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

Healthcare professionals' perspectives towards the role of ward-based advanced practice nurses: A cross-sectional study

AIMS

1. To explore the perceptions of physicians, registered nurses (RN) and allied health professionals (AHP) towards the role of ward-based advanced practice nurse (APN). 2. To examine healthcare professionals' perception of APN role expansion in inpatient care.

DESIGN

Cross-sectional study.

METHODS

A 43-item survey comprising of five domains was conducted on healthcare professionals' perceptions towards ward-based APNs in five medical wards of a tertiary hospital from November 2022 to February 2023. The participants were recruited using convenience sampling via email and cross-platform messaging service.

RESULTS

A total of 181 completed respondents including 26 physicians, 102 nurses and 45 AHPs. Statistical analysis was performed with IBM SPSS Version 28.0. APNs were perceived to be spending a great extent of time across all five domains, namely, 'direct comprehensive care', 'support of systems', 'research', 'education' and 'publication and professional leadership'. Significant differences were noted in perceptions based on prior experience with APNs and between different healthcare professions. The majority recognized APNs' positive impact on patient safety, efficiency and patient-centeredness.

CONCLUSION

This study offers valuable insights into ward-based APNs' practice patterns, roles and impact, revealing a positive shift in their acceptance and expanding roles within inpatient general wards. It also highlights the valuable roles and impact of ward-based APNs in direct patient care, system support, research, education and leadership, despite ongoing challenges in role clarity, particularly in treatment planning and ward rounds.

IMPLICATIONS FOR THE PROFESSION

APNs are highly regarded as competent and a consistent personnel in the wards. However, there are divided views on clinical activities that APNs undertake.

IMPACT (ADDRESSING)

What problem did the study address? ○ Role ambiguity for ward-based APNs. ○ Healthcare professionals' readiness and acceptance of APNs. What were the main findings? ○ APNs are perceived to have a strong involvement in direct patient care, support of system, research, education and leadership. ○ APNs are recognized for their significant impact on patient safety, efficiency and patient-centredness, but there were varied perceptions on the extent of time they spend in different practice domains. ○ The critical roles of APNs participating in daily ward rounds and initiating discharge plans were highlighted, emphasizing their importance in timeliness and continuity of care. Where and on whom will the research have an impact? ○ It will affect healthcare professionals including physicians, nurses, allied health professionals and healthcare administrators by providing insights into the roles and contributions of ward-based APNs. ○ The findings will guide policymakers and nurse leaders in making informed decisions about the implementation and development of APN roles, ultimately improving patient care and outcomes.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Nurses' Perceptions on the Role of Advanced Psychiatric Nurses in Mental Healthcare: An Integrative Review

Background/Objectives: Advanced psychiatric nurses' clinical skills and expertise are increasingly challenging registered nurses in mental health. Understanding registered nurses' perceptions of the role of advanced psychiatric nurses is vital for improving mental healthcare delivery and fostering collaboration for effective patient outcomes. This integrative review aims to explore how registered nurses perceive the role of advanced psychiatric nurses in mental healthcare. Methods: An integrative review methodology was used to synthesize the existing literature following PRISMA guidelines. Both qualitative and quantitative studies provided a comprehensive understanding of the registered nurses' perceptions regarding the role of advanced psychiatric nurses in mental health nursing. Results: Several key themes emerged from studies included in this review, including recognition of expertise, role ambiguity and boundaries, and the need for structured education and training. Conclusions: This review highlights the need to clarify roles and how communication is essential for improving collaboration, team cohesion, and patient outcomes while promoting interprofessional education to optimize mental healthcare, in addition to bridging the knowledge gap or the discrepancy between registered nurses and advanced psychiatric nurses. What registered nurses know and what they need to know to perform tasks will improve the quality of mental healthcare and optimize services for individuals with mental health needs.

Factors associated with resilience, spiritual and mental well-being of advanced practice nurses: Implications for role integration

AIM(S)

To examine the overall level of resilience and spiritual and mental well-being of advanced practice nurses (APN) in Singapore and to describe the associated factors of mental well-being.

BACKGROUND

Research shows that healthcare workers' resilience and mental well-being are positively associated with spiritual well-being, which encompasses a sense of peace and meaning. Understanding APNs' spiritual and mental health, alongside resilience, may help maintain the sustainability and effectiveness of the APN workforce within the healthcare system, especially in the post-pandemic environment.

