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IntroductionCombining behavioural support and pharmacotherapy is most effective for smoking cessation and recommended in clinical guidelines. Despite that smoking cessation assistance from the general practitioner can be effective, dissemination of clinical practice guidelines and efforts on upskilling has not lead to the routine provision of smoking cessation advice among general practitioners. Intensive counselling from the practice nurse could contribute to better smoking cessation rates in primary care. However, the effectiveness of intensive counselling from a practice nurse versus usual care from a general practitioner in combination with varenicline is still unknown.Materials and methodsA pragmatic randomized controlled trial was conducted comparing: (a) intensive individual counselling delivered by a practice nurse and (b) brief advice delivered by a general practitioner; both groups received 12-weeks of open-label varenicline. A minimum of 272 adult daily smoking participants were recruited and treated in their routine primary care setting. The primary outcome was defined as prolonged abstinence from weeks 9 to 26, biochemically validated by exhaled carbon monoxide. Data was analysed blinded according to the intention-to-treat principle and participants with missing data on their smoking status at follow-up were counted as smokers. Secondary outcomes included: one-year prolonged abstinence, short-term incremental cost-effectiveness, medication adherence, and baseline predictors of successful smoking cessation.DiscussionThis trial is the first to provide scientific evidence on the effectiveness, cost-effectiveness, and potential mechanisms of action of intensive practice nurse counselling combined with varenicline under real-life conditions. This paper explains the methodology of the trial and discusses the pragmatic and/or explanatory design aspects.Trial RegistrationDutch Trial Register NTR3067.

Background: Due to the high prevalence of prescription opioid misuse, the US Food and Drug Administration (FDA) mandated a Risk Evaluation and Mitigation Strategy (REMS) requiring manufacturers of extended-release/long-acting (ER/LA) opioids to fund continuing education based on an FDA curricular Blueprint. This paper describes the Safe and Competent Opioid Prescribing Education ( SCOPE of Pain) train-the-trainer program and its impact on (1) disseminating the SCOPE of Pain curriculum and (2) knowledge, confidence, attitudes, and performance of the participants of trainer-led compared with expert-led meetings. Methods: SCOPE of Pain is a 3-hour ER/LA opioid REMS education. In addition to expert-led live statewide meetings, a 2-hour train-the-trainer (TTT) workshop was developed to increase dissemination nationally. The trainers were expected to conduct SCOPE of Pain meetings at their institutions. Participants of both the trainer-led and expert-led SCOPE of Pain programs were surveyed immediately post and 2 months post meetings to assess improvements in knowledge, confidence, attitudes, and self-reported safe opioid prescribing practices. Results: During 9 months (May 2013 to February 2014), 89 trainers were trained during 9 TTT workshops in 9 states. Over 24 months (May 2013 to April 2015), 33% of the trainers conducted at least 1 SCOPE of Pain training, with a total of 79 meetings that educated 1419 participants. The average number of meetings of those who conducted at least 1 meeting was 2.8 (range: 1–19). The participants of the trainer-led programs were significantly more likely to be practicing in rural settings than those who participated in the expert-led meetings (39% vs. 26%, P < .001). At 2 months post training, there were no significant differences in improvements in participant knowledge, confidence, attitudes, and performance between expert-led and trainer-led meetings. Conclusions: The SCOPE of Pain TTT program holds promise as an effective dissemination strategy to increase guideline-based safe opioid prescribing knowledge, confidence, attitudes, and self-reported practices.

Purpose The purpose of this paper is to investigate a boundary spanning, interprofessional collaboration between advanced practice nurses (APNs) and junior doctors to support junior doctors’ learning and improve patient management during the overtime shift. Design/methodology/approach A mixed methods evaluation of an intervention in an adult tertiary referral hospital, to enhance interprofessional collaboration on overtime shifts. Phase 1 compared tasks and ward rounds on 86 intervention shifts with 106 “regular” shifts, and examined the effect on junior doctor patient management testing a model using regression techniques. Phase 2 explored the experience of the intervention for stakeholders. 91 junior doctors participated (89 percent response rate) on 192 overtime shifts. Junior doctors, APNs and senior medical professionals/administrators participated in interviews. Findings The intervention was associated with an increase in self-initiated ward rounds by junior doctors, partially explained by junior doctors completing fewer tasks skilled nurses could also complete. The intervention significantly reduced doctors’ engagement in tasks carried over from day shifts as well as first year (but not more experienced) junior doctors’ total tasks. Interviews suggested the initiative reduced junior doctors’ work pressure and promoted a safe team climate, situation awareness, skills, confidence, and well-being. Originality/value Junior doctors overtime shifts (5 p.m. to 11 p.m.) are important, both for hospitals to maintain patient care after hours and for junior doctors to learn and develop independent clinical decision making skills. However, junior doctors frequently report finding overtime shifts challenging and stressful. Redesigning overtime shifts to facilitate interprofessional collaboration can improve patient management and junior doctors’ learning and well-being.

