Advanced Nursing Roles Research Articles

Advanced Nursing Practice and Advanced Practice Nursing roles within low and lower-middle-income countries.

Population health initiatives rely on the availability and skills of an appropriate workforce to meet required goals. One global workforce initiative with demonstrated ability to expand health care services and improve access to care is the development of Advanced Nursing Practice and Advanced Practice Nursing roles. Given the sparse published information about these roles in Low and Lower-Middle-Income countries, this study seeks to describe their development and application in these countries. The researchers developed a descriptive cross-sectional multilingual survey for online distribution to nursing experts within the targeted countries. Survey questions addressed demographic information on the population served, Advanced Nursing Practice and Advanced Practice Nursing titles, the time frame and rationale for creating the title, and how the roles relate to the International Council of Nurses' Advanced Practice Nursing guidelines characteristics of education, practice, and regulation. Of the 167 responses received, only 24 participants met the inclusion criteria. This represented five low-income countries and nineteen lower-middle-income countries from four World Bank regions. Seventy-one roles were identified. Roles emerged predominantly over the last 20 years, focusing on care for underserved populations, with an almost even spread across primary and acute care settings. There were differences in education, practice, and regulation amongst the roles. Roles that required a master's education or higher with practice-related characteristics had a broader scope of practice, which is consistent with international guidelines. This paper describes how Advanced Nursing Practice and Advanced Practice Nursing roles from Low and Lower Middle-Income Countries have been implemented to address gaps in service and highlights disparities in education, practice and regulation compared to international guidelines. Maintaining and increasing support from organizations and universities internationally may be required to assist in developing and expanding educational programs for advanced nursing roles in these countries. Understanding how these advanced nursing roles are operationalized in relation to education, practice, and regulation in Low and Lower-Middle-Income countries can provide baseline information that will inform workforce development policies to address healthcare needs in similar jurisdictions.

7.L. Workshop: New roles and innovative skill-mix in nursing across Europe: trends and lessons for implementation

Abstract Many countries in Europe are changing the roles and skill-mix of their nursing workforce. A sufficient and well-skilled nursing workforce has shown to be key for population health, most recently demonstrated during the Covid-19 pandemic. An increasing number of countries have introduced Master-level education for nurses to work in advanced practice nursing (APN) roles. These changes in the educational systems have implications on patients, clinical practice, teams and health systems. Moreover, many countries are re-orienting their health services from hospital to primary health care and prevention, driving new roles for nurses. The relevance of high-quality education and upskilling has been exemplified during the Covid-19 pandemic, where nurses had to quickly adapt to new treatment and caregiving situations in challenging work environments. Objectives of the workshop. This workshop will provide an overview of research and policy developments in Europe, drawing on recent research. First, an overview of innovative skill-mix changes in nursing will be presented and evidence on health outcomes, based on a study from the European Observatory on Health Systems and Policies. Second, research from Germany in five innovator hospitals will be presented, a country which is still at an early stage with integrating nurses in advanced roles. The panel discussion will address innovations in APN research, practice and policy lessons in Europe and with in-depth insights from four countries (Netherlands, Finland, Switzerland, Germany). In the Netherlands, the policy instrument “experimental law” has led to full practice authority for Nurse Practitioners, its impact on practice as well as barriers and enablers will be addressed. In Finland, the focus will be on recent evidence on the expanded role of nurse prescribers, the policy process and early evidence on impacts for nurses and patients. In Switzerland, the lack of regulation and reimbursement schemes restrict advanced practice, whereas drivers comprise changes in population needs, education (master and doctoral level) and reduced workforce availability. Developments at the national and cantonal level and the evaluation of innovative care models with APNs will be presented using case examples and recent research (e.g. university hospitals, primary care). The panelists will discuss implications for research, policy and nursing management, also taking into account the Covid-19 pandemic and other unexpected “health shocks” which have shown to impact considerably on nurses’ roles in practice. Lessons will be shared on strategies for a well-qualified and -resourced nursing workforce integrated in systems. The format is ‘regular workshop’ with two presentations and a panel discussion with experts from four countries. Key messages • Multiple innovative nursing skill-mix model exist, with promising outcomes for individuals and population groups if nurses are well trained and equipped. • Implementation of APN roles requires enabling policy contexts, sufficient funding, clinical leadership, teams that are open to innovations, and strong nurses that take on APN roles.