METHODS

This nationwide cross-sectional online survey (May-June 2023) assessed APNs' resilience and spiritual and mental well-being. The Connor-Davidson Resilience 10 Scale, the Warwick-Edinburgh Mental Well-Being Scale, and the Functional Assessment of Chronic Illness Therapy-2-Factor Non-Illness Spiritual Well-Being Scale Version 4 were used. Sociodemographic and work-related information were collected to explore associations between participants' characteristics and their level of resilience and spiritual and mental well-being.

RESULTS

Eighty-two APNs and APN interns participated in the study, representing 21.4% nationwide. Participants' level of resilience, peace and meaning components of spirituality, and whether they worked in an acute care setting, were statistically significant predictors of APNs' mental well-being. APNs working in acute care hospitals had higher levels of mental well-being than other healthcare settings.

CONCLUSION

The significant roles of the Peace and Meaning subscales of spiritual well-being underscore the importance of fostering supportive work environments. Supportive work environments can foster peace and meaning by facilitating the integration of APN roles and nurturing a sense of purpose and connection within their professional practice.

IMPLICATIONS FOR NURSING

Effective APN integration into the healthcare system, crucial for their mental well-being, requires addressing macro-, meso- and micro-level issues. At the macro level, clear scopes of practice and legislative support can provide stability and purpose, fostering peace of mind. Meso-level strategies, such as collaborative practice models, can cultivate a sense of connection and shared meaning within teams. Micro-level strategies, including professional development, mentorship and supportive work environment, can nurture reflective practice and personal growth, further enhancing APNs' spiritual well-being through a sense of peace and meaning. These strategies collectively strengthen APNs' professional identity, job satisfaction and mental well-being, leading to better patient outcomes and a more resilient healthcare workforce.

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.

Empowering nurses and midwives: the evidence-base for the Nurses and Midwives Certification Programme of ESHRE†

STUDY QUESTION

How were the logbook and curriculum for the Nurses and Midwives Certification Programme of ESHRE developed?

SUMMARY ANSWER

The logbook and corresponding curriculum for the ESHRE Nurses and Midwives Certification Programme were based on an extensive literature review, an international expert panel, and a survey of Belgian and Dutch nurses and midwives (N&M) working in reproductive medicine (RM).

WHAT IS KNOWN ALREADY

ESHRE has been running a certification programme for N&M working in RM since 2015. To the best of our knowledge, clinical practice guidelines for nursing/midwifery care within RM are lacking as is consensus on role descriptors of N&M working in RM.

STUDY DESIGN, SIZE, DURATION

The Nurses and Midwives Certification Committee (NMCC), established by the ESHRE Executive Committee in 2012, decided to gather background information by: (i) systematically reviewing the literature on the tasks of N&M working in RM, (ii) consulting and surveying an expert panel of international senior N&M, and (iii) surveying Belgian and Dutch N&M working in RM across different clinics. Finally, the NMCC developed a logbook and curriculum fostering a more expanded theoretic background.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The NMCC comprised four N&M, one clinical embryologist, and one gynaecologist (both in an advisory capacity). The Medline database was searched for papers relating to the tasks of N&M working in RM, by entering a search string in PubMed. In an attempt to capture insight into the tasks and roles of N&M working in RM, the NMCC subsequently surveyed N&M experts across nine countries (Denmark, Finland, France, Norway, Slovenia, Sweden, Turkey, Ukraine, and the UK), and 48 Belgian and Dutch N&M working in RM.

MAIN RESULTS AND THE ROLE OF CHANCE

There were 36 papers on the tasks of N&M working in RM originating from 13 countries (in Asia, Oceania, Europe, and North America), identified. Initially, 43 tasks in which N&M working in RM participated, were identified by literature only (n = 5), the international expert panel only (n = 4), Belgian and Dutch N&M working in RM only (n = 5), or a combination of two (n = 13) or three (n = 16) of these sources. The number and composition of tasks included in the logbook were adapted yearly based on novel insights by the NMCC. In response to the annual review, the extended role of N&M working in RM is now reflected in the 2024 version by 73 tasks. Seven specialist tasks (i.e. embryo transfer) were performed independently by N&M working in RM in some countries, while in other countries N&M merely had an 'assisting' role. Candidates are also expected to submit a mature ethical reflection on one clinical case. To support applicants throughout the certification process, the NMCC developed a curriculum in line with all tasks of N&M working in RM.

LIMITATIONS, REASONS FOR CAUTION

The literature review was not completed prior to consulting the international expert panel or surveying the Belgian and Dutch N&M working in RM.