This paper provides an overview of Advanced Practice Nursing (APN) in the USA, Canada, Australia and Hong Kong. It is based upon documents presented to the China Medical Board (CMB) China Nursing Network (CNN) as background for discussions held by the CNN in Shanghai. It discusses the APN role in these countries and regions according to topics identified by the CNN. These are APN educational preparation; role legitimacy; capacity requirements; scope of practice, domains of activities and limited rights for prescription and referral; professional promotion ladder; accreditation system; and, performance evaluation system. Both Canada and Australia have adapted many aspects of the USA model of APN to fit their specific legislative requirements and local conditions. Hong Kong has taken a different path which may be of interest in the Chinese context.

IntroductionThe management of critically ill patients is challenged by increasing population age and prevalence of comorbid diseases. High-quality intensive care nursing practice is imperative to accommodate these issues. The roles of the nurse practitioner (NP) and the acute care NP have existed for decades in the USA, Canada and Australia but are still evolving in Europe. Some European countries have introduced the advanced practice nurse (APN), but the current standard of the advanced level of nursing is variable and consensus regarding the framework, role and definition is lacking. Literature and evidence are sparse as well. Identification of skills and competencies required for the APN is warranted. Mapping skills and competencies will enable future educational harmonisation and facilitate mobility of the advanced-level intensive care nursing workforce across Europe. The aim of our scoping review is to identify literature describing skills, competencies and policies characterising advanced nursing practice in intensive care across Europe.Methods and analysisWe will apply a five-stage scoping review methodology with a comprehensive systematic literature search as outlined by Arksey and O’Malley. In collaboration with a research librarian, we will search nine interdisciplinary databases and grey literature for publications originating in European countries in 1992–2018. Using a two-stage screening process with Covidence to remove duplicates, we will first scan the title and abstract and then perform full-text review to determine the eligibility of the papers. Qualitative content analysis will be used to chart the data.Ethics and disseminationOur study is a part of the European Union-funded INACTIC project (International Nursing Advanced Competency-based Training for Intensive Care) with the overall aim of developing a common European curriculum for advanced practice critical care nursing. Results from this scoping review mapping the evidence of APNs in Europe will be presented at national and international conferences and published in a peer-reviewed journal.

Efficiency and effectiveness of care coordination depends on a match between the needs of the population and the skills, scope of practice, and intensity of services provided by the care coordinator. There is limited existing literature that addresses the relevance of the APN role as a fit for coordination of care for children with SHCN. The objective of this paper is to describe the value of the advanced practice nurse’s (APN’s) enhanced scope of knowledge and practice for relationship-based care coordination in healthcare homes that serve children with complex special health care needs (SHCN). The TeleFamilies project is provided as an example of the integration of an APN care coordinator in a healthcare home for children with SHCN.

Background Dementia is the leading cause of loss of independence in older adults worldwide. In the U.S., approximately 15 million family members provide care to relatives with dementia. This paper presents the rationale and design for a translational study in which an evidence-based, non-pharmacologic intervention for older adults with dementia and family caregivers (CGs) is incorporated into a publicly-funded home care program for older adults at risk for nursing home admission. Methods The 4-month Care of Persons with Dementia in their Environments (COPE) intervention is designed to optimize older adults' functional independence, and to improve CG dementia management skills and health-related outcomes. COPE features 10 in-home occupational therapy visits, and 1 in-home visit and 1 telephone contact by an advanced practice nurse. COPE was deemed efficacious in a published randomized clinical trial. In the present study, older adults with dementia enrolled in the Connecticut Home Care Program for Elders (CHCPE) and their CGs are randomly assigned to receive COPE plus their ongoing CHCPE services, or to continue receiving CHCPE services only. Outcomes The primary outcome for older adults with dementia is functional independence; secondary outcomes are activity engagement, quality of life, and prevention or alleviation of neuropsychiatric symptoms. CG outcomes include perceived well-being and confidence in using activities to manage dementia symptoms. Translational outcomes include net financial benefit of COPE, and feasibility and acceptability of COPE implementation into the CHCPE. COPE has the potential to improve health-related outcomes while saving Medicaid waiver and state revenue-funded home care program costs nationwide.

The acute care nurse practitioner (ACNP) role was developed in Canada in the late 1980s to offset rapidly increasing physician workloads in acute care settings and to address the lack of continuity of care for seriously ill patients and increased complexity of care delivery. These challenges provided an opportunity to develop an advanced practice nursing role to care for critically ill patients with the intent of improving continuity of care and patient outcomes. For this paper, we drew on the ACNP-related findings of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing. The synthesis revealed that ACNPs are working in a range of clinical settings. While ACNPs are trained at the master's level, there is a gap in specialty education for ACNPs. Important barriers to the full integration of ACNP roles into the Canadian healthcare system include lack of full utilization of role components, limitations to scope of practice, inconsistent team acceptance and funding issues. Facilitators to ACNP role implementation include clear communication about the role, with messages tailored to the specific information needs of various stakeholder groups; supportive leadership of healthcare managers; and stable and predictable funding. The status of ACNP roles continues to evolve across Canada. Ongoing leadership and continuing research are required to enhance the integration of these roles into our healthcare system.

