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Progressing advanced practice: innovations in partnership
Abstract: During early March 2023, Health Education England (HEE) had the privilege of working with multi-professional health education leaders from Australia. We collaborated with Universities Australia’s Health Professions Education Standing Group (HPESG) to host senior academic, health policy and regulatory body colleagues for a week-long study tour in England to share learning on how the two countries are implementing innovative solutions to address healthcare workforce development challenges.
Source: Barratt, J. International Journal for Advancing Practice, Apr 2023; 1(1): 5-6
Developing a pre-course workbook for advanced practice students in the UK
Abstract: The UK has taken a unique multiprofessional approach to the development of advanced practice. Higher education institutes across the UK provide master’s-level programmes for advanced practice. Requirements vary with master’s level awards mandatory in some countries but not in others. Educators recognise the need to support students to develop both clinically and academically.
Source: Jones, A. British Journal of Nursing, Feb 2023; 32(4): 224-225
Join the debate on advanced practice
Abstract: The UK needs a coherent approach to advanced nursing roles, says Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, which the NMC is now in the process of considering.
Source: Foster, S. British Journal of Nursing, May 2023; 32(10): 491
Enabling the research pillar of advanced practice
Abstract: Research, as an integral part of advanced practice, is the key ethos of the research pillar in the Multi-professional framework for advanced clinical practice in England (Health Education England (HEE), 2017). The HEE’s Centre for Advancing Practice is developing an increased focus on the research pillar, to increase the representation of advanced practice research of all types across multiple disciplines throughout the international community.
Source: Conway, J. International Journal for Advancing Practice, Jul 2023; 1(2): 57-58
A survey exploring the development needs of advanced clinical practitioners
Abstract: The multi-professional framework for advanced practice in England defines the four pillars of advanced practice as: clinical, leadership, research and education. A survey was designed to explore how aspirant, trainee and qualified advanced clinical practitioners used continuing professional development opportunities to develop and/or maintain capabilities across these pillars. This survey was marketed widely across all health providers in an integrated care system (UK). Respondents (n=38) were mainly from nursing and physiotherapy and represented NHS acute, community and charity sector providers. Respondents valued MSc-level modules and ongoing mentorship consistently across all pillars.
Source: Davies, B. International Journal for Advancing Practice, Apr 2023; 1(1): 7-12
Exploring the journey and impact of advanced practice in care delivery for people with learning disabilities and/or autism
Abstract: Background: Practitioners working in the field of learning disability and/or autism have seen their roles expand over the past several decades to promote and accommodate the complex needs of the population group. While the nuances and intricacies of working with this group of people may be less clearly defined, advanced practitioners are required to develop the roles in the field across the four pillars of clinical practice, leadership and management, education and research. Aim: This study aimed to review the published literature and explore, identify and describe the journey for practitioners towards advanced practice in learning disability and autism, as well as their impact on care delivery. Method: A scoping review approach was used to address the review question. The PRISMA extension for scoping reviews (PRISMA-ScR) guidelines was used as a structured format to report the review. Research question: What are the positionality, identity and impact of advanced practice for care delivery by advanced practitioners in learning disability and autism? Discussion: This scoping review is being designed to conceptualise the journey towards advanced practice, with a specific focus on learning disability and autism, exploring the impact on care delivery in this field of practice by advanced practitioners.
Source: Appleby, B. International Journal for Advancing Practice, Jul 2023; 1(2): 89-94
The Advanced Clinical Practice Integrated Degree Apprenticeship end point assessment: history, challenges and implementation
Abstract: The advanced clinical practitioner (ACP) apprenticeship is one of several new apprenticeships that have been developed since the introduction of higher apprenticeships in England in 2010. The end point assessment (EPA) is a compulsory part of an apprenticeship and forms an independent assessment of the occupational competence of the apprentice. The EPA is set out in an assessment plan that end point assessment organisations (in this case, the higher education institution delivering the master’s degree) must adhere to. Its initial introduction presented challenges for educators, because of its unfamiliar nature. These challenges have been addressed through an end point assessment organisation (EPAO) network, hosted by the Association of Advanced Practice Educators UK (AAPEUK), who has provided support, consistency and a wealth of resources for educators and students preparing to take the EPA. Since the first EPAs were delivered in 2020, more is known about how learners might best prepare and how educators and supervisors in practice can support them. The ACP EPA is becoming recognised as a valuable synoptic module that marks the successful achievement of the apprenticeship programme. The achievement allows both learners and employers to appreciate and have confidence in their abilities during the sometimes-challenging transition to advanced practice roles.
