Outcomes of nurse practitioner-led care in patients with cardiovascular disease: A systematic review and meta-analysis

Unlocking the potential of primary healthcare nurse practitioners globally: A concept analysis of their added value

BACKGROUND

Primary healthcare nurse practitioners (PHCNPs) are expanding globally to meet rising healthcare demands. Despite positive outcomes, their added value remains underexplored.

PURPOSE

To clarify and refine the added value PHCNPs bring.

METHODS

Building on a previous concept analysis of the added value of nurse practitioners, we analyzed 37 systematic reviews focusing on PHCNPs' roles across various settings, using Rodgers' evolutionary approach.

FINDINGS

Attributes include PHCNPs' skills and competencies, activities, positive outcomes, and professional autonomy. Antecedents involve PHCNP characteristics and structural and institutional factors, while consequences highlight improved patient outcomes, satisfaction, professional dynamics, and system efficiency.

DISCUSSION

Understanding PHCNPs' added value is crucial for policy development, role implementation, and healthcare optimization. Clear regulatory frameworks and supportive policies are needed to maximize their impact.

CONCLUSION

This analysis provides and updates the conceptual definition of PHCNPs' added value, offering insights for policy, education, and research to support their critical role in healthcare.

Software for the care of people with cardiovascular risk: construction and evidence of validity

OBJECTIVES

to build and validate software for the care of people with cardiovascular risk.

METHODS

a methodological study, applied to software development, anchored in a nursing theory and classification system, in three stages: 1) requirements engineering; 2) software architecture and coding; and 3) testing and content validity by 12 experts in computer science, with a Content Validity Ratio score.

RESULTS

called e-TEORISC, in software format, for nursing care for people with cardiovascular risk, online and offline, containing a database linked to the Nursing Process stages. Experts considered that the attributes of functional suitability, performance efficiency, reliability, maintainability, usability, safety and portability obtained desirable scores.

CONCLUSIONS

e-TEORISC has evidence of validity to instrumentalize care for people at cardiovascular risk, with potential for technology transfer to the Brazilian Health System.

Evaluation of a Specialist Nurse-Led Post-Coronary Heart Disease Support Program: A Prospective Pre-Post Interventional Study

INTRODUCTION

The impact of multidisciplinary supervised cardiac rehabilitation programs on reducing the risk of having heart problems in the future is well documented. However, little is known about nurse-led post-coronary heart disease (post-CHD).

PURPOSE

Our aim was to evaluate the effectiveness of an educational and counseling-structured nurse-led post-CHD support program by assessing the prediction of psychological, behavioral and dietary variables in relation to adherence to a care plan in a single hospital in Athens (Greece).

METHOD

A prospective follow-up comparative approach in a single group of CHD patients was applied. The structured nurse-led program included eight topics (management of anxiety, physical activity, dietary habits, weight control, smoking cessation, alcohol moderation, family engagement and adherence to a care plan). Participants received tailored nursing interventions focused on psychological and behavioral needs and dietary habits by a CHD-specialized nurse based on patients' medical prescriptions and/or instructions. A modified clinical assessment questionnaire by the European Society of Cardiology was applied to identify pre-post clinical baseline measurements. A nurse-led post-coronary Heart Disease Support Program was evaluated by assessing the predictivity (effect) of specific interventions on adherence to a care plan by employing a logistic regression beta coefficient (Generalized Estimating Equations model).

RESULTS

The sample consisted of 275 patients (66.2% male), with a mean age of 68.5 ± 12.5 years old. CHD patients presented significantly lower anxiety rates (54.27 [1st m] vs. 49.63 [2nd m], p < 0.05). In addition, significant differences were observed between the first and the second measurements of total cholesterol (163.27 [1rst m] vs. 134.44 [2nd m], p < 0.001), BMI (obesity) (33.69 [1rst m] vs. 32.79 [2nd m], p < 0.001), smoking (42.18 [1rst m] vs. 22.55 [2nd m], p < 0.001) and adherence to a care plan (78.90 [1rst m] vs. 89.10 [2nd m], p < 0.001). A Generalized Estimating Equations model revealed that participants with higher levels of anxiety showed significantly lower adherence to a care plan (beta -0.10, p < 0.001) and those with family history of CHD (beta -0.71, p = 0.04) in comparison to those with no CHD history. No significant differences were observed in the predictive variables of smoking (beta 0.08, p = 0.69), alcohol consumption (beta 0.09, p = 0.79) and family engagement (beta -0.11, p = 069) with respect to adherence to a care plan, even after adjusting for age, sex and history of CHD.

CONCLUSION

Our findings indicate that the nurse-led post-CHD support program was found to be partially feasible and effective in our single-group study, emphasizing the need for effective training and retention strategies to enhance the specialization of nurses providing post-CHD care and support.

[Experiences of Patients and Their Families Receiving Medical Services Provided by Advanced Practice Nurses at Tertiary General Hospitals]

PURPOSE

This study aimed to understand and describe the experiences of patients and their families who have received medical services from advanced practice nurses in tertiary general hospitals in Korea.

METHODS

Data were collected through four focus group interviews with 20 patients and their families who had received medical services from advanced practice nurses for more than six months at four tertiary hospitals from November 29 to December 28, 2023. Verbatim transcripts were analyzed using qualitative content analysis.

