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Kuczawski M, Ablard S, Sampson F, Croft S, Sutton-Klein J, Mason S. Exploring advanced clinical practitioner perspectives on training, role identity and competence: a qualitative study. BMC Nurs 2024; 23:185. [PMID: 38500131 PMCID: PMC10946138 DOI: 10.1186/s12912-024-01843-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Advanced Clinical Practitioners (ACPs) are a new role that have been established to address gaps and support the existing medical workforce in an effort to help reduce increasing pressures on NHS services. ACPs have the potential to practice at a similar level to mid-grade medical staff, for example independently undertaking assessments, requesting and interpreting investigations, and diagnosing and discharging patients. These roles have been shown to improve both service outcomes and quality of patient care. However, there is currently no widespread formalised standard of training within the UK resulting in variations in the training experiences and clinical capabilities of ACPs. We sought to explore the training experiences of ACPs as well as their views on role identity and future development of the role. METHODS Five online focus groups were conducted between March and May 2021 with trainee and qualified advanced clinical practitioners working in a range of healthcare settings, in the North of England. The focus groups aimed to explore the experiences of undertaking ACP training including supervision, gaining competence, role identity and career progression. Thematic analysis of the focus group transcripts was performed, informed by grounded theory principles. RESULTS Fourteen advanced clinical practitioners participated. Analysis revealed that training was influenced by internal and external perceptions of the role, often acting as barriers, with structural aspects being significant contributory factors. Key themes identified (1) clinical training lacked structure and support, negatively impacting progress, (2) existing knowledge and experience acted as both an enabler and inhibitor, with implications for confidence, (3) the role and responsibilities are poorly understood by both advanced clinical practitioners and the wider medical profession and (4) advanced clinical practitioners recognised the value and importance of the role but felt changes were necessary, to provide security and sustainability. CONCLUSIONS Appropriate structure and support are crucial throughout the training process to enable staff to have a smooth transition to advanced level, ensuring they obtain the necessary confidence and competence. Structural changes and knowledge brokering are essential, particularly in relation to role clarity and its responsibilities, sufficient allocated time to learn and practice, role accreditation and continuous appropriate supervision.
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Affiliation(s)
- Maxine Kuczawski
- Centre for Urgent and Emergency Care Research (CURE), Sheffield Centre for Health and Related Research (ScHARR), The University of Sheffield, S1 4DA, Sheffield, UK.
| | - Suzanne Ablard
- Centre for Urgent and Emergency Care Research (CURE), Sheffield Centre for Health and Related Research (ScHARR), The University of Sheffield, S1 4DA, Sheffield, UK
| | - Fiona Sampson
- Centre for Urgent and Emergency Care Research (CURE), Sheffield Centre for Health and Related Research (ScHARR), The University of Sheffield, S1 4DA, Sheffield, UK
| | - Susan Croft
- Centre for Urgent and Emergency Care Research (CURE), Sheffield Centre for Health and Related Research (ScHARR), The University of Sheffield, S1 4DA, Sheffield, UK
- Emergency Department, Northern General Hospital, S5 7AU, Sheffield, UK
| | - Joanna Sutton-Klein
- Centre for Urgent and Emergency Care Research (CURE), Sheffield Centre for Health and Related Research (ScHARR), The University of Sheffield, S1 4DA, Sheffield, UK
- Manchester Royal Infirmary, Oxford Rd, M13 9WL, Manchester, UK
| | - Suzanne Mason
- Centre for Urgent and Emergency Care Research (CURE), Sheffield Centre for Health and Related Research (ScHARR), The University of Sheffield, S1 4DA, Sheffield, UK
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Posmyk L, Carter-Wale RL, Clark K, Donson L, Halstead J, Lennox N, Milnes H. Research priority setting in UK podiatric surgery. J Foot Ankle Res 2023; 16:32. [PMID: 37268962 DOI: 10.1186/s13047-023-00629-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/07/2023] [Indexed: 06/04/2023] Open
Abstract
Evidence-based practice provides the foundation for high quality patient care, and in the NHS, research is seen as vital to enable service transformation and improve outcomes. Research is one of the four pillars of enhanced and advanced clinical practice and is therefore a fundamental part of podiatric surgery services. In order to meet the UK health research strategies, the most recent being 'Saving and Improving Lives: The Future of UK Clinical Research Delivery' (2021), the Faculty of Podiatric Surgery in the UK agreed to support the development of research priorities in order to inform a future research strategy.The Podiatric Surgery Research Strategy Group was set up and embarked on a project with the aim of engaging its members in formulating and agreeing national research priorities. The initial stage included a national research scoping survey to identify key themes, topic, and research questions. The final stage consisted of developing and enabling a live consensus vote conducted at the 2022 national Faculty of Podiatric Surgery Conference. At the end of the vote, the top five research topics that met the agreement criteria were: 1. Surgical treatment - forefoot, 2. Patient reported outcome measures, 3. Post-operative management, 4. Surgical treatment - midfoot and 5. Service delivery. The top five research questions that met the criteria were1. How does quality of life improve following elective foot surgery? 2. How does podiatric surgery benefit the health of the population? 3. How does podiatric surgery benefit the health of the population in the at-risk foot? 4. What is the most effective Lapidus fixation option? and 5. What is the benefit of utilising PASCOM-10 to improve large scale outcome data? These will inform the initial UK podiatric surgery research priorities in the next three to five years.
