Own Scope Of Practice Research Articles

Rural Healthcare Providers' Perceptions and Opinions of Their Own Scope of Practice: A Survey

Rural Healthcare Providers' Perceptions and Opinions of Their Own Scope of Practice: A Survey

Developing pre-licensure interprofessional and stroke care competencies through skills-based simulations

ABSTRACT Interprofessional collaboration (IPC) in stroke care is accepted as best practice and necessary given the multi-system challenges and array of professionals involved. Our two-part stroke team simulations offer an intentional interprofessional educational experience (IPE) embedded in pre-licensure occupational therapy, physical therapy, pharmacy, medicine, nursing and speech-language pathology curricula. This six-year mixed method program evaluation aimed to determine if simulation delivery differences necessitated by COVID-19 impacted students’ IPC perception, ratings, and reported learning. Following both simulations, the Interprofessional Collaborative Competency Assessment Scale (ICCAS) and free-text self-reported learning was voluntarily and anonymously collected. A factorial ANOVA using the ICCAS interprofessional competency factors compared scores across delivery methods. Content and category analysis was done for free-text responses. Overall, delivery formats did not affect positive changes in pre-post ICCAS scores. However, pre and post ICCAS scores were significantly different for interprofessional competencies of roles/responsibilities and collaborative patient/family centered approach. Analysis of over 10,000 written response to four open-ended questions revealed the simulation designs evoked better understanding of others’ and own scope of practice, how roles and shared leadership change based on context and client need, and the value of each team member’s expertise. Virtual-experience-only students noted preference for an in-person stroke clinic simulation opportunity.

Healthcare provider awareness, attitudes, beliefs, and behaviors regarding the role of pharmacists as immunizers

ABSTRACT We explored perceptions of healthcare providers in Nova Scotia and New Brunswick about pharmacists as immunizers. Pharmacists’ scopes of practice are increasingly broadening to include immunization, and providers and policymakers may find meaning in the lessons we learned. Invitations to participate in our online survey were circulated by professional associations, health authorities, and in social media posts. A total of 204 healthcare providers completed our survey, of whom 59.3% were pharmacists, 17.6% were nurses, and 23.0% were physicians. Nurses (30.6%) and physicians (34.0%) experienced fewer logistical barriers to immunizing compared to pharmacists, 71.1% of whom identified practice logistics as a determinant in offering vaccines to patients (p < .001). Pharmacists were most supportive of the expansion of their own scope of practice to include the provision of vaccines to adults (95.9%) and children as young as five years (92.6%) compared to nurses (72.2% and 69.4%) and physicians (61.7% and 40.4%) (p < .001). Diversity of opinion was evident even among pharmacists about whether they should be permitted to vaccinate children younger than five years. Nurse and physician respondents had lower odds of thinking pharmacists have enough training to vaccinate (p < .001), that vaccines should be given in a pharmacy (p < .001), and of supporting the expansion of pharmacists’ scope of practice (p < .001) than pharmacists did in the multivariable analyses. Pharmacists are well-positioned and willing to vaccinate and generally have support from their nurse and physician peers, but logistical challenges and interprofessional complexities persist as barriers to optimizing immunization by pharmacists.

Transformation in the Nurse-Patient Dyad or the Caregiver-Patient Dyad

Dependent nursing practice is following the doctor’s orders for medications, treatments, diet, activity, tests, etc. We ensure that the medical treatment is given.Shared practice is when the doctor is giving us parameters but leaves us to make judgments, as well. One example is giving medications “as needed” or titrating vasoactive medications in the intensive care unit according to blood pressure.Independent practice is what we do in our own scope of practice. What do we do with and for patients for which we do not need an order?

How registered nurses determine their scope of practice: a cross-sectional study

In respect of professional nursing, the term scope of practice is regularly used, yet is often poorly defined both in Australia and internationally. This study explores the determinants of scope of practice from a national sample of Australian registered nurses using an online survey (Scope-QAu). This paper reports on two parts of a large cross-sectional survey wherein 1231 registered nurses in Australia provided data on how they determined their scope of practice. Scope of practice in the Australian nursing context is influenced by a range of professional publications, guidelines and standards, as well as professional peers and one’s own judgement. Findings reveal that few demographic characteristics predicted the way nurses determined their own scope of practice. Nurses commonly relied upon three professional publications, peers and line managers, to establish their individual scope of practice.Impact statement: Registered nurses do not rely solely on professional guidelines or regulatory frameworks when determining their scope of practice.

Who Judges Harm?