RESULTS

The four themes extracted from the experiences of patients and their families were as follows: unfamiliar medical personnel encountered during the treatment process, healthcare professionals who exhibited excellence, companions to light my way through the tunnel of illness, and an advanced practice nurse system that must be activated urgently.

CONCLUSION

The study's findings indicate that patients and their families view the care provided by advanced practice nurses as excellent, reliable, and holistic. Research suggests that advanced practice nurses are valuable healthcare professionals in team-based care. The findings suggest that hospitals should utilize an advanced practice nurse system to improve patient outcomes and ensure the quality of care.

Interprofessional teams with and without nurse practitioners and the level of adherence to best practice guidelines in cardiac surgery: A retrospective study

AIM

To examine the level of adherence to best-practice guidelines of interprofessional teams with acute care nurse practitioners (ACNPs) compared to interprofessional teams without ACNPs.

DESIGN

A retrospective observational study was conducted in 2023.

METHOD

A retrospective cohort was created including 280 patients who underwent a coronary artery bypass graft and/or a valve repair and hospitalised in a cardiac surgery unit of a university affiliated hospital in Québec (Canada) between 1 January 2019 to 31 January 2020. The level of adherence to best-practice guidelines was measured from a composite score in percentage. The composite score was created from a newly developed tool including 99 items across six categories (patient information, pharmacotherapy, laboratory tests, post-operative assessment, patient and interprofessional teams' characteristics). Multivariate linear and logistic regression models were computed to examine the effect of interprofessional teams with ACNPs on the level of adherence to best-practice guidelines.

RESULTS

Most of the patients of the cohort were male and underwent a coronary artery bypass graft procedure. Patients under the care of interprofessional teams with ACNP were 1.72 times more likely to reach a level of adherence higher than 80% compared to interprofessional teams without ACNPs and were 2.29 times more likely to be within the highest quartile of the scores for the level of adherence to best-practice guidelines of the cohort.

IMPACT

This study provides empirical data supporting the benefits of ACNP practice for patients, interprofessional teams and healthcare organisations.

RELEVANCE FOR PRACTICE

Our findings identify the important contributions of interprofessional teams that include ACNPs using a validated instrument, as well as their contribution to the delivery of high quality patient care.

REPORTING METHOD

This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The effect of consultations performed by specialised nurses or advanced nurse practitioners on patient and organisational outcomes in patients with complex health conditions: An umbrella review

BACKGROUND

Policymakers and researchers often suggest that nurses may play a crucial role in addressing the evolving needs of patients with complex conditions, by taking on advanced roles and providing nursing consultations. Nursing consultations vary widely across settings and countries, and their activities range from complementing to substituting traditional physician-led consultations or usual care.

OBJECTIVE

This study was aimed at describing the effects of nursing consultations with patients with complex conditions in any setting on patient outcomes (quality of life, physical status, psychosocial health, health behaviour, medication adherence, mortality, anthropometric and physiological outcomes, and patient satisfaction) and organisational outcomes (health resource use and costs).

DESIGN

Umbrella review.

METHODS

We followed the Joanna Briggs Institute method for umbrella reviews. We searched PubMed, Embase, Cochrane Database of Systematic Reviews and CINAHL to identify relevant articles published in English, Dutch, French, Spanish or German between January 2013 and February 2023. We included systematic literature reviews, with or without meta-analyses, that included randomised controlled trials conducted in high-income countries. Reviews were eligible if they pertained to consultations led by specialised nurses or advanced nurse practitioners. Article selection, data extraction and quality appraisal were performed independently by at least two reviewers.

RESULTS

We included 50 systematic reviews based on 473 unique trials. For all patient outcomes, nursing consultations achieved effects at least equivalent to those of physician-led consultations or usual care (i.e., non-inferiority). For quality of life, health behaviour, medication adherence, mortality and patient satisfaction, more than half the meta-analyses found statistically significant effects in favour of nursing consultations (i.e., superiority). Cost results must be interpreted with caution, because very few and heterogeneous cost-related data were extracted, and the methodological quality of the cost analyses was questionable. Narrative syntheses confirmed the overall conclusions of the meta-analyses.

CONCLUSIONS

The effects of nursing consultations on patients with complex health conditions across healthcare settings appear to be at least similar to physician-led consultations or usual care. Nursing consultations appear to be more effective than physician-led consultations or usual care in terms of quality of life, health behaviour, mortality, patient satisfaction and medication adherence. Further analysis of the primary data is necessary to determine the patient populations and settings in which nursing consultations are most effective. Moderate study quality, diversity amongst and within systematic reviews, and quality of reporting hamper the strength of the findings.

Measures of Success: Making the Case for Advanced Practice-Sensitive Quality Indicators

Description Advanced practice registered nurses (APRNs) are key health care providers in a variety of settings. Often APRNs are grouped in a collective category, along with physician assistants, and referred to collectively as advanced practice providers. As APRNs assume an increasing role in patient care management in hospital, outpatient, and community settings, such as clinics and rural practices, measuring the impact of their care on patient outcomes and quality of care becomes a necessary component of performance evaluation. APRN-sensitive outcome indicators are an important way to identify the impact of the role. While a number of studies have been conducted that demonstrate APRN outcomes, identifying specific APRN-sensitive outcome indicators can be challenging. This article reviews the use of APRN-sensitive outcome indicators to identify the impact of the APRN role, highlighting exemplars from several clinical practice sites.

