Leveraging nurse practitioner capacities to achieve global health for all: COVID-19 and beyond

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.

Implementation and effectiveness of a nurse navigation programme based on noddings' care theory in first-year undergraduate nursing students for professional identity and career planning: A quasi-experimental study

AIMS

Development and evaluation of the effectiveness of a Nurse Navigation programme based on Noddings' Care theory on two dependent variables which were professional identity and career planning among first-year undergraduate nursing students.

BACKGROUND

First-year undergraduate nursing students generally have a low sense of professional identity and career planning, resulting in a loss of nursing power after graduation. Implemention of a Nurse Navigation program based on Noddings' Care theory may be potentially useful in cultivating their professional identity and career planning.

DESIGN

A quasi-experimental study.

METHODS

A convenience sample of 122 first-year undergraduate nursing students from two medical universities was recruited between September 2021 and June 2022. Students in the experimental group (n = 63) participated in the Nurse Navigation programme based on Noddings' Care theory, which contained four core components, spreading over 50 lessons. Those in the control group (n = 59) underwent a traditional training programme with five components across 44 lessons. The two groups were compared in terms of their level of professional identity by Professional identity questionnaire for nurse students (PIQNS) and career planning by Career planning questionnaire (CPQ) after the training using the t-test.

RESULTS

The mean score of professional identity in the experimental group increased significantly from 51.02 ± 8.46 at baseline to 58.02 ± 8.81 after the intervention (p < 0.001), with a large effect size (Cohen's d=0.810). Also, this post-intervention score was statistically significantly higher than that (52.86 ± 9.27) in the control group (p = 0.002), with a medium effect size (Cohen's d=0.571). The mean score of career planning in the experimental group increased significantly from 81.76 ± 9.86 at baseline to 94.52 ± 10.81 after the intervention (p < 0.001), with a large effect size (Cohen's d = 1.233). Also, this post-intervention score was statistically significantly higher than that (88.25 ± 9.30) in the control group (p < 0.001), with a medium effect size (Cohen's d=0.623).

CONCLUSIONS

The Nurse Navigation programme based on Noddings' Care theory showed effectiveness in enhancing professional identity and career planning among first-year undergraduate nursing students in China. Further rigorous studies are needed to examine its effectiveness and long-term impacts on these students.

Enhancing nurses' perceptions of having a place to reduce turnover intentions

AIM

To investigate whether education, tenure, being an advanced practice nurse, skill level, and time pressure impact perceptions of "having a place" and, further, turnover intentions.

BACKGROUND

Nursing shortages persist worldwide. Nurses' turnover intentions are negatively related to their perceptions of "having a place" (i.e., the feeling that the nursing workplace is their territory). However, the sources of nurses' perceptions of the perception of "having a place" remain unknown.

METHODS

Our research employed a cross-sectional and correlational design. This research was conducted at a large-scale hospital in northern Taiwan from December 2021 to January 2022. We used personnel data pertaining to 430 nurses as well as scales for time pressure, "having a place" and turnover intentions to assess nurses' intention to leave their place of employment. The inclusion criteria focused on full-time nurses who worked for the hospital under investigation. Most of our participants were women. The STROBE statement was used as the EQUATOR checklist (supplemental file).

RESULTS

"Having a place" was positively related to educational level, tenure, and skill level, while being an advanced practice nurse was negatively associated with perceptions of "having a place," which in turn were negatively related to turnover intention among nurses.

CONCLUSION

Our study is the first to examine the antecedents of nurses' perceptions of "having a place," which include education, tenure, and skill level.

IMPLICATIONS FOR NURSING POLICY

Nursing policymakers could encourage nurses to pursue higher degrees and update their nursing skills while instilling perceptions of "having a place" in nurses with a brief tenure and advanced practice nurses.

Advanced practice nursing in Europe-Results from a pan-European survey of 35 countries

AIM

To report the results of a mapping exercise by the European Federation of Nurses on current advanced practice nursing frameworks and developments across Europe.

DESIGN

Online, cross-sectional, questionnaire study.

METHODS

An online questionnaire was distributed among 35 national nurses' associations across Europe in March 2021. The questionnaire solicited input on 60 items concerning key features of advanced practice nursing, intending to map existing developments and better understand the current state of advanced practice nursing in Europe. Data analysis used descriptive statistics, including counts and percentages, tabulation; open-text responses were handled with thematic synthesis techniques.