The American Medical Association’s (AMA’s) “Opinion 1.1.7, Physician Exercise of Conscience” attempts to help physicians strike a reasonable balance between their own conscientious beliefs and their patients’ medical interests in an effort to minimize harms to both. However, some ambiguity still remains as to whether the severity of harms experienced by physicians and patients is to be assessed externally (by policy makers or by a professional body like the AMA), or internally by the subjects of those harms. Conflicts between conscientious physicians’ self-assessments of the moral harm associated with various actions and the AMA’s external assessments of such harms are likely to lead to challenges in the implementation of some provisions of its opinion. This commentary argues, however, that provisions (b) and (e) of the opinion, which describe the information physicians should provide about their own scope of practice and about the existence of controversial procedures, are less likely to conflict with physicians’ subjective assessments of moral harm, and therefore will face fewer challenges in implementation.

Developing the Australasian Hepatology Association’s consensus-based guidelines for the nursing care of patients with liver disease

Purpose: Hepatology nursing is an emerging speciality. To define best practice, the Australasian Hepatology Association (AHA) developed consensus-based guidelines for the nursing care of patients with liver disease. Methods: Using the Delphi technique, six rounds of consultation were conducted with Australian hepatology nurses and nonnursing hepatology professionals. Input was captured through face-to-face and electronic communication and questionnaires. Results: The experts’ opinions were collated and consensus on the delivery of hepatology nursing care was achieved. In total, 90 consensus guidelines were developed. The principles underpinning the Guidelines include patient-centred care, non-discriminatory practice, cultural competence, collaboration and partnership and working within own scope of practice. Conclusion: Internationally, the AHA Guidelines are the first to document a consensus on the scope of hepatology nursing practice. The Guidelines reflect the expansion of hepatology nursing, from viral hepatitis to caring for patients with advanced liver disease and hepatocellular carcinoma, and provides a framework for future nursing practice.

Developing the Australasian Hepatology Association's Consensus-based Guidelines for the Nursing Care of Patients with Liver Disease.

Abstract Purpose: Hepatology nursing is an emerging speciality. To define best practice, the Australasian Hepatology Association developed consensus-based guidelines for the nursing care of patients with liver disease. Methods: Using the Delphi technique, six rounds of consultation were conducted with Australian hepatology nurses and non-nursing hepatology professionals. Input was captured through face-to-face and electronic communication and questionnaires. Results: The experts' opinions were collated and consensus on the delivery of hepatology nursing care was achieved. In total, 90 consensus guidelines were developed. The principles underpinning the Guidelines include patient-centred care, non-discriminatory practice, cultural competence, collaboration and partnership and working within own scope of practice. Conclusion: Internationally, the Australasian Hepatology Association Guidelines are the first to document a consensus on the scope of hepatology nursing practice. The Guidelines reflect the expansion of hepatology nursing, from viral hepatitis to caring for patients with advanced liver disease and hepatocellular carcinoma, and provides a framework for future nursing practice.

The Experience and Effectiveness of Nurse Practitioners in Orthopaedic Settings: A Comprehensive Systematic Review.

Review question/objective This review asks “What is the experience and effectiveness of nurse practitioners in orthopaedic settings”? The objective of the quantitative component of this review is to synthesise the best available evidence on effectiveness of orthopaedic nurse practitioner specific care on patient outcomes and process indicators. The objective of the qualitative component of this review is to synthesise the best available evidence on the experience of becoming or being an orthopaedic nurse practitioner in relation to role development, role implementation and (ongoing) role evaluation. The objective of the text and opinion component of this review is to synthesise the best available evidence of the contemporary discourse on the effectiveness and experience of nurse practitioners in orthopaedic settings. Types of participants Nurse practitioner is an expanded form of advanced practice.11 For the purpose of this systematic review the International Council of Nurses (ICN) definition20 of nurse practitioner will apply whereby a Nurse Practitioner/Advanced Practice Nurse is defined as a Registered Nurse with expert knowledge, complex decision making skills and possessing competency for expanded practice. Importantly the practice of nurse practitioner/advanced practice nurse is characterised further by the “context and/or country” that they practice within.20 Therefore an ‘orthopaedic’ nurse practitioner is defined in accordance with the above definition and with a specific scope of practice (as authorised) within a relevant and specific ‘orthopaedic’ setting. The quantitative and qualitative components of this review will consider studies that include orthopaedic nurse practitioners in acute care or sub-acute orthopaedic settings. The textual component of this review will consider publications that pertain to orthopaedic nurse practitioners in acute care or sub-acute orthopaedic settings, where there exists a particular focus on the ‘orthopaedic’ aspect of nurse practitioner practice. Types of intervention(s)/phenomena of interest The quantitative component of this review will examine interventions of orthopaedic nurse practitioner specific care. For this systematic review, orthopaedic nurse practitioner specific care refers to those aspects of care the orthopaedic nurse practitioner is responsible for and/or records as performance outcomes such as: occasions of service/numbers seen; time to and length of nurse practitioner consultation; time to nurse practitioner intervention; referral patterns and other measures of intervention effectiveness. The qualitative component of the review will examine as phenomena of interest the experience of becoming or being an orthopaedic nurse practitioner in relation to role development, role implementation and (ongoing) role evaluation. The text and opinion component of the review will examine opinions on the effectiveness and experience of nurse practitioners in orthopaedic settings including role development, implementation and evaluation of nurse practitioners in orthopaedic settings. Types of outcomes The quantitative component of this review will consider as primary outcomes the following patient outcomes: • patients’ level of pain • pressure injury • urinary tract infection • patient satisfaction • in-hospital patient mortality • hospital readmission • patients’ health-related quality of life • functional status • malnutrition score • constipation • wound care/complications • other clinical complications • morbidity • other patient encounter data that characterise orthopaedic nurse practitioner practice • other relevant nurse-sensitive outcome data The quantitative component of this review will consider as secondary outcomes the following nurse related outcomes or process indicators/outcomes: • orthopaedic nurse practitioner satisfaction • key stakeholder (health professional) satisfaction • specialised knowledge/skill translation • hospital length of stay • cost benefit

