decreasing costs, increasing efficacy, and improving patient-practitioner relationships. Nonegoic listening is a transformative practice that can be integrated into clinical training and practice. A growing body of experiential and anecdotal evidence indicates that this is an area ripe for further investigation to enhance nursing interventions and cultural competencies. Given the significant role that advance practice nurses have in directing patient care, integrative listening can be valuable in shaping patient care.

Advance Practice Provider Transformational Leadership Structure: A Model for Change

BACKGROUND

The role of the advanced practice provider (APP) is rapidly expanding in healthcare, whereas infrastructure to support it is not keeping pace. A large academic healthcare organization implemented the role of a director of APPs; supported by the C-suite, one who understands scope of practice, revenue models, and compliance and addresses engagement and retention to meet this challenge. This article chronicles the implementation of innovative success strategies, supporting APPs across a large academic health system, employing more than 1000 APPs, which has led to improvements in APP-generated revenue, patient access, engagement, and alignment.

METHODS

Emory Healthcare rapidly expanded the number of APPs (nurse practitioners and physician assistants) over the past 10 years. APPs reported to administration or nursing leadership leading to APP dissatisfaction, questions on return on investment (ROI) and productivity, and poor utilization due to lack of role clarity. An APP leadership structure was created so that every APP reported to an APP leader. In alignment with the goals and plan for Emory Healthcare, standardized service line productivity and accountability expectations were developed and implemented, as well as a vision and strategic plan to support APPs.

RESULTS

Improvement in productivity was seen across service lines, supported by the increase in full-time equivalent numbers, while improving the ROI for the organization. A roadmap to aligning an APP and organizational strategic plan has been created and implemented. Improvement in APP engagement was realized.

CONCLUSIONS

An APP director and leadership structure are vital to the creation of infrastructure to support APPs in this healthcare. Optimization and standardization of APP practice resulted in role clarity and allowed for support of practice development.

Teaching research to graduate nursing students: a strategy using clinically based research projects

This article describes an approach to teaching advanced practice nursing students the research process through the application of the research process to clinical problems. In the course, students propose solutions to clinically based research projects through conceptualizing the problem, identifying an appropriate theoretical framework, conceptualizing the intervention or clinical guidelines, and designing a project that includes the research design, sampling strategies, procedures for implementation of the project, and plans for data collection and analysis. These strategies challenge the advanced practice nursing student to apply research concepts to problems encountered in clinical practice and reinforces the skills needed to critique the literature, to summarize the published findings on a problem, to conceptualize a research study, and to disseminate their findings in oral presentations.

Involvement of Advanced Practice Nurse in the Management of Geriatric Conditions: Examples from Different Countries

The increasing demand for healthcare services is placing great strain on healthcare systems throughout the world. Although the older population is increasing worldwide, there is a marked deficit in the number of persons trained in geriatrics. It is now recognized that early detection and treatment of geriatric conditions (e.g., frailty, sarcopenia, falls, anorexia of aging, and cognitive decline) will delay or avert the development of disability. At the same time, recent years have seen an increased interest and use of advanced practice nurses (APN). Models of best practices of supervision and collaboration have been promulgated by many organizations. APN's roles and scope of practice have been expanded in many countries and the quality and cost-effectiveness of healthcare systems have improved. Nevertheless, in older people, evidence of advanced practice roles remains scattered, and there is little synthesis of evidence, and therefore it is not easy to visualize the different practice models and their components. The aim of this paper is to explain the need for advanced practice nurses to manage geriatric conditions.

A scoping review of Advanced Practice Registered Nurses Consensus Model outcomes: Part four of a four-part series on critical topics identified by the 2015 Nurse Practitioner Research Agenda

BACKGROUND AND PURPOSE

The Advanced Practice Registered Nurses (APRN) Consensus Model was produced by the APRN Joint Dialogue Group in 2008. The aim of the Consensus Model is to guide state boards on the implementation of APRN practice components, including licensure, accreditation, certification, and education and to clarify the legal scope of practice and APRN roles. The purpose of this scoping review and gap analysis was to appraise the evidence related to patient, nurse practitioner (NP) and organizational outcomes resulting from the Consensus Model.

