Advanced Practice Education Research Articles

Advanced practice education and development

Colette Henderson looks at the importance of education and development for advanced practitioners UK government policy directives support the development of multidisciplinary advanced practice roles. Advanced practitioners must align their practice and subsequent continuing professional development (CPD) with four pillars of practice: clinical practice; facilitation of learning; leadership and evidence; and research and development. Lifelong learning is a mandatory requirement for healthcare practitioners. This article will focus on the importance of education and development for advanced practitioners and starts by providing some detail of the background development of advanced practice in the UK to justify the focus on ongoing achievement of capability across the four pillars.

Continuous Ketone Monitoring Consensus Report 2021.

This article is the work product of the Continuous Ketone Monitoring Consensus Panel, which was organized by Diabetes Technology Society and met virtually on April 20, 2021. The panel consisted of 20 US-based experts in the use of diabetes technology, representing adult endocrinology, pediatric endocrinology, advanced practice nursing, diabetes care and education, clinical chemistry, and bioengineering. The panelists were from universities, hospitals, freestanding research institutes, government, and private practice. Panelists reviewed the medical literature pertaining to ten topics: (1) physiology of ketone production, (2) measurement of ketones, (3) performance of the first continuous ketone monitor (CKM) reported to be used in human trials, (4) demographics and epidemiology of diabetic ketoacidosis (DKA), (5) atypical hyperketonemia, (6) prevention of DKA, (7) non-DKA states of fasting ketonemia and ketonuria, (8) potential integration of CKMs with pumps and automated insulin delivery systems to prevent DKA, (9) clinical trials of CKMs, and (10) the future of CKMs. The panelists summarized the medical literature for each of the ten topics in this report. They also developed 30 conclusions (amounting to three conclusions for each topic) about CKMs and voted unanimously to adopt the 30 conclusions. This report is intended to support the development of safe and effective continuous ketone monitoring and to apply this technology in ways that will benefit people with diabetes.

General practice nurses' experiences of participation in an advanced nursing practice education programme.

In the UK, transformation of the nursing workforce, including development of the role of the advanced nurse practitioner within general practice, is essential to meet healthcare demands. This article presents the results of a small, qualitative study conducted among students at one university in Scotland, describing their experiences of participation in advanced practice education. Data were collected through semi-structured interviews to generate in-depth descriptions and to identify the facilitators and barriers to learning. The study identified that a shared responsibility for patient care creates opportunities for learning. The facilitators to learning were identified as foundation level education in history taking and clinical examination, finance, having a supportive network and mentorship. Barriers included pressure of work and a lack of clarity about roles and training needs. Given the key role that these nurses will have in future healthcare models, there is a requirement for a national education standard. It is recommended that the Nursing and Midwifery Council leads on defining advanced nurse practitioner in general practice programme learning outcomes. The overall aim of such courses is to enhance the experience for future nurses to encourage recruitment and transform the nursing workforce.

Exploring advanced nursing practice in stroke services: a scoping review

Background: Stroke care is becoming increasingly reliant on advanced nursing practice (ANP); however, little is known about these roles within the stroke specialty. Aims: To explore the current knowledge of advanced nursing practice in stroke services internationally, specifically, the conceptualisation of ANP and the rationale for its implementation. Methods: Arskey and O'Malley's scoping review methodology was employed, and six academic databases were used. Findings: Two key themes were identified; ‘role development’ and ‘four pillars of advanced practice’. The review identifies that ANP is implemented primarily to provide acute stroke care. Conclusions: Current research does not clarify the rationale for implementing these posts or how ANP is conceptualised. This review does identify that stroke ANP incorporates the four pillars of advanced practice (clinical, research, leadership and education) and was implemented to improve the quality of stroke care. Barriers and facilitators to implementation were also identified.

