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.

Tendency and foci of nurse practitioners:bibliometric analysis based on the CiteSpaceV

Objective:Nurse practitioners(NPs)have drawn significant attention recently and played a major role in healthcare.We aim to find the evaluation of NPs through published studies and then visualize the research status and hotspots in this field.Methods:All data came from the Web of Science Core Collection,and the data were counted and entered into Excel 2016.The key documents nodes were excavated by analyzing the knowledge network map using Cite Space V software.In this study,these nodes of“author,country,institution,keyword,co-citation(referencecited-authorcited-journal),and grant”were harvested for analysis and comparison.Results:A total of 4912 records,which were published between 2007 and 2018 and pertained to NPs,were retrieved from the Web of Science Core Collection database(Wo SCC)from a diversity of languages.The total and the annual number of publications and citations of these continually increased over time.Most publications were in 2018(618 records).This study involved 8241 authors located in 98 countries and 4557 institutions totally.The United States(2737 records)and the University of Michigan(90 records)dominated in publication frequency.There are 902 journals and 2449 articles with funding support that have been analyzed.Most articles were from JAMA:The Journal of the American Medical Association(1386,IF=47.661),followed by the Journal of Advanced Nursing(1359,IF=2.267),and The New England Journal of Medicine(1109,IF=79.258).The reference“The Role of Nurse Practitioners in Reinventing Primary Care”was co-cited most frequently,which revealed it as the highest landmark article in NP.The top-ranked keyword was“Care,”other than“Nurse practitioner,”which has an ultra-high frequency.Some of the high-frequency keywords represent the significant direction of NPs.Conclusions:NPs are at the crux of health-care delivery and play an important role in providing high-quality nursing.Publications on NPs in Wo SCC have increased notably during the recent years,and have appeared in some journals that have a high impact factor.Research frontiers and developmental trends were revealed by the analysis in this study,which can be used to forecast future research developments in NPs and taken as a reference to choose the right directions by subsequent researchers who wish to use these results.However,the grant support from administration or research institutions is still in need of improvement and the scope of research in NPs should be broadened in the future.

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.

重症医学高级实践护士的研究进展

从重症高级实践护士的起源和发展、资格认证、应用现状、临床价值以及国内外重症专科高级实践护士的培养现状及处方权问题等方面进行综述,以提高当前的重症护理服务质量和水平,为我国高级实践护理的规范化管理提供参考。

A family nurse-led intervention for reducing health services’utilization in individuals with chronic diseases:The ADVICE pilot study

Objectives:Intensive health services'utilization is common in older individuals affected by chronic diseases.This study assessed whether a structured family nurse-led educational intervention would be effective in reducing health services'use(readmissions and/or emergency service access)among older people affected by chronic conditions.Methods:This is a non-randomized before-after pilot study.A sample of 78 patients was recruited from two general practices in Italy and 70 among them were followed for 8 months.Standard home care was provided during the first four months'period(months 1-4),followed by the educational intervention until the end of the study(months 5-8).The intervention,based on the teach-back method,consisted of by-weekly 60-min home sessions targeting aspects of the disease and its treatment,potential complications,medication adherence,and health behaviours.Rates of health services'use were collected immediately before(T0),and after the interventions(T1).Differences in utilization rates were examined by the McNemar's test.Potential factors associated with the risk of health services'use were explored with a Cox proportional hazard regression model.Results:The sample(n=78)was predominantly female(n=50,64.1%),and had a mean age of 76.2(SD=4.8)years.Diabetes mellitus was the most frequent disease(n=27,34.6%).McNemar's test indicated a significant reduction in health services'use at T1(McNemar χ^(2)==28.03,P<0.001).Cox regressions indicated that time and patient education,as well as their interaction,were the only variables positively associated with the probability of health services'use.Conclusion:A teach-back intervention led by a family nurse practitioner has the potential to reduce health services'use in older patients with chronic diseases.

