Perceptions of the effectiveness of Advanced Practice Nurses on a neurosurgery unit in a Canadian Tertiary Care Centre:A pre-and-post implementation design

Objectives:A framework for the advanced practice nurse(APN)role was developed in our Canadian Tertiary Care Centre,delineating five domains of advanced nursing practice:clinical practice,consultation,research,education and leadership.The goal of this study was to evaluate perceptions of the effectiveness of the implementation of an innovative APN role on an in-patient Neurosurgery unit.Methods:A pre-and-post implementation design,incorporating both qualitative and quantitative data,was utilized.An innovative APN role was implemented within the Neurosurgery program focusing on the clinical domain and required the successful candidates to be NP prepared.This APN role was designed to improve patient flow,documentation,communication and patient and staff satisfaction.Three primary outcomes were measured:pre-implementation questionnaire(nurses),post-implementation questionnaire(nurses and residents)and number of pages to the on-call resident.Results:Survey scores by nurses and residents indicated improvement across all aspects studied.Average scores increased from 1.1 to 2.6,reflecting an overall statistically significant increase.The number of pages to the on-call resident also showed a decrease.Conclusion:Perceptions of patient care delivery and professional collaboration improved following implementation of the APN role.Responses indicated that APNs significantly impacted patient care and improved nurses and residents'job satisfaction.

A review of advanced practice nursing in the United States, Canada, Australia and Hong Kong Special Administrative Region (SAR), China

This paper provides an overview of Advanced Practice Nursing(APN)in the USA,Canada,Australia and Hong Kong.It is based upon documents presented to the China Medical Board(CMB)China Nursing Network(CNN)as background for discussions held by the CNN in Shanghai.It discusses the APN role in these countries and regions according to topics identified by the CNN.These are APN educational preparation;role legitimacy;capacity requirements;scope of practice,domains of activities and limited rights for prescription and referral;professional promotion ladder;accreditation system;and,perfor-mance evaluation system.Both Canada and Australia have adapted many aspects of the USA model of APN to fit their specific legislative requirements and local conditions.Hong Kong has taken a different path which may be of interest in the Chinese context.

Strategic directions and actions for advanced practice nursing in China

There is a need and opportunity for China to develop education and practice innovations given that advance practice nurses (APNs) improve health care and outcomes.The China Medical Board (CMB)China Nursing Network (CCNN) began planning for an Advanced Nursing Practice Program for education and career development that will facilitate CCNN's contributions to meeting national nursing policy priorities.This paper presents the discussion,recommendations and action plans developed at the inaugural planning meeting on June 26,2015 at Fudan University in Shanghai.The recommendations are:Develop standards for advanced nursing practice;Develop Master's level curricula based on the standards;Commence pilot projects across a number of University affiliated hospitals;and Prepare clinical tutors and faculty.The strategic directions and actions are: Develop a clinical career ladder system;Expand the nursing role from hospital to community;and Build a specialty nurse accreditation system.

Examining advanced nursing practice in Hong Kong and Guangzhou

Objective:There were studies evaluating advanced nursing practice independently in the mainland and Hong Kong Special Administrative Region of China,but there was no attempt to make a comparison of practice between them.This study employed a case study method to examine and compare advanced nursing practice in Hong Kong and Guangzhou.Method:Purposive sampling method was used to recruit 24 advanced practice nurses(APN)who came from the specialty of medical,surgical and pediatric in Hong Kong and Guangzhou.A questionnaire survey and semi-structured interview were conducted to solicit quantitative and qualitative data for exploring the structure-process-outcome of advanced nursing practice.The structure component explored the factors influencing advanced nursing practice.The process part examined APN role components and illustrations of exemplary advanced nursing practice.The outcomes described outcome indicators that best reflected advanced nursing practice.Findings:Findings revealed that in the structure domain,APN education and career development,team approach in healthcare,and support from management,physicians and professional associations were important contextual factors for APN development in both cities.For the process domain,participants had at least 80%of their time practicing independently/interdependently and were engaged in APN activities including direct/indirect patient care,research/project work,initiation of staff and patient protocols.All participants demonstrated competencies with impacts on patient,service and profession in their description of exemplary practice.Participants from both cities ranked patient-related outcomes as top indicators for their advanced nursing practice.Conclusion:This study has revealed that APNs in Guangzhou and Hong Kong shared similar work involvement and impacts and their demonstrated competencies were on par with international counterparts.Continued efforts need to be put in establishing formal APN education,clear clinical career pathway and title protection to empower nurses to provide optimal care to the fullest extent that they are prepared for.

