Clinical Nurse Specialist: A Critical Member of the ICU Team

Nursing specialization in intensive care: A scoping review

INTRODUCTION

Nursing in Intensive Care Units (ICU) presents an additional difficulty due to the highly complex nature of the patients. This implies a demand for training, skills, and management from the nurses attending to this type of patient, which is not currently guaranteed due to the lack of mandatory prior training. Despite the importance of such education and training, there is currently no existing regulation or national or international consensus regarding its mandatory requirement for performing professional activities in ICUs.

OBJECTIVES

The main research question posed is to identify the existing recommendations on specialised nursing care in adult intensive care.

METHODOLOGY

A scoping review was conducted using the databases PubMed, CINAHL, MEDLINE, COCHRANE, CUIDEN, and SciELO. The review included studies in both Spanish and English with varied designs on the topic of study. The quality of the articles was analyzed, achieving moderate to high levels of compliance with quality guidelines.

RESULTS

A sample of N = 25 was selected, divided according to the primary theme of the articles: 40% (n = 10) on the implementation of training programmes in ICUs, 24% (n = 6) on nursing competencies, 16% (n = 4) on the needs identified by ICU staff themselves, and 20% (n = 5) on the clinical specialty of ICU nursing.

CONCLUSIONS

The findings indicate an improvement in both patient outcomes and the functioning of ICUs following appropriate training of nursing staff. A model for an Intensive Care Nursing Specialty in Spain is proposed as a viable option to develop the necessary specific training.

Patient preferences and willingness to pay for transitional care in breast cancer: a discrete choice experiment

PURPOSE

Most chemotherapy reactions occur outside of the hospital; therefore, providing transitional care (TC) to patients is essential. However, patients' preferences for TC remain poorly understood. This study aims to investigate the preferences and willingness to pay for TC among breast cancer patients.

METHODS

Data were collected using a discrete choice experiment from a large general hospital in North China. The study used six attributes to describe the preferences of patients for TC. Conditional logit and mixed logit models were applied to assess patient preferences, estimate willingness to pay, and simulate uptake probabilities across different scenarios.

RESULTS

A total of 261 respondents completed the survey. The study showed that patients strongly preferred a TC to be provided by a specialist doctor and specialist nurse (β = 0.925; p < 0.001) and were willing to pay CNY¥105.381. The service content most preferred was symptom management, psychological care, and rehabilitation guidance (β = 0.286; p < 0.001), and patients were willing to pay CNY¥32.606. The forms of services most preferred were at outpatient clinics (β = 0.239; p < 0.001), and patients were willing to pay CNY¥27.285. Low out-of-pocket expense was preferred by patients (β = - 0.009; p < 0.001). When TC was provided by a specialist doctor and specialist nurse in an outpatient clinic in conjunction with multidimensional care services and out-of-pocket payment of CNY¥20 per visit, the probability of breast cancer patients' participation increased to 91.39%.

CONCLUSION

The results of this study suggest that breast cancer patients have strong preferences for the provider, content, and form of transitional care (TC), as well as for minimizing out-of-pocket costs.

Evaluation of advanced practice nurse competencies: validation of an instrument for primary care

OBJECTIVE

to evaluate the construct validity and reliability of the Brazilian version of the Instrument for the Evaluation of Advanced Practice Nurse Competencies in Primary Health Care.

METHOD

methodological study carried out in 78 primary health care centers in the southeast of Brazil, with 215 nurses. Data was collected using three instruments: the sample characterization form, the Brazilian version of the Advanced Practice Nurse Competency Assessment Instrument and the Therapeutic Interventions category of the Nurse Competency Scale. Construct validity was verified using confirmatory factor analysis and Spearman's correlation coefficient. Reliability was assessed using Cronbach's alpha and composite reliability.

RESULTS

in the factor analysis, the model converged on a satisfactory result, with six items excluded, resulting in an instrument with 38 items distributed over eight dimensions. In convergent construct validity, positive, significant correlations were observed (p<0.0001) and ranged from weak to moderate in magnitude (r=0.2701 and r=0.397). Satisfactory evidence was found through the Composite Reliability analysis (0.78-0.89).

