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British Journal of Nursing (Mark Allen... Nov 2019A lack of awareness exists within healthcare services on the differences between the roles of advanced nurse practitioner (ANP) and clinical nurse specialist (CNS). This... (Review)
Review
A lack of awareness exists within healthcare services on the differences between the roles of advanced nurse practitioner (ANP) and clinical nurse specialist (CNS). This may lead to ambiguity in relation to the development, scope of practice and impact of these roles. The aim of this review was to compare the similarities and differences between the ANP and CNS within the research literature. Databases (CINAHL, Medline and Embase) were searched using selected search terms. This resulted in 120 articles of potential interest being identified. Following a rigorous review process for content and relevance, this was reduced to 12. Both roles are valuable and effective, predominately being clinically based with education, leadership and research components. CNS roles are specialist, ANP are more likely to be generalist. Where there is regulation and governance the role of the ANP is clearly defined and structured; however, a lack of governance and regulation is evident in many countries.
Topics: Advanced Practice Nursing; Humans; Nurse Clinicians; Nurse Practitioners; Nurse's Role
PubMed: 31714817
DOI: 10.12968/bjon.2019.28.20.1308 -
International Journal of Nursing Studies Apr 2020Workload and workforce issues in primary care are key drivers for the growing international trend to expand nursing roles. Advanced nurse practitioners are increasingly... (Review)
Review
BACKGROUND
Workload and workforce issues in primary care are key drivers for the growing international trend to expand nursing roles. Advanced nurse practitioners are increasingly being appointed to take on activities and roles traditionally carried out by doctors. Successful implementation of any new role within multidisciplinary teams is complex and time-consuming, therefore it is important to understand the factors that may hinder or support implementation of the advanced nurse practitioner role in primary care settings.
OBJECTIVES
To identify, appraise and synthesise the barriers and facilitators that impact implementation of advanced practitioner roles in primary care settings.
METHODS
A scoping review conducted using the Arksey and O'Malley (2005) framework and reported in accordance with PRISMA-ScR. Eight databases (Cochrane Library, Health Business Elite, Kings Fund Library, HMIC, Medline, CINAHL, SCOPUS and Web of Science) were searched to identify studies published in English between 2002 and 2017. Study selection and methodological assessment were conducted by two independent reviewers. A pre-piloted extraction form was used to extract the following data: study characteristics, context, participants and information describing the advanced nurse practitioner role. Deductive coding for barriers and facilitators was undertaken using a modified Yorkshire Contributory Framework. We used inductive coding for barriers or facilitators that could not be classified using pre-defined codes. Disagreements were addressed through discussion. Descriptive data was tabulated within evidence tables, and key findings for barriers and facilitators were brought together within a narrative synthesis based on the volume of evidence.
FINDINGS
Systematic searching identified 5976 potential records, 2852 abstracts were screened, and 122 full texts were retrieved. Fifty-four studies (reported across 76 publications) met the selection criteria. Half of the studies (n = 27) were conducted in North America (n = 27), and 25/54 employed a qualitative design. The advanced nurse practitioner role was diverse, working across the lifespan and with different patient groups. However, there was little agreement about the level of autonomy, or what constituted everyday activities. Team factors were the most frequently reported barrier and facilitator. Individual factors, lines of responsibility and 'other' factors (i.e., funding), were also frequently reported barriers. Facilitators included individual factors, supervision and leadership and 'other' factors (i.e., funding, planning for role integration).
CONCLUSION
Building collaborative relationships with other healthcare professionals and negotiating the role are critical to the success of the implementation of the advanced nurse practitioner role. Team consensus about the role and how it integrates into the wider team is also essential.
Topics: Health Personnel; Humans; Leadership; Nurse Practitioners; Nurse's Role; Primary Health Care
PubMed: 32120089
DOI: 10.1016/j.ijnurstu.2019.103443 -
Annals of Global Health 2022Several subgroups of the International Council of Nurses Nurse Practitioner/Advanced Practice Nurse Network (ICN NP/APNN) have periodically analyzed APN (nurse...
BACKGROUND AND OBJECTIVES
Several subgroups of the International Council of Nurses Nurse Practitioner/Advanced Practice Nurse Network (ICN NP/APNN) have periodically analyzed APN (nurse practitioner and clinical nurse specialist) development around the world. The primary objective of this study was to describe the global status of APN practice regarding scope of practice, education, regulation, and practice climate. An additional objective was to look for gaps in these same areas of role development in order to recommend future initiatives.
METHODS
An online survey was developed by the research team, and included questions on APN practice roles, education, regulation/credentialing, and practice climate. The study was launched in August 2018 at the 10 Annual ICN NP/APNN Conference in Rotterdam, Netherlands. Links to the survey were provided there and via multiple platforms over the next year.
