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Evidence based practice is essential to advanced practice nursing, enabling the delivery of quality care and improved patient outcomes. As the name suggests, it requires healthcare decisions to be based on the best available and current evidence. Advanced practice nurses need astute critical analysis skills to appraise the evolving literature, and require research skills to lead on scientific inquiry and develop the profession. Yet, advanced practice nurses may not recognize themselves as research leaders. Participation in a journal club can promote evidence‐based practice, improve clinician's critical thinking skills, and expose members to different research methodologies, however, nurses continue to face barriers to participation in these clubs. Establishing a clinical‐academic partnership appears to be both mutually beneficial for clinicians and academics and is a significant enabler in the sustainability and functioning of the club through sharing expertise and experience. A supportive workplace culture is favourable to research utilization and knowledge translation. This paper outlines the role, practicalities, challenges, and benefits of setting up a hybrid urology journal and research club for advanced practice nurses in a clinical‐academic partnership. [ABSTRACT FROM AUTHOR]

Aim: This paper aims to highlight the vital importance of investing in advanced practice nursing (APN) for enhancing emergency care throughout Africa. Background: APN's role is increasingly recognized as pivotal in optimizing healthcare, particularly in emergency settings in Africa. It offers improved patient care quality and strengthens the healthcare workforce. Sources of evidence: Evidence is drawn from successful implementations of APN in various healthcare environments. This includes the development of APN‐specific curricula and training, mentorship initiatives, clinical supervision, and defining advanced nursing roles within healthcare organizations. Investing in APNs in emergency care in Africa can lead to improved quality and access to care, cost‐effectiveness, enhanced patient outcomes and satisfaction, and opportunities for professional development and career advancement in the healthcare workforce. Discussion: Despite facing barriers in implementation, APN in emergency care presents innovative solutions. Investing in APN can help healthcare entities and policymakers surmount these challenges, providing specialized patient care and improving health outcomes. The discussion emphasizes the benefits such as enhanced access to care, reduced healthcare costs, and improved patient outcomes, alongside bolstering the healthcare workforce. Conclusion: The necessity and benefits of investing in APN for emergency care in Africa are clear. It is crucial for improving healthcare delivery and outcomes. Implications for nursing practice: APN investment leads to a more competent and efficient nursing workforce, capable of addressing complex emergencies and improving patient care. Implications for nursing policy and health/social policy: The paper advocates for policies that support APN development and integration into the healthcare system, emphasizing the need for research to assess APN's long‐term impact and establish best practices for its implementation in emergency care across Africa. [ABSTRACT FROM AUTHOR]

Aim: This paper discusses the development and progression of the advanced practice nurse practitioner role in Africa. Background: Providing adequate primary health care is problematic in Africa. The World Health Organization and International Council of Nurses proposed that nurses, specifically advanced practice nurse practitioners with the requisite skills in disease prevention, diagnosis and management, can be key to solving the primary care issue. Sources of evidence: This paper utilized publications from PUBMED, CINAHL, policy papers, websites, workgroups, conferences, and the experiences and knowledge of authors involved in leading and moving forward key events and projects. Discussion: Four African countries have formally adopted the advanced practice nurse practitioner role, with significant interest from countries throughout Africa, and ever‐increasing requests for assistance regarding initiation, development and integration of advanced practice roles. Initiatives to advance the roles have been supported by the International Council of Nurses Nurse Practitioner/Advanced Practice Nurse Network and Global Academy of Research and Enterprise. Next steps and projects for future role development are discussed. Conclusions: There is a progression towards the adoption of the advanced practice nurse practitioner role in Africa, and further mechanisms are suggested to allow full uptake and utilization. Implications for nursing practice: Prioritization and investment in initiatives implementing nurse practitioner/advanced practice nurse roles in Africa allows nurses to pursue further education, advanced role and leadership opportunities consistent with Nursing Now goals. Implications for health policy: Implementation of nurse practitioner/advanced practice nurse roles increases the primary care workforce, consistent with recommendations and priorities in the World Health Organization Global Strategic Directions for Nursing and Midwifery 2021–2025 helping countries ensure that nurses optimally contribute to achieving universal health coverage and other population health goals. [ABSTRACT FROM AUTHOR]

Aim: This paper highlights a new role of Advanced Practice Nurse/Nurse Practitioner as the clinical planning lead in the development of a unique model of care and service delivery for children living with health complexity, in the context of a LEADS leadership framework and related capabilities. Background: The LEADS in a Caring Environment Framework is an effective tool for leadership development and systems change. An experienced Advanced Practice Nurse/Nurse Practitioner hired into a leadership role contributes to system change for a complex population across a large geographic area. Sources of evidence: World Health Organization, Canadian Nurses Association and other websites, academic databases (PubMed and CINAHL) and relevant books were explored, and the expertise and knowledge of the authors and the redevelopment project team were utilized. Discussion: The Advanced Practice Nurse/Nurse Practitioner (first author) shares and reflects on her own lived experience as a leader in the planning for programmes and services at the new centre utilizing the five LEADS domains and related capabilities. Conclusion: The utilization of the LEADS in a Caring Environment Capabilities Framework showcases the strengths and skills of an Advanced Practice Nurse/Nurse Practitioner shifting from direct clinical care to successfully leading system‐level change. By incorporating the LEADS framework into practice, in any setting or role, Advanced Practice Nurse/Nurse Practitioners can both evaluate and develop their leadership skills while positively effecting system transformation. Implications for nursing practice: The LEADS framework fosters ongoing professional development and can be used to measure the added value of Advanced Practice Nurses within an organization. Implications for nursing policy: Advanced Practice Nurses improve outcomes within the health care system. Leaders must consider this evidence in health workforce planning, ensuring that Advanced Practice Nursing roles become fully integrated and are supported in the context of national and regional health systems. [ABSTRACT FROM AUTHOR]