Enablers and barriers to nurse practitioners working in Australian aged care: A scoping review

OBJECTIVE

To identify evidence reporting on nurse practitioners working in aged care in Australia and to categorise the reported factors found to be barriers or facilitators to operation in terms of establishment, sustainability, and expansion.

INTRODUCTION

Nurse practitioners work in a variety of aged care contexts throughout Australia but are underutilised and uncommon. Despite evidence for their effectiveness, it is unclear what barriers or enabling factors contribute to the successful and sustainable implementation of nurse practitioners working in this sector.

METHODS

Based on an a-priori protocol the JBI methodology for scoping reviews was used and the review reported against the PRISMA extension for scoping reviews (PRISMA-ScR). Databases searched included MEDLINE, Embase, Emcare, Web of Science, and Scopus. Peer reviewed and grey literature describing the role of Australian nurse practitioners in aged care were included.

RESULTS

Of 2968 retrieved sources, 18 were included representing studies of a variety of designs from all Australian states and territories. Residential care and in-home care contexts as well as metropolitan, regional, and remote locations were represented. Overall, 123 individual barriers and facilitators were identified across seven inductively derived categories: staff/individual, organisational, system, operational, resource, data, and consumers/clients/residents. In many cases, factors appeared across both positive (facilitators) and negative (barriers) categories.

CONCLUSIONS

Nurse practitioners can improve the quality of care being provided to older people accessing aged care in Australia. When establishing or maintaining nurse practitioner roles in aged care knowledge users should have a comprehensive understanding of the range of factors potentially contributing to or limiting success or sustainability. As implementation is highly contextual, various types of organisational and sectoral factors as well as individual and overarching factors related to the regulation of nurse practitioners practice should be considered.

A global perspective of advanced practice nursing research: A review of systematic reviews

INTRODUCTION

The World Health Organization (WHO) called for the expansion of all nursing roles, including advanced practice nurses (APNs), nurse practitioners (NPs) and clinical nurse specialists (CNSs). A clearer understanding of the impact of these roles will inform global priorities for advanced practice nursing education, research, and policy.

OBJECTIVE

To identify gaps in advanced practice nursing research globally.

MATERIALS AND METHODS

A review of systematic reviews was conducted. We searched CINAHL, Embase, Global Health, Healthstar, PubMed, Medline, Cochrane Library, DARE, Joanna Briggs Institute EBP, and Web of Science from January 2011 onwards, with no restrictions on jurisdiction or language. Grey literature and hand searches of reference lists were undertaken. Review quality was assessed using the Critical Appraisal Skills Program (CASP). Study selection, data extraction and CASP assessments were done independently by two reviewers. We extracted study characteristics, country and outcome data. Data were summarized using narrative synthesis.

RESULTS

We screened 5840 articles and retained 117 systematic reviews, representing 38 countries. Most CASP criteria were met. However, study selection by two reviewers was done inconsistently and language and geographical restrictions were applied. We found highly consistent evidence that APN, NP and CNS care was equal or superior to the comparator (e.g., physicians) for 29 indicator categories across a wide range of clinical settings, patient populations and acuity levels. Mixed findings were noted for quality of life, consultations, costs, emergency room visits, and health care service delivery where some studies favoured the control groups. No indicator consistently favoured the control group. There is emerging research related to Artificial Intelligence (AI).

CONCLUSION

There is a large body of advanced practice nursing research globally, but several WHO regions are underrepresented. Identified research gaps include AI, interprofessional team functioning, workload, and patients and families as partners in healthcare.

PROSPERO REGISTRATION NUMBER

CRD42021278532.

Senior Nurse Manager Perceptions of Nurse Practitioner Integration: A Quantitative Study

Aim

To determine Senior Nurse Managers' perceptions of integration of Nurse Practitioner roles in Healthcare Organisations across Ireland and Australia.

Background

Introduction of the Nurse Practitioner role in both countries is well established with national policies aimed at developing a critical mass in the health workforce. Current policy requires Senior Nurse Managers to be actively involved in the introduction of and oversight of the integration of Nurse Practitioners across healthcare settings. This is integral in the context of the success and sustainability of the services provided by the Nurse Practitioner.

Methods

A quantitative, cross-sectional cloud-based survey of senior nurse managers across Ireland and Australia from April to September 2022.

Results

Of 300 responses received, 122 were eligible for analysis. Of these, 77% expressed that there should be a specific role to support the integration of Nurse Practitioner roles at local level, and 61% recommended that this should occur at a national level, whilst 48% reported the absence of a standardised governance structure. Three reporting structures were identified: professional, clinical, and operational. Autonomous clinical decision making and prescribing were two Nurse Practitioner functions most identified. Fifty-five percent reported having performance indicators for Nurse Practitioner roles, with 24% agreeing that performance indicators captured the quality of care provided. Thirty-five percent of senior nurse managers indicated that there were agreed reporting timelines for performance indicators and a requirement for the provision of an annual report.

Conclusion

Whilst some participants reported structure to guide and evaluate the work and value of Nurse Practitioners, the approach was inconsistent across organisations and countries. This paper demonstrates that integration is not broadly established across both countries. Implications for the Profession. The main findings were that Nurse Practitioners were misunderstood and the development of a structured framework to support the integration of Nurse Practitioners would provide long-term benefits.