RESULTS

The definition, sense-making and operationalization of advanced practice nursing vary across Europe. Important variations were noted in the definition and requirements of advanced practice nursing, resulting in different views on the competencies and scope of practice associated with this role. Importantly, the level of education and training required to qualify and practice as an advanced practice nurse varies across European countries. Furthermore, only 11 countries reported the existence of a national legislation establishing minimum educational requirements.

CONCLUSION

Significant variation exists in how countries define advanced practice nursing and how it is regulated at academic and practice levels. More research is needed to clarify whether this variation results from designing models of advanced practice nursing that work in different contexts; and what impact a standardized regulatory framework could have to grow the volume of advanced practice nurses across Europe.

IMPACT

The current paper exposes the lack of clarity on the development and implementation of advanced practice nursing across Europe. We found significant variation in the definition, recognition, regulation and education of advanced practice nurses. Our data are essential to policymakers, professional associations and employers to ensure a coordinated and systematic effort in the consistency and ongoing development of advanced practice nurses across Europe.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution applied; the participants were national nurses' associations.

Models of care with advanced practice nurses in the emergency department: A scoping review

INTRODUCTION

Emergency departments play a critical role in healthcare systems internationally. Visits for emergency care continue to increase, related to poor access to primary care, the COVID-19 pandemic, and health human resource issues. International literature shows similar stressors in the emergency department. Extended wait times to see health providers lead to poor outcomes, and innovative models of care are needed to address emergency department overcrowding and to meet the needs of patients. Advanced practice nurses have the expertise and scope of practice to optimize and address primary and acute care needs and could be further integrated into the emergency healthcare systems. It is unclear what and how advanced practice nurses are functioning in emergency departments to improve patient and organization outcomes.

METHODS

This scoping review was a comprehensive search of MEDLINE, EMCARE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and gray literature. Authors developed inclusion and exclusion criteria, performed title and abstract screening, and full text screening using review software. Data about models of care with advanced practice nurses were extracted and organized to understand patient, provider, and organizational outcomes. We also extracted information about the development and implementation of roles.

RESULTS

Of the 6780 records identified, 76 met inclusion criteria. Emergency department models of care, mainly using nurse practitioners, include fast-track, generalized emergency, minor injury, orthopedics, pediatrics, geriatrics, specific populations, and triage. Reported patient outcomes include improvement in key metrics specific to emergency departments, such as total length of stay, wait times to be seen by a provider, left without being seen rates, treatment for pain, costs, and resource use. When comparing nurse practitioners to other providers, outcomes were similar or better for patient and organizational outcomes.

DISCUSSION

Various models of care utilizing advanced practice nurses in emergency departments are present internationally and information about how they are developed, integrated, and utilized provides practical information to support and sustain new roles. There is an opportunity to expand the use of these roles into emergency departments as the nurse practitioner scope of practice grows. Given the current crisis across healthcare systems, there is need for innovation, and improving delivery of emergency services with these advanced practice nursing models of care can help to address important health policy priorities in Canada and other countries.

TWEETABLE ABSTRACT

Advanced Practice Nurse models of care in emergency - Improved outcomes for patients and organizations - A review of the literature. @SamanthaH_RN.

Experience in developing innovative practical ability for Master of Nursing Specialist degree program in China: A qualitative descriptive study of postgraduates

BACKGROUND

Nursing talent training should be adjusted in accordance with policies and regulations, the priority areas of health care, the development of nursing disciplines, and changes in nurses' roles. Experience from nursing education stakeholders indicates that postgraduate education faces numerous challenges. Thus, it is necessary to discuss postgraduates' experience in cultivating innovative practical ability.

OBJECTIVES

To analyze the experiences of nursing specialist postgraduates in cultivating innovative practical ability to provide a reference for further improvement of the Master of Nursing Specialist program.

DESIGN

A qualitative study.

SETTING

A university and its three affiliated tertiary hospitals in H city, China.

PARTICIPANTS AND METHODS

Individual, semi-structured interviews were conducted face-to-face with 12 postgraduates currently in clinical practice and six postgraduate nurses within two years of graduation between April and June 2022. All interviews were audio-recorded and transcribed verbatim, and the data were analyzed using the Colaizzi method.