CONCLUSION

the instrument showed evidence of construct validity and internal consistency. It could be used to help implement strategies for developing advanced practice in nursing.

BACKGROUND

(1) Encourage discussion on Advanced Practice Nursing (APN) in Brazil. (2) To provide an instrument for evaluating APN in Primary Health Care. (3) To help implement APN in Brazil in Primary Health Care. (4) The Brazilian version of the instrument can be applied in different contexts. (5) A strategy for strengthening the nursing workforce.

Advanced practice nursing, critical care, and Spain: A point of view

Advanced Practice Nursing (APN) continues to gain recognition. Despite the guidelines published by the International Council of Nurses in 2020, there is still some confusion about this concept. In general, APN is used in three different and not necessarily compatible ways: as an umbrella term that regulates four different roles, as a level of practice, or as a role itself. Specialization in nursing does not always imply advanced practice, although both concepts are not mutually exclusive. The "Acute Care Nurse Practitioners" in the United States can conduct physical examinations and medical histories, diagnose, prescribe medications, or request and interpret complementary tests. They pose no risk to patients and have shown positive clinical outcomes in Critical Care Units. They also add "value" by improving communication, interprofessional coordination, or adherence to protocols. The "Clinical Nurse Specialists" in Critical Care help improve quality, staff education, and provide care to complex patients. They have a beneficial impact on reducing nosocomial infections, adverse events, hospital stay, or costs. The implementation of APN roles in Spain faces challenges due to its circumstances, such as the high number of physicians or the lack of systematic and transparent measurement of outcomes. Historically, the nursing corporation has promoted a disproportionately positive view of the Spanish healthcare system and nursing. The corporation has followed the model of medical specialization without supporting studies and a framework that hinders its integration into APN. The orthodox vision of Spanish nursing still holds significant weight, where experience is valued more than education, complicating the expansion of competencies. Numerous regional projects have been developed without a unified voice or approach. APN should not be a distraction from continuing to advocate for improvements in nurses' working conditions.

Experience of an advanced practice nurse in an intensive care unit

The intensive care units structure, the technological improvement and the severity of the patients, require that there be harmony between all the actors involved in assisting the critically ill patient. Added to this context is that the current role of the supervisor involves assuming more and more management skills, without losing sight of the need to frame professional practice within the framework of a philosophy of care. Given this challenge for the supervisor, the appearance in our environment of the Advance Practice Nurse figure (APN) is an opportunity. The APN is essential to improving patient care, staff development and the implementation of evidence-based practice. This article describes how the APN works with the different members of the health team and what the results have been since their incorporation. The APN leads efforts to maintain quality of care. They use their knowledge to assess gaps in practice and between practice settings, and to design and lead evidence-based practice changes so that benchmarks can be met in the most efficient and timely manner. Additionally, it supports the organization to respond to a constantly changing healthcare environment and is instrumental in achieving its goals.

Global Scope of Practice of an APN Anesthesia: A Scoping Review

PURPOSE

Perioperative care requires health care professionals with more competencies and skills in clinical assessment, patient education, and advocacy to respond to current and future challenges in health care. Advanced practice nurses (APN) in Anesthesia may represent an approach to improve perioperative care. Specialization in anesthesia care already exists in many countries, but rarely on advanced practice level. An APN Anesthesia is an additional role with expanded skills and competencies and is not yet established in all countries. Therefore, defining the role of APN Anesthesia is necessary. To establish the role of APN Anesthesia effectively, the current evidence on the competencies and scope of practice (SOP) of established roles of APN Anesthesia was summarized.

DESIGN

A scoping review according to the framework by Arksey and O'Malley and the JBI reviewer's manual.

METHODS

We conducted a scoping review by searching the PubMed, PsycINFO, CINAHL, and Scopus databases. The literature search included papers from 2010 to 2023 dealing with the prerequisites and SOP of APN Anesthesia. Descriptions of APN Anesthesia from the United States of America, Asia, and Europe were assessed.