METHODS

A scoping review of research studies and grey literature reports was conducted and focused on the outcomes and key concepts related to the Consensus Model. Areas of foci included patients, NPs, and organizations. A subsequent gap analysis was conducted.

CONCLUSIONS

Several positive findings related to the Consensus Model, or components thereof, were identified for patient, NP, and organizational outcomes on various levels. Research gaps exist. Additional research is needed to fully evaluate the health outcomes on a broader scale.

IMPLICATIONS FOR PRACTICE

Existing evidence may support NPs and supporting organizations to further legislative efforts to more fully implement the Consensus Model nationwide.

Patient-centered medical homes: presenting a role for the advanced practice mental health nurse

As the burden of mental illness grows in the United States, recent data show that many in need of behavioral health services are not currently receiving them. Recent passage of the Patient Protection and Affordable Care Act has presented an opportunity to change the delivery of behavioral health care to a consumer-driven, evidence-based model geared toward the coordination of care within the primary care setting. Psychiatric-mental health clinical nurse specialist/nurse practitioners are in an ideal position to deliver cost-effective behavioral health care in collaboration with primary care providers under the new patient-centered medical home model of care.

The role for advanced practice nursing in Canada

The delivery of modern health services is a complex activity that increasingly relies on inter-professional collaboration. The different roles of the members of these inter-professional teams may depend not only on traditional job demarcations but also on a division of labour that maximizes efficiency and improves outcomes.

Recognising air embolism as a complication of vascular access

The insertion and maintenance of advanced vascular access devices is increasingly becoming the remit of advanced nurses. Understanding the potential for air embolism as a complication of this procedure, recognising and managing the signs and symptoms, and being able to apply preventative measures, are imperative to enhance patient safety. A range of outcomes can present from air embolism depending on the rate and volume of air entrained, from sub-clinical to death, so the application of expert knowledge and vigilance is essential to minimise risk. According the the available literature, supplemental oxygen administration appears to be the most effective treatment.

Engagement in Psychotherapy Improves Outcomes for Veterans

The longstanding partnership between the Birmingham Veterans Affairs Medical Center (BVAMC) and the University of Alabama at Birmingham School of Nursing inspired the establishment of one of the country's first psychiatric-mental health nurse practitioner (PMHNP) residencies and subsequent formation of a Resident Continuity Clinic (RCC). Within the RCC, PMHNP residents deliver evidence-based care that is informed by measurement-based care (MBC) to improve patient outcomes and reduce time to recovery. Determined by the BVAMC Institutional Review Board to be a quality improvement project, PMHNP residents administered the Patient Stress Questionnaire (PSQ), a MBC tool that uses four independently validated screening tools to measure the behavioral health symptoms of depression, anxiety, trauma, and alcohol use. Additional clinical variables of interest included patient use of illicit substances, participation in psychotherapy, and use of psychotropic medications. PSQ scores were reviewed retrospectively via descriptive statistics and nonparametric tests. Analysis demonstrated statistically significant improvements in depression and anxiety. Data also revealed that patients engaged in psychotherapy demonstrated greater improvements on all PSQ screening tools compared to patients not involved in psychotherapy. The results reinforce the value of MBC in psychiatric care and highlight the importance of engaging Veterans in psychotherapy to improve outcomes. [Journal of Psychosocial Nursing and Mental Health Services, 57(6), 30-38.].