WIDER IMPLICATIONS OF THE FINDINGS

The differences in tasks and roles of N&M working in RM across and within countries, clinics and individuals illustrated by the literature review, the international expert panel, and the surveyed Belgian and Dutch N&M working in RM suggest an opportunity for structured professional development. Further research is required to elicit the post-certification experience of N&M working in RM and its impact on their professional development.

STUDY FUNDING/COMPETING INTEREST(S)

The expert panel meeting was funded by ESHRE and the literature review and surveys were supported by Leuven University (Belgium) and the postdoctoral fellowship of the Research Foundation Flanders of E.A.F.D. H.K. received consulting fees and honoraria from Gedeon Richter, Finox and MEDEA, and travel support from Gedeon Richter and Finox. The other authors declare no conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

Low-value health care, de-implementation, and implications for nursing research: A discussion paper

Globally, the nursing profession constitutes the largest proportion of the health workforce; however, it is challenged by widespread workforce shortages relative to need. Strategies to promote recruitment of the nursing workforce are well-established, with a lesser focus on strategies to alleviate the burden on the existing workforce. This burden may be exacerbated by the impact of low-value health care, characterised as health care that provides little or no benefit for patients, or has the potential to cause harm. Low-value health care is a global problem, a major contributor to the waste of healthcare resources, and a key focus of health system reform. Evidence of variation in low-value health care has been identified across countries and system levels. Research on low-value health care has largely focused on the medical profession, with a paucity of research examining either low-value health care or the de-implementation of low-value health care from a nursing perspective. The objective of this paper is to provide a scholarly discussion of the literature around low-value health care and de-implementation, with the purpose of identifying implications for nursing research. With increasing pressures on the global nursing workforce, research identifying low-value health care and developing approaches to de-implement this care, is crucial.

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.

Igniting the Fire of Discovery: Creating Partnerships Between Research, Education, and Practice

In the 28th H.P. Maley Lecture, Stacey Dusing, PT, PhD, FAPTA, shares a perspective on the importance of clinician-scientists in bridging the chasm that currently exists between scholarship and clinical practice. Describing herself as a clinician-scientist, or a qualified health care professional who functions mainly as a career scientist with the other portion of time dedicated to clinical practice, Dusing highlights the potential impact of limited training for clinician-scientists in the physical therapist profession and its impact on the future of physical therapy. She challenges all physical therapists to consider the impact of Commission on Accreditation in Physical Therapy Education requirements on scholarship and the lack of requirement for clinical practice while also recognizing that training programs for clinician-scientists are quite limited. Reviewing some historical data and highlighting possible areas for growth, Dusing calls physical therapists to action in 4 areas. This paper calls all physical therapists, especially educators and administrators, to consider the role of clinician-scientist in promoting physical therapy and knowledge translation. The author challenges the profession to consider whether we are helping to train or embed clinician-scientists in our clinical workplaces to promote knowledge translation. Suggestions are made to improve research and clinical training programs to increase the number of clinician-scientists in physical therapy.

Stepping outside national borders: International active learning educational collaboration events

AIM

This paper discusses the benefits of international collaborations for advanced practice nursing education. It identifies new perspectives and innovative practices to enhance cultural competency.

BACKGROUND

Competent, well-trained advanced practice nurses (APNs) are necessary to provide high-quality and safe patient care, improve access to care, and address health disparities that are no longer geographically bound. In 2021, an international network of advanced practice educators established an active learning program to teach students their role in global citizenship and increase awareness of health disparities. APN students from Scotland, Wales, Minnesota, Houston, and Rotterdam participated in presentations, online discussions, and in-country scholarships.

SOURCES OF EVIDENCE

Growing health disparities have created the need for efficient international collaboration to develop new concepts, approaches, and bidirectional exchange of experiences, culture, and knowledge. Integrating global health into curricula engages students' curiosity and integrates education, research, practice, and leadership while improving cultural competency.

DISCUSSION

Forty-two students participated in the international presentations. The students strongly believed in the benefit of international collaboration and the need for a universal role for the advanced practice nurse. They responded positively to sharing cultural and clinical experiences.

CONCLUSION

The recent global health challenge supported the development of innovative methods to deliver education and created an opportunity for advanced practice students to develop cultural competence and critical thinking. Collaborative solutions are essential to education and healthcare as we move forward in the 21st century.

IMPLICATIONS FOR NURSING PRACTICE

Robust international collaborations have enabled the development of cultural competence and critical thinking. These are crucial elements for advanced practice roles.