Aim: To describe activities and professional characteristics of nurses in expanded roles in acute care in Germany and achieve a greater understanding of the current situation of advanced practice nursing. Background: Advanced practice nursing plays an important role in meeting increased demands in healthcare and promoting high‐quality care. Introduction: In Germany, advanced practice nursing is still at an early stage with a lack of studies describing the scope of practice of nurses in expanded roles. Methods: We conducted a cross‐sectional‐study using a paper‐and‐pencil questionnaire. In a nationwide convenience sample, we surveyed nurses with an academic degree, who work in an acute care hospital and take over expanded roles in direct patient care. Reporting followed the STROBE checklist. Results: Of 108 eligible nurses, 84 (77%) completed the survey. The majority had a Master's degree (63.1%) and the average work experience was 18.2 years. Participants carried out activities in all the domains that were queried (direct clinical practice, guidance and coaching, consultation, leadership and research) with differences within and between domains. Foci were on direct clinical practice and coaching and guidance. Discussion: In Germany, qualifications are nearing the international standard of advanced practice nursing. Results suggest that participants partly undertake activities within the scope of registered nurses' practice that do not correspond fully to their formal qualifications. Conclusion and implications for nursing and/or health policy: In order to foster the role development of expanded practice nurses in Germany, political efforts are needed in terms of training (e.g. specific Master's programmes), funding of corresponding positions in practice and control mechanisms (e.g. professional registration). [ABSTRACT FROM AUTHOR]

Aim: Identify and map international evidence regarding innovations led by or involving advanced practice nurses in response to COVID‐19. Background: COVID‐19 necessitated unprecedented innovation in the organization and delivery of healthcare. Although advanced practice nurses have played a pivotal role during the pandemic, evidence of their contributions to innovations has not been synthesized. Evidence is needed to inform policies, practices, and research about the optimal use of advanced practice nurses. Methods: A scoping review was conducted and reported using the PRISMA‐ScR checklist. Electronic databases were searched for peer‐reviewed articles published between January 2020 and December 2021. Papers were included that focused on innovations emerging in response to COVID‐19 and involved advanced practice nurses. Results: Fifty‐one articles were included. Four themes were identified including telehealth, supporting and transforming care, multifaceted approaches, and provider education. Half of the articles used brief and mostly noncomparative approaches to evaluate innovations. Conclusion: This is the first synthesis of international evidence examining the contributions of advanced practice nurses during the pandemic. Advanced practice nurses provided leadership for the innovation needed to rapidly respond to healthcare needs resulting from COVID‐19. Innovations challenged legislative restrictions on practice, enabled implementation of telehealth and new models of care, and promoted evidence‐informed and patient‐centered care. Implications for practice: Advanced practice nurses led, designed, implemented, and evaluated innovations in response to COVID‐19. They facilitated the use of telehealth, supported or transformed models of care, and enabled health providers through education, mentorship, and mental health support. Implication for policy: Advanced practice nurses are a critical resource for innovation and health system improvement. Permanent removal of legislative and regulatory barriers to their full scope of practice is needed. [ABSTRACT FROM AUTHOR]

Aim: This paper describes the characteristics of the new advanced practice nursing roles in France, as well as their challenges and perspectives, and compares the French model with the recommendations of the International Council of Nurses. Background: Advanced practice nursing is particularly well established in English‐speaking countries. Since 2018, France has become the second French‐speaking region to legalize and regulate advanced practice nurses. Source of evidence: The International Council of Nurses and French government websites, and scientific databases (PubMed, CINALH, Cochrane Library) were explored. Feedback from French nursing academics was also requested. Discussion: The advanced practice nursing model in France is described according to the scope and conditions of professional practice. The educational program leads to a State diploma with master's degree, which it is mandatory to be a registered nurse. Remuneration depends on the sector of practice in the public hospital, primary care or private sector. Although there is no national strategy for the implementation of advanced practice nursing roles, research projects are being initiated to guide and evaluate the practice. Based on concordance analysis with the recommendations of the International Council of Nurses, the French advanced practice nursing model appears to be similar to the nurse practitioner model. Conclusion: Adjustments in the scope of practice and education can be expected as the implementation of these roles is evaluated. Implications for nursing practice: This is a historical evolution of the nursing profession in France, for which communication with patients and healthcare professionals is essential. Implications for nursing policy: The implementation of advanced practice nursing roles in clinical settings requires the development of national strategies to support initiatives and ensure the sustainability of these roles. [ABSTRACT FROM AUTHOR]