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Affiliation(s)
- Lesley Posmyk
- Department of Podiatric Surgery, North Tees & Hartlepool NHS Foundation Trust, Hartlepool, UK.
| | - Robyn L Carter-Wale
- Department of Podiatric Surgery, Central London Community Healthcare NHS Trust, London, UK
| | - Kerry Clark
- Department of Podiatric Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lorna Donson
- Department of Podiatric Surgery, Wye Valley NHS Trust, Hereford, UK
| | - Jill Halstead
- Department of Podiatry, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Natalie Lennox
- Department of Podiatric Surgery, Wye Valley NHS Trust, Hereford, UK
| | - Helen Milnes
- Department of Podiatric Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Swart L, Claassen N, Buys T. Mapping the evidence on assessment of fitness to work at heights: a scoping review protocol. BMJ Open 2023; 13:e067847. [PMID: 37225273 DOI: 10.1136/bmjopen-2022-067847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Falls from height are a leading cause of serious injury and fatality globally. In South Africa, work at heights is regulated by occupational health and safety legislation, which places responsibility on employers to ensure their workers are fit for high-risk work. There is however no formal procedure or consensus on how fitness to work at heights should be assessed. This paper presents an a priori protocol for a scoping review that seeks to identify and map the current evidence base around the assessment of fitness to work at heights. It forms the initial phase of a PhD study aimed at developing an interdisciplinary consensus statement for assessing fitness to work at heights in the South African construction industry. METHODS AND ANALYSIS This scoping review will follow the Joanna Briggs Institute (JBI) scoping review framework and will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping reviews (PRISMA-ScR) checklist. An iterative search will be conducted in a selection of multidisciplinary databases including, Proquest Central, PubMed, Scopus, Science Direct, Web of Science, PsychINFO and Google Scholar. Thereafter, searches for grey literature will be performed in Google.com and websites of various national and international agencies, governing bodies and professional organisations with an interest in occupational health and work at heights. Where appropriate, targeted requests for clarification for further information will be undertaken with information sources. A descriptive qualitative content analysis of the results will be conducted and a level of evidence rating will be assigned to each study using the JBI approach. This will allow us to provide some commentary on the rigour of the existing evidence base. ETHICS AND DISSEMINATION Ethics approval for the PhD study was granted by the Research Ethics Committee, Faculty of Health Sciences, University of Pretoria, ethics reference number, 486/2021. Results of the scoping review will be submitted to a scientific journal for publication. TRIAL REGISTRATION NUMBER This protocol is registered on the Open Science Framework at osf.io/yd5gw.
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Affiliation(s)
- Lyndsey Swart
- Occupational Therapy, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Nicolaas Claassen
- Enviromental and Occupational Health, University of Pretoria, Pretoria, South Africa
- Occupational and Environmental Health, Edith Cowan University School of Medical and Health Sciences, Joondalup, Western Australia, Australia
| | - Tania Buys
- Occupational Therapy, University of Pretoria, Pretoria, South Africa
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Karatepe HK, Türkmen E. Serial–multiple mediation of transformational and clinical leadership in the relationship between work overload and quality of work life among nurses: A Job Demands-Resources Framework. Collegian 2023. [DOI: 10.1016/j.colegn.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
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Woodman H, Spencer S. Advanced clinical practice in paediatric haematology and oncology: developing a capability document. Nurs Child Young People 2023; 35:27-33. [PMID: 35875922 DOI: 10.7748/ncyp.2022.e1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 01/06/2023]
Abstract
Specialist roles have been developed to provide holistic care to children and young people with cancer, one of which is the advanced clinical practitioner (ACP) in paediatric oncology and haematology. A survey showed that paediatric oncology and haematology ACPs in the UK work in a wide variety of roles and that their numbers vary greatly between treatment centres. The survey also confirmed the need for a national standardised framework delineating the knowledge, skills and expertise required of ACPs working in paediatric oncology and haematology. This article describes the development of a capability document to support and standardise advanced practice in paediatric oncology and haematology. The document reflects the advanced level of critical thinking, autonomy and decision-making required of ACPs and has been endorsed by the Children's Cancer and Leukaemia Group and by the Royal College of Nursing. It is hoped that it will support ACPs to consistently deliver high-quality, safe care for the benefit of children and young people with cancer and their families.