Delphi survey on the application of advanced practice nursing competencies: Strong points and unfinished business in cancer care.

This study assessed the application of advanced practice nursing competencies in cancer care to identify obstacles to their full implementation. Internationally, the implementation of advanced practice nursing roles depends on the context and environment, which shape the definition, scope and competencies associated with these roles. Nurses participated in two rounds of an online Delphi survey about the competencies of advanced practice oncology nurses. The threshold for expert consensus was set at 75%. Eleven competency domains were proposed; all yielded consensus of over 75%. However, for 57.8% of the specific competencies proposed in round 1 and for 62.2% in round 2, there was no consensus on which were applied in practice. There was more agreement on the competencies applied in the domains of direct clinical practice, consultation and collaboration and interprofessional relations than in dimensions such as health care promotion, quality improvement, evidence-based practice and research. Barriers related to unimplemented competencies were identified. The competencies applied in advanced practice nursing reflect incomplete development of these roles. Domains related to direct clinical practice, consultation and collaboration and interprofessional relations are relatively well developed, whereas those related to leadership, research, evidence-based practice and quality improvement are not. The identified barriers hindering implementation of some competencies can inform strategies to develop this role in cancer care. Hospital administrators and nurse managers should reflect and be mindful of the development of advanced practice nurse (APN) competencies along with the challenges associated with implementing advanced practice roles.

How do general hospitals respond to people diagnosed with a personality disorder who are distressed: A qualitative study of clinicians in mental health liaison.

WHAT IS KNOWN ON THE SUBJECT?: People diagnosed with a personality disorder might be more likely to have physical health problems and be admitted to the hospital. Treatment in hospitals might be complicated by mental health crises or self-injury, and barriers to NHS care may increase the risk of developing further illness with serious consequences. Literature on "personality disorder" and the general hospital has to date primarily focused on emergency departments. Research on how general hospital inpatient wards respond to people diagnosed with a "personality disorder" has been long overdue. Thirteen clinicians working in mental health liaison in the general hospital were interviewed as part of a sequence of research studies. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: This study identified unjust and avoidable differences in the care and treatment received by people diagnosed with a "personality disorder" in general hospitals. People with a "personality disorder" diagnosis were discriminated against and over- and under-medicated. Mental health liaison clinicians reported limited understanding and skills among general hospital clinicians. People working in general hospitals were fearful of the "personality disorder" diagnosis. Poor care was accepted because general hospital clinicians did not consider themselves to be "mental health trained." WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Clinicians working in mental health liaison need credible knowledge of mental and physical health and medicines. Capability, influence, and high-level interpersonal skills are needed to successfully work across mental health services and the general hospital. More advanced and consultant-level nursing roles in more mental health liaison teams are needed to strengthen this specialist workforce. ABSTRACT: Introduction Literature on "personality disorder" and the general hospital has to date primarily focused on emergency departments. Research on how general hospital inpatient wards respond to people diagnosed with a "personality disorder" has been long overdue. Aim Qualitative telephone interviews were undertaken to explore the views and perspectives of clinicians working in mental health liaison in this final strand of a mixed methods explanatory sequential study. Method Participants were recruited via social media and professional networks by snowball sampling. Data were analysed using a framework approach. Results Four themes were identified: knowledge, understanding, skills, and discriminatory practice; alliances, diplomacy, care, and treatment of people diagnosed with a "personality disorder"; achieving parity of esteem in a disparate healthcare system; and organizational stress, mismatched expectations, and service led decision-making. Discussion There were unjust and avoidable differences in the care and treatment received by people diagnosed with a "personality disorder" in the general hospital. People were discriminated against and routinely over- and under-medicated. Implications for practice Clinicians working in mental health liaison need capacity for partnership working, clinical capability spanning mental and physical health, credibility and influence and high-level interpersonal skills to address the entrenched discrimination of people diagnosed with a "personality disorder."