Source: MacArthur, V. International Journal for Advancing Practice, Apr 20213; 1(1): 37-41
Developing the Royal College of Emergency Medicine's advanced clinical practitioners in the Wessex region: design, implementation and review of a regional training programme
Abstract: Background: Since 2015, the Royal College of Emergency Medicine (RCEM) has championed an advanced clinical practitioner (ACP) credentialing process for clinicians working in advanced practice roles in the emergency department. While this process ensures a standard of advanced practice that is both governable and robust, it requires structure and support to complete successfully. This article reports the design and implementation of a regional programme aimed at supporting trainees through the RCEM ACP training process to the point of credentialing. Methods: A regional training programme was implemented and a mixed-methods approach (that included a quantitative analysis of training programme completion rates and a qualitative review of trainee feedback) was used to analyse the outcomes. The programme incorporated a structured educational programme, educational supervision and annual review, alongside integration into the deanery school board and facilitation of training time. Results: Between 2016 and 2022, a total of 46 trainee RCEM ACPs were recruited to the programme. Of these, 19 had credentialed by spring 2022 and 20 were in ongoing training, aiming for credentialing. During this time, these participants accounted for 19% of the nationally credentialed ACP workforce (19 of 99). Since 2020, the first pass rate for programme trainees has been 71%, compared to the national average of 38%. Credentialed ACPs, when asked how well the programme prepared them to credential with the RCEM, responded positively, with most scoring the programme between 4 and 5, with 5 being marked as ‘excellent’. Free text comments in feedback on the programme were collated and reviewed for common themes resulting in key themes of ‘supportive’, ‘excellence’ and ‘adequate preparation for credentialing’. Conclusion: Meeting the criteria for RCEM credentialing as an ACP is a demanding process that requires support and structure. The development and implementation of a regional training programme not only meets these requirements but yields higher credentialing success rates and creates trainee satisfaction in the process.
Source: Freshwater, E. International Journal for Advancing Practice, Jul 2023; 1(2): 59-64
Germany pioneers an expansion of the advance practice nurse role
Abstract: Germany is pioneering a new advance nursing programme, focusing on person-centered, evidence-based care for patients with multimorbidities. This article details its successes and challenges.
Source: Henderson, C. International Journal for Advancing Practice, Jul 2023; 1(2): 100-102
The role of advanced clinical practitioners in clinical research
Abstract: Advanced clinical practitioners (ACPs) contribute immensely to patient care, so there is consequently a need to develop and create a sustainable environment for advanced clinical practice in clinical research. To achieve this it is necessary to evaluate the current challenges to enable stakeholders and policymakers to take the appropriate measures in safeguarding the future of advanced clinical practice in clinical research. The ACP workforce presents an opportunity to enhance access to clinical research. This article looks at the role of ACPs in clinical research and significant developmental milestones. The challenges of ACPs in clinical research are discussed, with an analysis of the needed interventions within the UK context. Strategies aimed at increasing the utilisation of the larger ACP workforce in clinical research are proposed.
Source: Badu, Samuel A. British Journal of Nursing, Mar 2023; 32(6): 284-290
Advanced clinical practitioners and the research pillar
Abstract: This paper considers the development of multidisciplinary advanced clinical practice in the UK and further afield. Consideration is given to education, governance and the four pillars of advanced practice: clinical, education, leadership and management, and research, as defined in Health Education England’s Multi-Professional Framework for Advanced Clinical Practice (2017). The research pillar is subsequently considered in more detail, with the following aspects being explored: the key drivers and support for increasing research engagement; the value of advance care practitioners (ACPs) developing research capabilities to enhance the provision of high-quality evidence-based patient care; and the barriers to achieving the research capabilities. The close relationship between advanced practice and clinical academic roles is identified, alongside both the evolving situation regarding clinical academic roles within the NHS, and the need to develop the research pillar through doctoral level study (to support the development of ACPs into future research leaders). This paper concludes by offering the Health Education England/National Institute for Health and Care Research’s Integrated Clinical and Practitioner Academic programme as a potential solution to the challenges surrounding ACPs accessing additional training and development avenues—which are necessary for them to progress as professionals and active researching academics.