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Affiliation(s)
- Helen Woodman
- oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, England
| | - Sally Spencer
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, England
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Singaram VS, Bagwandeen CI, Abraham RM, Baboolal S, Sofika DNA. Use of digital technology to give and receive feedback in clinical training: a scoping review protocol. Syst Rev 2022; 11:268. [PMID: 36514135 PMCID: PMC9746573 DOI: 10.1186/s13643-022-02151-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/25/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Feedback is vital to improving trainee competencies in medical education. The challenges of the global COVID-19 pandemic related to social distancing to curb the spread of the virus ignited a rapid transition to online medical education. These changes highlight the need for digital feedback tools that enhance the efficacy and efficiency of feedback practices. This protocol is for a scoping review that aims to identify the different digital tools and applications in medical education as reported in the literature, as well as highlight gaps in the current literature and provide suggestions for future technological developments and research. METHODS AND ANALYSIS A review of the relevant literature will be guided using the Joanna Briggs Institute methodological framework for scoping studies. Using the search strategy developed by the authors, an electronic search of the following databases will be conducted: PubMed/MEDLINE, EBSCOhost (academic search complete, CINAHL with full text) Scopus, Google Scholar, Union Catalogue of Theses and Dissertations (UCTD) via SABINET Online and World Cat Dissertations and Theses via OCLC. Studies will be identified by searching literature from January 2010 to date of review. Using a validated data extraction form developed for the scoping review, the review team will screen eligible studies and import them onto an electronic library created specifically for this purpose. Data collection for the review will be documented through a PRISMA-P flowchart, and the scoping review will use a basic descriptive content analysis to analyse and categorise the extracted data. All review steps will involve two or more reviewers. DISSEMINATION The review will provide a comprehensive list of digital tools and applications used to enhance feedback in clinical training and inform future technological developments. The findings will be disseminated through medical education conferences and publications.
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Affiliation(s)
- Veena S Singaram
- Clinical and Professional Practice, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Chauntelle I Bagwandeen
- Discipline of Public Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Reina M Abraham
- Clinical and Professional Practice, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sandika Baboolal
- NHS Foundation Trust, Moorfields Eye Hospital, London, UK.,Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Dumisa N A Sofika
- Clinical and Professional Practice, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Sheward N, Ellis L. Assessing the impact of introducing trainee advanced clinical practitioners onto an acute oncology triage unit. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:690-694. [PMID: 35797080 DOI: 10.12968/bjon.2022.31.13.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Advanced clinical practitioners (ACPs) have largely been based within acute emergency areas such as emergency departments (EDs) and acute medical units. At The Royal Wolverhampton NHS Trust, ACPs are a new element within oncology services. The acute oncology triage unit sees patients who have received systemic anti-cancer therapy (SACT) presenting with a variety of side effects and symptoms including oncological emergencies, reducing the need for ED attendance. The trainee ACPs identified the neutropenic sepsis pathway as an area requiring urgent change. Through the creation of a new neutropenic sepsis screening tool, as well delivering educational sessions to nursing staff on the unit, the trainee ACPs were able to significantly improve door-to-needle times for patients as well as increasing the use of patient group directions (PGDs), thus reducing delays in antibiotic administration.