A Case Study Evaluation Protocol to Assess Processes, Effectiveness and Impact of a Nurse Practitioner-Led Memory Clinic

The prevalence of dementia is predicted to increase significantly as the population ages and with no foreseeable cure options the burden of dementia will continue to grow. Early diagnosis provides many benefits, including timely access to appropriate support services and provision of tailored therapeutic interventions for people with dementia and their carers. Memory clinics are a key response to the need for specialist assessment and diagnosis of dementia. Multidisciplinary team memory clinics are considered the “gold standard”;however, such resource intensive clinics are likely unsustainable. The nurse-led memory clinic format may provide a primary care focused, diagnostic service for dementia that does not have the cost implications of multidisciplinary memory clinics but there is limited research using nurse practitioners. This study is exploring the potential of a nurse-led memory clinic as a primary health care approach to health promotion (brain health awareness), disease prevention (risk factor reduction) and early intervention (diagnosis and management of dementia). A realistic evaluation of a nurse practitioner-led memory clinic is described. Realistic evaluation is concerned not only with the outcomes of an intervention but also with the context and mechanisms of the intervention. We are using a mixed methods case study design to describe and evaluate the impact of the nurse practitioner-led memory clinic. The nurse practitioner in this study is an advanced practice aged care nurse who focuses on mental health, and dementia diagnosis, management and risk factor reduction. This study seeks to inform the development of an expanded scope role for nurse practitioners in assessment and referrals for dementia diagnosis. The heterogeneity of clients attending the nurse-led memory clinic will allow us to evaluate what works in the memory clinic, for whom, and under what circumstances, in what respects, and to what extent.

Canadian nurse practitioner's quest for identity:A philosophical perspective

The role of nurse practitioners in primary healthcare has been validated over the years and is now being considered as a key solution in various primary healthcare settings to the provision of comprehensive care.The context in which the role has been established positions nurse practitioners'practice within medical and nursing paradigms.As the healthcare system evolves,nurse practitioners must define their identity to advocate for roles that reflect their professional values.A historical overview highlighting the context in which the NP role expanded will guide a philosophical discussion regarding role identity.After exposing tensions between the nursing and medicine disciplines,Abbots'theory of profession will be utilized to understand the foundations leading to initial research on nurse practitioner integration within the healthcare system.Feminist philosopher bell hooks'discourse on marginality will serve as a platform to reflect on the nurse practitioner identity within the current social context.Foucault's notions of governmentality,parrhesia and care of the self will then guide reflections regarding ways for nurse practitioners to locate themselves as a profession.

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.

A qualitative study of nurse practitioner promotion of interprofessional care across institutional settings:Perspectives from different healthcare professionals

Objective:Interprofessional care,an aim of institutional healthcare settings globally,promotes safe,cost-effective,quality care.How professionals act to enable interprofessional care has not been described.The nurse practitioner role,with its expertise in both medicine and nursing,is known to enhance collaboration and promote interprofessional care delivery.The objective of this study was to identify,from the healthcare professionals'perspective,nurse practitioner strategies used to enhance interprofessional care.Method:A hermeneutic phenomenology design was employed.Healthcare professionals from acute care hospitals and associated long-term care residences(n=6)in one Canadian province were invited to participate.Individual interviews were held with healthcare professionals(n=52)who regularly work with a nurse practitioner.The participants were asked to share experiences that held significance or value in promoting interprofessional care.Results:Four valued role attributes were identified;consistent role presence,time to focus on the patient,effective communication,and respectful centrality.Identified strategies extending from the attributes included knowledge sharing,respectful negotiation,identifying patient issues,being open and transparent,listening to opinions,bridging professions,and working as the hub of the group.Multiple types of interprofessional relationships were perceived,with the hierarchical type as the most common.Conclusions:Nurse practitioners in acute care hospital and long-term care settings have valued attributes that can promote interprofessional care.Effective strategies to promote interprofessional care emerge from these role attributes.However,the interprofessional relationship type perceived could enhance or impede the contribution of the strategies to interprofessional care promotion.