RESULTS
Survey results from 325 respondents, representing 26 countries, were analyzed through descriptive techniques. Although progress was reported, particularly in education, results indicated the APN profession around the world continues to struggle over titling, title protection, regulation development, credentialing, and barriers to practice.
CONCLUSIONS AND PRACTICE/POLICY RELEVANCE
APNs have the potential to help the world reach the Sustainable Development Goal of universal health coverage. Several recommendations are provided to help ensure APNs achieve these goals.
Topics: Advanced Practice Nursing; Educational Status; Humans; Netherlands; Nurse Clinicians; Nurse Practitioners
PubMed: 35755314
DOI: 10.5334/aogh.3698 -
Nursing Ethics Feb 2020Medical Assistance in Dying, also known as euthanasia or assisted suicide, is expanding internationally. Canada is the first country to permit Nurse Practitioners to... (Review)
Review
BACKGROUND
Medical Assistance in Dying, also known as euthanasia or assisted suicide, is expanding internationally. Canada is the first country to permit Nurse Practitioners to provide euthanasia. These developments highlight the need for nurses to reflect upon the moral and ethical issues that euthanasia presents for nursing practice.
PURPOSE
The purpose of this article is to provide a narrative review of the ethical arguments surrounding euthanasia in relationship to nursing practice.
METHODS
Systematic search and narrative review. Nine electronic databases were searched using vocabulary developed from a stage 1 search of Medline and CINAHL. Articles that analysed a focused ethical question related to euthanasia in the context of nursing practice were included. Articles were synthesized to provide an overview of the literature of nursing ethics and euthanasia.
ETHICAL CONSIDERATIONS
This review was conducted as per established scientific guidelines. We have tried to be fair and respectful to the authors discussed.
FINDINGS
Forty-three articles were identified and arranged inductively into four themes: arguments from the nature of nursing; arguments from ethical principles, concepts and theories; arguments for moral consistency; and arguments from the nature of the social good. Key considerations included nursing's moral ontology, the nurse-patient relationship, potential impact on the profession, ethical principles and theories, moral culpability for acts versus omissions, the role of intention and the nature of the society in which euthanasia would be enacted. In many cases, the same assumptions, values, principles and theories were used to argue both for and against euthanasia.
DISCUSSION
The review identified a relative paucity of literature in light of the expansion of euthanasia internationally. However, the literature provided a fulsome range of positions for nurses to consider as they reflect on their own participation in euthanasia. Many of the arguments reviewed were not nursing-specific, but rather are relevant across healthcare disciplines. Arguments explicitly grounded within the nature of nursing and nurse-patient relationships warrant further exploration.
Topics: Ethics, Nursing; Euthanasia; Humans; Nurse Practitioners; Nursing Care; Suicide, Assisted
PubMed: 31113279
DOI: 10.1177/0969733019845127 -
Human Resources For Health Dec 2019Nurse prescribing of medicines is increasing worldwide, but there is limited research in Europe. The objective of this study was to analyse which countries in Europe...
BACKGROUND
Nurse prescribing of medicines is increasing worldwide, but there is limited research in Europe. The objective of this study was to analyse which countries in Europe have adopted laws on nurse prescribing.
METHODS
Cross-country comparative analysis of reforms on nurse prescribing, based on an expert survey (TaskShift2Nurses Survey) and an OECD study. Country experts provided country-specific information, which was complemented with the peer-reviewed and grey literature. The analysis was based on policy and thematic analyses.
RESULTS
In Europe, as of 2019, a total of 13 countries have adopted laws on nurse prescribing, of which 12 apply nationwide (Cyprus, Denmark, Estonia, Finland, France, Ireland, Netherlands, Norway, Poland, Spain, Sweden, United Kingdom (UK)) and one regionally, to the Canton Vaud (Switzerland). Eight countries adopted laws since 2010. The extent of prescribing rights ranged from nearly all medicines within nurses' specialisations (Ireland for nurse prescribers, Netherlands for nurse specialists, UK for independent nurse prescribers) to a limited set of medicines (Cyprus, Denmark, Estonia, Finland, France, Norway, Poland, Spain, Sweden). All countries have regulatory and minimum educational requirements in place to ensure patient safety; the majority require some form of physician oversight.
CONCLUSIONS
The role of nurses has expanded in Europe over the last decade, as demonstrated by the adoption of new laws on prescribing rights.