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Affiliation(s)
- Nicola Sheward
- Trainee Advanced Clinical Practitioner, The Royal Wolverhampton NHS Trust, Wolverhampton
| | - Leanne Ellis
- Advanced Clinical Practitioner, The Royal Wolverhampton NHS Trust, Wolverhampton
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Morley DA, Kilgore C, Edwards M, Collins P, Scammell JME, Fletcher K, Board M. The changing role of Advanced Clinical Practitioners working with older people during the COVID- 19 pandemic: A qualitative research study. Int J Nurs Stud 2022; 130:104235. [PMID: 35427944 PMCID: PMC8956343 DOI: 10.1016/j.ijnurstu.2022.104235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND COVID-19 was identified as a pandemic by the World Health Organisation (WHO) in December 2020. Advanced Clinical Practitioners (ACPs) in England working with older people with frailty, experienced their clinical role changing in response to the emergency health needs of this complex population group. In contrast to other countries, in England Advanced Clinical Practitioners are drawn from both nursing and allied health professions. Whilst much of the literature emphasises the importance of ensuring the sustainability of the Advanced Clinical Practitioners' role, the pandemic threw further light on its potential and challenges. However, an initial review of the literature highlighted a lack of research of Advanced Clinical Practitioners' capabilities working with uncertainty in disaster response situations. AIM To capture the lived experience of how English Advanced Clinical Practitioners working with older people adapted their roles in response to the COVID-19 pandemic (October 2020-January 2021). DESIGN, SETTING AND PARTICIPANTS A qualitative research design was used. Following ethical approval, 23 Advanced Clinical Practitioner volunteer participants from across England with varied health professional backgrounds were recruited from Advanced Clinical Practitioners' professional and social media networks on Twitter using a snowballing technique. METHODS Depending on preference or availability, 23 participants (nurses (18), physiotherapists (2), paramedics (2) and a pharmacist (1)) were interviewed singularly (n = 9) or as part of 3 focus groups (n = 14) using Zoom video communication. Audio recordings were transcribed and using qualitative data analysis software, NVivo 12 pro, coded for an essentialist thematic analysis of Advanced Clinical Practitioners' responses using an inductive approach. 27 codes were identified and collated into five themes. For the purposes of this paper, four themes are discussed: experiencing different work, developing attributes, negotiating barriers and changing future provision. FINDINGS Advanced Clinical Practitioners successfully transferred their advanced practice skills into areas of clinical need during the pandemic. Their autonomous and generic, high level of expertise equipped them for management and leadership positions where speed of change, and the dissolution of traditional professional boundaries, were prioritised. Barriers to progress included a lack of knowledge of the Advanced Clinical Practitioner role and friction between Advanced Clinical Practitioners and physicians. DISCUSSION AND CONCLUSION The study demonstrated the successful adaption of the Advanced Clinical Practitioner role to enable more creative, personalised and sustainable solutions in the care of older people living with frailty during the pandemic. The potential of Advanced Clinical Practitioner development is in a juxtaposition to the threat of pandemic services being dismantled once the emergency nature of care has passed. Healthcare organisations have a vital part to play in considering the enablers and barriers of Advanced Clinical Practitioner capability-based practice when responding to uncertainty.
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Affiliation(s)
- Dawn A. Morley
- Department of Nursing Science, Faculty of Health and Social Science (FHSS), Bournemouth University, Bournemouth Gateway Building, St Pauls Lane, Bournemouth BH8 8AJ, United Kingdom,Corresponding author
| | - Cliff Kilgore
- Dorset Healthcare Universities NHS Foundation Trust, United Kingdom
| | - Mary Edwards
- Dorset Healthcare Universities NHS Foundation Trust, United Kingdom
| | - Pippa Collins
- Dorset Healthcare Universities NHS Foundation Trust, United Kingdom
| | - Janet ME Scammell
- Department of Nursing Science, Faculty of Health and Social Science (FHSS), Bournemouth University, Bournemouth Gateway Building, St Pauls Lane, Bournemouth BH8 8AJ, United Kingdom
| | - Kelsie Fletcher
- Department of Nursing Science, Faculty of Health and Social Science (FHSS), Bournemouth University, Bournemouth Gateway Building, St Pauls Lane, Bournemouth BH8 8AJ, United Kingdom
| | - Michele Board
- Department of Nursing Science, Faculty of Health and Social Science (FHSS), Bournemouth University, Bournemouth Gateway Building, St Pauls Lane, Bournemouth BH8 8AJ, United Kingdom
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Fielding C, Riley J, Sutherland C, Swift K, Gordon A. Research as part of the advanced clinical practitioner role. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:372-374. [PMID: 35404650 DOI: 10.12968/bjon.2022.31.7.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Catherine Fielding