Implementation of the Nurse Practitioner as Most Responsible Provider model of care in a Specialised Mental Health setting in Canada.

Globally, mental health systems have failed to adequately respond to the growing demands of mental health services resulting in a disparity between the need and provision of treatment. Paucity of mental health care providers contributes to the aforementioned disparity. This can be addressed by engaging Nurse Practitioners (NPs) in an integrated model within healthcare teams. This paper describes the implementation of NPs as Most Responsible Provider (MRP) care of model in a specialised mental health hospital in Ontario, Canada. Guided by the participatory, evidence-based, patient-focused process for advanced practise nursing (APN) role development, implementation, and evaluation (PEPPA) framework, authors developed a model of care and implemented the first seven steps of the PEPPA framework - (a) define the population and describe the current model of care, (b) identify stakeholders, (c) determine the need for a new model of care (d) identify priority areas and goals of improvement, (e) define the new model of care, and (f) plan and implement the NP as MRP model of care. Within these steps, different strategies were implemented: (a) revising policies and procedures (b) harmonising reporting structures, (c) developing and implementing a collaborative practise structure for NPs, (d) standardised and transparent compensation (e) performance standards and monitoring (f) Self-Assessment Competency frameworks, education, and development opportunities. This paper contributes to the state of the knowledge by implementing NPs as MRP model of care in a specialised mental health care setting in Ontario, Canada; and advocates the need for incorporating mental health programmes within the Ontario nursing curriculum.

Development of competencies for advanced nursing practice in intensive care units across Europe: A modified e-Delphi study

PurposeThe aim of this study was to identify and define core competencies for advanced nursing roles in adult intensive care units across Europe. MethodsThree round electronic Delphi conducted between September 2018 and November 2019, with an expert panel of 184 nurses from 20 countries, supplemented by consensus meetings with 16 participants from 10 countries before each round. ResultsIn Round 1, participants generated 275 statements across 4 domains (knowledge skills and clinical performance; clinical leadership, teaching and supervision; personal effectiveness; safety and systems management). These were re-worded as competency statements and refined at a consensus meeting resulting in 230 statements in 30 sub-domains. The expert panel rated the ‘importance’ of each statement in Round 2; further refinement at the consensus meeting and the addition of descriptors for sub-domains resulted in 95 competency statements presented to the panel in Round 3. These were all retained in the final set of competency statements. ConclusionWe have used consensus techniques to generate competencies for advanced practice in intensive care nursing that are relevant across European countries and available in eight languages. These have provided the basis for an outline curriculum from which education programmes can be developed within countries.

Observed structured clinical examination as a means of assessing clinical skills competencies of ANPs.

Observed structured clinical examinations (OSCEs) are a common method of assessment within higher education to prepare for the advanced nurse practitioner (ANP) role. This article reviews a wide range of literature relating to OSCE assessment in the healthcare arena, from an ANP, interprofessional and advanced clinical practice perspective. Theories underpinning OSCE and advanced nursing roles are explored, with relevant supporting literature indicating how established OSCEs can become integrated with other methods to improve outcomes for this level of practice. Alternative assessments are explored with specific reference to the context of the education delivered, and the suitability for higher education today.

The development and implementation of the After Cancer Treatment Transition (ACTT) Program for survivors of cancer.