Topics: Drug Prescriptions; Europe; Humans; Nurse Practitioners; Nurse's Role; Nurses
PubMed: 31815622
DOI: 10.1186/s12960-019-0429-6 -
Nurse Education Today Mar 2021Globally, the role of nurse practitioner is evolving to meet increased healthcare demands. Nevertheless, there are factors hindering the development of this role, one of... (Review)
Review
OBJECTIVE
Globally, the role of nurse practitioner is evolving to meet increased healthcare demands. Nevertheless, there are factors hindering the development of this role, one of which involves differences in nurse practitioner education worldwide. Therefore, the objective of the present study is to identify what is known in the research field on the content of nurse practitioner educational programmes.
DESIGN AND DATA SOURCES
The literature scoping review follows a six-stage methodological framework including: i) formulate research questions, ii) identify relevant studies, iii) select studies, iv) chart data, v) collate, summarize and report the results, vi) consultations. Data bases searched included CINAHL, PubMed and ERIC and were followed by manual searching of reference list in the included papers. Of the 1553 papers identified, 16 met the aim of this study.
REVIEW METHODS
To answer the research questions 'what is the content of curricula in nurse practitioner education?' a deductive content analysis was used.
RESULTS
Two main categories emerged. The first was related to the professional nurse practitioner role and includes research and nursing theories, leadership and collaboration, and organizational, political, economic, regulatory and legislative issues. The second is related to becoming an autonomous practitioner and includes health promotion and disease prevention, and other medically oriented content.
CONCLUSIONS
The content identified is consistent with the core competencies that nurse practitioners are expected to have after graduation, which have been described by the International Council of Nurses and by other researchers. Given the lack of recent research in nurse practitioner education, the results of the present study advance knowledge in this research field. Additionally, this study may be of practical value in developing new nurse practitioner educational programmes.
Topics: Clinical Competence; Curriculum; Humans; Leadership; Nurse Practitioners; Nurse's Role
PubMed: 33203544
DOI: 10.1016/j.nedt.2020.104650 -
Nursing Outlook 2020The delivery of emergency, trauma, critical, and intensive care services requires coordination among all members of the care team. Perceived teamwork and role clarity...
BACKGROUND
The delivery of emergency, trauma, critical, and intensive care services requires coordination among all members of the care team. Perceived teamwork and role clarity may vary among physicians (MDs) and nurse practitioners (NPs).
PURPOSE
To examine differences in perceived roles and responsibilities of NPs and MDs practicing in emergency, trauma, critical, and intensive care.
METHODS
Secondary Analysis of the National Survey of Emergency, Intensive, and Critical Care Nurse Practitioners and Physicians, a cross-sectional national survey of clinicians. Mail survey of randomly selected stratified cross-sectional samples of MDs and NPs drawn from national lists of clinicians in eligible specialties working in emergency, trauma, intensive, and critical care units in the United States. 814 clinicians (351 NPs and 463 MDs) were recruited from national by postal mail survey. Our initial sample included n = 2,063 clinicians, n = 1,031 NPs and n = 1,032 MDs in eligible specialties. Of these, 63.5% of NPs and 70.1% of MDs completed and returned the survey excluding those who were ineligible due to lack of current practice in a relevant specialty.
FINDINGS
NPs in ICU/CCU are more likely to be female and report working fewer hours than do MDs and provide direct care to more patients. 55% of NPs and 82% of MDs agree that their individual role in their unit is clear (p < .001); 34% of MDs and 42% of NPs agree that their unit is an example of excellent team work among professionals (p = 0.021); 41% of MD and 37% of NP clinicians (p = 0.061) agree that their teams are "prepared to provide outstanding care in a crisis or disaster." Perceived role clarity was significantly associated with increased perceptions of excellent teamwork and disaster preparedness.
DISCUSSION
At the time of this survey, and majority of NPs and MDs working in emergency, critical and intensive care did not agree that their teams were prepared for a crisis or disaster. Leaders of health organizations should encourage teamwork and professional role clarity to assist units to perform effectively in emergency and disaster preparedness.
Topics: Adult; Critical Care; Cross-Sectional Studies; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Nurse Practitioners; Nurse's Role; Physicians; Surveys and Questionnaires; United States
PubMed: 32622648
DOI: 10.1016/j.outlook.2020.04.010 -
Health Care Management Review 2020The organizational environment can foster or impede full deployment of advance practice registered nurses (APRNs), affecting the quality of care and patient outcomes.... (Review)
Review
BACKGROUND
The organizational environment can foster or impede full deployment of advance practice registered nurses (APRNs), affecting the quality of care and patient outcomes. Given the critical role APRNs play in health care, it is important to understand organizational factors that promote or hinder APRN practice to maximize the potential of this workforce in health care systems.