- Clinical Academic Trainee Advanced Clinical Practitioner and Health Education England (HEE) and National Institute for Health Research (NIHR) Integrated Clinical Academic (ICA) Clinical Doctoral Research Fellow, University Hospitals of Derby and Burton NHS Foundation Trust, Derby
| | - Jennifer Riley
- Associate Director for Advanced Practice, University Hospitals of Derby and Burton NHS Foundation Trust, Derby
| | - Clare Sutherland
- Associate Director for Advanced Practice, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, Associate Dean Interprofessional Learning, Health Education England East Midlands and Senior Professional Advisor ACP, Health Education England National Team
| | - Karen Swift
- ACP Teaching Fellow, University Hospitals of Derby and Burton NHS Foundation Trust, Derby
| | - Adam Gordon
- Consultant Geriatrician, University Hospitals of Derby and Burton NHS Foundation Trust, and Professor of the Care of Older People, University of Nottingham
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Fothergill LJ, Al-Oraibi A, Houdmont J, Conway J, Evans C, Timmons S, Pearce R, Blake H. Nationwide evaluation of the advanced clinical practitioner role in England: a cross-sectional survey. BMJ Open 2022; 12:e055475. [PMID: 34987045 PMCID: PMC8734004 DOI: 10.1136/bmjopen-2021-055475] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND STUDY OBJECTIVE In response to growing pressures on healthcare systems, the advanced clinical practice (ACP) role has been implemented widely in the UK and internationally. In England, ACP is a level of practice applicable across various healthcare professions, who exercise a level of autonomy across four domains, referred to as the four pillars of practice (education, leadership, research and clinical practice). A national framework for ACP was established in 2017 to ensure consistency across the ACP role, however current ACP governance, education and support is yet to be evaluated. This study aimed to analyse data from a national survey of the ACP role to inform the development and improvement of policies relating to ACP in the National Health Service (NHS) in England. DESIGN A cross-sectional survey with free-text comments. SETTING The survey was distributed across primary and secondary levels of care to three distinct groups in England, including individual ACPs, NHS provider organisations and Trusts and primary care settings. PARTICIPANTS A total of 4365 surveys were returned, from ACP staff (n=4013), NHS provider organisations and Trusts (n=166) and primary care organisations (n=186). RESULTS Considerable variation was found in role titles, scope of practice, job descriptions and educational backgrounds of ACPs. Differing approaches to governance were noted, which led to inconsistent ACP frameworks in some organisations. A further challenge highlighted included committing time to work across the four pillars of advanced practice, particularly the research pillar. ACPs called for improvements in supervision and continuing professional development alongside further support in navigating career pathways. CONCLUSIONS A standardised approach may support ACP workforce development in England and enable ACPs to work across the four pillars of practice. Due to the wide uptake of ACP roles internationally, this study has relevance across professions for global healthcare workforce transformation.
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Affiliation(s)
| | - Amani Al-Oraibi
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Joy Conway
- Centre for Health, Medicine and Life Sciences, Brunel University London, Uxbridge, Middlesex, UK
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Stephen Timmons
- University of Nottingham Business School, Nottingham, Nottingham, UK
| | - Ruth Pearce
- School of Nursing, AHPs and Midwifery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Holly Blake
- NIHR Nottingham Biomedical Research Centre, Nottingham, Nottinghamshire, UK
- University of Nottingham School of Health Sciences, Nottingham, Nottinghamshire, UK
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Wallis L, Locke R, Sutherland C, Harden B. Assessment of advanced clinical practitioners. J Interprof Care 2022; 36:946-950. [PMID: 34979852 DOI: 10.1080/13561820.2021.1997950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To continue growing the advanced clinical practitioner (ACP) role nationally, and similar roles internationally, there must be widely held trust in the level of practice and the roles worked in service by ACPs. This requires infrastructure to support ACPs through their training and ensure they are fit to qualify. This short report focuses on an evaluation of assessment processes in the acute sector in a county in England, to understand their feasibility and suitability. The qualitative research design was attendance at assessment panels and 17 semi-structured interviews with assessors and ACP trainees, from nursing, physiotherapy, paramedicine and operating department practice backgrounds based at two hospitals. Key themes identified through thematic analysis were the different approaches to assessment and the support required to engage effectively with assessment. One hospital had a well understood process, including ACPs with a clear identity. The other hospital had a credible assessment process that continues to be developed. The insights from this study enabled lessons to be drawn for those responsible for workforce development who are key to the future development of the ACP role and to ensure high standards of interprofessional care.