Nurse practitioner coverage is associated with a decrease in length of stay in a pediatric chronic ventilator dependent unit

AIM: To hypothesize a dedicated critical care nurse practitioner(NP) is associated with a decreased length of stay(LOS) from a pediatric chronic ventilator dependent unit(PCVDU).METHODS: We retrospectively reviewed patients requiring care in the PCVDU from May 2001 through May 2011 comparing the 5 years prior to the 5 years post implementation of the critical care NP in 2005. LOS and room charges were obtained. RESULTS: The average LOS decreased from a median of 55 d [interquartile range(IQR): 9.8-108.3] to a median of 12(IQR: 4.0-41.0) with the implementation of a dedicated critical care NP(P < 1.0001). Post implementation of a dedicated NP, a savings of 25738049 in room charges was noted over 5 years.CONCLUSION: Our data demonstrates a critical care NP coverage model in a PCVDU is associated with a significantly reduced LOS demonstrating that the NP is an efficient and likely cost-effective addition to a medically comprehensive service.

山东省高校临床实习护生工作准备度的潜在剖面分析及其影响因素

目的:探讨山东省高校实习护生工作准备度现状,分析不同类别护生工作准备度的潜在特征差异,并分析其影响因素,为制定针对性的工作准备度干预方案提供参考。方法:2023年9月—10月,采用一般人口学资料调查表、工作准备度量表、反馈寻求行为量表对山东省不同地区1 478名实习护生进行调查,并对工作准备度进行潜在类别分析。结果:1 478名实习护生工作准备度可分为低准备度组(26.05%)、中准备度组(41.88%)、高准备度组(32.07%)3个类别。与高准备度组比较,女性、反馈寻求行为越低,越容易进入高准备度组;与高准备度组比较,女性、本科学历、反馈寻求行为越低,越容易进入中准备度组;与中准备度组相比,寻求反馈行为越少越容易进入低准备度组。结论:山东省实习护生工作准备度水平可分为3类,护理管理者可根据不同类型实习护生的临床特征,提高实习护生反馈寻求行为,从而提升实习护生的工作准备度。

美国开业护士执业管理概况及对我国的启示

开业护士通过提供系统化和全面的护理服务,在提高初级医疗质量、解决全科医生短缺问题方面发挥重要作用。本文综述了美国开业护士的发展现状、教育体系、注册认证及执业管理,对高质量的培训体系和持续再认证机制进行分析,旨在为建立具有中国特色的开业护士资格认证及评价管理体系提供参考。

基于描述性质性研究的国内试点地区高级执业护师执业范畴分析

目的:明晰目前我国试点地区高级执业护师的执业范畴。方法:以滚雪球目的抽样法选取高级执业护师及其协作者和管理者,结合提纲进行半结构化深入访谈,资料分析采用内容分析法。结果:共有13名受访者接受了访谈,提取105个分析单位,形成47个编码,总结出18个分类,最终确定5个主题,即高级执业护师执业范畴包括独立评估和协助诊断、诊疗护理计划的制定与实施、进行健康教育、参与教学和科研、协调分级诊疗及多学科协作。结论:与临床护士、专科护士的临床实践相比,高级执业护师超越了传统护士的执业范畴,参与了更加广泛和深入的临床实践,涉及评估、诊断、处置、治疗、护理、健康教育、随访等健康管理全过程。

利益相关者视角下开业护士在糖尿病管理中角色期望的质性研究

目的探讨利益相关者对开业护士糖尿病管理角色的期望。方法采取目的抽样法选取34名在不同省市工作的卫生行政管理者、内分泌科医生和护士,以及12例糖尿病患者及11名家庭成员作为研究对象进行半结构化访谈,采用内容分析法分析资料、提炼主题。结果共提炼出职业多元化角色(高级临床护理实践者,教育与咨询者,协调者,领导者),糖尿病管理职责(糖尿病评估与诊断,药物与非药物处方权限,长期管理与随访),开业护士的培训(教育模式探索,理论与实践相结合),角色推动因素与困难(推动因素,面临多种困难)4个主题及11个亚主题。结论开业护士参与糖尿病管理具有角色多元、责职具体,有待培训和面临较多困难等情况。