Understanding how advanced practice registered nurses function as patient advocates

Although patient advocacy experiences for registered nurses (RNs) have been researched over the past 40 years, very little is known about patient advocacy at the advanced practice registered nursing (APRN) level. The APRN role is distinct from the RN role, in that APRNs are focused on diagnosing, prescribing, and management of treatment of various medical conditions in the settings where APRNs are used. The purpose of this study was to explore the APRN's experience with patient advocacy using a phenomenology-based qualitative design. A total of seven Texas APRNs were randomly selected for participation in telephone interviews. Interview transcripts were analyzed by the research team for repetitive statements and four themes emerged from the data: (a) patients with APRN advocacy is providing resources, information, and protection; (b) outcomes of patient with APRN advocacy: positive and negative; (c) patient advocacy mostly experientially learned at APRN level; and (d) increased medical knowledge increases advocacy ability. This pilot study provides important preliminary exploratory results regarding APRN advocacy and differentiates it from RN level advocacy. In addition, this study provides significant insight into APRN educational preparation for the APRN advocate role, thus serving as a foundation for improving educational approaches to advocacy.

Implementation of nurse authorisation of blood components

A collaborative project between the Better Blood Transfusion teams in the Scottish National Blood Transfusion Service (SNBTS) and NHS Blood and Transplant (NHSBT) explored the feasibility of nurses prescribing blood components, and clarified that blood components are not considered medicinal products, so the term prescription does not apply. No legal barriers to trained, competent nurses and midwives undertaking this role were identified and nurse authorisation of blood components was seen as having the potential to improve patients' experiences. A number of NHS Scotland boards showed interest in implementing this but there are challenges to ensuring that a robust governance structure is in place to support role development . Progress has been made with support from the Scottish Government Health Department and using a governance framework that was developed to support nurses who wish to undertake this role.

Interpreting measures of risk: Translating evidence into practice

Advanced practice registered nurses must have a working knowledge of statistical principles in order to provide high-quality, evidence-based care. This article presents basic concepts of risk indexes and case study examples illustrating how these measures can inform practice.

Elevating Elderly Cancer Care: A Systematic Review of Advanced Practice Nursing's Role in Senior Oncology Patients' Quality of Life

Background

According to projections based on current trends, it can be anticipated that from 2024 onward, approximately 70% of all cancer cases will be diagnosed in individuals 65 years and older. Given this complex intersection between population ageing and cancer incidence, it is of great importance to address this issue from a comprehensive care perspective. Here comes the importance of advanced practice nurse into play. However, this figure is still not sufficiently valued in many countries. Its roles are also not clearly defined at the international level. For this reason, a systematic review of the scientific literature was carried out to analyze the impact of advanced practice nurse on the quality of life of older adults with cancer.

Methods

Searches were carried out in PubMed, Web of Science (WoS), Scopus, CINAHL, LILACS, and ScienceDirect databases. They were limited to studies conducted in the last 7 years. Only open-access articles were selected. To analyze the chosen articles and assess their quality, the criteria of the PRISMA and CASPe statements were applied. All authors participated in both the selection of the articles and their analysis.

Results

Of the initial 58 articles selected, a total of 10 articles were finally included, as they met the eligibility criteria established after further analysis. The results show a positive relationship between the advanced practice nurse intervention and quality of life in older adults with cancer.

Conclusions

Advanced practice nurse (APN) plays a key role in the care of older adults with cancer, significantly improving their quality of life and contributing to the comprehensive care of these patients. The findings evidenced in this work support the integration of APNs in cancer care teams to improve patient experience and overall well-being.

Ethical Reasoning in Prescribing and Monitoring Psychotropic Medications

Traditionally, schools of nursing teach legal and ethical responsibilities at the pre-licensure and advanced practice levels, with emphasis on legal duties and ethical principles. However, involving clinicians in the process of ethical reasoning, a process similar to the scientific method and nursing process, is much less common. The current article describes and demonstrates the steps in ethical reasoning in common situations faced by prescribing advanced practice RNs and psychiatric-mental health nurses. [Journal of Psychosocial Nursing and Mental Health Services, 57(1), 7-10.].