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Affiliation(s)
- Lucy Wallis
- Faculty of Health and Wellbeing, University of Winchester, Winchester, UK
| | - Rachel Locke
- Faculty of Health and Wellbeing, University of Winchester, Winchester, UK
| | - Clare Sutherland
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Experiences of out-of-hours task-shifting from GPs: a systematic review of qualitative studies. BJGP Open 2021; 5:BJGPO.2021.0043. [PMID: 34158369 PMCID: PMC8450886 DOI: 10.3399/bjgpo.2021.0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background The current GP workforce is insufficient to manage rising demand in patient care within out-of-hours (OOH) primary care services. To meet this challenge, non-medical practitioners (NMPs) are employed to fulfil tasks traditionally carried out by GPs. It is important to learn from experiences of task-shifting in this setting to inform optimal delivery of care. Aim To synthesise qualitative evidence of experiences of task-shifting in the OOH primary care setting. Design & setting Systematic review of qualitative studies and thematic synthesis. Method Electronic searches were conducted across CINAHL (Cumulative Index of Nursing and Allied Health Literature), PsychINFO, Cochrane, MEDLINE, Embase, and OpenGrey for qualitative studies of urgent or OOH primary care services, utilising task-shifting or role delegation. Included articles were quality appraised and key findings collated through thematic synthesis. Results A total of 2497 studies were screened, of which six met the inclusion criteria. These included interviews with 15 advanced nurse practitioners (ANPs), three physician assistants (PAs), two paramedics, and a focus group of 22 GPs, and focus groups with 33 nurses. Key findings highlight the importance of clearly defining and communicating the scope of practice of NMPs, and of building their confidence by appropriate training, support, and mentoring. Conclusion While NMPs may have the potential to make a substantial contribution to OOH primary care services, there has been very little research on experiences of task-shifting. Evidence to date highlights the need for further training specific to OOH services. Mentorship and support to manage the sometimes challenging cases presenting to OOH could enable more effective OOH services and better patient care.
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Evans C, Poku B, Pearce R, Eldridge J, Hendrick P, Knaggs R, Blake H, Yogeswaran G, McLuskey J, Tomczak P, Thow R, Harris P, Conway J, Collier R. Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review. BMJ Open 2021; 11:e048171. [PMID: 34353799 PMCID: PMC8344309 DOI: 10.1136/bmjopen-2020-048171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/23/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES In response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the UK. This review was undertaken to establish a baseline of evidence on ACP roles and their outcomes, impacts and implementation challenges across the UK. DESIGN A scoping review was undertaken following JBI methodological guidance. METHODS 13 online databases (Medline, CINAHL, ASSIA, Embase, HMIC, AMED, Amber, OT seeker, PsycINFO, PEDro, SportDiscus, Osteopathic Research and PenNutrition) and grey literature sources were searched from 2005 to 2020. Data extraction, charting and summary was guided by the PEPPA-Plus framework. The review was undertaken by a multi-professional team that included an expert lay representative. RESULTS 191 papers met the inclusion criteria (any type of UK evidence, any sector/setting and any profession meeting the Health Education England definition of ACP). Most papers were small-scale descriptive studies, service evaluations or audits. The papers reported mainly on clinical aspects of the ACP role. Most papers related to nursing, pharmacy, physiotherapy and radiography roles and these were referred to by a plethora of different titles. ACP roles were reported to be achieving beneficial impacts across a range of clinical and health system outcomes. They were highly acceptable to patients and staff. No significant adverse events were reported. There was a lack of cost-effectiveness evidence. Implementation challenges included a lack of role clarity and an ambivalent role identity, lack of mentorship, lack of continuing professional development and an unclear career pathway. CONCLUSION This review suggests a need for educational and role standardisation and a supported career pathway for advanced clinical practitioners (ACPs) in the UK. Future research should: (i) adopt more robust study designs, (ii) investigate the full scope of the ACP role and (iii) include a wider range of professions and sectors.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Brenda Poku
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Ruth Pearce
- School of Education, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jeanette Eldridge
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Roger Knaggs
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Gowsika Yogeswaran
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - John McLuskey
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Philippa Tomczak
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Ruaridh Thow
- Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter Harris
- Health Education England East Midlands, Leicester, UK
| | - Joy Conway
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Richard Collier
- Centre for Advancing Practice, Health Education England, Leeds, UK
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14
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Diamond-Fox S, Stone S. The development of advanced clinical practice roles in the UK. ACTA ACUST UNITED AC 2021; 30:32-33. [PMID: 33433276 DOI: 10.12968/bjon.2021.30.1.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sadie Diamond-Fox
- Senior Lecturer in Advanced Critical Care Practice, Northumbria University, Advanced Critical Care Practitioner, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Co-Lead, Advanced Critical/Clinical Care Practitioners Academic Network (ACCPAN)
| | - Sonya Stone
- Assistant Professor of Advanced Clinical Practice, University of Nottingham, Advanced Critical Care Practitioner, Nottingham University Hospitals NHS Trust, and Co-Lead, ACCPAN
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15
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Abstract
Robin Hyde considers some of the anxieties around advanced practice and reflects on how to allay these.