FINDINGS

A total of 1,749 papers were identified of which 24 were included in this review. There is no uniform SOP for APN Anesthesia. The certified registered nurse anesthetist as an established Advanced Practice role in the United States of America, with a high degree of autonomy, is best described. Some APN Anesthesia focus on specific medical conditions such as dementia or autism. APN Anesthesia also works in postoperative care, outpatient clinics, pediatric day surgery, or palliative care settings. Practice development, clinical assessment, education, and family involvement encompass the expanded role of an APN Anesthesia compared with the specialist nurse in Anesthesia.

CONCLUSIONS

The APN Anesthesia is a complementary role in anesthesia because they possess both nursing expertise and advanced medical knowledge. APN Anesthesia provides preoperative assessments with patient and family education, intraoperative care for specific patient populations, and expanded duties in the postanesthesia care unit and palliative care.

The Clinical Nurse Specialist: Maximizing Return on Investment

The United States health care system is facing an unprecedented nursing shortage, increasing complexity of care, and fewer experienced nurse mentors. These factors contribute to a cycle of burnout, turnover, decreased quality and safety, and a worsening financial bottom line. Improving these contributing factors depends on our ability to mitigate the structural causes of burnout and turnover. The clinical nurse specialist role is essential to improving the work environment, advancing evidence-based nursing practice, reducing turnover, and stabilizing the bottom line.

Effects of nurses-led multidisciplinary-based psychological management in spinal surgery: a retrospective, propensity-score-matching comparative study

BACKGROUND

Patients in spine surgery often have emotional disorders which is caused by multi-factors. Therefore, a multidisciplinary and multimodal intervention program is required to improve emotional disorders during the perioperative period. However, related studies were rare. This study aimed to confirm that the multidisciplinary-based psychological management leading by nurses was effective in treating emotional disorders and show the assignments of the members of the multidisciplinary team with the orientations of nurses.

DESIGN

A retrospective, comparative study.

METHOD

This study was a retrospective cohort research and compared the results between the intervention group and control group using the Huaxi Emotional Distress Index (HEI) which was used to evaluate emotional disorders. The intervention group consisted of patients who underwent surgery between January 2018 and December 2020 after psychological management was implemented. The control group consisted of patients with regular care who underwent surgery between January 2015 and December 2017. To improve comparability between the two groups, baseline data from the recruited patients were analyzed using propensity-score-matching (PSM) based on age, sex, marital status, education, and disease region.

RESULTS

A total of 539 (11.5%) people developed emotional disorders, of which 319 (6.8%), 151 (3.2%) and 69 (1.5%) had mild, moderate mood and severe emotional disorders, respectively. 2107 pairs of patients were matched after PSM. Scores of HEI in the intervention group were heightened compared with those in the control group (P<0.001) after matching. Moreover, the incidence of emotional disorders in patients decreased after implementing psychological management (P = 0.001). The severity of emotional disorders was alleviated with statistical significance as well (P = 0.010).

CONCLUSIONS

Nurses-led Multidisciplinary-Based psychological management was able to reduce the incidence of emotional disorders and improve the severity of these in spine surgery patients.

Transition of Care for Older Adults Undergoing General Surgery

The demand for surgical intervention and hospitalization is expected to increase with the growth of the older adult population. Despite advances in technology and minimally invasive surgical procedures, the needs of the older adult in the perioperative period are unique. Transitions of care from the decision to support surgery through surgical intervention, subsequent hospitalization, and postacute discharge must be supported to achieve optimal patient outcomes. The clinical nurse specialist is well suited to address care delivery and assure implementation of best practices across the continuum.