An evidence-based approach to Public/Community Health Nursing (P/CHN) requires that P/CHN educators prepare practitioners with the relevant skills, attitudes, and knowledge. Such education should be competency-based and have measurable outcomes to demonstrate student preparation. In 2003, the Quad Council competencies were developed to be applied at two levels of public health nursing practice: the staff nurse/generalist role and the manager/specialist/consultant role. This paper describes a process for evaluation and revision of a graduate curriculum to prepare Advanced Practice Clinical Nurse Specialists (CNS) in P/CHN, to ensure that the educational program addresses and develops knowledge and proficiency in all relevant competencies. This paper documents the process of integrating the competencies throughout the P/CHN graduate curriculum at varying levels, guiding students to achieve proficiency in each competency by the end of the program. Measurement of achievement in these competencies will be discussed, and examples provided. Advanced Practice Public Health Nurses educated via this competency-based approach will be prepared to sit for national certification as a CNS in Public/Community Health, and to assume leadership roles in public health nursing. [ABSTRACT FROM AUTHOR]

Purpose To identify the interventions provided by advanced practice nurses to older people in different contexts with standardized nursing language. Data Source This is a qualitative study. Content analysis was applied to the texts of experimental research papers about advanced practice nursing for older people. Deductive coding through the Nursing Intervention Classification was carried out. Data Synthesis Seventy-three interventions codified with the Nursing Intervention Classification were extracted, mainly related to the behavioral and healthcare system domains, which could be explained due to the need for improving the psychosocial functioning and self-care of these patients to preserve their quality of life. Conclusion and Implication for Nursing Practice Advanced practice nurses interventions can be better described, reported, and analyzed along different contexts with standardized languages. Objetivo Identificar las intervenciones realizadas por las enfermeras de práctica avanzada a personas mayores en diferentes contextos de atención con lenguajes estandarizados. Fuente De Datos Se trata de un estudio cualitativo. Se aplicó análisis de contenido a los textos de estudios experimentales sobre enfermería de práctica avanzada en población mayor y se llevó a cabo una codificación deductiva con las intervenciones de la Clasificación de Intervenciones de Enfermería. Síntesis De Datos Se extrajeron setenta y tres intervenciones codificadas con la Clasificación de Intervenciones de Enfermería, mayormente pertenecientes a los campos Conductual y Sistema Sanitario, lo que podría explicarse por la necesidad de mejorar el funcionamiento psicosocial y de auto-cuidado de este tipo de pacientes, para preservar su calidad de vida. Conclusión E Implicaciones Para La PráCtica De Enfermería Las intervenciones de las enfermeras de práctica avanzada pueden ser descritas, referidas y analizadas en diferentes contextos con lenguajes estandarizados. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Clinical nurse specialists ( CNSs) are major providers of transitional care. This paper describes a systematic review of randomized controlled trials ( RCTs) evaluating the clinical effectiveness and cost-effectiveness of CNS transitional care. Methods We searched 10 electronic databases, 1980 to July 2013, and hand-searched reference lists and key journals for RCTs that evaluated health system outcomes of CNS transitional care. Study quality was assessed using the Cochrane Risk of Bias and Quality of Health Economic Studies tools. The quality of evidence for individual outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation ( GRADE) tool. We pooled data for similar outcomes. Results Thirteen RCTs of CNS transitional care were identified ( n = 2463 participants). The studies had low ( n = 3), moderate ( n = 8) and high ( n = 2) risk of bias and weak economic analyses. Post-cancer surgery, CNS care was superior in reducing patient mortality. For patients with heart failure, CNS care delayed time to and reduced death or re-hospitalization, improved treatment adherence and patient satisfaction, and reduced costs and length of re-hospitalization stay. For elderly patients and caregivers, CNS care improved caregiver depression and reduced re-hospitalization, re-hospitalization length of stay and costs. For high-risk pregnant women and very low birthweight infants, CNS care improved infant immunization rates and maternal satisfaction with care and reduced maternal and infant length of hospital stay and costs. Conclusions There is low-quality evidence that CNS transitional care improves patient health outcomes, delays re-hospitalization and reduces hospital length of stay, re-hospitalization rates and costs. Further research incorporating robust economic evaluation is needed. [ABSTRACT FROM AUTHOR]

The complexity of public health problems and advancement of science framing public health demand an expansion of traditional educational approaches and curriculum to prepare a futuristic advanced practice public health nursing (APPHN) workforce. This position paper sponsored by the Association of Community Health Nursing Educators challenges nurse educators to apply innovative strategies in preparing public health nursing (PHN) professionals and to expand curriculum paradigms to promote PHN's ecological approach to solving problems. To meet the challenges of ensuring public health in the 21st century, advanced practice public health nurses must have greater foundational knowledge in critical content areas discussed in this document. Competence in these areas will enable advanced practice public health nurses to address future health care challenges such as rapidly changing social structures, escalating knowledge explosion, globalization, and growth of new technologies. This education will prepare nurses to forge new knowledge and establish health care teams to create effective solutions. [ABSTRACT FROM AUTHOR]

Models of care for frail older adults have increasingly used advanced practice nurses (APNs) to achieve outcomes. Knowledge of the common APN functions and skills that contribute to the success of these models could better inform education and evidence-based practice and guide further research, but published investigations associated with models of gerontologic care neither describe fully these functions and skills nor link the activities of the APN with specific outcomes. Using examples primarily from the University of Pennsylvania School of Nursing, this paper identifies, describes, and analyzes common functions and skills of APNs in published gerontologic care models; examines the strength of the evidence for the effect of APNs on outcomes of care; and identifies areas for further study. [ABSTRACT FROM AUTHOR]