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Affiliation(s)
- Robin L Hyde
- Senior Lecturer-Children's Nursing, Advanced Paediatric Nurse Practitioner, Department of Nursing, Midwifery & Health, Northumbria University
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16
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Lawler J, Maclaine K, Leary A. Workforce experience of the implementation of an advanced clinical practice framework in England: a mixed methods evaluation. HUMAN RESOURCES FOR HEALTH 2020; 18:96. [PMID: 33272304 PMCID: PMC7713001 DOI: 10.1186/s12960-020-00539-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/23/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND This study aims to understand how the implementation of the advanced clinical practice framework in England (2017) was experienced by the workforce to check assumptions for a national workforce modelling project. The advanced clinical practice framework was introduced in England in 2017 by Health Education England to clarify the role of advanced practice in the National Health Service. METHODS As part of a large-scale workforce modelling project, a self-completed questionnaire was distributed via the Association of Advanced Practice Educators UK aimed at those studying to be an Advanced Clinical Practitioner or who are practicing at this level in order to check assumptions. Semi-structured phone interviews were carried out with this same group. Questionnaires were summarised using descriptive statistics in Excel for categorical responses and interviews and survey free-text were analysed using thematic analysis in NVivo 10. RESULTS The questionnaire received over 500 respondents (ten times that expected) and 15 interviews were carried out. Advanced clinical practice was considered by many respondents the only viable clinical career progression. Respondents felt that employers were not clear about what practicing at this level involved or its future direction. 54% (287) thought that 'ACP' was the right job title for them. 19% (98) of respondents wanted their origin registered profession to be included in their title. Balancing advanced clinical practice education concurrently with a full-time role was challenging, participants underestimated the workload and expectations of employer's training. There is an apparent dichotomy that has developed from the implementation of the 2017 framework: that of advanced clinical practice as an advanced level of practice within a profession, and that of Advanced Clinical Practitioner as a new generic role in the medical model. CONCLUSIONS Efforts to establish further clarity and structure around advanced clinical practice are needed for both the individuals practising at this level and their employers. A robust evaluation of the introduction of this role should take place.
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Affiliation(s)
- Jessica Lawler
- School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA, UK
| | - Katrina Maclaine
- School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA, UK
| | - Alison Leary
- School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA, UK.
- University of South Eastern Norway, Drammen, Norway.
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17
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An analysis of advanced and specialist posts in diagnostic radiography: Do job descriptions describe advanced practice? Radiography (Lond) 2020; 27:437-442. [PMID: 33115632 DOI: 10.1016/j.radi.2020.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/06/2020] [Accepted: 10/11/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Underpinned by a multi professional advanced clinical practice (ACP) framework, role consistency in practice level and education has been advocated across allied health professions. However little research has evaluated ACP expectations in radiography. This study identified the capability requirements of advanced and specialist diagnostic radiographers and mapped these to home country advanced practice frameworks and the Society and College of Radiographers (SCoR) Education and Career Framework. METHODS A consecutive sample of UK job advertisements was collected over six months and analysed for role focus, professional and clinical responsibilities, reporting or procedural expectations and knowledge and experience. Qualitative content analysis was used to scrutinise capabilities during role mapping. RESULTS A total of 42 job descriptions were analysed across UK Trusts and Health Boards, with 31 roles (73.8%) containing the terms advanced or specialist. Half of the advertised roles expected proficiency in reporting (n = 21; 50%). Responsibilities mapped to the practice outcomes of the SCoR framework in 31 roles (n = 31/42; 73.8%). The English documents (n = 40/42; 95.2%) evaluated against the multi professional framework identified significantly (χ2 = 14.6; p < 0.01) fewer capabilities (n = 13/40; 32.5%). Clinical practice was reflected broadly in textual behavioural descriptors however, leadership, education and research responsibilities were internal and operational in nature. CONCLUSION This analysis of diagnostic radiographer job descriptions has demonstrated that many posts advertised as 'advanced' differ from advanced practice roles defined by the multi professional ACP framework, although they meet professional body standards. IMPLICATIONS FOR PRACTICE Utilisation of diagnostic radiographers as 'true' advanced clinical practitioners remains intermittent. Greater consistency in job descriptions is required to strengthen radiography advanced practice and support radiographer development.