In 1996 Hegney published a seminal review of the literature concerning the status of Australian rural nurses. This article updates and expands that original paper by reporting on an integrative review exploring the same topic area between the years 1996 and 2008. Findings show that definitions of rural nursing are now integrated with those of remote nursing on a continuum of distance and contextual difference. The role and function of rural nurses is examined, along with a discussion of the importance of a primary health care approach in meeting community needs. The influence of social determinants of health is explored in this context. The culture of rural health workplaces in relation to the role and function of rural nurses is also a feature of this review. Research into the rural nursing workforce and, in particular, the recruitment and retention of staff are examined, with the high attrition rate of new or novice rural nurses pinpointed as a common theme in these studies. Important legislative changes that have affected rural nursing practice are also identified. This article concludes with a discussion of the latest research into Australian rural nursing, focusing on education in rural universities and the potential to develop new or novice nurses through the development of supportive relationships.

This paper is based on the premise that nurses come to terms with the realities of patients by forming an understanding of their cultural viewpoints through embracing the person’s story. The author presents her journey in coming to understand the importance of attending to the patient’s story in the delivery of advanced practice nursing. Highlights of the journey include: a reconstructed story of a women deeply immersed in the cultural and religious traditions of Appalachia; literature on Appalachian culture, religious practices, and beliefs; and story theory as a theoretical approach to guide culturally sensitive nursing practice.

Effective care coordination is a key quality and safety strategy for populations with chronic conditions, including children with medical complexity (CMC). However, gaps remain in parent report of the need for care coordination help and receipt of care coordination help. New models must close this gap while maintaining family-centered focus. A three-armed randomized controlled trial conducted in an established medical home utilized an advanced practice registered nurse intervention based on Presler’s model of clinic-based care coordination. The model supported families of CMC across settings using telephone only or telephone and video telehealth care coordination. Effectiveness was evaluated from many perspectives and this paper reports on a subset of outcomes that includes family-centered care (FCC), need for care coordination help and adequacy of care coordination help received. FCC at baseline and end of study showed no significant difference between groups. Median FCC scores of 18.0–20.0 across all groups indicated high FCC within the medical home. No significant differences were found in the need for care coordination help within or between groups and over time. No significant difference was found in the adequacy of help received between groups at baseline. However, this indicator increased significantly over time for both intervention groups. These findings suggest that in an established medical home with high levels of FCC, families of CMC have unmet needs for care coordination help that are addressed by the APRN telehealth care coordination model.

Bakgrund: I dagens läge finns det kunskapsluckor om hur den perioperativa omvårdnadsprocessen uppfattas ur operationssjuksköterskans synvinkel. För att operationssjuksköterskan ska kunna ge god vård till patienten utifrån dennes önskningar och behov är det viktigt att operationssjuksköterskan får en bra kontakt med patienten. Får operationssjuksköterskan dela patientens värld d.v.s. om patienten både vill och är förmögen till att dela med sig av sina tankar och önskemål, då blir det lättare att ge en personcentrerad vård. Syfte: Syftet med föreliggande litteraturstudien är att undersöka hur operationssjuksköterskan uppfattar den vårdande relationen ur ett perioperativt synsätt. Metod: Det är en litteraturstudie med elva artiklar som har en kvalitativ ansats och en artikel som har en kvantitativ ansats. Föreliggande studien har en kvalitativ ansats då fokus är att beskriva och tolka operationssjuksköterskans upplevelser av omvårdnadsprocessen. Resultat: Generellt sett hade operationssjuksköterskorna en positiv inställning till den perioperativa processen. Operationssjuksköterskorna upplevde att den perioperativa processen bidrog till ökad kontinuitet och ökad trygghet hos patienterna men framförallt också hos dem själva. Operationssjuksköterskorna utvecklades i sin yrkesroll men också som individer. De kände att deras arbete var meningsfullt och att det fanns en vårdande relation mellan patienten och operationssjuksköterskan. Slutsats: Föreliggande studie lyfter fram att arbetet för operationssjuksköterskor skulle bli effektivare, säkrare vård, få mer kontinuitet och gynna både sjuksköterskorna och patienterna om den perioperativa processen användes i större utsträckning. Det skulle bli lättare att uppnå välmående och god omvårdnad i slutändan. Background: At present, there are gaps in the knowledge of how the perioperative process is seen from the point of view of the operating room nurse. When it comes to the operating theater nurse to provide quality care to the patient, it is important that the operating theater nurse gets a good contact with the patient. The operating room nurse has to share the patients’ world. Then, it will be easier to give a patient-centered care. Aim: The purpose of this study is to investigate how the operating theater nurse experienced the perioperative process from her/his point of view. Method: This study is a literature review of eleven articles that have a qualitative approach and one article which has a quantitative approach. This study has a more qualitative approach. Its focus is describing and interpreting the surgery nurses’ experience of the perioperative process. Result: The surgical nurses had, to a large extent, a favorable attitude to the perioperative process. Surgical nurses felt that the perioperative process contributed to increased continuity and increased safety for patients, but above all for themselves. Surgical nurses developed professionally, but also as individuals, they felt that their work was meaningful and that there was a caring relationship between the patient and the surgical nurse. Conclusion: This paper emphasizes that if the perioperative process would be used on a larger scale, the work for operative nurses would be more efficient, provide a more secure care, give more continuity and be very favourable to nurses as well as patients. The result for the patients would be a good care and well-being.