Aims: To report on the engagement of Swiss nursing homes and of nurses in expanded roles in quality improvement. Design: A cross‐sectional study (2018–2019). Methods: Survey data from a sample of 115 Swiss nursing homes and 104 nurses in expanded roles. Descriptive statistics were used. Results: Most participating nursing homes reported carrying several quality improvement activities (median of eight out of 10 activities surveyed) but some were only engaged in five activities or less. Nursing homes working with nurses in expanded roles (n = 83) showed greater engagement in quality improvement than those working with none. Nurses with more advanced qualifications (Bachelor's or Master's degree) engaged more in quality improvement than nurses with standard training. Specifically, higher educated nurses were more involved in data‐focused activities. Using nurses in expanded roles can be a way forward for nursing homes seeking to actively carry out quality improvement in their facilities. Conclusion: Although a large proportion of nurses in expanded roles surveyed were implementing quality activities, their level of engagement depended on their educational level. Our findings support the principle that higher level competencies are a key aspect of data‐based quality improvement in nursing homes. However, as Advance Practice Registered Nurses will remain difficult to recruit in nursing homes, using nurses in expanded roles might contribute to quality improvement. [ABSTRACT FROM AUTHOR]

Aim To identify and synthesize the national and international literature on forensic nursing in Brazil. Background Forensic nursing is a new specialty to the nursing practice in Brazil, being recognized by the Federal Nursing Council of Brazil in 2011. In 2016, the first forensic nursing specialization programme was authorized in the country. Introduction The implementation of forensic nursing specialty in Brazil marks new possibilities for the nursing practice, making it possible for nurses to develop additional skills to intervene in various situations under the Brazilian Unified Healthcare System. Methods A systematic search of the literature was conducted using the keyword 'Forensic nursing' in combination with 'Brazil'. LILACS, MEDLINE, EMBASE, Scopus and Web of Science databases were searched. Studies were also retrieved from the grey literature. Once literature had been identified, a thematic analysis was undertaken in order to extract themes, which were: establishment of the forensic nursing specialty and its contributions to Brazil and its practical implications. Results Eight manuscripts and 20 studies from the grey literature were included in the final review. Most studies (54%) were literature reviews that indicated forensic nursing as an emerging specialty in Brazil, addressing educational, instructional, communicative or contextual aspects of the specialty in the country. Discussion In the nursing profession in Brazil, few studies exist on forensic nursing and those are limited to short communications. Although most studies address the definition of forensic nursing, others present its implications in various situations such as intimate partner violence, domestic violence, sexual abuse and elder mistreatment. Conclusion and implications for nursing and health policy Despite the study limitations, it provides evidence that forensic nursing has been silently implemented in the country with the need for more evidence-based studies to support its constitution as a specialty in Brazil. [ABSTRACT FROM AUTHOR]

Objectives: To examine the characteristics of the first Advanced Practice Nurses in France and to compare the French model to international standards. Background: Common barriers and facilitators to their integration in healthcare provision have been identified internationally. In France, the legislative framework was introduced in 2016, and the first graduates entered the workforce in 2019. Methods: The French model was examined in comparison with Hamric's conceptual framework and to the International Council of Nurses' guidelines and definitions. A cross‐sectional survey was also conducted, using three self‐administered online questionnaires. Two were distributed to 2019 and 2020 graduates and a third to the accredited programme directors. The characteristics of advanced practice nursing graduates were described and compared based on employment status and field of practice (primary vs secondary/tertiary care). Results: Although the French model of advanced practice nursing meets Hamric's primary criteria and core competencies, it does not differentiate between Nurse Practitioner and Clinical Nurse Specialist roles. Of the 320 students enrolled in one of the 11 accredited training programmes 165 participated in the survey. Mean age was 40, and mean prior nursing experience was 15 years. By February 2021, 30% of respondents were still employed as Registered Nurses. Barriers to practice included insufficient income generation (primary care), the lack of position creation (secondary/tertiary care), the physician‐dependent patient referral process and delays in prescription credentials approval. Conclusions: The implementation of advanced practice nursing in France faces several barriers. Legislative adjustments and greater financial incentives to practice seem warranted. Relevance to clinical practice: as in other countries, France introduced advanced practice nursing to respond to the Public Health challenge of improving access to quality health care in the context of increasing chronic disease prevalence and limited resource allocation. Facilitating its integration in the healthcare provision landscape seems paramount. [ABSTRACT FROM AUTHOR]

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 a 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. [ABSTRACT FROM AUTHOR]

Aim: To describe the clinical nurse specialist role and its outcomes and challenges. Design: Participatory Action Research conducted in Finland between the fall of 2017 and the end of 2018. Methods: A core participatory action research team (n = 10) led the design, implementation and evaluation of the research. Multiple data collection methods were used. The study is reported using the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) guidelines for participatory action research. Results: The clinical nurse specialist used most of the time in clinical patient care followed by clinical nursing leadership and scholarship activities. Outcomes of successful implementation led to increased visibility of nursing expertise, development, integration and quality assurance of nursing processes and practice, and promotion of knowledge translation and unit and collaborator cooperation. Furthermore, role challenges were also recognized. [ABSTRACT FROM AUTHOR]