A survey of moral distress in certified registered nurse anesthetists:A theoretical perspective for change in ethics education for advance practice nurses

Objective:The aim of this study was to examine the relationship between moral distress that may affect patient safety,and the clinical practice model,assessing ethical decision-making skills of certified registered nurse anesthetists(CRNAs).Methods:A survey using the Ethical Stress Scale(ESS)and the Ethical Assessment Skills Survey(EASS)was conducted with 134 CRNAs.Results:Results indicated no significant effect of practice model on level of moral distress or perceived ethical assessment skill knowledge[Wilks's lambda=0.952,F(6,256)=1.068,P=0.382,n^(2)=0.02].A statistically significant positive correlation existed between importance and skill(r=0.275,P=0.001).CRNAs felt skilled to manage the actions or activities they deemed important.Conclusion:CRNAs who perceived a higher skill level in addressing ethical issues experienced lower levels of moral distress.Findings indicate content-specific curricula for the CRNAs need to be evaluated for ethical decision-making skill assessment content.

Contextualisation of Early and Enhanced Clinical Exposure Model through Development of Curricula for Advanced Practice Nursing and Midwifery

Background: An Advanced Practice Nurse is a generalist or specialized nurse who has acquired thorough graduate education a minimum of a master’s degree. The need for Advanced Practice Nurses is increasingly recognized globally. This paper describes the process, which was undertaken by School of Nursing Sciences, University of Zambia in reviewing and developing advanced practice nursing and midwifery curricula which will be implemented using the Early and Enhanced Clinical Exposure model (EECE). Materials and Methods: The curricula development/review process utilized a modified Taba’s Model which followed a step-by-step approach including: 1) desk review, 2) diagnosis of needs (needs assessment), 3) stakeholder consultations, 4) content development, 5) validations and approval from which several lessons were learnt and recommendations made. Findings and recommendations from different stages were used as a basis for reviewing and developing advanced practice nursing and midwifery curricula. Results: Desk review needs assessment and stakeholder consultations identified both strengths and weaknesses in the existing curricula. Major strengths were duration and core courses which met the minimum requirement for postgraduate nursing and midwifery training. Major weaknesses/gaps included some content that was too basic for the master’s level and the delayed exposure to practicum sites which limited the development of advanced practice skills. Others were inadequate competence for advanced practice, inadequate research methodology course, lack of content to foster development of personal soft skills and predominant use of traditional teaching methods. Stakeholders recommended implementing advanced, clinical and hands-on Masters of Nursing and Midwifery programmes which resulted in the review of four existing and development of five demand-driven curricula. Conclusion: The reviewed and developed curricula were strengthened to close the identified gaps. Both the reviewed and developed curricula have been implemented using the Early and Enhanced Clinical Exposure Model with a view to producing Advanced Practice Nurses and Midwives who are competent to meet diverse health care needs and contribute to improving patient outcomes.

Nurses Perception of Advance Nurse Practitioners Roles in Public Hospitals: A Qualitative Study

Aim: To explore the nurses’ perceptions about the advanced nurses’ practitioner’s role in public hospitals in Saudi Arabia. Background: Advanced nurse practitioners are one of the leading professionals who contribute to health promotion, disease prevention, health counseling and patient education. However, misunderstandings of their roles may have an impact on the performances of the function that limits their access and the use of significant resources that can help patients to obtain treatment. Methods: This is a qualitative exploratory study conducted on nurses working in three public hospitals. Semi-structured interviews were conducted among fourteen nurses between October-January 2020. The three public hospitals were based in Eastern (1) and Central (2) Saudi Arabia regions. Data analysis was conducted through thematic analysis utilizing inductive and deductive coding. Results: The study found that the role of Advanced Practice Nurses will enhance, motivate, and sustain the status of nurses in Saudi Arabia. Findings indicated that advanced practitioners’ educational preparedness, organizational, and contextual factors are important factors that need to be addressed to promote their role and to improve nurse’s perception about the APN role in clinical practice. Conclusion: This research provided new evidence to support the need to raise understanding of the role of advanced nurse practitioners among nurse members, advanced nurses and clinical nurse specialists who wish to enhance quality healthcare delivery and job satisfaction in the Kingdom of Saudi Arabia. Recognizing the factors that comprise the function and status of APNs will assist health-care officials to make informed decisions when designing a national policy and a plan for the implementation and the development of the role of APNs.