Advanced clinical practitioners’ experience of establishing a workplace jurisdiction

ABSTRACT Background In 2017 a national policy framework for advanced clinical practice in England was introduced by Health Education England, to establish clarity around the level of practice. Whether the implementation of this framework has resulted in adoption of advanced clinical practice into public and workplace jurisdictions is yet to be explored. Aims This health service workforce evaluation aims to explore the views and opinions of Advanced Clinical Practitioners and trainees in England on their experiences since the implementation of the 2017 framework. Methods This is secondary analysis of a workforce dataset. A self-completed questionnaire was distributed via the Association of Advanced Practice Educators United Kingdom aimed at those undertaking Advanced Clinical Practitioner education or who are practicing at this level. Semi-structured phone interviews were carried out with a subset of this group on their views and opinions to obtain depth of insight. Questionnaires were summarized using descriptive statistics in Excel and interviews analysed using thematic analysis. Results The identity of the advanced clinical practitioner role is developing. Of questionnaire respondents, 29% thought their line manager didn’t understand their role, and 42% thought that patients didn’t understand their role. Three quarters (75%) had access to clinical supervision. Interview respondents reported restriction in their role as a result of a perceived lack of understanding and awareness from colleagues. Interviewees reported that they had to spend time explaining their role to colleagues, patients and managers. Conclusions Advanced Clinical Practitioners in this evaluation perceived a lack of clarity and understanding around their role from their colleagues, patients and managers. Relevance to clinical practice This suggests that Advance Clinical Practitioners are currently under-prepared to negotiate jurisdictions, a key aspect in the introduction of a new role.

Continuing Education for Gerontological Social Work: Findings From Post-Graduate Advanced Practice Training

The social work profession aims to help all individuals, families, and communities enhance their overall well-being. While gerontological social workers primarily work with seniors, they are often tasked with addressing the needs of not only their senior client, but the client’s network as well. Social workers are also asked to stay current with respect to new legislation, policy, and systemic changes to help their clients. Thus, gerontological social workers often need to obtain advanced practice education in a number of areas, as related to gerontology. Responding to this gap, the National Initiative for the Care of the Elderly (NICE) and Sinai Health offered a series of innovative advanced practice gerontological social work courses - hybrid online and in-class - to those looking to improve their knowledge and competencies in the following five identified 'high impact' areas: (1) Medical Assistance in Dying (MAiD); (2) cultural competence and LGBTQI2S; (3) mental health; (4) legal issues and aging; (5) dementia. Participants in the courses completed pre- and post-surveys assessing knowledge, attitudes and competencies with the subject matter, with responses helping to improve understanding of how to provide the most appropriate resources for those who care for older adults and how to better shape future education/training programs. Findings suggest that gerontological social workers may benefit from 'tailored refresher courses' that bridge knowledge and practice gaps, that the optimal update time may be every three years, and that clinicians benefit from being trained by interdisciplinary teams, rather than by someone of the same profession.

Workforce experience of the implementation of an advanced clinical practice framework in England: a mixed methods evaluation

BackgroundThis study aims to understand how the implementation of the advanced clinical practice framework in England (2017) was experienced by the workforce to check assumptions for a national workforce modelling project. The advanced clinical practice framework was introduced in England in 2017 by Health Education England to clarify the role of advanced practice in the National Health Service.MethodsAs part of a large-scale workforce modelling project, a self-completed questionnaire was distributed via the Association of Advanced Practice Educators UK aimed at those studying to be an Advanced Clinical Practitioner or who are practicing at this level in order to check assumptions. Semi-structured phone interviews were carried out with this same group. Questionnaires were summarised using descriptive statistics in Excel for categorical responses and interviews and survey free-text were analysed using thematic analysis in NVivo 10.ResultsThe questionnaire received over 500 respondents (ten times that expected) and 15 interviews were carried out. Advanced clinical practice was considered by many respondents the only viable clinical career progression. Respondents felt that employers were not clear about what practicing at this level involved or its future direction. 54% (287) thought that ‘ACP’ was the right job title for them. 19% (98) of respondents wanted their origin registered profession to be included in their title. Balancing advanced clinical practice education concurrently with a full-time role was challenging, participants underestimated the workload and expectations of employer’s training. There is an apparent dichotomy that has developed from the implementation of the 2017 framework: that of advanced clinical practice as an advanced level of practice within a profession, and that of Advanced Clinical Practitioner as a new generic role in the medical model.ConclusionsEfforts to establish further clarity and structure around advanced clinical practice are needed for both the individuals practising at this level and their employers. A robust evaluation of the introduction of this role should take place.

Pediatric nurse practitioners' attitudes/beliefs and knowledge/perceived competence in caring for transgender and gender-nonconforming youth.