Source: Dean, S. International Journal for Advancing Practice, Apr 2023; 1(1): 42-46
Advancing practice: what exactly is being advanced?
Abstract: The advanced practitioner role has an elusive quality, lacks clarity and is a relatively new concept in some parts of the world, which has huge implications for the provision of services, advanced practitioners themselves and the development of advanced practice. Despite this, advanced practice is picking up momentum and gaining traction.
Source: Peate, I. International Journal for Advancing Practice, Jan 2023; 1(0): 10
Advancing practice: a legacy of innovation
Abstract: Welcome to the inaugural issue of the International Journal for Advancing Practice.
Source: Advancing Practice, Jan 2023; 1(0): 6-7
The role of the advance nurse practitioner in mental health in Scotland
Abstract: In this article, Elaine J Armstrong discusses the role of the advance nurse practitioner in mental health, along with the challenges and opportunities that this role brings.
Source: Armstrong, Elaine J. British Journal of Mental Health Nursing, Aug 2023; 12(3): 1-3
Elevating Advanced Practice Provider Fellowships Through Accreditation
Abstract: The American Nurses Credentialing Center (ANCC) launched its newest credentialing program, Advanced Practice Provider Fellowship Accreditation™ (APPFA). This credential will provide Advanced Practice Provider fellowships with the ability to seek and earn recognition for excellence against a set of evidence-based standards. Explore the five domains that make up APPFA and learn about a few highlighted standards.
Source: Cosme, S. The Journal of Continuing Education in Nursing, Jan 2023; 54(1): 6-8
Construct validity of advanced practice nurse core competence scale: an exploratory factor analysis
Abstract: Background Determining the core competence of advanced practice nurses is foundational for promoting optimal design and implementation of advanced practice nursing roles. Core competencies specific to the contexts of the advanced practice nurse in Hong Kong have been developed, but not yet validated. Thus, this study aims to assess the construct validity of advanced practice nurse core competence scale in Hong Kong. Methods We performed a cross-sectional study using an online self-report survey. Exploratory factor analysis was used to examine the factor structure of a 54-item advanced practice nurse core competence scale through principal axis factoring with direct oblique oblimin rotation. A parallel analysis was conducted to determine the number of factors to be extracted. The Cronbachs α was computed to evaluate the internal consistency of the confirmed scale. The STROBE checklist was used as reporting guideline. Results A total of 192 advanced practice nurse responses were obtained. Exploratory factor analysis led to the final 51-item scale with a three-factor structure, which accounted for 69.27% of the total variance. The factor loadings of all items ranged from 0.412 to 0.917. The Cronbachs alpha of the total scale and three factors ranged from 0.945 to 0.980, indicating robust internal consistency. Conclusion This study identified a three-factor structure of the advanced practice nurse core competency scale: client-related competencies, advanced leadership competencies, and professional development and system-related competencies. Future studies are recommended to validate the core competence content and construct in different contexts. Moreover, the validated scale could provide a cornerstone framework for advanced practice nursing roles development, education, and practice, and inform future competency research nationally and internationally.
Source: Sek Ying Chair. BMC Nursing, Mar 2023; 22(1): 57
Teaching strategies of clinical reasoning in advanced nursing clinical practice: A scoping review
Abstract: Aim/objective To report and synthesize the main strategies for teaching clinical reasoning described in the literature in the context of advanced clinical practice and promotes new areas of research to improve the pedagogical approach to clinical reasoning in Advanced Practice Nursing. Background Clinical reasoning and clinical thinking are essential elements in the advanced nursing clinical practice decision-making process. The quality improvement of care is related to the development of those skills. Therefore, it is crucial to optimize teaching strategies that can enhance the role of clinical reasoning in advanced clinical practice. Design A scoping review was conducted using the framework developed by Arksey and O’Malley as a research strategy. Consistent with the nature of scoping reviews, a study protocol has been established. Methods The studies included and analyzed in this scoping review cover from January 2016 to June 2022. Primary studies and secondary revision studies, published in biomedical databases, were selected, including qualitative ones. Electronic databases used were: CINAHL, PubMed, Cochrane Library, Scopus, and OVID. Three authors independently evaluated the articles for titles, abstracts, and full text.Results1433 articles were examined, applying the eligibility and exclusion criteria 73 studies were assessed for eligibility, and 27 were included in the scoping review. The results that emerged from the review were interpreted and grouped into three macro strategies (simulations-based education, art and visual thinking, and other learning approaches) and nineteen educational interventions. Conclusions Among the different strategies, the simulations are the most used. Despite this, our scoping review reveals that is necessary to use different teaching strategies to stimulate critical thinking, improve diagnostic reasoning, refine clinical judgment, and strengthen decision-making. However, it is not possible to demonstrate which methodology is more effective in obtaining the learning outcomes necessary to acquire an adequate level of judgment and critical thinking. Therefore, it will be necessary to relate teaching methodologies with the skills developed.