Aim: To describe the mentoring process between the ICN Advanced Practice Nurse Network practice subgroup and the University of Pécs to support the emerging advanced practice role in Hungary, and explore the creation of a mentoring algorithm for faculty and other key stakeholders worldwide who wish to develop advanced practice nursing programs. Background: Advanced practice nurses provide comprehensive clinical care and expand access to care in more than 70 countries. In March of 2017, a representative of the Faculty of Health Sciences of the University of Pécs requested assistance in curricula development for the inaugural advanced practice nursing program in Hungary. Methods: A mixed‐methods single case study was undertaken. The sources of evidence include interviews, e‐mails, review of the literature, and related documents. Qualitative data were analyzed for content, and frequencies were calculated for quantitative indicators. Findings and discussion: The findings highlight the importance of clear communication, development of shared goals, and determination to see the project through. Enriching information was provided by colleagues from diverse global settings. Credibility was gained in Hungary from the support of national and international experts. Conclusion: The mentoring foundation and process facilitated the role development in Hungary and contributed to an increased understanding of advanced practice nurses' scope of practice. The intentional approach and the careful ongoing reflection may lead to future successful endeavors. Multinational engagement and collaborations will promote advanced practice nursing contributions globally. Implications for nursing policy: Mentoring can effectively empower nurses and advanced practice nurses to work to their full capacity. The shared experiences of international mentoring colleagues can contribute to and support the development and acceptance of national policies for the advanced practice nursing roles. [ABSTRACT FROM AUTHOR]

Objective: Remote area nurses provide primary health care services to isolated communities across Australia. They manage acute health issues, chronic illness, health promotion and emergency responses. This article discusses why their generalist scope of practice should be formally recognised as a specialist nursing practice area. Design: Constructivist grounded theory, using telephone interviews (n = 24) with registered nurses and nurse practitioners. Setting: Primary health care clinics, in communities of 150–1500 residents across Australia. Participants: A total of 24 nurses participated in this study. Results: Nurses' perceived their clinical knowledge and skill as insufficient for the advanced, generalist, scope of practice in the remote context, especially when working alone. Experience in other settings was inadequate preparation for working in remote areas. Knowledge and skill developed on the job, with formal learning, such as nurse practitioner studies, extending the individual nurse's scope of practice to meet the expectations of the role, including health promotion. Conclusion: Remote area nursing requires different knowledge and skills from those found in any other nursing practice setting. This study supports the claim that remote area nursing is a specialist–generalist role and presents a compelling case for further examination of the generalist education and support needs of these nurses. Combined with multidisciplinary collaboration, developing clinical knowledge and skill across the primary health care spectrum increased the availability of health resources and subsequently improved access to care for remote communities. Further research is required to articulate the contemporary scope of practice of remote area nurses to differentiate their role from that of nurse practitioners. [ABSTRACT FROM AUTHOR]

A career ladder for nurses, including several levels of nursing practice and specific roles for advanced practice nurses, was introduced in Hong Kong around the start of the 21st century. To date no studies have distinguished the practices of advanced practice nurses in Hong Kong. This cross‐sectional study, conducted between November 2020 and March 2021, aims to identify and differentiate the practice patterns of advanced practice nurses by utilizing the Advanced Practice Role Delineation tool. A total of 191 responses were obtained. Three roles were identified: nurse consultant, advanced practice nurse, and advanced practice nurse in management. Among the five advanced practice nursing domains, nurses were most frequently involved in Education and in Direct Comprehensive Care activities, while least active in Research and in Publication and Professional Leadership. Identifying activities in various nursing roles helps to differentiate their responsibilities and provides new insights for role utilization and support. Although the role characteristics are shaped by country contexts, research evidence on practice patterns may be used to support international discussion and efforts to promote role clarity and effective role introduction and optimization. [ABSTRACT FROM AUTHOR]

Background: Stronger healthcare models are increasingly sought to address new population needs, health workforce inefficiencies and nursing shortages. One strategy is to focus on employees' strengths to capitalize on their competencies and maximize their scope of practice. Introduction: Globally, there is an exponential demand for advanced practice nursing services. This study aimed to identify the roles and positions of nurses who align with APN defining criteria at all levels of care in Catalonia, Spain. Methods: The first step of the study included the translation and validation to Catalan of the Advanced Practice Nurse Role Delineation Tool (IDREPA) and step 2 comprised a multicentre cross‐sectional study, in which 126 healthcare centres participated: 1209 nurses were included in the study. The STROBE checklist was used to report this study. Results: Transcultural equivalence and validation of the instrument showed a content validity index of 0.958 and the reliability of the questionnaire. The instrument identified 269 nurses who align with international APN defined criteria. They worked in specialized care, mental healthcare and primary and community care, especially in chronic conditions, ageing and end‐of‐life care. Discussion: Most areas of Catalonia have access to nurses practicing at APN defining criteria. These nurses were developed as an optimal resource to respond to patient needs in the context of study. Both recognition and strategic implementation are necessary to apply their full competencies to solve healthcare problems. Conclusion: Understanding the supply of services delivered by nurses practicing at an advanced level and their scope of practice may lay the foundations for effective workforce planning in a dynamic context. Nurses who align with APN defining criteria are working mainly in large acute services without regulation and recognition. Implications for nursing: Advanced practice nurses show the value of their role and activities in healthcare services. Implications for health policy: Promoting the establishment of APN defining criteria that includes credentialing and a regulatory framework within international guidelines should be a priority to make an impact on healthcare policy. [ABSTRACT FROM AUTHOR]