There is a growing number of youth and their parents seeking assistance from care providers related to gender dysphoria and transitional care for transgender and gender-nonconforming(TGNC) youth. The purpose of this study was to determine pediatric nurse practitioners' (PNP) attitudes/beliefs and knowledge/competence in caring for TGNC youth. This cross-sectional descriptive study surveyed PNPs (N = 93) from eight states using two survey instruments to measure attitudes and beliefs and knowledge and perceived competence related to caring for TGNC youth. Eighty-one percent of PNPs reported caring for TGNC youth in their practice. Despite this, only 15% of the PNPs received education related to transgender patients during their advanced practice education. Results showed that attending continuing education offerings related to caring for TGNC patients increases PNP perceived competence as well as knowledge. Attitudes and behaviors towards the transgender population were also more positive if the PNP had attended continuing nursing educationofferings. Three themes emerged from a qualitative portion of the survey, asking the participant to share thoughts related to caring for transgender youth: lack of education for healthcare providers, the need to refer patients to comprehensive gender services, and the need for support for transgender patients and their families. Education plays an important part in nurses' attitudes, beliefs, and perceived competence in caring for transgender patients. Because the PNP is likely to be exposed to patients with TGNC, it is imperative they seek out opportunities to learn about transgender issues and caring for transgender patients.

Continuous Glucose Monitors and Automated Insulin Dosing Systems in the Hospital Consensus Guideline.

This article is the work product of the Continuous Glucose Monitor and Automated Insulin Dosing Systems in the Hospital Consensus Guideline Panel, which was organized by Diabetes Technology Society and met virtually on April 23, 2020. The guideline panel consisted of 24 international experts in the use of continuous glucose monitors (CGMs) and automated insulin dosing (AID) systems representing adult endocrinology, pediatric endocrinology, obstetrics and gynecology, advanced practice nursing, diabetes care and education, clinical chemistry, bioengineering, and product liability law. The panelists reviewed the medical literature pertaining to five topics: (1) continuation of home CGMs after hospitalization, (2) initiation of CGMs in the hospital, (3) continuation of AID systems in the hospital, (4) logistics and hands-on care of hospitalized patients using CGMs and AID systems, and (5) data management of CGMs and AID systems in the hospital. The panelists then developed three types of recommendations for each topic, including clinical practice (to use the technology optimally), research (to improve the safety and effectiveness of the technology), and hospital policies (to build an environment for facilitating use of these devices) for each of the five topics. The panelists voted on 78 proposed recommendations. Based on the panel vote, 77 recommendations were classified as either strong or mild. One recommendation failed to reach consensus. Additional research is needed on CGMs and AID systems in the hospital setting regarding device accuracy, practices for deployment, data management, and achievable outcomes. This guideline is intended to support these technologies for the management of hospitalized patients with diabetes.

A snapshot of clinical educational experiences for advanced practice nurses worldwide.

Using a convenience sampling, nurse educators representing 10 countries were surveyed to describe required clinical education for advanced practice beyond basic traditional nursing education. This article explores the many factors currently influencing the structure and diversity of these clinical experiences worldwide.

Defining a "Good Death" in Pediatric Oncology: A Mixed Methods Study of Healthcare Providers.

Delivering optimal end-of-life (EOL) care to children and adolescents is a healthcare priority, yet relatively little is known about what patients, families, and healthcare providers (HCPs) consider “best” practices. The objective of this study was to identify factors that pediatric oncology HCPs consider important for EOL care. This was a cross-sectional mixed methods study. Participants were multidisciplinary pediatric oncology staff who completed surveys and participated in semi-structured qualitative interviews. Interviews were analyzed using a modified grounded theory approach. Provider statements were compared based on years of experience (≤10 or >10 years) and discipline (non-physician or physician). A total of n = 19 staff (74% female) enrolled, including physicians (n = 8), advanced practice providers (n = 4), nurses (n = 2), music/art therapists (n = 2), physical therapists (n = 1), educators (n = 1), and chaplains (n = 1). Most HCPs identified communication, symptom control, and acceptance as features of a “good” death. Compared to physicians, non-physicians focused on relationships (67% vs. 33%, p = 0.007); HCPs with ≤10 years of experience (n = 11) more frequently identified the benefits of a multidisciplinary team (74% vs. 26%, p = 0.004). This study identified many common HCP-defined components of “good” pediatric EOL care in addition to some differing perspectives depending on discipline and experience. Incorporating diverse HCP perspectives with those of the patient and family can guide contemporary high-quality pediatric EOL clinical care and education.