Promoting interprofessional learning with medical students in home care settings

Background: The home care setting is ideal for medical students to learn about the importance of interprofessional collaboration in the community.Aims: This project examined the impact of a unique program designed to facilitate medical students’ knowledge and awareness of the challenges of interprofessional care in the home.Methods: In pairs, medical students participated in two community visits with preceptors from different professions. Students completed a structured personal reflection after their first visit. Students and preceptors participated in focus groups or interviews to identify strengths and challenges of the experiences. The structured reflections and the focus group and interview transcripts were analyzed qualitatively.Results: 164 medical students and 36 preceptors participated in 326 visits. There were high ratings of satisfaction from students and preceptors. Students developed unexpected insights into peoples’ lives, developed a greater understanding of the patient's perspective and determinants of health, learned about others’ scope of practice, and developed an appreciation of the limitations of their own scope of practice. Preceptors had high expectations for student performance and engagement and enjoyed the opportunity to impart their knowledge to future physicians.Conclusion: Although organizationally complex, the program evaluation suggestions that students and preceptors benefit from interprofessional experiences in the home.

Surgeons and HIV: South African attitudes.

The HIV status of surgeons, in the context of the informed consent obtained from their patients, is a contentious matter. We surveyed the views of practising surgeons in South Africa regarding aspects of HIV and its impact on surgeons. A cross-sectional survey of surgeons who were members of the Association of Surgeons of South Africa, regarding their attitudes to the preceding issues. The salient findings included the view that a patient-centered approach requiring HIV status disclosure to patients would be discriminatory to surgeons and provide no clear benefit to patients, and that HIV-positive surgeons should determine their own scope of practice. Patient-centered approaches and restrictive policies, related to this issue, do not accord with clinician sentiment. In the absence of comparable local or international data, this study provides clinicians' views with implications for the development of locally relevant policies and guidelines.

Perceptions and Utilization of Palliative Care Services in Acute Care Hospitals

To understand perceptions of palliative care in acute care hospitals and identify barriers to earlier use of palliative care in the illness trajectory. In Pennsylvania hospitals, we completed semistructured interviews with 131 providers involved in decision making or discharge planning. We used qualitative methods to analyze transcripts. Most interviewees characterized palliative care as end-of-life or hospice care that is initiated after the decision to limit curative treatment is made. Few recognized the role of palliative care in managing symptoms and addressing psychosocial needs of patients with chronic illnesses other than cancer. Interviewees viewed earlier and broader palliative care consultations less in terms of clinical benefits than in terms of cost savings accrued from shorter terminal hospitalizations. In general, they thought nurses were most likely to facilitate these consultations, surgeons were most likely to resist them, and intensive care specialists were most likely to view palliative care as within their own scope of practice. Suggestions for broadening palliative care utilization included providing education and training, improving financial reimbursement and sustainability for palliative care, and fostering a hospital culture that turns to high-intensity care only if it meets individual needs and goals of chronically ill patients. In acute care hospitals, palliative care is primarily perceived as a means to limit life-sustaining treatment or allow death. Moving consultation earlier in the hospitalization of "dying" patients is a greater preoccupation than increasing palliative service use earlier in the illness trajectory. Any move short of far upstream will require palliative care specialists to market benefits to patients and referring providers in ways that emphasize compatibility with parallel treatment plans and do not threaten provider autonomy.