The After Cancer Treatment Transition (ACTT) program at Women's College Hospital (Toronto) is a transitional follow-up program for patients, their families, and healthcare providers to address the broad range of post-cancer treatment and survivorship needs. This publication describes the systematic development and implementation of the ACTT program, with a focus on the advanced practice nursing (APN) role. ACTT development required the collaboration of an APN, a general practitioner in oncology (GPO), and an inter-professional team. ACTT developers proposed a clinic structure in an ambulatory setting, linking healthcare professionals to provide post-treatment follow-up and ongoing survivorship care. Post-treatment guidelines were developed based on expert oncologist consensus, cancer site group input, and evidence-informed guidelines or best practice recommendations. Initial challenges and concerns were rooted in the requirements that post-cancer treatment care was maintained and survivor needs were addressed. Cancer site groups and the inter-professional teams provided continuous feedback on processes and protocols. ACTT established a standard approach to transition patients safely and effectively out of tertiary care and, ultimately, to primary care. ACTT delivers comprehensive posttreatment and survivorship care through close collaboration between the GPO and APN. Both roles specialize in managing late or persistent effects, cancer surveillance and prevention, and addressing psychosocial needs prior to discharge to primary care. The survivorship care plan provided by ACTT is an informative tool for both patient and primary care provider to continue post-treatment follow-ups. Next steps for ACTT include expanding to other cancer specialties, exploring new ways to deliver care, optimizing the transition of care, and conducting comprehensive evaluations of patient reported outcomes.

Advanced practice nursing roles in Arab countries in the Eastern Mediterranean region: a scoping review.

The objectives of this review were to map and summarize evidence regarding advanced practice nursing roles in Arab countries located in the Eastern Mediterranean region. Many countries have reported an increase in the number and types of advanced practice nursing roles as research demonstrating their positive impact on patient and health system outcomes continues to accumulate. There is international evidence that the achievement of these outcomes depends on the effective implementation of advanced practice nursing roles at the organizational and country levels. A comprehensive review of the status of advanced practice nursing role implementation in Arab countries in the Eastern Mediterranean region has not been conducted. Eligible studies included advanced practice nursing roles (including, but not limited to, nurse practitioners and clinical nurse specialists) in Arab countries in the Eastern Mediterranean region. Studies were considered if they focused on role development, titles, entry-level education, regulation and scope of practice, and facilitators and barriers to role implementation. A comprehensive systematic search was completed for both published and non-published literature. The databases searched included CINAHL, PubMed, PsycINFO, Embase, Nursing and Allied Health Database, and Scopus. Gray literature was searched using websites such as Google Scholar, ProQuest Dissertations and Theses, International Council of Nurses, World Health Organization regional office for the Eastern Mediterranean region, and websites of nursing associations and Ministries of Health in Arab countries. The search included literature published in Arabic and English from the inception of the databases to August 2020. A total of 35 articles were included, the majority (n = 24) of which were published from 2010 onward. Ten of the included studies were empirical research papers that used qualitative and quantitative research designs. Advanced practice nursing role development is still in its infancy in most of the Arab countries in the Eastern Mediterranean region and can be described as slowly and steadily evolving. The main driving forces for the implementation of the roles in this region included a shortage of physicians both in number and specialties, the emergence of chronic diseases due to lifestyle changes, the desire to have more cost-effective primary care, and to advance nursing as a profession. Clinical nurse specialists and nurse practitioners are the most common titles for the advanced nursing roles practiced in the region. Some advanced practice nursing roles stipulated a master's degree as a minimum requirement, while others required a 12-month in-house training program. Oman is the only Arab country that authorizes nurse practitioners to prescribe pre-set medications. The common barriers to advanced practice nursing role implementation included a lack of recognition of roles at national levels, role ambiguity, lack of clear scope of practice, resistance from male physicians, low involvement of nurses in policy-making, and low status of nursing as a profession. The successful implementation and sustainment of advanced practice nursing roles in Arab countries in the Eastern Mediterranean region requires foundational work, including development of definitions, educational standards, regulations, and a clear scope of practice. Open Science Framework: https://osf.io/wyj8a.

Perspectives for Advanced Practice Nursing in Brazil.

This is a reflective study aiming to analyze the implementation of Advanced Practice Nursing (APN) and provide perspectives regarding the role of these professionals in the Region of the Americas, particularly in Brazil. Several countries in the world have introduced advanced nursing roles to improve quality of care and reduce health care costs. However, these roles have not been fully implemented in Latin American countries, although some countries have held advanced discussions about it and proposed graduated courses. Brazil fulfills all conditions necessary for the implementation of the education of advanced practice nurses. The investment in advanced practice nurses will result in positive outcomes for the health of the population in a short period of time, with lower costs for governments than other possible actions. It is also a strategic way to address the persistent pressure on health services, whether related to the COVID-19 pandemic or other health needs of the population, and it can be a viable strategy for the provision of care to vulnerable populations and those living in remote areas.