Source: Giuffrida,S. Nurse Education in Practice, Feb 2023; 67: 103548
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Exploring the role of advanced clinical practitioners (ACPs) and their contribution to health services in England: A qualitative exploratory study
Abstract: Background An extended role being explored globally is the advanced clinical practitioner (ACP). In England this is an extended role for allied health professions, nurses and midwives in a range of settings. Objectives This paper focuses on three research questions: 1) What is the role of ACPs in England? 2) What are the barriers and facilitators to implementing the role? and 3) What is the contribution of ACPs to health services in England? Design/setting A qualitative, exploratory study to explore perspectives on the ACP role in a range of clinical settings. Participants We recruited 63 stakeholders, including 34 nurses, working in an ACP role or ACP education. A purposive snowball sampling technique identified participants meeting inclusion criteria. Methods One-to-one semi-structured interviews throughout 2020 recorded and transcribed verbatim, anonymised and thematically analysed. Results The ACP role in England was undertaken in a broad range of clinical contexts. In England advanced clinical practitioner was not a protected title. There were high levels of variability and ambiguity of understanding and deployment of the ACP role in England. Facilitators to the implementation process included training and education, clinical supervision and organisational support. Lack of protection for the role and variances in experience were barriers. Employer support facilitated development of the ACP role, however where support was limited, at either an individual or organisation level, this was a barrier. Our study highlighted the wide range of ways the ACP role benefitted patient outcomes and workforce development. Conclusions This study outlines the contribution that ACPs can make to health services, contributing factors and key barriers and facilitators to implementing this role. The work showed the positive contribution ACPs can make to service redesign, workforce development and patient outcomes, whilst accepting there is much work to do to ensure protected status and parity across all professions and clinical contexts.
Source: Mann, C. Nursing Education in Practice, Feb 2023; 67: 103546
Effects of advance care planning training on advanced practice nurse students’ knowledge, confidence, and perception of end-of-life care: A mixed-method study
Abstract: Aims This study aimed to assess how an advance care planning training program affected advanced practice nursing student’s knowledge, confidence and perception of end-of-life care in South Korea. Background Effective communication between healthcare providers, patients and their families is one of the most important components of quality end-of-life care. However, nurses in South Korea may feel uncomfortable helping patients and families with advance care planning because of the cultural taboo against talking about dying. Design A mixed-method design was used with data obtained from self-administered questionnaires at the onset and end of the advance care planning training program and qualitative data from participant feedback after the program. Methods Data collected from 65 advanced practice nursing students who participated in advance care planning training programs in June-July 2020 and 2021, conducted as part of a graduate clinical practice course, were analyzed. Data were originally collected to examine student’s course outcomes. A training program was provided to advanced practice nursing students to improve their knowledge, confidence and perception in advance care planning conversations with their patients. The program comprised three sessions: online lectures, face-to-face simulations and discussions on advance care planning and ethical issues. Changes in advance care planning knowledge, confidence in supporting patient’s advance directives, perceived nursing roles in end-of-life treatment decisions and perception of a good death were examined before and after the training. Results There were statistically significant increases in participants advance care planning knowledge, confidence in supporting patients advance directives and perception of the active role of nurses in patient’s end-of-life treatment decisions after the training. Conclusions The results indicate the effects of training programs on advanced practice nursing student’s knowledge, confidence and perception of advance care planning communication. They also provide evidence about what contents and methods can be helpful in developing end-of-life care training for advanced practice nursing students.