Exploring heart failure nurse practitioner outcome measures: a scoping review

AIMS

Clinical guidelines recommend people with heart failure are managed within a multidisciplinary team to receive optimal evidence-based management of the syndrome. There is increasing evidence that Nurse Practitioners (NP) in heart failure demonstrate positive patient outcomes. However, their roles as key stakeholders in a multidisciplinary heart failure team are not clearly defined. The aim of the review was to explore the literature related to NP-sensitive outcomes in heart failure.

METHODS AND RESULTS

A scoping review was conducted according to accepted guidelines using the Joanna Briggs Institute framework for conducting a scoping review, to identify the literature that related to NP-sensitive outcomes in heart failure management. Sixteen texts were selected for data extraction and analysis. The most common outcome measures reported were readmission rates, self-care measurement scales, functional status scores, quality of life measurements, and medication optimization outcomes. No two studies collected or reported on the same outcome measurements.

CONCLUSION

This review highlights that the reporting of heart failure (HF) NP outcome indicators was inconsistent and disparate across the literature. The outcome measures reported were not exclusive to NP interventions. Nurse Practitioner roles are not clearly defined, and resulting outcomes from care are difficult to characterize. Standardized NP-specific outcome measures would serve to highlight the effectiveness of the role in a multidisciplinary HF team.

Nano revolution in cardiovascular health: Nanoparticles (NPs) as tiny titans for diagnosis and therapeutics

Cardiovascular diseases (CVDs) are known as life-threatening illnessescaused by severe abnormalities in the cardiovascular system. They are a leading cause of mortality and morbidity worldwide.Nanotechnology integrated substantialinnovations in cardiovascular diagnostic and therapeutic at the nanoscale. This in-depth analysis explores cutting-edge methods for diagnosing CVDs, including nanotechnological interventions and crucial components for identifying risk factors, developing treatment plans, and monitoring patients' progress with chronic CVDs.Intensive research has gone into making nano-carriers that can image and treat patients. To improve the efficiency of treating CVDs, the presentreview sheds light on a decision-tree-based solution by investigating recent and innovative approaches in CVD diagnosis by utilizing nanoparticles (NPs). Treatment choices for chronic diseases like CVD, whose etiology might take decades to manifest, are very condition-specific and disease-stage-based. Moreover, thisreview alsobenchmarks the changing landscape of employing NPs for targeted and better drug administration while examining the limitations of various NPs in CVD diagnosis, including cost, space, time, and complexity. To better understand and treatment of cardiovascular diseases, the conversation moves on to the nano-cardiovascular possibilities for medical research.We also focus on recent developments in nanoparticle applications, the ways they might be helpful, and the medical fields where they may find future use. Finally, this reviewadds to the continuing conversation on improved diagnosis and treatment approaches for cardiovascular disorders by discussing the obstacles and highlighting the revolutionary effects of nanotechnology.

A case for the health welfare of Texans-A nurse practitioner state regulation policy analysis

ABSTRACT

Restrictive nurse practitioner (NP) practice regulation at the state level continues to obstruct patient access to quality affordable care because primary care provider shortages heighten across the nation. Evidence-based research supports NPs as cost-effective providers without conceding quality of care. A patchwork of highly variable state policies subjectively determines the degree of collaborative oversight required for NPs to practice in each state. An objective review of policies influencing NP capacity to deliver care promotes evidence-informed policy adaptation. A policy analysis was completed using Bardach and Patashnik's framework to evaluate policy options for NP practice regulation in Texas. Full practice authority (FPA) policy effect was quantitively evaluated through difference-in-differences regression models using selected measures of all 50 states and the District of Columbia. Health welfare outcomes were calculated using emergency department utilization, average household health expenditures, poor physical health days, and NP-specific adverse action reports (AAR). Overall, FPA policy did not have a statistically significant effect on state-clustered emergency department utilization, average household health expenditures, or poor physical health days. Full practice authority was associated with decreased NP AAR. The analysis supports FPA as a viable policy option for states such as Texas and counters claims FPA policy adoption results in detrimental sequalae in the health of the population.

Multifunctional role of nanoparticles for the diagnosis and therapeutics of cardiovascular diseases

The increasing burden of cardiovascular disease (CVD) remains responsible for morbidity and mortality worldwide; their effective diagnostic or treatment methods are of great interest to researchers. The use of NPs and nanocarriers in cardiology has drawn much interest. The present comprehensive review provides deep insights into the use of current and innovative approaches in CVD diagnostics to offer practical ways to utilize nanotechnological interventions and the critical elements in the CVD diagnosis, associated risk factors, and management strategies of patients with chronic CVDs. We proposed a decision tree-based solution by discussing the emerging applications of NPs for the higher number of rules to increase efficiency in treating CVDs. This review-based study explores the screening methods, tests, and toxicity to provide a unique way of creating a multi-parametric feature that includes cutting-edge techniques for identifying cardiovascular problems and their treatments. We discussed the benefits and drawbacks of various NPs in the context of cost, space, time and complexity that have been previously suggested in the literature for the diagnosis of CVDs risk factors. Also, we highlighted the advances in using NPs for targeted and improved drug delivery and discussed the evolution toward the nano-cardiovascular potential for medical science. Finally, we also examined the mixed-based diagnostic approaches crucial for treating cardiovascular disorders, broad applications and the potential future applications of nanotechnology in medical sciences.