RESULTS

Three key themes emerged: (1) the cognition of innovative practical ability; (2) the experience of cultivating innovative practical ability at school; and (3) the experience of cultivating innovative practical ability in the hospital.

CONCLUSIONS

With a full understanding of the training experience of postgraduates' innovative practical ability, policymakers and training units can clarify the shortcomings of the training model, make targeted improvements, and work together to build a more scientific and complete MNS training model. Our findings have the potential to inform faculty structure, catalyze curriculum reform, optimize clinical practice to facilitate the development of Master of Nursing Specialist programs, improve the quality of care, and promote patient recovery.

Cognitive Competence and Curriculum Development in Nurse Anesthesia Education: A Pilot Study

Background

Advanced practice nursing in the United States is shifting toward doctoral certification, most commonly a Doctor of Nursing Practice degree. However, there is limited evidence that this transition improves clinical competence.

Purpose

The aim of this study was to determine whether modifications in a nurse anesthesia curriculum that transitioned from a Master of Nursing to a Doctor of Nursing Practice program were associated with improved cognitive performance using an oral examination.

Design

A prospective, comparative observational study of students from a single, university-based nurse anesthesia program.

Methods

This study was a small-scale investigation (n = 22) that used a quantitative method to compare the performances of consecutive cohorts of Master of Nursing and Doctor of Nursing Practice nurse anesthesia students as rated by oral examinations designed to evaluate critical thinking skills and previously shown to demonstrate internal consistency and reliability.

Results

After completing an expanded curriculum, Doctor of Nursing Practice nurse anesthesia students performed significantly better than Master of Nursing students on oral examination, with improvements in cognitive domains previously identified as areas of underperformance by Master of Nursing students.

Conclusion

Targeted curricular additions in a Doctor of Nursing Practice program correlated with improvements in nurse anesthesia student cognitive competence as measured by oral examination.

Improvements in the infrastructure for nursing research in universities in Kazakhstan

AIM

This study aimed to describe the status and analyze the improvements made by universities in Kazakhstan to nursing research infrastructure in the following services: library, internationalization, finance, information and communication technology (ICT), and research, development, and innovation (RDI).

BACKGROUND

In higher education institutions (HEIs), a strong research infrastructure is a necessity for academic education and research. In Central Asian countries, nursing is regarded as an assistive field to medicine, affecting nursing research infrastructures.

METHODS

In this descriptive study, following benchmarking and a recommendations report, an interview of nursing faculty members was used to obtain data regarding nursing research infrastructure in ten universities in Kazakhstan. The SQUIRE-EDU was used to ensure the quality of reporting.

RESULTS

The Kazakhstani universities providing nursing education are still in the process of developing their nursing research infrastructure. They have not acquired access to nursing databases, and only one textbook concerning nursing research can be found from their libraries. None of the universities have joined international nursing networks. The participation of the university staff and students in conferences with nursing themes has increased. The universities are investing in staff capacity building, but not yet in nursing research projects.

DISCUSSION AND CONCLUSION

Kazakhstani universities have the autonomy to develop nursing research and its infrastructure. Active measures by the university management, such as financing access to nursing databases, international cooperation, and international projects, are necessary.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Research infrastructures' quality strongly impacts the development of nursing science and practice in any country. It is crucial to increase the volume of research that demonstrates the effectiveness of clinical nursing and its contribution to health outcomes. To enable the faster development of nursing science in Central Asian countries, this development should be supported through international collaboration.

Towards Green and Sustainable Healthcare: A Literature Review and Research Agenda for Green Leadership in the Healthcare Sector

The health sector is one of the keys to sustainable development. Although it is directly related to only one Sustainable Development Goal (Goal 3, "Ensuring a healthy life and promoting well-being at all ages"), the sector itself, which aims to protect health, is paradoxically at the same time the main emitter of environmental pollutants that have a negative impact on health itself. Therefore, sustainability has become a key priority for health sector organizations, and leadership in this area is essential at all levels. Scientific research plays a particular role here, helping to more clearly define the links between environmental sustainability and the health effects of a polluted environment and climate change as well as indicating the direction of actions needed and disseminating good practices that can help accelerate the adoption of efforts towards climate neutrality and sustainable development of health sector organizations. The aim of this article is to present the current state of the art and future research scenarios in the field of green and sustainable healthcare through a literature review by using the Preferred Reporting Items for Systematic Reviews Meta-Analyses (PRISMA) method to perform a bibliometric analysis of papers published in 2012-2022. The Web of Science Core Collection (WoSCC) database is used for this purpose. A total of 144 papers are included for analysis, categorized based on eight fields: author(s), title, year of publication, country, journal, scientific category, and number of citations. Based on the results, themes for future research on green leadership in the healthcare sector are identified and recommended.