Source: Minjeong Jo. Nurse Education in Practice, Feb 2023; 67: 103555
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Advanced practice and clinical supervision: An exploration of perceived facilitators and barriers in practice
Abstract: Aim and Objectives The aim of this study was to investigate current advanced practice Masters students experience of clinical supervision, to explore how clinical supervision works in practice and to identify students perceptions of the facilitators and barriers to clinical supervision in their workplace. Background Advanced practitioners, and in particular nurses, play a pivotal role in delivering health care across acute and primary care settings. These non‐medical professionals fulfil a rapidly expanding proportion of roles traditionally undertaken by medically qualified staff within the National Health Service in the United Kingdom and often lead specialist clinics and services. To prepare for the advanced practice role, individuals are required to undertake a Master's in advanced practice to develop the required skills and knowledge and work in clinical practice with a clinical assessor/supervisor to demonstrate competence and performance. Design A mixed method study using an online descriptive cross‐sectional survey and qualitative data were collected via focus groups and has been reported using the Good Reporting of a Mixed Methods Study checklist. Results A total of 79 students completed the online survey (from 145 AP students), a response rate of 55%. Most respondents were nurses (n = 73) with 49 (62%) in a formal advanced practice trainee role, and the majority believed their clinical supervisor had a good understanding of advanced practice and the advanced practice role. Two focus groups were held with 16 participants in total. Thematic analysis revealed five themes: (a) perceived level and amount of support from clinical supervisors, (b) skill level of clinical supervisors, (c) physicians and their perceptions on supervising, Advanced practitioners (d) clinical supervisors preparation for the role and (e) transition from trainee to qualified advanced practitioner. Conclusion The survey revealed that advanced practitioner students perceived that clinical supervisors and workplace colleagues had a good understanding of the advanced practice role with good levels of support in practice. A more coherent approach is required for clinical supervision and an implementation framework that can be formally evaluated. Relevance to clinical practice Several significant barriers to clinical supervision for advanced practitioner students were identified, and there are currently more barriers (including COVID‐19) than facilitators.
Source: Lee, Geraldine A. Journal of Clinical Nursing, Mar 2023; 32(5-6): 780-788
Approach to advanced practice nursing student clinical during COVID-19
Abstract: While many states adopted policies that allow for simulation or other experiences to replace direct clinical hours in pre-licensure nursing programmes during COVID-19 (National Council of State Boards of Nursing, 2020), AP nursing education regulations continue to require a minimum of 500 supervised direct patient clinical care hours for nurse practitioner (NP) students to meet graduation and certification requirements (National Organization of Nurse Practitioner Faculties [NONPF], 2020). [...]NP programmes must seek novel ways to maximize the use of available resources for students to earn supervised direct patient clinical care hours during this ongoing global health crisis. [...]many AP clinical sites (66 of the 79) restricted student access for a variety of reasons, including a lack of personal protective equipment (PPE), increased workload of preceptors, staffing shortages and concerns about social distancing required for staff and student safety. Another opportunity allowed students to assist with a phone line at a local health centre where they spoke with low income, mostly uninsured patients about symptoms, emotional distress about community infections, and how to remain healthy during the pandemic. Other considerations for student learning include maintenance of privacy and standard of care in virtual visits, awareness of acceptable HIPAA-compliant platforms, how to educate patients on the use of technology and to join with preceptors as they also expand their learning of telehealth.
Source: McIltrot, K. Nursing Open, Mar 2023; 10(3): 1931–1935
Advanced practice nurse capabilities: A mixed methods systematic review
Abstract: Background Global health challenges demand the optimal use of nurses' professional competence and capability. Competencies related to the roles of advanced practice nurses have been developed, but research on these nurses' capabilities remains limited. Aim To summarise and compare the literature on the capabilities of advanced practice nurses and the dimensions of these capabilities. Methods We carried out mixed methods systematic review, using CINAHL, PubMed, and Scopus to search literature published between 1998 and 2021. The quality of the selected articles was evaluated with the JBI Critical Appraisal Tools. We employed abductive content analysis, including deductive and inductive analysis. The reporting was guided by the standards of the Preferred Reporting Items for Systematic Review and Meta‐Analysis Statement. Results Eleven articles out of 357 met the inclusion criteria. We identified all five dimensions of Hase and Davis's (1999) capability framework: can apply competencies in familiar as well as unfamiliar situations, is creative, has a high degree of self‐efficacy, knows how to learn, and works well in teams. Additionally, we found a new dimension of capability: identifies factors affecting the scope of practice. Limitations This mixed methods systematic review was conducted about a little‐studied topic. Because country‐specific differences exist and consensus on advanced practice nursing roles is lacking, the concept of advanced practice nurse capabilities cannot be directly generalised. Conclusions Capability is a requirement and a necessity in the performance of advanced practice nurses. Identifying and defining the dimensions of advanced practice nurses' capabilities will lead the way in developing the roles, education, and capability assessments of advanced practice nurses. Identification of advanced practice nurses' capability will facilitate role understanding, visibility, and implementation in health care services. This can improve the quality and accessibility of care and improve the cost‐effectiveness of the use of health care professionals.