Aim: We compared Japan nurse practitioner‐led care and physician trainee‐led care in terms of patients' length of stay in a secondary emergency department in Japan. Methods: This was a retrospective observational study, utilizing medical records. Participants (n = 1419; mean age = 63.9 ± 23.4 years; 52.3% men) were patients transferred to the emergency department by ambulance between April 2016 and March 2018 in western Tokyo. Multiple linear regression analyses were performed, with length of stay as the dependent variable and factors related to the length of stay, including medical care leaders, as the independent variable. Results: Approximately half of the patients (n = 763; 53.8%) received Japan nurse practitioner‐led care. Patients' length of stay was significantly shorter, by 6 min, in the Japan nurse practitioner‐led care group, compared with the physician trainee‐led care group (unstandardized coefficient: −6.81; 95% confidence interval: −13.35 to −0.26; p < 0.05). Conclusion: Patients' shorter length of stay in the Japan nurse practitioner group, compared with the physician trainee group, suggests that Japan nurse practitioners are not inferior to physician trainees in terms of the time spent to manage patients. [ABSTRACT FROM AUTHOR]

Patients with prostate cancer (PCa) often experience physical and psychological challenges after diagnosis and therapeutic side effects after radical prostatectomy. To meet the needs of these patients and their partners, an advanced practice nurse (APN) support programme was initiated at a Swiss university hospital. The APN served as a constant contact person and offered psycho‐oncological counselling from the first day after radical prostatectomy to follow‐up care in the outpatient clinic, every third month over the first year and twice in the second year. Counselling was provided in‐person and through the phone. It focused on coping skills regarding cancer‐related distress, hospital stay, treatment and therapeutic side effects, post‐discharge life, and physical activity. This study aimed to explore the experiences of patients and partners with the disease, including diagnosis, radical prostatectomy, and follow‐up care. Additionally, their experience with the APN support programme was evaluated. A qualitative content analysis, according to Mayring, was used. Interviews were conducted with 10 patients and 8 partners who participated in the APN counselling programme. Interviews were performed individually in‐person or by telephone. Patients reported a variety of experiences with respect to the diagnostic process and the final decision for radical prostatectomy. Patients and spouses also described some unmet information needs during the PCa care continuum. They wished they received more information about PSA testing, treatment options, and management of surgically induced side effects such as incontinence and erectile dysfunction. While most couples mastered the situation together, some patients did not involve their spouses. During the hospital stay, patients felt well cared for; the spouses agreed. Urinary incontinence was the primary challenge after discharge. Later, erectile dysfunction was a challenge for most participants. While counselling was experienced differently, patients and spouses valued the trustworthy APN as a constant contact person. In clinical practice, needs‐tailored information should be provided by all involved healthcare professionals. In addition, a support programme for patients and partners that includes an APN as a constant contact person over the PCa continuum is recommended. [ABSTRACT FROM AUTHOR]

Aim: To critically appraise and synthesize evidence of integrated care stemming from advanced practice nursing in elderly primary care settings throughout the United States and Thailand. Background: Advanced practice nurses are key to accelerating integrated elderly care in the community. Yet, their scope and capacity vary greatly across countries, making impact measurement highly challenging. Methods: A systematic search of PubMed, CINAHL, Scopus and ThaiJo databases was performed. Full‐text articles in English or Thai language were reviewed using an inductive thematic approach from the integrated people‐centred Health Services framework, adopted by the World Health Organization. Results: A total of 42 articles were appraised according to framework strategies: (1) people and community empowerment/engagement; (2) governance and accountability strengthening; (3) model of care reorientation; (4) service coordination; and (5) enabling environment creation. Collaborative roles and empowerment of older people were associated with higher quality of care. Thai nurses empowered individuals through community networks and resources, incorporating care models (strategy 1). In contrast, US nurses adopted a quality improvement and safety approach, incorporating technology into nursing interventions (strategy 5). Conclusion: Advanced practice nurses employ an array of strategies and approaches in caring for older people. Although their role varies from mostly substitute (US) to supplemental (Thailand), nurses in both countries contribute towards integrated person‐centred care. Implication for nursing practice and nursing policy: Preparing advanced practice nurses to work in the community is a prerequisite for meeting ageing population health needs in a sustainable manner. Education, professional development and leadership training opportunities should focus on capacity building in: a) strengthening mutual accountability, b) reorienting the work environment through innovative care models and c) coordinating services through partnerships to achieve universal health and ensure healthy ageing. [ABSTRACT FROM AUTHOR]

Aim: To argue that nurse practitioners have been under‐utilized generally in the current global health environment, creating barriers to achieving universal health coverage and the Sustainable Development Goals. Background: Nurse practitioners are advanced practice nurses possessing expert knowledge and leadership skills that can be optimized to narrow disparities and ensure access to high‐quality health care globally. Nurses worldwide have been challenged to meet global public health needs in the context of COVID‐19 (SARS‐CoV‐2 virus), and there are early indications that nurse practitioners are being called upon to the full extent of their capabilities in the current pandemic. Sources of evidence: PubMed; Google Scholar; the International Council of Nurses; World Health Organization; United Nations; and the experiences of the authors. Discussion: Several international reports, nursing and health organizations have called for continued investment in and development of nursing to improve mechanisms that promote cost‐effective and universally accessible care. Expanding nurse practitioner scopes of practice across nations will leverage their clinical capacities, policy and advocacy skills, and talents to lead at all levels. Conclusion: Ongoing empirical data and policy change is needed to enable the full scope and strategic utilization of nurse practitioners across healthcare systems and contexts. Implications for nursing practice, and nursing and health policy: Widespread education regarding nurse practitioner capacities for interdisciplinary partners, policymakers and the public is needed. Policies that safely expand their roles are critical. Role titles and remuneration reflective of their scope and service are required to lead, sustain and grow the workforce internationally. [ABSTRACT FROM AUTHOR]