A Mixed-Methods Sequential Explanatory Study of the Factors That Impact Nurses' Perspectives toward Nurse Practitioners' Roles in Saudi Arabia

Nurse practitioners' roles need to be clearly defined in Saudi Arabia. Therefore, we aimed to explore potential factors that impact nurses' perspectives toward nurse practitioners' roles and whether they are interested in becoming nurse practitioners. A mixed-methods study design was employed using a questionnaire and focus groups. The survey was sent to nurses working at a public hospital in the Riyadh region. Participants (N = 77) reported that having more nurse practitioners would improve quality of care and patient safety. Additionally, most participants stated that an increased supply of nurse practitioners would have a positive impact on effectiveness, equity of care, and healthcare costs. In regression analysis, participants with favorable perspectives towards nurse practitioners were significantly more likely to have interest in becoming nurse practitioners (odds ratio [95% confidence interval]:1.04 [1.01-1.07]). In the qualitative domain, three positive factors were identified: effective collaboration with other staff, better contribution to quality care and patient safety, and better contribution to evidence-based practice. Two barriers were also determined: lack of motivation to become a nurse practitioner and unclear scope of practice. Results showed that nurse practitioners can provide quality healthcare services that meet patients' different needs. The growing role of this speciality warrants further research to show its value in daily practice.

Understanding End of Life Nursing Practices and End of Life Across Cultures

Nurses are the largest group of health and social care professionals globally and they are central to the provision of palliative care.

Veränderungen in anhaltenden Extremsituationen

Background

The Covid-19 virus caused increased challenges for nursing professionals.

Objectives

This study aims to explore psychosocial stress in the work environment of nursing staff resulting from the pandemic within an Austrian hospital. In addition, differences in the experience between nurses and nursing assistants, in leadership and management positions, as well as between wards with (suspected) Covid-19 positive patients and wards without Covid-19 patients will be recorded.

Design and Methods

In a mixed-method study, a web-based survey was conducted using the Copenhagen Psychosocial Questionnaire (COPSOQ). The qualitative data was collected with four open questions. The results were analysed descriptively and inferentially with a one-way analysis of variance and the Mann-Whitney-U test. The qualitative data were analysed using content analysis.

Results

A total of 104 participants completed the survey. The results show that there is a burden on nursing professionals (p = 0.03) within the area of emotional and quantitative demands (p < 0.01), but no differences between the individual nursing groups emerged. Leadership and management positions report less stress than the rest of the nursing staff (p ≤ 0.05). When distinguishing between Covid-19 (suspected) wards and non-Covid-19 wards, two scales (demands for hiding emotions % possibilities for development) were statistically significant (p ≤ 0.04).

Conclusion

The results of this study illustrate the psychosocial burden of the Covid-19 pandemic on nurses with different characteristics and are in line with current research. Further studies should address the impact of the burden on nursing practice.

Best Nursing Intervention Practices to Prevent Non-Communicable Disease: A Systematic Review

Objectives: To explore nursing health education interventions for non-communicable disease patients.

Methods: The design was a systematic review of research work published between 2008 and 2018. The data sources included the Web of Science, PubMed, Scopus, COCHRANE, and LILACS. The studies that met the inclusion were assessed, and the analysis for methodological quality through the recommended tools CASPe, and JADAD.

Results: Fifteen original studies from eight counties were included in the review; Findings revealed 13 studies with randomized samples and six used power analysis. Nurses’ interventions included house calls, home care, and individual and group health education.

Conclusion: Nursing interventions showed 76.4% the effectiveness of results in patient outcomes to promote and improve healthier lifestyles and quality of life of non-communicable disease patients. This review discloses the significant impact of nursing health education interventions. Nursing leadership and political decision-makers should consider providing programs to enhance health education knowledge and abilities. All of this can favor the sustainability of the global economy by changing the life style of thousands of people worldwide.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42020208809.