Source: Hako, L. Scandinavian Journal of Caring Sciences, Mar 2023; 37(1): 3-19
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Advanced Nursing Practice and Advanced Practice Nursing roles within low and lower-middle-income countries
Abstract: Introduction: 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. Design: 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. Results: 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. Conclusion: 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. Clinical Relevance: 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.
Source: Scanlon, A. Journal of Nursing Scholarship, Mar 2023; 55(2): 484-493
Use of a Competency-Based Framework to Transition New Graduate Advanced Practice Registered Nurses into Practice
Abstract: With a growing shortage of primary care services, the nurse practitioner role is of increasing importance. The transition of advanced practice registered nurses (APRNs) into practice must adequately address gaps in education while providing a structured process for enculturation and competency assessment. This article shares results of data collected from new graduate APRNs who participated in the Versant APRN Fellowship in 2020 and 2021. Results revealed that while the new graduate APRNs are still developing in their new role, participating in a structured transition-to-practice program provides the support and processes necessary for a successful transition.
Source: Africa, L. Nursing Economics, Mar/Apr 2023; 41(2): 59-95
How Advanced Practice Holistic Nurses Meet International Criteria for Advanced Practice
Abstract: Much has been written about the inclusion of holistic nursing philosophy and practices in undergraduate nursing education, but their inclusion and influence in advanced practice nursing education have not been fully explored. Supporting a holistic paradigm and model of care founded on evidenced-based clinical theory allows for expanded nursing practice and health care options for patients. Holistic nursing aligns with culturally competent, patient-centered care and is consistent with how our current health care landscape has evolved in recent years. Health care reform highlights a new direction in practice toward self-transformation, accountability, natural treatment options, and a patient's active role in health care decisions. To demonstrate the role, this article will address how advanced practice holistic nurses meet the International Council of Nurses Criteria for Advanced Practice and are substantially equivalent and exceeds current APRN competencies.
Source: Southard, Mary E. Holistic Nursing Practice, May-Jun 2023; 37(3): 118-125
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Advanced Practice Registered Nurse Leadership in Compassionate Extubation: A Novel Evidence-Based Framework
Abstract: High-quality care at the end of life is a cornerstone of nursing practice, yet the specific role of the advanced practice registered nurse (APRN) in facilitating compassionate extubation is poorly defined. Evidence-based process guidance for APRN-led compassionate extubation is needed to ground nursing curricula and buoy the APRNs confidence in taking on a leadership role during this significant patient-centered procedure. In this clinical feature, one patient’s narrative is interwoven with a review of current evidence regarding best practices for before, during, and after compassionate extubation. A novel framework is then built upon the Standards of Practice and Professional Performance for Palliative Nursing.
Source: Roberts, B. The Journal of Nurse Practitioners, May 2023; 19(5): 104581
Factors affecting the critical appraisal of research articles in Evidence-Based practices by advanced practice nurses: A descriptive qualitative study
Abstract: Aim To describe factors affecting critical appraisal of research articles in evidence-based practice by certified nurse specialists who were advanced practice nurses in Japan. Design A descriptive qualitative study. Methods Fourteen certified nurse specialists with master's degree were included by a snowball sampling to maximize the variety of specialty fields for advanced practice nurses in Japan. Individual semi-structured interviews were conducted between November 2016 and March 2017. Interview guides included the experience of evidence-based practice and learning about critical appraisal. Results The following four aspects were identified as factors affecting the critical appraisal of research articles in evidence-based practices—individual beliefs and attitude, learning status, organizational readiness and availability of research evidence. Each factor included both positive and negative aspects for critical appraisal in evidence-based practice. Patient or Public Contribution If advanced practice nurses acquire knowledge/skills of critical appraisal, they would be able to select more appropriate care. This will increase to improve the health-related outcome for patients or populations.