Coaching and Social Work: Challenges and Concerns

has rapidly grown in the past five years (Grodzki, 2002), and clinical social work practitioners are increasingly considering coaching as an alternative or additional mode of practice (Valliantos, 2001). It is seen as an opportunity to diversify practice without the hindrance of managed care (Grodzki, 2002; Kodish, 2002). Although the exact number of social workers providing coaching services is unknown, it is clear that it is of interest. Evidence of the growth of coaching in social work can be seen by the increases in presentations on coaching at social work conferences, in articles and classified advertisements in NASW News, and in NASW state chapter publications. Coaching workshops are now approved for social work continuing education credits in more than 30 states. Despite its rapid growth, there has been little discussion regarding the relationship of coaching to the field of social work. This commentary is intended to begin the dialogue. WHAT IS COACHING? To understand coaching, it is important to know that the term simultaneously refers to two distinct undertakings--a method and a movement (Caspi, 2004). As a method, coaching is akin to other intervention approaches (for example, solution-focused, cognitive-behavioral). In its second use, the word describes an emerging practice movement, with its own scope of practice. Although not yet a profession or discipline in its own right, coaching may be on its way to becoming one (Grant, 2003). A body of research is developing, and coaching organizations are flourishing, already offering training, credentialing, and sizeable annual conferences. There is little agreement in coaching about its practice focus (Grant, 2003). It goes by many names, each of which suggests a different area. Some examples are personal, life, executive, corporate, career, professional, performance, family and parenting--all followed by the word (for example, personal coach). Despite its two overarching denotations, coaching has been broadly defined to describe a goal-focused process of assisting individuals and companies to improve personal and professional achievement (Kilburg, 1996; Nowack, 2003). The undertaking entails identifying steps to take to reach clear objectives, in the way a sports coach works to boost an athlete's performance (Hargrove, 2000). Coaching assists with a wide range of objectives, which can include developing leadership skills, realizing life dreams (for example, becoming a business owner, learning a musical instrument), achieving lifestyle changes (for example, increasing family time, dating more frequently), professional advancement (for example, getting a raise, promotion, increasing sales, achieving tenure), enhancing personal development (for example, educational advancement, developing public speaking skills), achieving financial order, or improving internet marketing. The focus on goals has been used to distinguish coaching from traditional mental health treatment approaches, which have been more concerned with ameliorating personal pathologies (Grant, 2003). Other differences exist as well. Coaching claims to be distinct from therapy with regard to the practitioner-client relationship and to the setting in which it is conducted (Hart, Blattner, & Leipsic, 2001). Coaching is less concerned about avoiding dual relationships and practitioner self-disclosure. Coaching is often done on the phone, in the client's home, or in the client's workplace. Nonetheless, coaching and clinical social work practice have similarities. Both involve helping processes that focus on self-understanding and self-discipline to change behaviors, attitudes and feelings (Caspi & Caspi, 2003). Negotiating these differences and similarities poses challenges and should raise concerns for social workers and for the profession. CHALLENGES AND CONCERNS Although interest among practitioners has rapidly expanded, few writings about coaching have appeared in social work journals. …

The scope of enrolled nurse practice: A grounded theory study

This paper follows an earlier paper presented in this journal where the scope of practice of Enrolled Nurses (EN) was critically reviewed from the available literature on this topic. In this paper the authors (Milson-Hawke & Higgins, 2003) recommended the need for research into the scope of practice of ENs. The purpose of the paper presented here is to describe the outcomes of a grounded theory study that explored the nature of EN practice within an acute hospital setting and the processes that ENs used to guide their practice. Although the findings of the study are incomplete because of the limits of time and scope of the study, the theory developed provides a useful description of how of the ENs in this study determined their own scope of practice in the acute hospital setting. The processes that the ENs used emerged as ‘doing the work without overstepping the mark’. ‘Doing the work without overstepping the mark’ required ENs to make judgements about the nature of the work they were being asked to do. The nature of the work of ENs emerged as ‘doing routine work’ and ‘deciding to do non-routine work’. Routine work comprised ‘essential nursing’ and ‘advancing practice’. Essentially, the ENs in this study determined their own scope of practice as they undertook nursing activities beyond their level of preparation. The impact of the care provided by ENs, however, was not within the scope of this small study. This needs to be the focus of future studies along with the impact on health care of the changing roles of ENs.

Establishing the scope of dentistry

Establishing the scope of dentistry