Enhancing nursing documentation in Kazakhstan: assessing utilization and standardization for improving patient care

Background and aim

This article stresses the importance of comprehensive nursing documentation in scientific medicine and discusses the adoption of standardized terminologies in Europe. The study also presents findings from a cross-sectional study conducted in Kazakhstan, assessing the utilization of standard operating procedures and nursing documentation in various clinical scenarios. The aim was evaluate the level of use of the form of nursing documentation and Standard Operating Procedure within the framework of reforming the Republic of Kazakhstan.

Materials and methods

During the period from December 2021 to February 2022, a cross-sectional study was conducted in Kazakhstan, involving a randomly selected sample of nurses with technical and vocational education as well as those with applied/academic baccalaureate degrees in nursing.

Results

In this cross-sectional study of 2,263 female nurses, 75.3% were nurse practitioners, and 44% held the highest qualification category. Awareness levels varied, with around 64.7% aware of the pilot program for care services, 65.8% aware of the deputy head position, and 73.8% familiar with the "extended practice nurse" role. Only 55.2% knew about the International Clinical Nursing Classification, and 54.5% observed changes in their nursing approach due to education. The limb edema measurement checklist was not used by the majority (88.4%) of respondents, and 68% did not utilize the antibiotic susceptibility testing checklist. Various other checklists and algorithms had limited utilization, with percentages ranging from 9.1 to 69.3%, indicating varying levels of adoption among participants. For assisting children with cerebral palsy, the "Assessment of hand use capacity according to the MACS classification system" was utilized by 9.1%, while 90.9% did not employ it. In the context of communication, 30.7% of the respondents utilized the "Algorithm of actions of a medical registrar when communicating with a patient," while 69.3% did not use it. These findings highlight variable adoption rates among participants for these medical procedures and protocols.

Conclusion

In Kazakhstan, nursing documentation forms and Standard Operating Procedures face challenges and limited utilization, but their implementation has shown positive impacts on patient care and healthcare outcomes. Overcoming resistance to change, increasing awareness, and addressing resource constraints are essential for further improvement.

Impact of a heart failure nurse practitioner service on rehospitalizations, emergency presentations, and survival in patients hospitalized with acute heart failure

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.

Identifying indicators sensitive to primary healthcare nurse practitioner practice: A review of systematic reviews

AIM

To identify indicators sensitive to the practice of primary healthcare nurse practitioners (PHCNPs).

MATERIALS AND METHODS

A review of systematic reviews was undertaken to identify indicators sensitive to PHCNP practice. Published and grey literature was searched from January 1, 2010 to December 2, 2022. Titles/abstracts (n = 4251) and full texts (n = 365) were screened independently by two reviewers, with a third acting as a tie-breaker. Reference lists of relevant publications were reviewed. Risk of bias was examined independently by two reviewers using AMSTAR-2. Data were extracted by one reviewer and verified by a second reviewer to describe study characteristics, indicators, and results. Indicators were recoded into categories. Findings were summarized using narrative synthesis.

RESULTS

Forty-four systematic reviews were retained including 271 indicators that were recoded into 26 indicator categories at the patient, provider and health system levels. Nineteen reviews were assessed to be at low risk of bias. Patient indicator categories included activities of daily living, adaptation to health conditions, clinical conditions, diagnosis, education-patient, mortality, patient adherence, quality of life, satisfaction, and signs and symptoms. Provider indicator categories included adherence to best practice-providers, education-providers, illness prevention, interprofessional team functioning, and prescribing. Health system indicator categories included access to care, consultations, costs, emergency room visits, healthcare service delivery, hospitalizations, length of stay, patient safety, quality of care, scope of practice, and wait times.

DISCUSSION

Equal to improved care for almost all indicators was found consistently for the PHCNP group. Very few indicators favoured the control group. No indicator was identified for high/low fidelity simulation, cultural safety and cultural sensitivity with people in vulnerable situations or Indigenous Peoples.

CONCLUSION

This review of systematic reviews identified patient, provider and health system indicators sensitive to PHCNP practice. The findings help clarify how PHCNPs contribute to care outcomes.

PROSPERO REGISTRATION NUMBER

CRD42020198182.

Nursing Interventions and Care Strategies for Patients with Coronary Heart Disease: A Comprehensive Review

Cardiovascular diseases are a major cause of death worldwide, and coronary heart disease (CHD) is a prevalent cardiovascular condition and a significant health burden for the population. In this disease, insufficient blood flow to the heart due to plaque accumulation in the coronary arteries causes chest pain, heart attack, and even death. So, it is vital to identify risk factors, prevention, appropriate treatment, and rehabilitation. Nurses play an indispensable role in managing and caring for patients with CHD. Indeed, they possess a deep understanding of the disease and its complexities, enabling them to provide comprehensive care to patients. Nurses monitor vital signs, administer medications, and perform diagnostic tests, ensuring patients receive timely and appropriate interventions. They also educate patients and their families about CHD, emphasizing lifestyle modifications, medication adherence, and self-care practices. Moreover, nurses offer emotional support, guiding patients through the physical and psychological challenges associated with CHD. Their expertise, compassion, and dedication significantly improve patient outcomes and overall quality of life. Nurses are responsible for assessing, diagnosing, and counseling patients on how to manage their disease, making them the front line of defense in preventing and addressing this serious condition. In the current study, we reviewed the literature to consider the best practices and emerging trends in nursing interventions and care strategies for patients with CHD.