Impact of Wound Dressing Changes on Nursing Workload in an Intensive Care Unit

The objective of this study is to understand how the type of wound dressing changes (routine or frequent) in patients admitted to intensive care units influences nurses' workload. This study used a database of retrospective and analytical observational study from one Portuguese intensive care unit. The sample included 728 adult patients admitted between 2015 and 2019. The nursing workload was assessed by the TISS-28 scale, both at admission and at discharge. The linear regression results show that patients with frequent dressing changes are associated with a higher nursing workload, both at admission (Coef. 1.65; 95% CI [0.53; 2.77]) and discharge (Coef. 1.27; 95% CI [0.32; 2.22]). In addition, age influences the nursing workload; older people are associated with a higher nursing workload (at admission Coef. 0.07; 95% CI [0.04; 0.10]; at discharge Coef. 0.08; 95% CI [0.05; 0.10]). Additionally, an increase in nursing workload at admission would significantly increase the nursing workload at discharge (Coef. 0.27; 95% CI [0.21; 0.33]). The relative stability of the nursing workload over the studied years is also another important finding (the influence of studied years is non-significant). In conclusion, patients with frequent dressing changes presented higher TISS-28 scores when compared with patients with an exchange of routine dressings, which leads to a higher nursing workload.

The implementation of physicians assistant in a surgical ward improves continuity in daily clinical work and increases comprehensibility of nurses and physicians

Introduction

Physician Assistant (PA) have been deployed to increase the capacity of a team, supporting continuity and medical cover. The goal of this study was to assess the implementation of PAs on continuity of surgical rounds, on the collaboration of nurses and physicians and on support of administrative work.

Methods

This cross-sectional survey was performed on nurses and physicians who work full-time at a surgical ward in a Swiss reference center. PAs were introduced in our institution in 2019. Participants answered a self-developed questionnaire 6 and 12 months after the implementation of PAs. Administrative work, teamwork, improvement of workflow, and training of physicians has been assessed. Participants answered questions on a 5-point Likert scale and were stratified according to profession (nurse, physician).

Results

Participants (n = 53) reported a positive effect on the regular conduct of rounds (2.9, SD 1.1 points after 6 weeks and 3.5, SD 1.1 points after 12 weeks, p = 0.05). A significant improvement of nurse-doctor collaboration has been reported (3.6, SD 1.0 and 4.2, SD 0.8, p = 0.05). Nurses (n = 28, 52.8%) reported the that PAs are integrated in the physicians team rather than the nurses team (4.0, SD 0.0 points and 4.4, SD 0.7 points, p = 0.266) and a significant beneficial effect on the surgical clinic (3.7, SD 1.0 points and 4.4, SD 0.8 points, p = 0.043). Improved overall management of surgical cases was reported by the physicians (n = 25, 47.2%) (4.8, SD 0.4 and 4.3, SD 0.6, p = 0.046).

Conclusion

The implementation of PA has improved the collaboration of physicians and nurses substantially. Continuity of rounds has improved and the administrative workload for residents decreased substantially. Overall, the implementation of PA was reported to be beneficial for the surgical clinic.

Influencing Factors of Patients' Trust in Nurses During the COVID-19 Pandemic: A Mixed-Methods Study

OBJECTIVE

This study aimed to investigate the nurse-patient trust among in-patients in the context of the coronavirus disease (COVID-19) epidemic; it further analyzed the related influencing factors, which will provide a theoretical basis for developing corresponding measures.

METHODS

This study employed a mixed-method design and analyzed 149 patients at the Hongqi Hospital, affiliated with Mudanjiang Medical University, from December 2020 to February 2021. Quantitative analysis was carried out using the "Nurse Patient Trust Scale," and qualitative analysis was performed using a semi-structured interview with in-patients.

RESULTS

The average score on the scale was 46.65 ± 2.83, and the scores of the 2 dimensions were: 23.24 ± 1.51 for ability and peace of mind, and 23.32 ± 1.53 for attitude and care. According to the interview data, the factors included 3 aspects: a comfortable hospital environment and humane management measures; the nurse's own competence; and effective communication with patients.

CONCLUSION

During the COVID-19 epidemic, there are still many factors affecting patients' trust in nurses that can be addressed by taking different measures. All these factors must be considered by the relevant managers and clinical nursing staff to maintain a better nurse-patient trust relationship.