Objective: As the population of Australia ages, EDs will experience an increasing frequency of presentations of older adults from residential aged care facilities (RACFs). These presentations are often complex and time consuming in the chaotic and potentially hazardous ED environment. The Geriatric Emergency Department Intervention (GEDI) model was developed to optimise the care of frail older adults, especially RACF residents, in the ED. The aim of the present study was to evaluate the effectiveness of the GEDI model on the primary outcomes of disposition (admission, discharge or death) and ED length of stay for residents of RACFs, presenting to an ED in regional Queensland, Australia. Methods: GEDI is a nurse‐led, physician‐championed, innovative model delivered by advanced practice nurses with expertise in gerontology. This quasi‐experimental pragmatic study compared outcomes for RACF residents who presented to a regional Queensland ED during three time periods: pre‐GEDI, interim GEDI and post‐GEDI implementation of the GEDI model. Outcomes included disposition, ED length of stay, ED re‐presentation and mortality. Results: A significant increase in the likelihood of discharge from ED (hazard ratio 1.15, 95% confidence interval 1.05–1.26) and reductions in ED length of stay (hazard ratio 1.49, 95% confidence interval 1.24–1.78) were evident for RACF residents following the implementation of the GEDI intervention. There were no differences in mortality, ED re‐presentation or in‐hospital length of stay between the three time periods. Conclusion: There is a paucity of evidence to support the implementation of nurse‐led teams in EDs designed to target older adults living in RACFs. The GEDI model was effective in reducing ED length of stay while increasing the likelihood of safe discharge for RACF residents. [ABSTRACT FROM AUTHOR]

Rational: The demand to increase nursing competence is brought on by the requirement of safe, accessible and more effective use of healthcare provider expertise. Clinical nurse specialist competency development dates back to the late 20th century; however, an examination of the literature reveals a lack of research and discussion to support the competency development. Objectives: To describe the formulation and validation process of the clinical nurse specialist core competencies. Design: Exploratory sequential mixed‐method design. Methods: This mixed‐method study, conducted between 2013 and 2017 in Finland, involved four phases: I) a Policy Delphi study (n = 25, n = 22, n = 19); II) cross‐mapping of preliminary competency criteria against international competency sets; III) content validity study of expanded competency criteria (n = 7, n = 10); and IV) verification of competency criteria with practicing CNSs (n = 16). Data were analysed by both qualitative and quantitative analysis methods. Results: Seventy‐four preliminary clinical nurse competency criteria were formulated in the first phase of the study. Through cross‐mapping the competencies against the US and Canadian clinical nurse specialist competency sets, they were further concised to 61 criteria. The examination of Content Validity Indexes and experts' comments led to the clarification and consequent inclusion of 50 criteria to the final scale, with Scale Content Validity Index Average of 0.94. The competency criteria were evaluated to be a solid set with potential to clarify and uniform the clinical nurse specialist roles. Conclusions: Through a rigorous research process, validated clinical nurse specialist competency criteria were formed with a high Scale Content Validity Index Average. The results allude to the potential of formulating international competency criteria to support global role clarity and understanding. However, further research is needed to validate the content and construct of the formulated competencies with a larger population across countries. [ABSTRACT FROM AUTHOR]

Rationale Clinical practice is the primary focus of advanced practice nursing (APN) roles. However, with unprecedented needs for health care reform and quality improvement (QI), health care administrators are seeking new ways to utilize all dimensions of APN expertise, especially related to research and evidence-based practice. International studies reveal research as the most underdeveloped and underutilized aspect of these roles. Aims To improve patient care by strengthening the capacity of advanced practice nurses to integrate research and evidence-based practice activities into their day-to-day practice. Methods An academic-practice partnership was created among hospital-based advanced practice nurses, nurse administrators, and APN researchers to create an innovative approach to educate and mentor advanced practice nurses in conducting point-of-care research, QI, or evidence-based practice projects to improve patient, provider, and/or system outcomes. A practice-based research course was delivered to 2 cohorts of advanced practice nurses using a range of teaching strategies including 1-to-1 academic mentorship. All participants completed self-report surveys before and after course delivery. Results Through participation in this initiative, advanced practice nurses enhanced their knowledge, skills, and confidence in the design, implementation, and/or evaluation of research, QI, and evidence-based practice activities. Conclusion Evaluation of this initiative provides evidence of the acceptability and feasibility of academic-practice partnerships to educate and mentor point-of-care providers on how to lead, implement, and integrate research, QI and evidence-based activities into their practices. [ABSTRACT FROM AUTHOR]