Effectiveness of nurse-led clinics on healthcare delivery: An umbrella review

BACKGROUND

Healthcare provision remains challenging leading to a focus on health service redesign including the development of nurse-led clinics. While there is a belief that nurse-led services positively impact on healthcare delivery, it is necessary to inform development through examination of the evidence.

METHODS

A search was conducted of Cumulative Index of Nursing and Allied Health Literature, MEDLINE, EMBASE, Scopus and the Cochrane Library for systematic reviews evaluating the effectiveness of nurse-led clinics when compared with usual care published between 2015 and 2020. Outcomes of interest were clinical outcomes, patient satisfaction and patient access to health care. Study quality was appraised using the AMSTAR 2 tool (A MeaSurement tool to Assess Systematic Reviews). A narrative analysis was conducted.

RESULTS

From 681 identified studies, nine were included, with reporting quality rated from very low to high quality. Patient clinical outcomes were reported as equal to or better than usual care across all studies included. There was evidence of high levels of patient satisfaction with nurse-led clinics across the included systematic reviews. While access to health care was the least reported variable, there were reports that access to health care increased or patient reliance on other healthcare providers reduced due to nurse-led clinics.

CONCLUSIONS

Despite the heterogeneous nature of the systematic reviews, along with some quality issues in reporting, there was evidence that nurse-led services provided comparable or superior care to usual care with high levels of patient satisfaction. There was a lack of reporting on the impact of nurse-led clinics on patient access to health care; further research is required on this area. Health service managers should consider nurse-led clinics an effective innovation in health service provision.

The level of adherence to best-practice guidelines by interprofessional teams with and without acute care nurse practitioners in cardiac surgery: A study protocol

BACKGROUND

Acute care nurse practitioners (ACNPs) in postoperative cardiac surgery settings provide significant benefits to patients and organizations. Recent studies have suggested that ACNPs increase the level of adherence to best-practice guidelines by interprofessional teams. It is however, unknown whether interprofessional teams with ACNP are associated with higher levels of adherence to best-practice guidelines compared to interprofessional teams without ACNPs. Furthermore, no extraction tool is available to measure the level of adherence to best-practice guidelines by interprofessional teams in postoperative cardiac surgery settings. This project aims to measure and examine the level of adherence to best-practice guidelines of interprofessional teams with and without ACNPs in a postoperative cardiac surgery setting in Québec, Canada.

METHODS

A retrospective observational study will be conducted of 300 patients hospitalized between January 1, 2019 and January 31, 2020 in a postoperative cardiac surgery unit in Québec, Canada. Data will be collected from patient health records and electronic databases. An extraction tool will be developed based on systematic review of the literature, and will include best-practice guidelines and confounding variables related to patient and interprofessional teams' characteristics. Content and criterion validation, and a pilot-test will be conducted for the development of the tool. A multivariate linear regression model will be developed and adjusted for confounding variables to examine the association between interprofessional teams with and without ACNPs, and level of adherence to best-practice guidelines by those teams.

DISCUSSION

This project represents the first study to measure and examine the level of adherence to best-practice guidelines by interprofessional teams with and without ACNPs in a postoperative cardiac surgery setting. The findings of this project will generate empirical data focusing on the contribution of ACNPs within interprofessional teams, and ultimately enhance the delivery of high quality and evidence-based care for patients and families.

The Effectiveness of Personalized Nursing on Quality of Life in Cardiovascular Disease Patients: A Systematic Review and Meta-analysis

Aims

This study aimed to examine the potential effectiveness of personalized nursing interventions on improving the heart-related quality of life of patients with CVDs versus an usual care.

Design

A systematic review and meta-analysis. Data Sources. The study researched the article between January 2011 and December 2021 from four electronic databases: PubMed, Embase, Cochrane library, and Web of Science. Review Methods. Randomized controlled trials (RCTs) related to personalized nursing in CVDs population were included. The main variables were analyzed by standardized mean differences with 95% confidence intervals and heterogeneity was used by the I ² test and P value.

Results

Of 734 studies, fourteen articles were eligible for this study. Personalized nursing significantly improved the quality of life [SMD = 0.39, 95% CI (0.29, 0.49)] with obvious heterogeneity (P = 0.000, I ² = 66.1%) which needs to be further subgroup analyzed. The nurse-led intervention was considered the main-related effect to influence the heterogeneity with value of 0.39 (I2 = 66.1%, P = 0.000; Group 1: I2 = 48.4%, P = 0.071, and Group 2: I2 = 0.0%,. In addition, related results of athletic ability and mental health and follow-up and education in the intervention had higher level of quality of life compared to the control group [SMD = 0.27, 95% CI (0.10, 0.44); SMD = 0.21, 95% CI (0.04, 0.37); SMD = 0.39, 95% CI (0.29, 0.49) and SMD = 0.28, 95% CI (0.11, 0.44)].

Conclusion

Effectiveness studies of personalized care focus on more relevant outcomes have higher health outcomes, whereas evidence of the effectiveness of personalized nursing approach is still limited. Therefore, more and more high-quality RCT are needed.

Nurse practitioner models of care in aged care: a scoping review protocol

OBJECTIVE

The objective of this review is to identify current and potential use of nurse practitioner models of care in aged care and to examine factors that have been linked to their failure or success in terms of establishment, sustainability, and expansion.