Advanced practice nurses, registered nurses and medical practice assistants in new care models in Swiss primary care: a focused ethnography of their professional roles

ObjectivesWe aimed to analyse roles and tasks of advanced practice nurses (APNs), registered nurses (RNs) without advanced practice education and medical practice assistants (MPAs) with regard to chronic care in...

Simulation in Advanced Practice Education: Let's Dialogue!!

Advanced practice nurses are in a key position to meet the increasing demand for health care providers in North America, but the lack of clinical sites, qualified nursing faculty, and small preceptor pools hinder advanced practice nursing program expansion. Simulation is a pedagogical methodology that is used in advanced practice nursing education, yet regulatory agencies do not allow simulation to replace direct patient care experiences. Simulation enhances clinical experiences and allows for better learning and assessment. This article invites dialogue regarding the role of simulation in providing quality clinical educational experiences for the advanced practice nursing student.

CN42 - The Gastrointestinal and Lymphoma Unit lead nurse research role in Royal Marsden Hospital

Background: Clinical research has expanded in many fields with oncology growing vastly in the last 5 years. Specialised nursing and healthcare support is imperative for the smooth operation of the research aspect of a unit, aiming to deliver better care to patients (pts) participating in clinical trials. Methods: Retrospective review of the structure of the Research Clinics between November 2016 and April 2018 in Royal Marsden Hospital in the Gastrointestinal and Lymphoma Unit. Results: The Lead Research Nurse (LRN) structured the team by identifying the complexities involved in running a dedicated Research clinic, developing new roles and assigning the appropriate research team members to support the Clinical Research Fellows. The LRN introduced the role of Assistant Practitioners (APs)who support the running of the clinic by taking vital signs, performing ECG’s and other trial related procedures, such as entering source data into the Electronic Case Report Forms for the sponsor of each clinical study. This has enabled the Clinical Research Nurses (CRN) to spend more time with pts, assessing them for new or existing adverse events, recording concomitant medications, checking blood results, and completing Holistic Needs Assessments at required points throughout treatment. The LRN expanded the role of the Biological Specimen Coordinator (BSC) enabling them to perform phlebotomy on Research pts and take consent for a Translational Research protocol, making their role more hands on and improving retention in this job group. Conclusions: The LRN has a crucial role leading, supervising and developing a split site team consisting of ten CRNs: 5 senior CRNs, 5 junior CRNs, a Translational Research Manager, 5 BSCs and 2 APs. We have achieved a holistic approach for the trial pts whose needs might differ from the usual treatment setting due to the experimental nature of these trials. Our well-structured process has helped pts build better rapport with the team, understanding the importance of all members and various aspects in clinical research. Further training is warranted with Research nurses undertaking advanced practice education, with the view for this model to be adopted in other specialties and institutions. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

The education and training needs of advanced clinical practitioners: An exploratory, qualitative study

Advanced clinical practitioners increasingly provide patient care in a variety of settings across the world. This paper reports a qualitative study exploring the training and education needs of these healthcare professionals in England. Four focus group discussions and one individual interview were conducted with a total sample of 17 people. Participants were adults enrolled on an Advanced Practice Masters programme at one Higher Education Institution or advanced clinical practitioners from across two large London National Health Service hospitals. Data collection took place March-April 2017. Following transcription, audio-recorded data were imported into Nvivo11 and subjected to a standard process of inductive thematic analysis. Three key themes were identified: Recognising advanced practice; Education for Advanced Practice; Programme delivery. Findings highlight the huge variation in titles, practice responsibilities and management structure, which make the development of a generic education programme challenging and the importance of flexibility key to success. At a time when public services are experiencing significant financial constraints, the need for improved collaborative practices, shared resources and a practice focus is considered vital for educating future advanced clinical practitioners worldwide.

Evaluation of Virtual Learning Clinical Option in a Family Nurse Practitioner Program

With the advent of the Affordable Care Act in 2010, there is a growing need for more primary health care practitioners (U.S. Department of Health and Human Services, 2013). Nurse practitioners can fill the gap; however, qualified applicants have been turned away from nurse practitioner programs due to lack of seats (American Academy of Colleges of Nursing [AACN], 2015a). Many programs struggle to guarantee clinical placement for NP students (AACN, 2015b). In the face of a national shortage of preceptors, nursing programs must explore alternate methods of concept delivery and the development of clinical judgment. Simulation is a potential solution, as clinical competence between students who participate in simulation compared with peers who do not is similar (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014). The purpose of the project was to determine if a virtual simulation through Shadow Health offered similar results in clinical judgment as one-on-one preceptorships. Scores on the Advanced Practice Education Associates (APEA) national certification predictor exam were compared for two groups: an experimental group (n = 102) who completed 125 a virtual learning experience (VLE), and a control group (n = 102) who completed 125 hours of clinical one-on-one with a preceptor. A Mann-Whitney U Test revealed no significant difference in the APEA scores of traditional precepted students (Md = 72, n = 102) and virtual clinical students (Md = 73, n = 102), U = 5413, z = .501, p = .616. The effect size (r = .04) indicated that clinical placement had a very small effect on test performance (Pallant, 2016). Recommendations for future research and implications for nursing education are discussed.