Perceptions and Expectations of Advanced Geriatric Nursing Role Development in Primary Health Care: A Qualitative Study Exploring Staff's Perspectives.

PurposeThis qualitative study aimed to explore multidisciplinary members’ perceptions and expectations of advanced geriatric nursing role development in primary health care.Patients and MethodsA multi-center, cross-sectional study based on semi-structured individual interviews was conducted with registered nurses, general physicians, and managers involved in the care of older people in primary health care between September 2020 and January 2021. Recruitment was purposive and the framework method was used to inductively analyze the data. The Consolidated Criteria for Reporting Qualitative research (COREQ) served to structure our manuscript.ResultsIn total, 29 registered nurses, 6 general physicians, and 10 managers from 8 health centers were interviewed. The relevant themes interpreted from the interview data were as follows: (1) the current roles of registered nurses in the care of older people; (2) the factors affect the advanced geriatric nursing role development; (3) expectations of the advanced geriatric nursing roles.ConclusionThere is a need for appropriate educational programs, well-established laws, and regulations to support the sustainable development of advanced geriatric nursing roles. To build the expected role model, the nursing education program in the future should integrate gerontological nursing, public health nursing, and nursing management to maximize the role of gerontological nurse practitioners in primary health care.

Advanced practice role delineation within Finland: A comparative descriptive study.

To identify and differentiate the practice patterns of generalist, specialist and advanced practice nursing roles in specialist and central hospital contexts. In Finland, as in other Nordic countries, advanced practice nursing roles emerged around 2000. There are over 60,000 registered nurses/midwives in Finland and the clinical career pathway from a registered nurse to advanced practice nurse has been described yet not fully implemented in healthcare organizations. However, the number and activities of nonadvanced and advanced practitioner roles are not well known. A descriptive comparative study. An online self-report survey was conducted between August and October 2020 using an advanced practice role delineation tool. A census sample of registered nurses, registered midwives, specialist nurses and advanced practice nurses in five university hospitals and one central hospital was recruited. Descriptive statistics were used to summarize the characteristics of participants and group differences were compared using analysis of variance (ANOVA). The STROBE checklist was used as the reporting guideline. A total of 1497 responses were obtained (response rate=10%). Overall, nurses used comprehensive care and education activities most frequently. The least used activities were research and publication and professional leadership. Univariate analysis of variance test between role effects, when education and grouped age were taken into account, showed statistically significant difference in all of the observed five activities (p<.001). Identifying activities in different levels of nursing is a crucial first step in delineating nursing roles thus improving the governance of the human resource management. The study results add to the international literature, delineating nursing roles in the spectrum of generalist to advanced practice nursing. As these roles become more formalized, we may incorporate novel ways of promoting the career development and optimal use and assessment of nursing roles and practice in various career levels.

Sustained impact of an academic-practice partnership

Academic-practice partnerships foster innovation and transition to nursing practice in healthcare systems. The purpose of this paper is to describe the impact of a public-private academic-practice partnership for Doctor of Nursing Practice (DNP) education designed to transform a large healthcare system's nursing workforce and model of care. The conceptual framework is organized around Rogers's (2003) principles of diffusion of innovation in organizations. A logic model illuminates how inputs, activities, outputs and outcomes resulted in sustained impact for graduates, the college and the healthcare organization. Partnership outcomes include education of baccalaureate and master's-prepared employed nurses (n = 95) in a DNP program for advanced practice nursing (APN) roles in the healthcare system; dissemination of scholarship; and revision of the healthcare system's research approval process. Sustained impact includes advancement of DNP-prepared graduates to complex leadership and practice roles; development of new programs and advanced practice roles based on scholarly project findings; expansion of population-specific patient programs; and extension of continuum- and access-to-care models in the healthcare organization. Recommendations include continuing development of academic-practice partnerships for transition to practice and advancement of roles and levels of champions to achieve sustained impact of academic-practice partnerships in healthcare organizations.