INTRODUCTION

Nurse practitioners work across a variety of sectors, including aged care. Nurse practitioner models of care have been found to be safe, effective, and highly regarded by clients and patients across many areas. They have particular benefit in areas where access to physicians is challenging, as well as for vulnerable populations. This review will provide a consolidated evidence base to determine the current state of the evidence on nurse practitioner models of care in the aged care sector.

INCLUSION CRITERIA

The review will consider studies on nurse practitioner models of care within aged care that report barriers/challenges and facilitators/success factors to their establishment, sustainability, and expansion. Evidence from all countries will be examined. Published and gray literature primary studies in English produced from 2010 onward will be eligible for inclusion. Expert opinion, including literature reviews, commentaries, and discussion, papers will be ineligible.

METHODS

This review will utilize the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Databases to be searched include MEDLINE, Emcare, Embase, Web of Science, and Scopus. Figurative, tabular, and accompanying narrative synthesis will be used to present the results, in line with the review questions.

A survey of nurse practitioner perceptions of integration into acute care organisations across one region in Ireland

Aim

The purpose of the study was to explore nurse practitioner perceptions of integration practices in acute hospitals across one health care region in Ireland.

Background

A recent Department of Health National policy towards developing a critical mass of nurse practitioners was implemented across Ireland. Successful integration of nurse practitioner roles is integral to the success of the service and sustainability of the roles for the long term.

Method

An electronic survey was circulated to a convenience sample of 85 nurse practitioners across a single, acute health care region in Ireland.

Results

Sixty‐six (78%) of nurse practitioners participated. A standardized governance structure was reported by 24 (36%) participants. Thirty‐two (48%) participants expressed their job description clearly defined their role. Consultant physicians were identified as the most supportive stakeholder by participants.

Conclusions

This research identifies that nurse practitioner integration is not currently structured. A framework to support nurse practitioner integration is required to ensure ongoing support for the role. This research identifies that integration is not currently optimized.

Implications for Nursing Management

Failure to successfully integrate the nurse practitioner role risks the long‐term sustainability of the role and is a missed opportunity to demonstrate the success of advanced clinical leadership to health care.

The level of quality care nurse practitioners provide compared with their physician colleagues in the primary care setting: A systematic review

BACKGROUND

There is an increasing demand for high-quality primary care providers without adequate supply to meet the need. Nurse practitioners (NPs) are uniquely positioned to fill this demand but influence on regulatory practice authority from concerned groups regarding patient safety and quality of care has delayed this as an effective solution.

OBJECTIVES

The objective was to address concerns abovt NP-led care by examining evidence regarding patient safety, clinical outcomes, cost, and patient satisfaction that reflect on the ability of NPs to provide high-quality care within the primary care setting and to compare their ability with standard models of care led by physicians.

DATA SOURCES

A systematic review was completed using PubMed, CINHAL Complete, and Scopus. Using PRISMA guidelines to critique literature and the John's Hopkins Research Evidence Appraisal tool, articles were analyzed comparing the quality of care between NP and physician providers in the primary care setting.

CONCLUSIONS

A total of 11 articles met the criteria and reveal that NPs provide equal or better quality of care for all outcomes outcomes when compared with their physician colleagues.

IMPLICATIONS FOR PRACTICE

Quality patient care provided by NPs in the primary care setting is equal to, and in several cases superior to, that of physicians. Concerns for patient safety and quality care outcomes seem unsupported by data, and state legislatures should continue to grant full practice authority. as an effective source of providing high-quality primary health care.

A translational research framework for nurse practitioners

AIMS

This study aims to explore a proposed translational research continuum for nurse practitioners.

BACKGROUND

Nurse practitioners are acknowledged as clinical leaders responsible for transforming health care delivery. It is important that nurse practitioners contribute to health care knowledge using scientific processes for the implementation of evidence-based practice and evaluation of outcomes of interventions for their patient groups.

EVALUATION

This paper provides a review of translational research literature including implementation science to align nurse practitioner activities to a modified translational research framework.

KEY ISSUES

A translational research framework has the potential to strengthen nursing research in the nurse practitioner role. Adapting an accepted translational research continuum for nurse practitioners places the clinical nursing leaders in an equitable research position with all health care professionals.

IMPLICATIONS FOR NURSING MANAGEMENT

The translational research continuum provides nursing management with a structure to benchmark nursing research. The continuum applies a modern research framework to support research engagement for the nurse practitioner role.

Recent evidence of nurse practitioner outcomes in a variety of care settings

ABSTRACT

When nurse practitioners (NPs) work to expand their scope of practice through state legislatures, the opposing lobbying groups are often physician-led organizations. The main argument against NP independence and limited scope of practice is that NP care is inherently inferior to that of physicians. However, more than three decades of research demonstrates quality and cost outcomes to be equal to or better than that of physicians. This article reviews a wide range of evidence documenting NP competency, satisfaction, and safety, as well as the challenges and consequences when limiting NP scope of practice. The evidence is clear and has not changed in over 30 years, NPs provide access to effective primary care in a variety of settings, equal in quality outcomes, safety, and cost-effectiveness compared with physicians.