Capacity building in low- and middle-income countries: The essentials of sustainable education programs

ABSTRACT

NPs are an essential resource in the organization and creation of capacity-building efforts to improve healthcare across the globe. There are limited data to guide the creation of effective supplementary education projects. Recent evidence highlights the essential components of sustainability, curriculum development, and program evaluation.

Validation of the Spanish Version of the Questionnaire on Environmental Awareness in Nursing (NEAT)

Environmental awareness of the ecological problems caused by this climate crisis and its impact on global health has been growing globally. Nurses are health care agents that usually hurt the environment and contribute to the unsustainability of the care system. Such behavior is perpetuated without the nurses’ awareness and is even magnified by the current pandemic, jeopardizing the health systems and the Sustainable Development Goals. However, there is no Spanish version of any survey that measures the awareness of these agents, only the Nurses Environmental Awareness Tool (NEAT) is available. The current research presents a unique investigation based on a mixed method, using the Spanish version of the NEAT, also called NEAT-es. The results of the mixed analysis (N = 376), a cognitive interview, and descriptive analysis indicated perfect consistency (Cronbach’s alpha > 0.80), better than the original. The survey validation achieved higher values and can be used to measure environmental awareness in Spain and Spanish-speaking countries.

Nurse Practitioners Navigating the Consequences of Directives, Policies, and Recommendations Related to the COVID-19 Pandemic in Long-Term Care Homes

Objectives

New models for the workforce are required in long-term care (LTC) homes, as was made evident during the Coronavirus Disease 2019 (COVID-19) pandemic. Nurse Practitioner (NP)-led models of care represent an effective solution. This study explored NPs’ roles in supporting LTC homes as changes in directives, policies, and recommendations related to COVID-19 were introduced.

Design

Qualitative exploratory study.

Context

Thirteen NPs working in LTC homes in Ontario, Canada.

Methods

Semi-structured interviews were conducted in March/April 2021. A five-step inductive thematic analysis was applied.

Findings

Analysis generated four themes: leading the COVID-19 vaccine rollout; promoting staff wellbeing related to COVID-19 fatigue; addressing complexities of new admissions; and negotiating evolving collaborative relationships.

Conclusions

Nurse practitioners were instrumental in supporting LTC homes through COVID-19 regulatory changes producing unintended consequences. The NPs’ leadership in transforming care is equally essential in LTC homes as in other established healthcare settings, such as primary and acute care.

Country-level mentoring for advanced practice nursing: A case study

AIM

To describe the mentoring process between the ICN Advanced Practice Nurse Network practice subgroup and the University of Pécs to support the emerging advanced practice role in Hungary, and explore the creation of a mentoring algorithm for faculty and other key stakeholders worldwide who wish to develop advanced practice nursing programs.

BACKGROUND

Advanced practice nurses provide comprehensive clinical care and expand access to care in more than 70 countries. In March of 2017, a representative of the Faculty of Health Sciences of the University of Pécs requested assistance in curricula development for the inaugural advanced practice nursing program in Hungary.

METHODS

A mixed-methods single case study was undertaken. The sources of evidence include interviews, e-mails, review of the literature, and related documents. Qualitative data were analyzed for content, and frequencies were calculated for quantitative indicators.

FINDINGS AND DISCUSSION

The findings highlight the importance of clear communication, development of shared goals, and determination to see the project through. Enriching information was provided by colleagues from diverse global settings. Credibility was gained in Hungary from the support of national and international experts.

CONCLUSION

The mentoring foundation and process facilitated the role development in Hungary and contributed to an increased understanding of advanced practice nurses' scope of practice. The intentional approach and the careful ongoing reflection may lead to future successful endeavors. Multinational engagement and collaborations will promote advanced practice nursing contributions globally.

IMPLICATIONS FOR NURSING POLICY

Mentoring can effectively empower nurses and advanced practice nurses to work to their full capacity. The shared experiences of international mentoring colleagues can contribute to and support the development and acceptance of national policies for the advanced practice nursing roles.

Global emotional and spiritual well-being and resilience of Advanced Practice Nurses during the COVID-19 pandemic: A cross-sectional study

Aim

To evaluate the impact of the COVID‐19 pandemic on the emotional and spiritual well‐being and resilience of a global sample of Advanced Practice Nurses.