The universal, collaborative and dynamic model of specialist and advanced nursing and midwifery practice: A way forward?

To inform and guide the development of a future model of specialist and advanced nursing and midwifery practice. There is a sizable body of empirical literature supporting the unique contributions of specialist and advanced practice roles to health care. However, there is very little international evidence to inform the integration of a future model for advanced or specialist practice in the Irish healthcare system. A qualitative study was conducted to initiate this important area of inquiry. Purposive sampling was used to generate a sample of informants (n=15) for the interviews. Nurses and midwives working in specialist and advanced practice and participants from other areas such as legislative, regulatory, policy, medicine and education were included in the sampling frame. Arguments for a new model of specialist and advanced practice were voiced. A number of participants proposed that flexibility within specialist and advanced practitioner career pathways was essential. Otherwise, there existed the possibility of being directed into specialised "silos," precluding movement to another area of integrated practice. Future specialist and advanced practice education programmes need to include topics such as the development of emotional and political intelligence. The contribution of specialist and advanced practice roles to the health service includes providing rapid access to care, seamless patient flow across services, early discharge and lead coordinator of the patient's care trajectory. There was a recommendation of moving towards a universal model to cultivate specialist and advanced nurse and midwife practitioners. The model design has Universal application in a range of contexts "U." It is Collaborative in its inclusivity of all key stakeholders "C." The model is Dynamic pertinent to accommodating movement of nurses and midwives across health continua rather than plateauing in very specialised "silos" "D."

The History and State of Neonatal Nursing Quality Improvement Practice and Education.

Quality improvement has evolved rapidly in neonatal nursing. This review outlines the history and current state of quality improvement practice and education in neonatal nursing. The future of neonatal nursing includes a stronger emphasis on quality improvement in advanced practice education that promotes doctoral projects that result in clinical improvements. A collective focus will ensure that neonatal nurses not only deliver evidence-based care, but also continually improve the care they deliver.

Creating Healthy Work Environments for Second Victims of Adverse Events.

Adverse events may cause a patient serious harm or death; the patient becomes the first victim of these events. The health care providers who become traumatized by the events are the second victims. These second victims experience feelings such as guilt, shame, sadness, and grief, which can lead to profound personal and professional consequences. An organizational culture of blame and a lack of support can intensify the provider's suffering. Second victims, as they move through predictable stages of recovery, can be positively influenced by a supportive organizational culture and the compassionate actions of peers, managers, advanced practice nurses, educators, and senior leaders. The American Association of Critical-Care Nurses Healthy Work Environment standards provide a framework for specific actions health care professionals should take to support colleagues during their recovery from adverse events.

Exploring factors affecting registered nurses' pursuit of postgraduate education in Australia.

The aim of this study was to explore the factors influencing registered nurses' pursuit of postgraduate education in specialty nursing practice in Australia. Despite the increased requirement for postgraduate education for advanced practice, little has been reported on the contributory factors involved in the decision to undertake further education. The Nurses' Attitudes Towards Postgraduate Education instrument was administered to 1632 registered nurses from the Nurses and Midwives e-Cohort Study across Australia, with a response rate of 35.9% (n = 568). Data reduction techniques using principal component analysis with varimax rotation were used. The analysis identified a three-factor solution for 14 items, accounting for 52.5% of the variance of the scale: "facilitators," "professional recognition," and "inhibiting factors." Facilitators of postgraduate education accounted for 28.5% of the variance, including: (i) improves knowledge; (ii) increases nurses' confidence in clinical decision-making; (iii) enhances nurses' careers; (iv) improves critical thinking; (v) improves nurses' clinical skill; and (vi) increased job satisfaction. This new instrument has potential clinical and research applications to support registered nurses' pursuit of postgraduate education.