Current status of clinical nursing specialists and the demands of osteoporosis specialized nurses in China's Mainland

The clinical nursing specialist(CNS)is an expert who applies an expanded range of practical,theoretical,and research-based competencies to the care of patients within in a specialty clinical area within the larger discipline of nursing.A large number of studies consistently conclude that the CNS is a valuable healthcare resource that provides highquality clinical and evidence-based nursing practice and improves patient outcome.The CNS has been involved in healthcare practices for many years,with an increasingly diverse role.However,the training for the CNS in China is only in a preliminary developmental stage.The aim of this article is to review the history and development of the CNS role.Furthermore,the epidemiologic status of osteoporosis,as well as the feasibility and necessity of developing training programs in China for the osteoporosis CNS,will be discussed.

A systematic review of the effectiveness of clinical nurse specialist interventions in patients with chronic obstructive pulmonary disease(COPD)

Objective： This review aimed to examine the effectiveness of clinical nurse specialist （CNS） interventions in patients with chronic obstructive pulmonary disease （COPD）. COPD significantly affects people＇s health worldwide. With the development in nursing, CNSs are playing increasingly important roles in different departments. However, the studies on the effectiveness of CNSs in COPD are not as well organized as the studies on the effectiveness of CNSs in bronchiectasis and asthma. Therefore, this review aims to find some updated evidence on the CNS interventions for patients with COPD and on whether these interventions are effective.Methods： A narrative analysis of the data was performed for the eligible studies. Four databases were chosen： CINAHL, MEDLINE, British Nursing Index, and Cochrane Library. Other websites such as the National Institute for Health and Clinical Excellence, National Health Service Evidence, Association of Respiratory Nurse Specialists, and National Association of Clinical Nurse Specialist were searched as well. Two reviewers performed study identification independently, and all the retrieved articles were stored using the EndNote X7 software. The risk of bias in the included studies was assessed using the Cochrane Collaboration＇s risk of bias tool. Results： A total of nine studies were included in this review. There were five current interventions by CNSs for patients with COPD. These interventions were home nursing support, CNS]s supported discharge, multidisciplinary cooperation programs, nurse-led care programs, and self-care management education. The effectiveness of these five interventions was evaluated individually. There is low- to moderate-quality evidence indicating that home nursing support interventions may have a positive effect on mortality and quality of life. No significant difference in quality of life has been found between the CNS-supported discharge intervention and the usual service. The multidisciplinary cooperation program probably had a positive effect on quality ot life in patients with COPD. Both nurse-led care and self-care management education intervention had a positive effect on mortality of patients with COPD.Conclusions： The findings of this review provide updated evidence on the effectiveness of CNS interventions for patients with COPD. Although nine trials were included and five types of interventions were identified, there is still lack of high-quality evidence.

国外APN实践阻力因素与促进因素的研究进展

介绍了高级实践护士(APN)实践的促进因素与阻力因素,以期为医疗系统引入APN角色的顶层设计提供指导,也为帮助APN个人完成角色转变的适应过渡,实现APN全范围、自主、高效实践提供参考。

Realities,scope,challenges,and facilitators for implementation of nurse practitioner's role in India:A review

India is in dire need of an alternative to general medical practitioners to overcome a severe shortage of doctors,especially in rural and underprivileged regions.Empowering nurses through nurse practitioner(NP)role is the superlative solution to provide quality health care in primary care setting.Based on conceptions and research findings of the NP's role,we analyzed and examined the realities,scope,and barriers for implementing the NP's role in India and propose future strategies to create a NP cadre.

Advanced practice nurses transitional care promotes anticoagulation therapy of warfarin in atrial fibrillation patients in South China

Background Advanced practice chronic conditions. However, nurse transitional care has been proofed to be important for older adults with such effectiveness has never been studied in the management of appropriate Warfarin use in clinical practice. Methods A total of 97 patients were randomly distributed into control group who received usual care, and interventional group who received transitional care provided by APNs. A 12-month observation of both groups were recorded by physicians and APNs and the impact of APNs on the managing of Warfarin therapy was also evaluated based on time in the therapeutic range （TTR）. Results APNs transitional care significantly （P 〈 0.01） improved patients＇ adherence, increased TTR and high TTR ratio compared with control group. Re-admission due to stroke was significantly （P 〈 0.01） reduced by APNs transitional care. Conclusion APNs transitional care improves patients＇ knowledge on AF and reduces stroke risk. The current research strongly suggest the necessity of APNs transitional interventional in managing anticoagulation therapy in AF patients in China.