The association between advanced practice nursing roles and outcomes in adults following cardiac surgery: A systematic review of randomized controlled trials

BACKGROUND

Empirical findings have shown significant and non-significant effects of advanced practice nursing roles within postoperative cardiac settings. The inconsistencies of the current literature preclude the identification of a significant effect of advanced practice nursing roles on patient and organizational outcomes.

OBJECTIVE

1) identify patient and organizational outcomes of advanced practice nursing roles in postoperative cardiac surgery and 2) synthesize the evidence of current roles of advanced practice nurses in postoperative cardiac surgery to provide the best quality of care for patients.

METHOD

A systematic review of randomized controlled trials was conducted in six electronic databases, including Medline, CINHAL, Embase, Cochrane Database, Joanna Briggs Database and Web of Science, and the grey literature. Randomized controlled trials published after 1999 were included if they examined advanced practice nursing roles and recruited patients who underwent cardiac surgery. The study selection was performed by two independent reviewers, and consensus was achieved with a third reviewer. Data extraction was conducted by one reviewer and revised by a second reviewer. The methodological quality of the included studies was assessed with the Evidence Project risk of bias tool by two independent reviewers and revised by a third reviewer. A narrative synthesis of the available evidence was completed. No meta-analysis technique was attempted because of the high heterogeneity of the included studies.

RESULTS

Among 4,448 retrieved papers, ten randomized controlled trials and three secondary analyses were included in this review. The methodological quality of the included studies was moderate. All studies included a comparison group and the majority of the studies collected data using a blinded researcher. However, all studies were based on small sample sizes and failed to randomly recruit participants. Five studies implemented nurse practitioner roles and five studies implemented clinical nurse specialist roles. The advanced practice nursing care included health condition management, lifestyle promotion and coping strategies with patients. A total of 22 outcomes were identified, including 13 patient outcomes (e.g., depressive symptoms) and nine organizational outcomes (e.g., rehospitalization after discharge). Each outcome was examined in one to five studies. All of the included outcomes were associated with inconsistent findings.

CONCLUSION

The findings from existing literature remain inconsistent. The high risk of bias and the small sample sizes could potentially explain the non-significant findings. Avenues for future research should focus on the development of methodologically high-quality studies with larger sample sizes to enhance our understanding of the effectiveness of advanced practice nursing roles.

Nurses and Pharmaceutical Care: Interprofessional, Evidence-Based Working to Improve Patient Care and Outcomes

Pharmaceutical care necessitates significant efforts from patients, informal caregivers, the interprofessional team of health care professionals and health care system administrators. Collaboration, mutual respect and agreement amongst all stakeholders regarding responsibilities throughout the complex process of pharmaceutical care is needed before patients can take full advantage of modern medicine. Based on the literature and policy documents, in this position paper, we reflect on opportunities for integrated evidence-based pharmaceutical care to improve care quality and patient outcomes from a nursing perspective. Despite the consensus that interprofessional collaboration is essential, in clinical practice, research, education and policy-making challenges are often not addressed interprofessionally. This paper concludes with specific advises to move towards the implementation of more interprofessional, evidence-based pharmaceutical care.

An integrative review to identify evidence of nurse practitioner-led changes to health-care delivery and the outcomes of such changes

AIMS

This study aimed to identify evidence of nurse practitioner-led changes to health-care delivery and the outcomes of such changes.

BACKGROUND

Changing health-care delivery is synonymous with the nurse practitioner role. The literature is critical of the lack of research by nurse practitioners, reporting the effects of a change to health-care delivery.

DESIGN

This study used a systematic integrative review by using Torraco's approach.

DATA SOURCES

Databases Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Web of Science and SCOPUS were searched for peer-reviewed publications from 2000 to 2019.

REVIEW METHODS

A systematic approach was used to screen and analyse the literature. Inclusion/exclusion criteria were applied, and quality appraisal was undertaken by two reviewers.

RESULTS

Eighteen articles were selected. The research projects were across the community and acute care settings. Research methodologies varied including preintervention and postintervention studies, evaluation of quality improvement projects, randomized controlled trial and descriptive studies. Multiple data collection tools were used. Two major themes were identified including evidence-based practice champions and improved patient outcomes.

CONCLUSION

The nurse practitioner role is pertinent toward improving evidence-based practice in clinical settings. Positive patient outcomes and praise for clinical leadership are evident in the literature. Research by nurse practitioners to date has focused on individual services.

Outcomes of nurse practitioner-led care in patients with cardiovascular disease: A systematic review and meta-analysis

Aim

To assess randomized controlled trials evaluating the impact of nurse practitioner‐led cardiovascular care.

Background

Systematic review of nurse practitioner–led care in patients with cardiovascular disease has not been completed.

Design

Systematic review and meta‐analysis.

Data sources

The Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, Web of Science, Scopus and ProQuest were systematically searched for studies published between January 2007 ‐ June 2017.

Review Methods

Cochrane methodology was used for risk of bias, data extraction and meta‐analysis. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation approach.

Results

Out of 605 articles, five articles met the inclusion criteria. There was no statistical difference between nurse practitioner‐led care and usual care for 30‐day readmissions, health‐related quality of life and length of stay. A 12% reduction in Framingham risk score was identified.

Conclusion

There are a few randomized control trials assessing nurse practitioner‐led cardiovascular care.

Impact

Low to moderate quality evidence was identified with no statistically significant associated outcomes of care. Nurse practitioner roles need to be supported to conduct and publish high‐quality research.