开业护士核心能力的范围综述

目的 了解国内外开业护士(nurse practitioner, NP)核心能力的内容及发展现状,为明确NP角色定位、促进专业发展提供参考。方法 按照范围综述的研究范式,检索了CINAHL、Embase、PubMed等11个中英文数据库中NP核心能力的相关研究,检索时限2008年1月至2023年8月。依据美国NP核心能力框架的8个维度采用内容分析法对纳入文献进行范围综述,对超出能力框架的条目设置为其他维度。结果 最终纳入29篇文献,共提取出784条核心能力,包括患者护理263条(34%)、基于实践的学习和改进96条(12%)、基于系统的实践88条(11%)、多学科合作82条(10%)、专业性82条(10%)、人际关系和交流技巧65条(8%)、实践知识55条(7%)、个人与专业发展46条(6%)、其他维度7条(1%)。结论 各国NP核心能力存在差异,我国尚缺乏NP的核心能力框架,可借鉴国外的NP核心能力,制定符合我国国情的NP核心能力指标体系。

澳大利亚护理研究生教育与职业资格衔接关系的介绍

目的介绍澳大利亚护理研究生教育与职业资格制度的衔接现状及监管体系,以期为建立我国的护理硕士专业学位教育与职业资格的衔接制度提供借鉴。方法采用文献调研法和专家访谈法,在对澳大利亚护理学位教育、职业资格及其衔接关系现状进行充分了解的基础上,系统地分析澳大利亚护理硕士学位开业护士方向教育与职业资格衔接的现状及监管体系。结果澳大利亚护理硕士学位开业护士方向教育与开业护士紧密衔接,且监管体系中各机构相互协作,共同参与开业护士的教育与管理,保证了开业护士的培养质量。结论建议我国借鉴澳大利亚开业护士的教育与职业资格衔接的模式,结合我国具体国情,将护理硕士专业学位教育或者其中某一专业方向教育作为取得某类职业资格的必需条件。完善护理硕士专业学位教育体系,健全护士分层级体系,构建有力的监管体系,最终培养出符合社会所需的高层次、应用型、专科型的护理专门人才。

美国老年初级保健开业护士培养认证体系及对我国的启示

随着我国人口老龄化进程的加速,老年医疗保健需求急剧增加,对老年初级保健护理人员的能力素质提出更高要求。目前我国尚无老年初级保健开业护士的培训和认证体系。美国初级保健开业护士对患者、家庭、社区及医疗卫生事业均具有深远的影响。本文以美国宾夕法尼亚大学护理学院老年初级保健开业护士的硕士研究生培养项目为案例,介绍其培养模式及认证体系,以期为我国老年专科护理发展提供借鉴。

我国高级执业护师方向护理硕士专业学位研究生教育的底层逻辑探索

我国已经具备开展高级执业护师本土化研究生教育的条件,部分地区已经进行了在职培养探索,但是依然存在教育体系不完整、缺乏独立性等问题。该文从高级执业护师这一中文专用称谓的确定、本土化培养的意义、培养定位以及培养的教育理念4个方面,逐层揭示我国高级执业护师方向护士硕士专业学位研究生教育的底层逻辑,为如何培养契合时代需求、顺应护理教育发展趋势的高素质护理人才提供理论基础。

上海市全科团队中社区护理人员配置的研究

目的探索在目前工作负荷下及满足人群实际需要的状况下,社区卫生服务中心全科团队服务模式中护理人员的配置。方法采用工作日记记录法,记录社区护士工作量。并采用问卷调查的方法,调查社区居民对社区护理服务的实际需求状况。根据人员需要量的工作量指标法测算在目前工作负荷下及满足人群实际需要的状况下,社区护理人力资源的配置量。结果社区护士所提供的服务主要为疾病护理和健康促进,以疾病护理为主,占总时间的70.5%,健康促进占7.6%;按照社区护士目前的工作负荷,计算社区护士的配置量为20人,比目前实际配置多2人。社区居民对社区护理服务的需求主要为疾病护理和健康促进,以疾病护理为主。根据社区居民对社区护理服务的实际需求,测算社区护士的配置为18人,与目前实际配置人数相当。结论社区护理服务重疾病轻保健;在目前的工作负荷下,社区护士的配置量不足;按照目前社区居民对护理服务的实际需求,社区护士的配置较适宜。

护理专业化发展过程中的角色区别

文章总结了作为高级实践护士的临床护理专家和开业护士以及作为其前身的专科护士之间的区别,分别从其起源、概念和角色职能、培养认证、工作场所及处方权方面进行了阐述,以帮助护理人员正确认识护理专业中的多种角色。