What are the barriers to implementing nurse practitioners’ role in health settings?

Background:Nurse practitioners can assist the healthcare system by administering care to patients with medical or complex or chronic conditions by providing medical and nursing care in an expanded scope of practice.However,there are barriers that influence the implementation of nurse practitioners'role in health settings.Influences among systemic or organization levels have impeded nurse practitioners'role implementation.All 10 studies included in this integrative review are critically explained based on the relevant information categorised into three themes:a lack of clarity regarding nurse practitioners'role,fees for service physician remuneration and resistance from other health professionals.The 10 studies included in this integrative review reveal barriers to nurse practitioners'role implementation in health settings.Objectives:The aim of this integrative literature review is to identify the barriers to implement the nurse practitioners'role.Therefore,the following research question is posed:"What are the barriers to implementing the nurse practitioners'role in health settings?".Methods:An integrative review of the medical and nursing research literature has been conducted using a systemic search accessing CINAHL,Medline,Scopus and PubMed databases.The identified 287 articles have been narrowed to 10 articles based on specific inclusion and exclusion criteria.A limitation search was applied at the beginning of the search phase to assist in identifying the range and type of studies potentially available for synthesis.The srearch was limited to human,peer reviewed and full text articles available in English language without a date limitation to obtain a large number of avilable studies that were relevant to the topic.Finding:The literature search resulted in 10 primary studies that met the inclusion criteria.All studies included in this integrative review reveal barriers to nurse practitioners'role implementation in health settings.All studies found three barriers that can impact on the implementation which are:the lack of clarity of nurse practitioners'role,fees for service physician remuneration and resistance from other health professionals.Conclusion:Health settings must prepare the surrounding environment and the culture before implementing a new role,such as that of nurse practitioners.Implementing new roles into the organization is not straightforward:multiple influences can affect the implementation,such as barriers.Understanding the involvement of nurse practitioners'role in health settings by health care providers have to be visible and clear and changes that may occur as a result of implementing the role need to be identified to ensure the successful implementation.

Geriatric nursing competence of clinical nursing staff at different hospital levels in Chongqing,China:A cross-sectional study

Objectives:This study aimed to survey the geriatric nursing competencies of clinical nursing staff in Chongqing City,China,and provide suggestions to enhance these competencies.Methods:This study was conducted in 204 hospitals in Southwest China from December 24,2022 to January 7,2023.The“Geriatric Nursing Competence of Clinical Nurse Investigation Tool”was used to explore factors that influence geriatric nurses’competencies via stratified sampling.The survey was conducted by distributing and collecting questionnaires through the online platform Wenjuanxing.Results:A total of 10,692 nurses answered the questionnaires.Of these questionnaires,9,442 were valid.The total geriatric nursing competence score of the clinical nursing staff was 2.29±0.81,the secondary hospital score was 2.23±0.78,and the tertiary hospital’s overall mean score was 2.33±0.83.The factors that influenced secondary hospitals included the department of medicine,age of nurses and total length of career(P<0.05).The factors that influenced tertiary hospitals included the department of medicine,age of nurses,nurses’professional title,and geriatric practical advanced nurses’certification(P<0.05).Conclusions:Geriatric nursing competence among clinical nursing staff is imbalanced at a lower-middle level and is influenced by various factors.Thefindings highlight the need for further clinical training in geriatric nursing.The training of geriatric nurses should focus on necessary clinical skills and on preparing them to adequately manage comprehensive geriatric syndromes.

APN排班工作职责作为实习目标的临床护理教学效果初探

目的 探讨APN排班工作职责作为实习目标的临床教学效果.方法 将2届护理实习生37人分为观察组和对照组：观察组（n=15）应用APN排班目标计划,对照组（n=22）应用周目标计划,对比2组护理实习生的出科考核成绩.结果 问答题分数：观察组为（19.80±8.33）分,对照组为（14.81±3.54）分,P＜0.05;基础护理操作分数：观察组为（86.46±4.46）分,对照组为（81.36±6.07）分,P＜0.01,差异均有统计学意义.结论 APN排班工作职责作为实习目标使临床护理实习生更能理论联系实际,达到提高临床护理教学效果.