Aim: To report on the outcomes of the European project ENS4Care, which delivered evidence‐based guidelines enabling implementation of eHealth services in nursing and social care. Background: Within a policy context of efficiency, safety and quality in health care, this project brought together a diverse group of stakeholders from academia, industry, patient and professional organizations to lead the development of five eHealth guidelines in the areas of prevention, clinical practice, integrated care, advanced roles and nurse ePrescribing. Sources of evidence: Data were collected through a cross‐sectional, online, questionnaire survey of health professionals from 21 countries. Quantitative data were analysed using descriptive and summary statistics, while comments to open questions underwent a process of content analysis. Discussion: Representing an evidence‐based consensus statement, the five guidelines outline key steps and considerations for the deployment of eHealth services at different levels of enablement. Through analysis of the data, and sharing of best practices, common deployment processes and implementation lessons were identified. Conclusion: Findings reveal the richness, diversity and potential that eHealth holds for enabling the delivery of safer, more efficient and patient‐centred health care. Nurses and social care workers as the main proprietors of such practices hold the key to a healthier future for citizens across Europe. Implications for nursing and health policy: The preparation, agreement and dissemination of the ENS4Care guidelines will enable European Union leaders to diagnose the organizational changes needed and prescribe the development of new skills and roles in the workforce to meet the challenge of eHealth. Nurses and social care workers, with the right knowledge and skills will add considerable value and form an important link between technological innovation, health promotion and disease prevention. [ABSTRACT FROM AUTHOR]

Purpose: To describe international trends on the developing role of the nurse practitioner-advanced practice nurse (NP-APN), including nomenclature, levels and types of NP-APN education, practice settings, scope of practice, regulatory policies, and political environment. Design: A cross-sectional, descriptive Web-based survey sent in February and March 2008 to a total of 174 key informants and active members of the International Nurse Practitioner-Advanced Practice Nursing Network of the International Council of Nurses. Methods: An international Web-based survey preceded by a pilot survey. Findings: Ninety-one nurses from 32 countries responded. Thirteen titles were identified on nomenclature for the NP-APN in different countries. NP-APN education was available in 71% of the 31 countries responding to this item, with 50% identifying the master's degree as the most prevalent credential. Twenty-three countries had formal recognition of the NP-APN role. Of these, 48% had licensure maintenance or renewal requirements for the NP-APN, with most requiring continuing education or clinical practice. The greatest support for the NP-APN role came from domestic nursing organizations (92%), individual nurses (70%), and the government (68%), while opposition came primarily from domestic physician organizations (83%) and individual physicians (67%). Conclusions: Interest in the NP-APN role has been gaining ground worldwide. This study presents a snapshot of education, practice, and regulation for NP-APNs as they develop their unique role in delivering health care in various countries. Areas that may require more support are highlighted. Clinical Relevance: The NP-APN role in healthcare systems is expanding and will benefit from international networking and support. [ABSTRACT FROM AUTHOR]

Purpose: To analyze and clarify the conceptual basis of advanced practice nursing to determine the state of the knowledge from the perspective of four overarching principles derived from the philosophy of science: epistemological, pragmatic, linguistic, and logical. Data sources: Written discourse regarding advanced practice nursing from refereed journals published between 2000 and 2007. Conclusions: Conceptualization of a core definition of advanced practice nursing will enhance external legitimacy and recognition; understanding advanced practice nurse (APN) roles, sub-roles, and competencies will enhance internal cohesion. The outcome of this concept analysis is a greater understanding of the conceptual basis of advanced practice nursing and a current best estimate of the probable truth surrounding advanced practice nursing. Implications for practice: A greater understanding of the conceptual basis of advanced practice nursing will help to gain clarity, internal cohesion, external legitimacy, and acceptance of APN roles by society and other healthcare professions. [ABSTRACT FROM AUTHOR]

Purpose: We sought to describe the prevalence and patterns of use of personal digital assistants (PDAs) among active nurse practitioners (NPs). Data sources: A descriptive correlational survey was conducted among NPs in the United States ( N = 126). Participants were randomly selected from members of the American Academy of Nurse Practitioners who had listed a practice site on their application. Conclusions: Sixty-four percent of participants used PDAs. A drug reference was reported to be the most useful and frequently installed application. A large majority of PDA users believed that PDA use supported clinical decision making (91%), promoted patient safety (89%), and increased productivity (75%). Sixty-two percent predicted that PDA use would change their practice within the next 5 years. Implications for practice: As innovative PDA applications with potential to improve patient outcomes become increasingly available, handheld computer skills will be a fundamental practice competency. To prevent errors in clinical decision making with quick access to PDA reference materials, NPs must critically evaluate the legitimacy and worth of PDA software programs. There is a critical need to evaluate the effectiveness of PDA use in clinical settings and develop an evidence base to guide use of the PDA in solving clinical problems. [ABSTRACT FROM AUTHOR]

In 2003, The John A. Hartford Foundation Institute for Geriatric Nursing, New York University Division of Nursing, convened an expert panel to explore the potential for developing recommendations for the caseloads of advanced practice nurses (APNs) in nursing homes and to provide substantive and detailed strategies to strengthen the use of APNs in nursing homes. The panel, consisting of nationally recognized experts in geriatric practice, education, research, public policy, and long-term care, developed six recommendations related to caseloads for APNs in nursing homes. The recommendations address educational preparation of APNs; average reimbursable APN visits per day; factors affecting APNs caseload parameters, including provider characteristics, practice models, resident acuity, and facility factors; changes in Medicare reimbursement to acknowledge nonbillable time spent in resident care; and technical assistance to promote a climate conducive to APN practice in nursing homes. Detailed research findings and clinical expertise underpin each recommendation. These recommendations provide practitioners, payers, regulators, and consumers with a rationale and details of current advanced practice nursing models and caseload parameters, preferred geriatric education, reimbursement strategies, and a range of technical assistance necessary to strengthen, enhance, and increase APNs' participation in the care of nursing home residents. [ABSTRACT FROM AUTHOR]

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