Although advanced practice nurses (APNs) have existed in Canada for over 40 years and there is abundant evidence of their safety and effectiveness, their full integration into our healthcare system has not been fully realized. For this paper, we drew on pertinent sections of a scoping review of the Canadian literature from 1990 onward and interviews or focus groups with 81 key informants conducted for a decision support synthesis on advanced practice nursing to identify the factors that enable role development and implementation across the three types of APNs: clinical nurse specialists, primary healthcare nurse practitioners and acute care nurse practitioners. For development of advanced practice nursing roles, many of the enabling factors occur at the federal/provincial/territorial (F/P/T) level. They include utilization of a pan-Canadian approach, provision of high-quality education, and development of appropriate legislative and regulatory mechanisms. Systematic planning to guide role development is needed at both the F/P/T and organizational levels. For implementation of advanced practice nursing roles, some of the enabling factors require action at the F/P/T level. They include recruitment and retention, role funding, intra-professional relations between clinical nurse specialists and nurse practitioners, public awareness, national leadership support and role evaluation. Factors requiring action at the level of the organization include role clarity, healthcare setting support, implementation of all role components and continuing education. Finally, inter-professional relations require action at both the F/P/T and organizational levels. A multidisciplinary roundtable formulated policy and practice recommendations based on the synthesis findings, and these are summarized in this paper.

Background A prospective Population Risk Stratification (PRS) tool was first introduced in the public Basque Health Service in 2011, at the level of its several Primary Care (PC) practices. This paper aims at exploring the new tool’s implementation process, as experienced by its potential adopters/users, ie. PC clinicians (doctors and nurses). Findings could help guide future PRS implementation strategies. Methods Three focus groups exploring clinicians’ opinions and experiences related to the PRS tool and its implementation in their daily practice were conducted. A purposive sample of 12 General Practitioners and 11 PC nurses participated in the groups. Discussions were digitally recorded, transcribed verbatim and analysed by two independent researchers using thematic analysis based on Graham et al.’s Knowledge Translation Theory. Results Exploring PC clinicians’ experience with the new PRS tool, allowed us to identify certain elements working as barriers and facilitators in its implementation process. This series of closely interrelated elements, which emerged as relevant in building up the complex implementation process of the new tool, as experienced by the clinicians, can be grouped into four domains: 1) clinicians’ characteristics as potential adopters, 2) clinicians’ perceptions of their practice settings where PRS is to implemented, 3) clinicians’ perceptions of the tool, and 4) the implementation strategy used by the PRS promoter. Conclusions Lessons from the implementation process under study point at the need to frame the implementation of a new PRS tool within a wider strategy encouraging PC clinicians to orientate their daily practice towards a population health approach. The PRS tool could also improve the perceived utility by its potential adopters, by bringing it closer to the clinicians’ needs and practice, and allowing it to become context-sensitive. This would require clinicians being involved from the earliest phases of conceptualisation, design and implementation of the new tool, and mounting efforts to improve communication between clinicians and tool promoters. Graham et al.’s Knowledge Translation Theory proved a suitable framework to explore the implementation process of a new PRS tool in the public Basque Health Service’s PC practice, and hence to identify implementation barriers and facilitators as experienced by the clinicians. Electronic supplementary material The online version of this article (doi:10.1186/1471-2296-15-150) contains supplementary material, which is available to authorized users.

