Scope of practice, competencies and impact of advanced practice nurses within APN-led models of care for young and middle-aged adult patients with multimorbidity and/or complex chronic conditions in hospital settings: a scoping review

INTRODUCTION

The number of young and middle-aged adult patients with multimorbid and/or complex chronic conditions is rising, presenting challenges for healthcare systems. Advanced practice nurses (APNs) are crucial in treating these patients due to their expertise and advanced nursing skills. The article outlines the scope of practice (SOP), competencies and impact of APNs in APN-led models of care for this patient group in hospital settings.

OBJECTIVES

Description of the SOP, competencies and impact of APNs within APN-led care models for young and middle-aged adult patients in hospital settings.

DESIGN

Scoping review based on the methodological framework by Arksey and O'Malley, incorporating the methodological enhancement of Levac and collegues, complying with the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews guidelines of Tricco and collegues. DATA SOURCES: Systematic research was conducted in the databases MEDLINE (PubMed), CINAHL (EBSCO), EMBASE (Ovid), CENTRAL and PsycINFO (Ovid) using all recognised keywords, item terms and search strings, and OpenGrey was scanned until December 2023. Studies published in English, German or translatable to English using translation tools were included.

ELIGIBILITY CRITERIA

Studies of APN-led models of care in hospitals were included if they involved adult participants aged 18-64 years with multimorbidity (two or more chronic conditions) and/or complex chronic conditions and provided information on SOP, competencies or impact.

DATA EXTRACTIONS AND SYNTHESIS

Data from full-text articles meeting the inclusion criteria were extracted independently by two reviewers, and a narrative summary was developed to present the results related to the objectives and questions of the study.

RESULTS

A total of 2119 records were retrieved, with five studies ultimately included. The results included predischarge, postdischarge and bridging transition SOP. The competencies of APNs varied in both form and intensity, due to the heterogeneity of the APN-led models. Direct clinical practice competencies were most frequently described, especially regarding nursing or medical tasks, and shaped and influenced competencies in leadership, collaboration, guidance and coaching, and evidence-based practice. Indirect care activities were often mentioned. These studies indicated that APNs in APN-led care models positively impact clinical and patient outcomes, although high-intensity integrated care did not lead to cost reductions.

CONCLUSION

The review aims to highlight the heterogeneity and current state of knowledge about the potential role of APNs in the integrated care of this increasing patient group in hospitals. The findings emphasise the significance of focusing on the unique needs of this patient population and may serve as a foundation for developing an APN-led model of care for this group in the clinical setting. However, further research is necessary to better elucidate the role of APNs within APN-led care models in relation to the care needs of this patient group.

TRIAL REGISTRATION NUMBER

OSF 4PM38.

Organising care for people with diabetes and renal disease

Diabetes and chronic kidney disease (CKD) are two of the commonest long-term conditions. One-fifth of patients with diabetes will have CKD, and diabetes is the commonest cause of advanced kidney disease. For most patients these comorbidities will be managed in primary care with the focus on cardiovascular prevention. Many patients with more advanced disease and complications require joint care from multidisciplinary specialist teams in diabetes and renal disease to ensure that care is consistent and coordinated. Models of joint speciality care, include joint registry management, parallel clinics, shared consulting and case discussion, but require more evaluation than has currently been performed. These underpin more informal interactions between the specialist teams. A local model of care for diabetes and renal disease that incorporates the roles of primary care, members of multidisciplinary teams and speciality care should be agreed, resourced appropriately and its effectiveness monitored.