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.

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.

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.

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.