The Association des Infirmières et Infirmiers du Canada (AIIC) (2008), defines Advanced Practice Nursing (APN), as “an advanced level of nursing practice that maximizes the use of specialized skills and nursing knowledge in order to respond to the customers’ needs in health’s sphere". APNs’ programs, were initially introduced in the 1960s to fulfil gaps both in services traditionally carried by physicians, in order to improve access to care particularly in under-served services and contexts by doctors (Delamaire & Lafortune 2010), and also as a consequence to the reduction of physicians’ and resident doctors hours internationally (Dowling et al. 2013; Olson & Chioffi 2005; Por 2008). Despite that, advanced practice is still being unclear due to the differences related to health settings and policies (Gardner et al. 2007). In the recent years, it has been introduced the concept of ‘complex chronic disease’, which is linked to the concept of aging and frailty, and determined by the presence of multiple and complex chronic conditions. The most differential characteristics of this group of people are the presence of several chronic diseases concurrently, multiple admissions in hospital emergency services in the same year, the presence of certain diseases such as heart failure or Chronic Obstructive Pulmonary Disease (COPD), polypharmacy and reduced personal autonomy. In addition, there are additional factors such as older age, living alone or not having enough family support and being in risk of falling, among others (Contel et al. 2012). In this sense, the APN is in an ideal position to cover the necessities of this population group. Case management and telemonitoring could be essential to the success in the developing of individualized care plans to improve chronic patients’ health status (Contel et al. 2012; Carroll et al. 2007; Clark et al. 2010). Moreover, several models of APN attention have been developed in a wide variety of heath contexts in the elderly population (Oeseburg et al. 2009; Low et al. 2011), with remarkable outcomes in terms of effectiveness. Examples of those models could be those in transitional care (Brand et al. 2004), case management (Leung et al. 2004) or heart diseases (Blaha et al. 2000; Duffy et al. 2010) to improve quality of life or reduce rehospitalizations. Also, APN carried out interventions in patients that suffered dementia (Callahan et al. 2006), with older people with low incomes and acute health problems (Counsell et al. 2007), or in the community, giving support to families and patients to manage resources (Thompson et al. 2008). However, there is a deficit of conceptual frameworks to characterize and describe the range of interventions and services by APNs in the older population (Morales Asencio 2010). In this sense, the availability of a standardized language to describe nursing interventions (Nursing Intervention Classification, NIC) (Bulecheck GM et al. 2008; Thoroddsen 2005) can provide an additional resource to classify the components of different APN models and could facilitate the description of APN in a universal language, available in a vast majority of health care record systems around the world. Aims: The aims of this thesis are: 1. To identify, assess and summarise available scientific evidence about the effect of interventions deployed by APNs when providing care to older people in different settings (hospital, home, outpatient, residential). 2. To describe the roles and components of the interventions developed by APNs in the contexts mentioned before. 3. To identify the interventions provided by APNs to older people in different contexts (acute and long-term care) with a Standardized Nursing Language, in the studies included in the Systematic Review. Design: The present study was divided in two parts: firstly, a systematic review, and secondly, a qualitative with mixed methods study. Methods: Systematic review: Data Sources: Sixteen electronic databases were consulted (1990-2010). The research also included reviews, papers, reports and evaluations from research health services centres and Health Technology Agencies. Review Methods: Studies that met inclusion criteria were reviewed for quality, using RevMan 5 application’s checklist of bias, together with the methodological quality criteria of the Cochrane COPD group. Qualitative study Quotes of the interventions carried out by advanced practice nurses were codified by experts into the Nursing Intervention Classification. A content analysis was carried out, followed by a Delphi technique Results: Systematic review: Eleven studies were included. They were classified depending on the follow-up period, and also on the scope of the advanced practice nursing services. In both cases, integrative, multi-component and continuous advanced practice nursing care, reduced readmissions, improved patients’ self-care and quality of life, as well as increased patients’ and caregivers’ satisfaction. Qualitative study: In total 73 different interventions codified in the Nursing Intervention Classification were extracted from the studies in different care contexts, with a clear predominance of interventions related to the Behavioural and Health care system domains, which could be explained due to the need of improving the psychosocial functioning and self-care of these patients to lead them to preserve their quality of life. Conclusion: Advanced practice nurses seems to be crucial to improve the health status of elderly people, which main characteristic is to bear with chronic diseases, in almost every care context. Moreover, Advanced Practice Nurses’ interventions could be considered as complex but with the use of standardized nursing languages as the Nursing Intervention Classification, they can be better described, reported and analysed along different contexts. Moreover, core elements of the APNs’ roles can be identified and they could be used for delineating or remodelling services. Further investigation will be needed to confirm that advanced practice nursing programs decreases health costs, to compare their effectiveness in both, the generalist and the specific model, and to analyse the pertinence of a mixed model. Bibliografía Morilla-Herrera, J.C. et al., 2012. Effectiveness of advanced practice nursing interventions in older people: protocol for a systematic review and qualitative study. Journal of advanced nursing.

This paper discusses challenging issues and guidelines for securing preceptorships for advanced practice registered nurse (APRN) students, i.e., clinical nurse specialists, nurse midwives, nurse practitioners, and nurse anesthetists. Student preceptorships are facilitated when there is a relationship that fosters collaboration and cooperation between faculty members in academic institutions and preceptors in clinical institutions. The faculty member in the academic setting ensures that requirements for the course and clinical experiences can be met through the choice of preceptor and patient population or setting within a clinical institution. Faculty must identify, select and contract with preceptors who are not only clinical experts, but who are able to function effectively in the roles of coach and mentor for the advanced practice nursing student. Consideration of the curriculum, student background and preceptor characteristics allows faculty to tailor the clinical assignment so that course and clinical outcomes and student goals are achieved. Faculty, preceptor and student engage in a dialog that delineates responsibilities for orientation, course and clinical expectations, supervision and evaluation. Securing written contracts and clarifying responsibilities is the result of a collaborative relationship that confirms the commitment of each partner in the preceptorship.