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Evans C, Pearce R, Greaves S, Blake H. Advanced Clinical Practitioners in Primary Care in the UK: A Qualitative Study of Workforce Transformation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124500. [PMID: 32585866 PMCID: PMC7344450 DOI: 10.3390/ijerph17124500] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 01/02/2023]
Abstract
Escalating costs and changing population demographics are putting pressure on primary care systems to meet ever more complex healthcare needs. Non-medical ‘advanced clinical practitioner’ (ACP) roles are increasingly being introduced to support service transformation. This paper reports the findings of a qualitative evaluation of nursing ACP roles across General Practices in one region of the UK. Data collection involved telephone interviews with 26 participants from 3 different stakeholder groups based in 9 practice sites: ACPs (n = 9), general practitioners (n = 8) and practice managers (n = 9). The data was analysed thematically. The study found a high degree of acceptance of the ACP role and affirmation of the important contribution of ACPs to patient care. However, significant variations in ACP education, skills and experience led to a bespoke approach to their deployment, impeding system-wide innovation and creating challenges for recruitment and ongoing professional development. In addition, a context of high workforce pressures and high service demand were causing stress and there was a need for greater mentorship and workplace support. System wide changes to ACP education and support are required to enable ACPs to realise their full potential in primary care in the UK.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (R.P.); (S.G.); (H.B.)
- Correspondence:
| | - Ruth Pearce
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (R.P.); (S.G.); (H.B.)
| | - Sarah Greaves
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (R.P.); (S.G.); (H.B.)
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (R.P.); (S.G.); (H.B.)
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2HA, UK
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Evans C, Poku B, Pearce R, Eldridge J, Hendrick P, Knaggs R, McLuskey J, Tomczak P, Thow R, Harris P, Conway J, Collier R. Characterising the evidence base for advanced clinical practice in the UK: a scoping review protocol. BMJ Open 2020; 10:e036192. [PMID: 32439696 PMCID: PMC7247387 DOI: 10.1136/bmjopen-2019-036192] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION A global health workforce crisis, coupled with ageing populations, wars and the rise of non-communicable diseases is prompting all countries to consider the optimal skill mix within their health workforce. The development of advanced clinical practice (ACP) roles for existing non-medical cadres is one potential strategy that is being pursued. In the UK, National Health Service (NHS) workforce transformation programmes are actively promoting the development of ACP roles across a wide range of non-medical professions. These efforts are currently hampered by a high level of variation in ACP role development, deployment, nomenclature, definition, governance and educational preparation across the professions and across different settings. This scoping review aims to support a more consistent approach to workforce development in the UK, by identifying and mapping the current evidence base underpinning multiprofessional advanced level practice in the UK from a workforce, clinical, service and patient perspective. METHODS AND ANALYSIS This scoping review is registered with the Open Science Framework (https://osf.io/tzpe5). The review will follow Joanna Briggs Institute guidance and involves a multidisciplinary and multiprofessional team, including a public representative. A wide range of electronic databases and grey literature sources will be searched from 2005 to the present. The review will include primary data from any relevant research, audit or evaluation studies. All review steps will involve two or more reviewers. Data extraction, charting and summary will be guided by a template derived from an established framework used internationally to evaluate ACP (the Participatory Evidence-Informed Patient-Centred Process-Plus framework). DISSEMINATION The review will produce important new information on existing activity, outcomes, implementation challenges and key areas for future research around ACP in the UK, which, in the context of global workforce transformations, will be of international, as well as local, significance. The findings will be disseminated through professional and NHS bodies, employer organisations, conferences and research papers.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Brenda Poku
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Ruth Pearce
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Paul Hendrick
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Roger Knaggs
- School of Pharmacy, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - John McLuskey
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Philippa Tomczak
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Ruaridh Thow
- Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter Harris
- Health Education England East Midlands, Nottingham, UK
| | - Joy Conway
- College of Health and Life Sciences, Brunel University, Uxbridge, UK
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