PURPOSE
The aim of this study was to synthesize evidence about APRN practice environments, identify organizational facilitators and barriers, and make recommendations for better APRN utilization.
METHODS
A literature search was conducted in CINAHL, PubMed, and PsychInfo, yielding 366 studies. No time or geographic limitations were applied. Study quality was appraised using the National Institutes of Health National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Studies.
RESULTS
Thirty studies conducted in the United States, Canada, and the Netherlands met inclusion criteria. The majority of the studies involved nurse practitioners. Facilitators to optimal practice environment were autonomy/independent practice and positive physician/APRN relations. Barriers included policy restrictions on practice, poor physician relations, poor administrator relations, and others' lack of understanding of the APRN role. Barriers correlate with job dissatisfaction and increased intent to leave job.
PRACTICE IMPLICATIONS
The review highlights the importance of physician and administration relations, organizational-level policies, and colleagues' understanding of the APRN role in promoting effective practice environments. Organizations should align policy reform efforts with factors that foster positive APRN practice environments to efficiently and effectively utilize this increasingly vital workforce. Future research is warranted.
Topics: Advanced Practice Nursing; Humans; Nurse Practitioners; Organizational Culture; Physician-Nurse Relations; Professional Autonomy
PubMed: 32865939
DOI: 10.1097/HMR.0000000000000229 -
Journal of the American Association of... Jan 2021Families have the potential to foster a healthy home environment aimed at reducing the risk of overweight and obesity. Establishing habits associated with reduced risk... (Review)
Review
Families have the potential to foster a healthy home environment aimed at reducing the risk of overweight and obesity. Establishing habits associated with reduced risk of obesity and overweight early in childhood can have lasting effects into adulthood. Nurse practitioners can encourage families to participate in healthy habits by addressing areas of growth for obesity prevention within the home. A review of the most recent literature, approximately over the past decade, was used to provide a consolidated source of reference for healthy home habits for the nurse practitioner. The search included terms such as "obesity," "overweight," "healthy habits," "physical activity," "obesogenic behaviors," "family meals," "screen time," "depression," "sugary beverages," and "portion sizes." The information was synthesized into three content areas: nutrition and consumption, patterns of activity, and stress within the home. Establishing healthy habits early in life can protect against the development of overweight and obesity. Nurse practitioners can serve a vital role in the prevention of pediatric, adolescent, and adult obesity. Equipped with the unique role of assisting those from a diverse patient base, nurse practitioners can inform patients how to improve healthy habits to decrease the likelihood of obesity or overweight. Encouraging behavior change related to the healthy habits associated with the prevention of overweight and obesity can have a long-term impact on the health of an entire family.
Topics: Adolescent; Adult; Child; Exercise; Feeding Behavior; Habits; Humans; Nutritional Status; Overweight; Pediatric Obesity
PubMed: 33534281
DOI: 10.1097/JXX.0000000000000556 -
Critical Care Medicine Oct 2019To provide a concise review of the literature and data pertaining to the use of nurse practitioners and physician assistants, collectively called advanced practice... (Review)
Review
OBJECTIVES
To provide a concise review of the literature and data pertaining to the use of nurse practitioners and physician assistants, collectively called advanced practice providers, in ICU and acute care settings.
DATA SOURCES
Detailed search strategy using the databases PubMed, Ovid MEDLINE, and the Cumulative Index of Nursing and Allied Health Literature for the time period from January 2008 to December 2018.
STUDY SELECTION
Studies addressing nurse practitioner, physician assistant, or advanced practice provider care in the ICU or acute care setting.
DATA EXTRACTION
Relevant studies were reviewed, and the following aspects of each study were identified, abstracted, and analyzed: study population, study design, study aims, methods, results, and relevant implications for critical care practice.
DATA SYNTHESIS
Five systematic reviews, four literature reviews, and 44 individual studies were identified, reviewed, and critiqued. Of the research studies, the majority were retrospective with others being observational, quasi-experimental, or quality improvement, along with two randomized control trials. Overall, the studies assessed a variety of effects of advanced practice provider care, including on length of stay, mortality, and quality-related metrics, with a majority demonstrating similar or improved patient care outcomes.
CONCLUSIONS
Over the past 10 years, the number of studies assessing the impact of advanced practice providers in acute and critical care settings continue to increase. Collectively, these studies identify the value of advanced practice providers in patient care management, continuity of care, improved quality and safety metrics, patient and staff satisfaction, and on new areas of focus including enhanced educational experience of residents and fellows.
Topics: Critical Care; Humans; Intensive Care Units; Nurse Practitioners; Physician Assistants; Time Factors
PubMed: 31414993
DOI: 10.1097/CCM.0000000000003925