Aim To report quantitative evidence of the effectiveness of advanced practice nursing roles, clinical nurse specialists and nurse practitioners, in meeting the healthcare needs of older adults living in long-term care residential settings. Background Although studies have examined the effectiveness of advanced practice nurses in this setting, a systematic review of this evidence has not been conducted. Design Quantitative systematic review. Data sources Twelve electronic databases were searched (1966–2010); leaders in the field were contacted; and personal files, reference lists, pertinent journals, and websites were searched for prospective studies with a comparison group. Review methods Studies that met inclusion criteria were reviewed for quality, using a modified version of the Cochrane Effective Practice and Organisation of Care Review Group risk of bias assessment criteria. Results Four prospective studies conducted in the USA and reported in 15 papers were included. Long-term care settings with advanced practice nurses had lower rates of depression, urinary incontinence, pressure ulcers, restraint use, and aggressive behaviours; more residents who experienced improvements in meeting personal goals; and family members who expressed more satisfaction with medical services. Conclusion Advanced practice nurses are associated with improvements in several measures of health status and behaviours of older adults in long-term care settings and in family satisfaction. Further exploration is needed to determine the effect of advanced practice nurses on health services use; resident satisfaction with care and quality of life; and the skills, quality of care, and job satisfaction of healthcare staff.

Meaningful use of electronic health records to coordinate care requires skillful synthesis and integration of subjective and objective data by practitioners to provide context for information. This is particularly relevant in the coordination of care for children with complex special health care needs. The purpose of this paper is to present a conceptual framework and example of meaningful use within an innovative telenursing intervention to coordinate care for children with complex special health care needs. The TeleFamilies intervention engages an advanced practice nurse in a full-time care coordinator role within an existing hospital-based medical home for children with complex special health care needs. Care coordination is facilitated by the synthesis and integration of internal and external data using an enhanced electronic health record and telehealth encounters via telephone and videoconferencing between the advanced practice nurse and the family at home. The advanced practice nurse’s ability to maintain an updated plan of care that is shared across providers and systems and build a relationship over time with the patient and family supports meaningful use of these data.

Health care in the United States is facing a crisis in providing access to quality care for those in underserved and rural regions. Advanced practice nurses are at the forefront of addressing such issues, through modalities such as health care technology. Many nursing education programs are seeking strategies for better educating students on technology utilization. Health care technology includes electronic health records, telemedicine, and clinical decision support systems. However, little focus has been placed on the role of social media in health care. This paper describes an educational workshop using standardized patients and hands-on experiences to introduce advanced practice nurses in a Doctor of Nursing Practice program to the role of social media in addressing issues inherent in the delivery of rural health care. The students explore innovative approaches for utilizing social media for patient and caregiver support as well as identify online resources that assist providers in a rural setting.

Background: The past few years has seen a growth in the number of new nursing rn of the profession provides an opportunity for the profession to debate and determine some consistency in position titles, responsibilities and areas ooles and position titles in many countries, including Australia. The Australian situation is unique due to the lack of professional engagement and debate in determining the purpose of some of these new positions. Often these new roles have been poorly defined, and there is no national consistency in nomenclature. The recent move to a national nursing registration system provides an opportunity for change. Method: Discursive paper. Results: New roles arise for a number of reasons, including a change in function or title for a pre-existing role or in response to the establishment a completely new position. However, the lack of a co-ordinated approach to introduction of new roles may lead to role proliferation (the rapid increase or spread of new positions and position titles), role blurring (where the boundaries of different positions become less distinct) and role confusion (where both nurses and health system clients experience a lack of clarity regarding the precise scope of roles). Conclusion: Professional nursing practice is defined by the impact on patient outcomes, not by position titles. As such, the potential positive impact of a new role on patient outcomes should be the primary consideration when considering its introduction. National regulatiof specialty practice. © 2011 Royal College of Nursing, Australia.

Supportive nursing leadership is important for the successful introduction and implementation of advanced practice nursing roles in Canadian healthcare settings. For this paper, we drew on pertinent sections of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing to describe and explore organizational leadership in planning and implementing advanced practice nursing roles. Leadership strategies that optimize successful role integration include initiating systematic planning to develop the roles based on patient and community needs, engaging stakeholders, using established Canadian role implementation toolkits, ensuring utilization of all dimensions of the role, communicating clear messages to increase awareness about the roles in the organization, creating networks and facilitating mentorship for those in the role, and negotiating role expectations with physicians and other members of the healthcare team. Leaders face challenges in creating and securing sustainable funding for the roles and providing adequate infrastructure support.

This timely paper provides a thought-provoking analysis of current advanced practice nursing education in Canada. It comes at a critical juncture in the evolution of Canadian healthcare services and the redefinition of nursing roles. Increasingly, multiple sectors of society are calling for more nurses with advanced practice preparation and for a wider range of advanced practice nursing specialties. Advanced practice nurses (APNs) are being proposed as a solution to a financially overburdened national healthcare system, the increasing complexity of healthcare services, and a crisis in access to primary healthcare. Thus, governments seeking greater fiscal efficiency, medical specialists needing sophisticated collaborative support, and healthcare consumers see APNs as the way forward.