Design

A web‐based cross‐sectional mixed methods study. Survey data were collected from Advanced Practice Nurses globally over a 2‐month period ending on 31 August 2020.

Methods

The Warwick‐Edinburgh Mental Well‐being Scale, FACIT‐12 Spiritual Well‐being Scale and Connor‐Davidson Resilience Scale 10 were used to quantify emotional and spiritual well‐being and resilience of Advanced Practice Nurses' globally. The survey was distributed internationally using snowball sampling via a secure platform (Qualtrics). Results were analysed using various bivariate tests for associations and group differences.

Results

Nine hundred and twenty‐eight Advanced Practice Nurses from 53 countries participated in the study. Study participants reported meaningfully lower scores in resilience and emotional well‐being compared with non‐pandemic scores. Participants from countries with well‐developed Advanced Practice Nurses roles reported lower resilience and well‐being scores compared with those from countries where Advanced Practice Nurses roles are still being developed. Each scale revealed significant positive associations with the other scales.

Conclusions

Emotional and spiritual well‐being and resilience of Advance Practice Nurses has been significantly impacted during the COVID‐19 pandemic. Regardless of their work location, work hours, credential or demographics, the APNs in our study reported lower levels of resilience and mental well‐being compared with typical scores on the instruments.

Mental Health of Nurses during the Fourth Wave of the COVID-19 Pandemic in Poland

In the face of the current COVID-19 pandemic crisis, healthcare professionals, including nurses who provide direct care for patients, are at particular risk of mental health problems. The aim of the study was to evaluate the prevalence of symptoms of depression, anxiety, and stress among nurses working in healthcare facilities during the COVID-19 pandemic.

MATERIALS AND METHODS

This was a cross-sectional observational study. A total of 333 professionally active nurses participated in the study. Data was collected in the period from 10 November to 20 November 2021. We collected sociodemographic data and used the short form of Depression Anxiety Stress Scale (DASS-21) to assess the mental health among nurses.

RESULTS

Severe and very severe symptoms of depression were found in 23.1% of nurses, whereas moderate symptoms were detected in 30.3%. High to very high levels of anxiety were observed in 46.5% of respondents, while 25.8% of nurses showed a moderate level of anxiety. Moderate and high levels of stress were found in 35.4% and 14.1% of the respondents, respectively. Contact with a patient suspected of having SARS-CoV-2 infection was a significant predictor of depressive symptoms. Gender, workplace, and contact with patients suspected of SARS-CoV-2 infection and patients with COVID-19 were significant predictors of anxiety, whereas contact with patients suspected of being infected with SARS-CoV-2 and COVID-19 patients was a significant predictor of stress.

CONCLUSIONS

High scores for depressive symptoms, anxiety, and stress among Polish nurses during the fourth wave of the COVID-19 pandemic are indicative of a direct threat to the mental health of nurses. Targeted support strategies need to be developed and implemented to prevent the deterioration of mental health in this group.

Optimizing the Global Nursing Workforce to Ensure Universal Palliative Care Access and Alleviate Serious Health-Related Suffering Worldwide

CONTEXT

Palliative care access is fundamental to the highest attainable standard of health and a core component of universal health coverage. Forging universal palliative care access is insurmountable without strategically optimizing the nursing workforce and integrating palliative nursing into health systems at all levels. The COVID-19 pandemic has underscored both the critical need for accessible palliative care to alleviate serious health-related suffering and the key role of nurses to achieve this goal.

OBJECTIVES

1) Summarize palliative nursing contributions to the expansion of palliative care access; 2) identify emerging nursing roles in alignment with global palliative care recommendations and policy agendas; 3) promote nursing leadership development to enhance universal access to palliative care services.

METHODS

Empirical and policy literature review; best practice models; recommendations to optimize the palliative nursing workforce.

RESULTS

Nurses working across settings provide a considerable untapped resource that can be leveraged to advance palliative care access and palliative care program development. Best practice models demonstrate promising approaches and outcomes related to education and training, policy and advocacy, and academic-practice partnerships.

CONCLUSION

An estimated 28 million nurses account for 59% of the international healthcare workforce and deliver up to 90% of primary health services. It has been well-documented that nurses are often the first or only healthcare provider available in many parts of the world. Strategic investments in international and interdisciplinary collaboration, as well as policy changes and the safe expansion of high-quality nursing care, can optimize the efforts of the global nursing workforce to mitigate serious health-related suffering.