Advancing Nursing Practice in India

Nurses, as key health personnel in the health-care industry, play a vital role in the delivery of care. Nurses work with different populations in varied settings to coordinate care aimed at the prevention of disease, promotion of health and care of sick and dying. With the impending rise in demand for quality care, skilled and specialised role of nurses is paramount to ensure high quality. The creation of advanced nursing roles and specialisation in nursing made the nurses independent and more autonomous in their roles. Advanced roles contributed a service model and best fit to the ever-changing demands of patients. At present, nurses participate in clinical research, decision-making and demonstrate clinical leadership skills to improve the safety and quality of care. Dynamic changes in the health-care industry and consumer awareness are other driving forces that influence the need for nurses to be highly competent and skilled to fulfil their responsibilities. This article briefly describes the nursing transformation in the United States and the different nursing programmes offered in India.

An exploration of the levels of clinical autonomy of advanced nurse practitioners: A narrative literature review.

The aims of the review are to synthesise current evidence about advanced nurse practitioner clinical autonomy and consider how this may inform clinical practice and research. Clinical autonomy is one of the cornerstones of advanced nursing practice globally, yet there is limited synthesis of clinical autonomy in the literature. This is a narrative literature review. The databases Cumulative Index to Nursing and Allied Health Literature, EBSCO host, Cochrane Library, CINAHL and MEDLINE were searched for publications between 2005 and 2020 inclusive. A systematic approach was used to analyse the literature reviewed. Two reviewers undertook quality appraisal. Nineteen articles were selected. Four major themes emerged: (1) 'ANP Stepping Up'-moving into and accepting advanced nursing practice roles and clinical responsibilities; (2) 'ANP Living It'-ANPs' ability to act independently including an understanding of task mastery and self-determination; (3) 'ANP Bounce-back ability'-depicted in challenges that threaten their ability to practice clinically autonomously; (4) 'ANP Setting in Motion'-indirect care activities and service-level improvements. A clearer understanding of advanced nurse practitioner clinical autonomy could help develop more in-depth knowledge. Research of advanced nurse practitioners' clinical autonomy would improve full utilisation in clinical practice.

Developing an innovative role for a clinical nurse specialist in structural heart disease services

This article explores a new advanced nursing role within interventional cardiology. The role was jointly developed by the lead consultant and clinical nurse specialist, and has received the first official centre of excellence award in the world. As a result, the service will now deliver expert training programmes taught by the consultant team and specialist nurse. This service was created for patients with mitral valve disease. It has a dedicated and structured pathway, with the patient always at the centre of care. This article introduces the role of nurse second operator in complex valvular intervention, which allows the clinical nurse specialist to be fully involved in the entire patient journey from referral to discharge. The author describes how the role was established and the developments that have been made in the first 3 years of the post. The role encompasses both inpatient and outpatient care in a bespoke, nurse-led service, as well as responsibility for maintaining accurate data collection and adherence to the patient pathway throughout the service. This has facilitated a streamlined and tailored service that strives to deliver high-quality, equitable care to patients across the UK. It is hoped that this will encourage other centres to develop such roles for specialist nurses.

Family and community nursing (FCN): guidelines of the network of Master for FCN of Italian Universities

. Family and Community Nursing(FCN): guidelines of the network of Master for FCN of Italian Universities. Developing new and more advanced roles for nurses could improve access to care, quality of care and contain costs. The joint document elaborated by the network of the University Masters for FCN aims to provide a guideline to standardize the postgraduate courses for the training of FCNs and to promote the development of core competencies, which are essential, also in the perspective of a possible future passage towards the second level Master degree. The skills and the core contents to be developed, are proposed together with indications are given for workshops to develop technical skills and the organization of practical training.