Source: Tomotaki, A. Nursing Open, Jun 2023; 10(6): 3719-3727
Evaluating an intervention of telehealth education and simulation for advanced practice registered nurse students: A single group comparison study
Abstract: As healthcare delivery continues to evolve and expand, nurse educators must prepare advanced practice registered nursing (APRN) students to use telehealth technology safely, effectively, and confidently. The aims of this study were to describe APRN students' beliefs and confidence regarding the delivery of care via telehealth in their future practice. To evaluate these aims, a single group comparison study was conducted. APRN students received an intervention comprised of multimodal telehealth instruction, which involved the simulated application of telehealth with standardized patients. Students' beliefs regarding telehealth did not significantly change between the pre- and post-intervention, in which all areas were rated high pre-intervention. Students reported an increase in their perception and confidence post-intervention. Integration of telehealth into the APRN curriculum is essential to instil knowledge and confidence as healthcare technology advances.
Source: Jones, Heather M. Nursing Open, Jun 2023; 10(6): 4137-4143
Development of an Advanced Practice Conceptual Model
Abstract: All professional disciplines have a body of knowledge consisting of theories, research, and methods of inquiry related to practice. However, a theory specifically for the advanced practice provider (APP) has not been developed. Delineating the professional goals and scope of the APP is possible through a conceptual model. To serve a gap in existing literature, a conceptual model for the phenomenon of APP practice is proposed. The elements within the APP conceptual model are described, including the relationships surrounding clinical care, education, and professional development. The middle-range theories supporting the development of this conceptual model are presented. Finally, the conceptual model was applied to the development of a Professional Advancement Model. The proposed APP conceptual model was applied and tested during the development of a Professional Advancement Model. Early benefits of improved engagement and involvement in professional development activities were noted. This demonstrates the work needed to foster the professional development and provider satisfaction of our APPs.
Source: Moore, Emily F. The Journal for Nurse Practitioners, Jul 2023; 19(7): 104669
The advanced nurse practitioner in context: Systemic processes
Abstract: Background: Healthcare systems are becoming increasingly complex. Systems thinking can help us to understand this complexity and how to apply that understanding to design and evaluate interventions that improve health outcomes. With the current emphasis on developing advanced nursing practice, it is timely to examine systemic processes that characterize ANP systems and their interactions with wider healthcare systems, and how these processes enable and constrain the role. Objective: To make explicit the systemic processes that characterizes the Advanced Nurse Practitioner (ANP) system and how they enable and constrain the role. Design: An interpretive descriptive study. Setting: The study was conducted in a large Hospital Group, consisting of eleven acute hospitals, within the Irish Healthcare System. Participants: Twenty nine participants, including ANPs, nurses, nurse managers, medics and allied health professionals, participated in the study. Methods: Data were collected through seven in-depth interviews and four focus groups. Data were analyzed using the Organic Systems Framework (OSF), where attention was on language indicative of the processes of individuation, integration, differentiation and homogenization. Results: Participants emphasize how ANP systems exert power by individuating and differentiating; however, restrictive regulations and medical control constrain this power. Integration and homogenization are expressed as ANPs encourage and engage in collaborative practice towards common purposes. When hierarchical structures and professional self-interest dominate, however, these processes are submerged, resulting in unbalanced systems. Conclusion: ANP systems realize their power through increased autonomy by individuating and differentiating. Hierarchical structures positioning ANPs in subservient roles should be challenged. Processes of integration and homogenization are expressed in collaborative practices. We recommend that ANPs realize and articulate the value and diversity that they bring to health systems to strengthen their contribution to them. Clinical Relevance: Lack of awareness of the systemic processes that enable and constrain the ANP role affects the role's potential contribution to the healthcare system. Systems thinking and employing the OSF as an analysis framework can help us to understand these processes and their implications, and how to apply that understanding to design and evaluate interventions that improve health outcomes.
Source: Thompson, W. Journal of Nursing Scholarship, Jul 2023; 55(4): 886-897
Advanced practice in Scotland
Abstract: Colette Henderson discusses the development of advancing practice guidance across Scotland and explores how it has evolved through UK- and international-based cooperation.
Source: Henderson, C. International Journal for Advancing Practice, Apr 2023; 1(1): 49-50
Abstract: Colette Henderson discusses the development of advancing practice guidance across Scotland and explores how it has evolved through UK- and international-based cooperation.
Source: Henderson, C. International Journal for Advancing Practice, Apr 2023; 1(1): 49-50