Estratégias internacionais de flexibilização da regulação da prática de profissionais de saúde em resposta à pandemia da COVID-19: revisão de escopo

A COVID-19 foi classificada como pandemia pela Organização Mundial da Saúde (OMS) em 11 de março de 2020. Diante da sua acelerada propagação, governantes, comunidades e serviços de saúde estão tendo que agir na mesma velocidade para ampliar a capacidade da força de trabalho em saúde. Este estudo objetivou, a partir do método revisão de escopo [scoping review], identificar as principais estratégias relacionadas a medidas de flexibilização de regulações que regem as práticas de profissionais de saúde que vêm sendo adotadas e/ou recomendadas internacionalmente. O estudo seguiu as etapas propostas pelo Instituto Joanna Briggs. Para a construção da questão de pesquisa, utilizou-se o método PCC (população, conceito e contexto). A busca se baseou nas seguintes bases de dados: PubMed, Scopus e Base de Dados da OMS; e na literatura cinzenta. Foram identificados 36 documentos, classificados nas seguintes estratégias: (1) ampliação de escopo de prática; (2) transferência de funções de uma categoria profissional para outra; (3) autorização para atendimento e faturamento via telemedicina; (4) licenciamento e recrutamento de profissionais não ativos; (5) recrutamento de profissionais de outras regiões/estado; (6) mudanças na formação e oferta de treinamento. Uma das estratégias mais importantes em resposta a situações de escassez de profissionais de saúde tem sido e a disponibilidade para adaptar, ampliar e redistribuir as atividades dos profissionais, de modo a atender as rápidas mudanças. Esta revisão reflete a importância em se realizarem reformas nas regulações profissionais de forma a otimizar a força de trabalho em saúde existente para que esta possa atender às demandas constantes de necessidade da população.

Kirkpatrick's evaluation of the effect of a nursing innovation team training for clinical nurses

AIM

This study aims to design a 100-h training programme for nursing innovation teams and to evaluate the effect of this training programme using Kirkpatrick's model.

BACKGROUND

The innovative capability of nurses is a powerful driver for the development of the nursing discipline, and it is currently at a low to medium level in China. Innovation competency development has become a research trend in nurses' in-service education, but only changes in nursing innovation behaviours before and after training have been evaluated. The cascading, continuous assessment tools are rarely used.

METHODS

This is a quasi-experimental research design: pretest and posttest design. Totally, 61 clinical nurses from Hangzhou Hospital of Traditional Chinese Medicine were enrolled for innovation training. This innovation team training programme consisted of a 36-h theoretical training phase and a 64-h collaborative training phase. The four levels of Kirkpatrick's model, that is, reaction, learning, behaviour, and result, were applied for the evaluation together with questionnaires.

RESULTS

At reaction level, the nurses' attendance was over 85% in two phases. The differences between nurse organizational innovation climate scores of tested nurses before and after training were statistically significant (t = -22.559, P < .001). At learning level, there were statistically significant differences between nurses' innovation self-efficacy scale scores of tested nurses before and after training (t = -16.832, P < .001). At behaviour level, the nursing innovation behaviour scale scores of tested nurses were significantly higher after training (t = -18.950, P < .001) than before the training. At result level, the clinical nurse innovation ability of tested nurses after the training were higher than before the training (t = -26.275, P < .001). The numbers of patent applications, granted patents, application for scientific research projects, sponsored scientific research projects, and papers published by team members after the training were larger than those before training (Z = -2.032, P = .042).

CONCLUSION

Kirkpatrick's model can evaluate the effectiveness of nursing innovation training for clinical nurses. The nursing innovation training is beneficial to improve nurses' innovation capacity, organizational innovation climate and innovation self-efficacy, and nursing innovation behaviour and promote the output of research and innovation projects.

IMPLICATIONS FOR NURSING MANAGEMENT

Managers can flexibly develop training modules with regional characteristics based on this programme to effectively improve the innovation ability of clinical nurses, thus meeting the urgent demand for innovative nursing talents and the rapid development of nursing disciplines.