Perspectives of the sarcoma clinical nurse consultant role: A qualitative study

BackgroundPatients diagnosed with sarcoma experience complex treatment pathways and unmet needs. The Sarcoma Clinical Nurse Consultant position was recently established in Western Australia to improve the quality of patient care. As this role is new in Western Australia and nationally, research is required to understand the duties, benefits, and gaps of the position. AimTo explore patients’, carers’, and health professionals’ perspectives of the role of the Sarcoma Clinical Nurse Consultant in Western Australia. Methods and designThe study employed a qualitative research design with semistructured interviews. Participants included: Patients diagnosed with sarcoma (n = 20), their family carers (n = 14), and health professionals working with people diagnosed with sarcoma (n = 21). Transcripts were analysed using thematic analysis. FindingsFour overarching themes were identified: (i) multiple responsibilities; (ii) inconsistent contact with the sarcoma nurse; (iii) the importance of the role; and (iv) lack of support for the sarcoma nurse. The Sarcoma Clinical Nurse Consultant was considered central to improving patient care, however, the position appeared to be inadequately supported at a systems' level. DiscussionThe Sarcoma Clinical Nurse Consultant role is essential to the delivery of evidence based patient-centred sarcoma care and support, coordinated care, and service improvement. ConclusionThe Sarcoma Clinical Nurse Consultant position should be supported with administrative support and support nurse positions so they can focus on clinical duties and providing patient support. Given this is a new and emerging role, it is critical that sarcoma services regularly review and evaluate these positions and ensure that they are adequately supported.

Attitudes towards advanced nursing roles in primary dementia care - Results of an observational study in Germany.

To demonstrate the attitudes of general practitioners (GPs), nurses, persons with dementia, and caregiver towards suitable tasks and qualification needs for and the acceptance and impact of advanced nursing roles in German dementia primary care. Observational study using a questionnaire survey with 225 GPs, 232 nurses, 211 persons with dementia, and 197 caregivers, conducted between December 2017-August 2018. A questionnaire was generated that includes specific assessment, prescription, and monitoring tasks of advanced nursing roles in dementia primary care as well as qualification requirements for and the acceptance and the impact of advanced nursing roles. Data were analysed using descriptive statistics. Group differences were assessed using the Fisher's exact test. Advanced nursing roles were highly appreciated across all groups. Assessment and monitoring tasks were rated as highly suitable, and prescription authorities as moderately suitable. Nurses felt less confident in assessment and monitoring, but more confident in prescribing as practitioners expected. Patients and caregivers would appreciate a takeover of tasks by nurses; nurses and practitioners preferred a delegation. A dementia-specific qualification was rated as best suitable for advanced nursing roles, followed by 'no specific qualification' if medical tasks that only can be carried out by practitioners were delegated and an academic degree if tasks were substituted. Advanced nursing roles were rated as beneficial, strengthening the confidence in nursing care and improving the cooperation between professionals and the treatment. Practitioners assumed that advanced nursing roles would improve job satisfaction of nurses, which was not confirmed by nurses. There is an extended consensus towards the enlargement of advanced nursing roles, represented by high endorsement, acceptance, and willingness to reorganize tasks. Results debunk the common notion that German practitioners would be reluctant towards advanced nursing roles and a takeover of current practitioner tasks, supporting the implementation of advanced nursing roles in Germany.

An advanced nurse-led clinic for patients following percutaneous coronary intervention

Percutaneous coronary intervention (PCI) is internationally recognised as the preferred initial treatment for acute coronary syndrome and as a treatment option for chronic coronary heart disease. The use of PCI has led to shorter inpatient stays. However, reduced length of stay can mean less opportunity for patient education. Once discharged from hospital, timely outpatient review encompassing symptom reassessment, advanced physical assessment, medication and cardiovascular risk management is a key component of patient care. In an Irish acute hospital setting, cardiology clinical nurse specialists and advanced nurse practitioners have established an advanced nurse-led post-PCI clinic. This article describes the post-PCI clinic and provides an overview of the patient profile and outcomes over a 2-year period, with an emphasis on advanced nursing roles and patient symptoms.