In the last decade the US federal government proposed a transformation vision of mental health service delivery; patient-centered, evidence-based and recovery oriented treatment models. Health care reform brings additional expectations for innovation in mental/substance use service delivery, particularly the idea of creating systems where physical health, mental health and substance use treatment is fully integrated. Psychiatric nurses, as one of the four core US mental health professions, have the potential to play a significant role in the both the transformation initiative and health care reform vision. However, psychiatric nurses, particularly advanced practice psychiatric nurses, are an untapped resource due in part to significant state regulatory barriers that limit their scope of practice in many states. The purpose of this paper is to document what is currently known about advanced practice psychiatric nurses and discuss policy implications for tapping into the strengths of this workforce. Strategies for facilitating utilization of advanced practice psychiatric nurses discussed.

To date, the nurse educator role in the Australian hospital setting has been poorly described. Current pressures for health care reform have prompted reviews of nursing roles. This paper discusses the literature pertaining to the nurse educator role within the context of the Australian health care environment and current health care policy. Building on this synthesis, barriers and facilitators impacting on the nurse educator role are identified and strategic directions for policy, role clarification and advanced practice role development are highlighted. Further research identifying the impact of the hospital-based nurse educator on patient outcomes and professional nursing practice are proposed.

Background and methodology Women have used the contraceptive diaphragm for decades. Although use has recently declined, the diaphragm may find a new role in STI/HIV and dual-prevention programmes when microbicides become available. We developed a questionnaire to examine seven provider issues identified as possible barriers to diaphragm use among advanced practice nurses (APNs) specialising in women9s health. The perceived degree to which each issue represented a barrier was examined. Non-parametric correlations were calculated between diaphragm fitting history, demographic and practice characteristics, and the response ratings for each issue. Results Responses were analysed for 204 APNs who averaged 15 years9 experience in women9s health care; 87% had fitted a diaphragm at least once, but 40% had not prescribed one in the past year. The degree to which each issue was perceived as a barrier varied. Based on respondents9 ratings of a 9more than moderate barrier,9 diaphragm non-promotion by women9s health providers, effectiveness doubts, unfamiliarity and lack of access to educational materials were more often perceived as impeding diaphragm use. Other results indicated that APNs with recent diaphragm fitting history perceived five of the seven issues to be less of a barrier: non-promotion by women9s health providers, lack of access to educational materials and to a fitting set, unfamiliarity, and inadequate reimbursement. Discussion and conclusions Formulation of successful strategies to reintroduce the diaphragm will depend on better identification and understanding of provider-perceived barriers. This paper offers new insights about such barriers and guidance for the development of strategies for diaphragm reintroduction.

Contains fulltext : 88278.pdf (Publisher’s version ) (Closed access) We have previously reported a preliminary taxonomy of patient error. However, approaches to managing patients' contribution to error have received little attention in the literature. This paper aims to assess how patients and primary care professionals perceive the relative importance of different patient errors as a threat to patient safety. It also attempts to suggest what these groups believe may be done to reduce the errors, and how. It addresses these aims through original research that extends the nominal group analysis used to generate the error taxonomy. Interviews were conducted with 11 purposively selected groups of patients and primary care professionals in Auckland, New Zealand, during late 2007. The total number of participants was 83, including 64 patients. Each group ranked the importance of possible patient errors identified through the nominal group exercise. Approaches to managing the most important errors were then discussed. There was considerable variation among the groups in the importance rankings of the errors. Our general inductive analysis of participants' suggestions revealed the content of four inter-related actions to manage patient error: Grow relationships; Enable patients and professionals to recognise and manage patient error; be Responsive to their shared capacity for change; and Motivate them to act together for patient safety. Cultivation of this GERM of safe care was suggested to benefit from 'individualised community care'. In this approach, primary care professionals individualise, in community spaces, population health messages about patient safety events. This approach may help to reduce patient error and the tension between personal and population health-care. 01 mei 2010

The purpose of this paper is to describe the results of a survey of advanced practice nurses (APNs) to determine the activities they perform related to caring for patients with addictions and or co-occurring mental health disorders, the amount of addictions education in their graduate programs, and their perceptions of the value of addictions education for their role. Data were obtained from 233 APNs in New York State using a tool adapted from a previous job analysis survey. APNs reported the greatest amount of experience in history taking for various types of addictions and cooccurring mental health disorders and least amount of experience in performing objective exams, using standardized screening tools, ordering related diagnostic tests, prescribing pharmacological treatments, and making referrals for addiction treatment. Respondents reported a mean of less than three hours addictions education in their graduate programs in contrast to their high perceived importance of this clinical area. peerReviewed