Access to Care: End-to-End Digital Response for Covid-19 Care Delivery

The coronavirus disease 2019 pandemic disrupted health care, requiring organizational leaders to act quickly to manage the health-related concerns of individuals and communities. The ability to offer a variety of digitally enabled telehealth services with 24/7 access to nurse practitioners and physician assistants allowed us to care for patients in their homes. It reduced the spread of the virus, protected our employees from further disease spread, and provided early interventions to those in need. The roles of nurse practitioner leaders, the enacted strategies, and patient outcomes demonstrate the impact of an innovative digital care delivery model on care across the continuum.

Nurse practitioner led model of after-hours emergency care in an Australian rural urgent care Centre: health service stakeholder perceptions

Background

The challenges of providing and accessing quality health care in rural regions have long been identified. Innovative solutions are not only required but are also vital if effective, timely and equitable access to sustainable health care in rural communities is to be realised. Despite trial implementation of some alternative models of health care delivery, not all have been evaluated and their impacts are not well understood. The aim of this study was to explore the views of staff and stakeholders of a rural health service in relation to the implementation of an after-hours nurse practitioner model of health care delivery in its Urgent Care Centre.

Methods

This qualitative study included semi-structured individual and group interviews with professional stakeholders of a rural health service in Victoria, Australia and included hospital managers and hospital staff who worked directly or indirectly with the after-hours NPs in addition to local GPs, GP practice nurses, and paramedics. Thematic analysis was used to generate key themes from the data.

Results

Four themes emerged from the data analysis: transition to change; acceptance of the after-hours nurse practitioner role; workforce sustainability; and rural context.

Conclusions

This study suggests that the nurse practitioner-led model is valued by rural health practitioners and could reduce the burden of excessive after-hour on-call duties for rural GPs while improving access to quality health care for community members. As pressure on rural urgent care centres further intensifies with the presence of the COVID-19 pandemic, serious consideration of the nurse practitioner-led model is recommended as a desirable and effective alternative.

An Update on Billing and Coding for the Psychiatric-Mental Health Nurse Practitioner

Nurse practitioners (NPs) possess expert clinical knowledge that can be optimized to ensure delivery of high-quality care. In the United States, NP scope of practice is generally expanding. With expanding scope of practice comes increased revenue potential, and in some cases, entrepreneurial opportunities for NPs. Therefore, NPs must be familiar with current procedural terminology codes to ensure appropriate billing and maximize reimbursement from payers. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Work environment of hospital nurses during the COVID-19 pandemic in Brazil

AIM

To investigate the nurses' work environment in university hospitals during the COVID-19 pandemic in Brazil.

BACKGROUND

The COVID-19 pandemic brought challenging times for nurses worldwide. In Brazil, as well as in several countries, nurses are working hard in hospital settings caring for patients infected with the virus, sometimes with unfavourable work environment conditions.

METHODS

This study was a convergent embedded mixed methods research. The sample comprised 104 nurses from three Brazilian university hospitals. Data were collected in April-June 2020 from an online questionnaire with a self-reporting Likert scale survey designed to measure the nurses' perceptions of their work environment. Qualitative data in the form of written comments were also collected through an open question. Data were analysed using descriptive statistics and content analysis.

RESULTS

The quantitative results showed that the responses to 'I received training on the correct use of personal protective equipment' and 'I am afraid of being infected' items had the best and worst evaluations, respectively. The qualitative findings revealed five themes: feeling of insecurity, lack of personal protective equipment, lack of diagnostic tests, changes in the care flow and fear of the unknown.

CONCLUSION

The study has highlighted the challenges faced by hospital nurses while caring for patients with COVID-19.

IMPLICATIONS FOR NURSING AND NURSING POLICY

The gaps identified will assist the policymakers and hospital managers in developing policies to enhance the support offered to nurses and improve the care provided to patients with COVID-19 in university hospitals. The results also indicate the need for attention to the mental health of the professionals due to the increasing workload and treatment of an illness hitherto unknown.

The Role of Advanced Practice Providers in Urology

The nation's undersupply of urology services disproportionately affects Medicare beneficiaries compared to the general population. Advanced Practice Providers (APPs), most commonly nurse practitioners and physician assistants may be a vehicle to meet this need. The increased use of APPs in urology is hampered by physician discomfort with delegating responsibility to APPs. This discomfort may be compounded by complexities with billing issues and interstate variation in scope of practice regulations. To expand access to urological services while simultaneously ensuring service quality, it is imperative that urologists engage with APPs individually and as a specialty.