以护理工作室为依托的APN模式在缺血性脑卒中病人居家康复中的应用

目的:探讨以护理工作室为依托的高级实践护士(APN)模式在缺血性脑卒中病人居家康复中的应用效果。方法:采用便利抽样的方法,将2020年10月—2021年1月成都市某三级甲等医院康复科和神经内科的缺血性脑卒中病人56例随机分为干预组29例和对照组27例。干预组采用APN模式依托护理工作室的方法进行缺血性脑卒中居家康复指导,对照组采用传统出院指导及定期健康随访的方法。分别于出院时和出院后1个月、3个月、6个月以及1年使用美国国立卫生研究院卒中量表(NIHSS)、改良Rankin量表(mRS)、改良Barthel指数评定量表(MBI)以及汉密尔顿抑郁量表(HAMD)对两组病人的神经功能恢复状况、生活自理能力及心理状况进行评估。结果:干预组病人NIHSS评分在出院1个月及3个月得分低于对照组,mRS评分在出院3个月及6个月得分低于对照组,MBI得分在出院3个月、6个月以及1年得分高于对照组,HAMD评分在出院1个月、3个月、6个月以及1年得分低于对照组,差异均有统计学意义(P<0.05)。重复测量方差分析显示,出院时长、分组与出院时长的交互作用对NIHSS、mRS以及HAMD评分有影响(P<0.05)。结论:APN模式依托护理工作室能改善缺血性脑卒中病人神经功能恢复,提高病人生活自理能力并且有利于病人心理状况康复。

A theoretical framework for interaction of nursing discipline with genetics and genomics

Background:Since the completion of the Human Genome Project,health science has been strongly influenced by the advances in genetics and genomics.However,the progress of embracing genetics and genomics into nursing discipline is limited.One of the main barriers is lack of understanding on the relevancy of genetics and genomics to nursing discipline.Objectives:This paper aims to synthesize and develop a theoretical framework for the interaction of nursing discipline with genetics and genomics.Methods:Through content analysis and constant comparative method,a theoretical framework was developed from synthesis of the studies regarding nursing and genetics/genomics indexed in multiple English and Chinese databases.Results:Four main theoretical statements were constructed in the framework:1)There are three ways to show how genetics and genomics can influence nursing discipline:a new specialty,new technologies and a new lens;2)The significant contribution of nursing discipline to genetics and genomics lies in how nurses could focus on the association between human responses and genes and how nurses could advocate for their clients in the genetic and genomic era;3)A paradigm shift occurs after a constant interaction of nursing discipline with genetics and genomics;4)Implementation strategies could be used to facilitate the integration of genetics and genomics to nursing discipline and advance the paradigm shift.Conclusions:The framework will help to understand the relationship between nursing discipline and genetics and genomics and implicate the future studies integrating genetics and genomic science into nursing discipline.

心脏康复APN发展现状与研究进展

高级实践护士(advanced practice nurses, APN)主导的心脏康复二级预防护理在预防和治疗心血管疾病显示出积极的结果, 为高质量慢性病管理做出了积极贡献。本文围绕心脏康复APN在国内外发展现状、临床价值及其未来的培养发展方式等展开综述, 旨在为我国心脏康复APN的发展提供借鉴。

高级实践护士角色能力评价研究进展

目前国际上较认可的高级实践护士(APN)角色能力评价工具有APN评估工具包、Scarpa的APN角色评估工具、Strong高级实践角色描述工具(M-Strong APRD)和胜任力角色评价工具(PEAC Tool)等。角色能力评价指标包括患者质量安全指标、护理专业发展指标、多学科合作指标和对医疗保健系统的影响指标等。本文旨在总结国际上APN角色能力评价的方法,为我国APN角色能力评价提供理论依据。在临床应用时,可将角色能力评价工具和角色能力评价指标相结合,综合应用多维度的评价方式进行全面地评价,以更好地明确APN的独立贡献。

中国台湾地区护理岗位进阶管理现状及启示

“十四五”时期,公立医院进入高质量发展新阶段,为进一步提升护理科学化管理水平,建立完善的护理岗位管理制度,深化护士岗位管理工作,文章从我国台湾地区医院护理人员的岗位进阶管理发展、管理现状等方面进行梳理归纳,以期为我国未来的护理岗位管理工作提供参考。