Aim To explore the main facilitators and barriers to task reallocation. Background One of the innovative approaches to dealing with the anticipated shortage of physicians is to reallocate tasks from the professional domain of medicine to the nursing domain. Various (cost-)effectiveness studies demonstrate that nurse practitioners can deliver as high quality care as physicians and can achieve as good outcomes. However, these studies do not examine what factors may facilitate or hinder such task reallocation. Method A systematic literature review of PubMed and Web of Knowledge supplemented with a snowball research method. The principles of thematic analysis were followed. Results The 13 identified relevant papers address a broad spectrum of task reallocation (delegation, substitution and complementary care). Thematic analysis revealed four categories of facilitators and barriers: (1) knowledge and capabilities, (2) professional boundaries, (3) organisational environment, and (4) institutional environment. Conclusion Introducing nurse practitioners in healthcare requires organisational redesign and the reframing of professional boundaries. Especially the facilitators and barriers in the analytical themes of ‘professional boundaries’ and ‘organisational environment’ should be considered when reallocating tasks. If not, these factors might hamper the cost-effectiveness of task reallocation in practice. Keywords: Professional delegation, Advanced Practice Nursing, Nurse practitioners, Organisational innovation, Physician–nurse relations, Systematic review

SummaryThe Clinical Nurse Consultant role in Australia is an Advanced Practice Registered Nurse Role (APRN). This role has been conceptualized from the discrete pillars of research, education, practice, system support and leadership, articulated in the Strong Model of Advanced Practice. This conceptualization has been manifested in job descriptions, workforce planning and course design. This paper explored whether there was a more refined way of conceptualizing the unique ‘value add’ of the role. A hermeneutic phenomenological approach was employed to explore the lived experience of the role. It was identified that the pillars of education, practice, leadership and research are interconnected and expressed in the system work of the Clinical Nurse Consultant. The findings have implications for education and workforce planning.

Title confusion and lack of role clarity pose barriers to the integration of advanced practice nursing roles (i.e., clinical nurse specialist [CNS] and nurse practitioner [NP]). Lack of awareness and understanding about NP and CNS roles among the healthcare team and the public contributes to ambiguous role expectations, confusion about NP and CNS scopes of practice and turf protection. This paper draws on the results of a scoping review of the literature and qualitative key informant interviews conducted for a decision support synthesis commissioned by the Canadian Health Services Research Foundation and the Office of Nursing Policy in Health Canada. The goal of this synthesis was to develop a better understanding of advanced practice nursing roles and the factors that influence their effective development and integration in the Canadian healthcare system. Specific recommendations from interview participants and the literature to enhance title and role clarity included the use of consistent titles for NP and CNS roles; the creation of a vision statement to articulate the role of CNSs and NPs across settings; the use of a systematic planning process to guide role development and implementation; the development of a communication strategy to educate healthcare professionals, the public and employers about the roles; attention to inter-professional team dynamics when introducing these new roles; and addressing inter-professionalism in all health professional education program curricula.

Advanced practice nursing (APN) is a term used to describe a variety of possible nursing roles operating at an advanced level of practice. Historically, APN roles haves evolved informally, out of the need to improve access to health care services for at-risk and disadvantaged populations and for those living in underserved rural and remote communities. To address health needs, especially ones related to primary health care, nurses acquired additional skills through practice experience, and over time they developed an expanded scope of practice. More recently, APN roles have been developed more formally through the establishment of graduate education programs to meet agreed-upon competencies and standards for practice. The introduction of APN roles is expected to advance primary health care throughout Latin America and the Caribbean, where few such roles exist. The purpose of the paper is to outline an implementation strategy to guide and support the introduction of primary health care APN roles in Latin America and the Caribbean. The strategy includes the adaptation of an existing framework, utilization of recent research evidence, and application of knowledge from experts on APN and primary health care. The strategy consists of nine steps. Each step includes a national perspective that focuses on direct country involvement in health workforce planning and development and on implementation. In addition, each step incorporates an international perspective on encouraging countries that have established APN programs and positions to collaborate in health workforce development with nations without advanced practice nursing.

In Canada, education programs for the clinical nurse specialist (CNS) and nurse practitioner (NP) roles began 40 years ago. NP programs are offered in almost all provinces. Education for the CNS role has occurred through graduate nursing programs generically defined as providing preparation for advanced nursing practice. For this paper, we drew on pertinent sections of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing to describe the following: (1) history of advanced practice nursing education in Canada, (2) current status of advanced practice nursing education in Canada, (3) curriculum issues, (4) interprofessional education, (5) resources for education and (6) continuing education. Although national frameworks defining advanced nursing practice and NP competencies provide some direction for education programs, Canada does not have countrywide standards of education for either the NP or CNS role. Inconsistency in the educational requirements for primary healthcare NPs continues to cause significant problems and interferes with inter-jurisdictional licensing portability. For both CNSs and NPs, there can be a mismatch between a generalized education and specialized practice. The value of interprofessional education in facilitating effective teamwork is emphasized. Recommendations for future directions for advanced practice nursing education are offered.

This paper considers how the decision to enter advanced practice nursing (e.g., the occupations of nurse practitioner, certified nurse-midwife, nurse anesthetist, and clinical nurse specialist) is affected by State laws on the scope of practice of APNs. ...