The added value of the nurse practitioner: An evolutionary concept analysis.

AIM: Nurse practitioners' added value is often mentioned in publications, but there is no consensus on what value is being added, what value is being added to, and in comparison with what can be considered to be an added value. A concept analysis was conducted to clarify the attributes, antecedents and meaning and better understand the Nurse practitioners' added value. DESIGN: Rodgers' evolutionary concept analysis. METHODS: We selected 16 studies from CINAHL, PubMed, Embase and Medline to conduct a thematic analysis, considering the date, location and discipline of publications. RESULTS: Nurse practitioners' added value include: skills and competencies, activities performed, positive outcomes, and positive role perceptions, and antecedents and consequences were also identified. Nurse practitioners' added value is context-dependent and is often understood by comparing it to a context prior to implementation or other professional roles.

Systematic review of the characteristics of brief team interventions to clarify roles and improve functioning in healthcare teams.

AIM: Describe brief (less than half a day) interventions aimed at improving healthcare team functioning. METHODS: A systematic review on brief team interventions aimed at role clarification and team functioning (PROSPERO Registration Number: CRD42018088922). Experimental or quasi-experimental studies were included. Database searches included CINAHL, Medline, EMBASE, PUBMED, Cochrane, RCT Registry-1990 to April 2020 and grey literature. Articles were screened independently by teams of two reviewers. Risk of bias was assessed. Data from the retained articles were extracted by one reviewer and checked by a second reviewer independently. A narrative synthesis was undertaken. RESULTS: Searches yielded 1928 unique records. Final sample contained twenty papers describing 19 studies, published between 2009 and 2020. Studies described brief training interventions conducted in acute care in-patient settings and included a total of 6338 participants. Participants' socio-demographic information was not routinely reported. Studies met between two to six of the eight risk of bias criteria. Interventions included simulations for technical skills, structured communications and speaking up for non-technical skills and debriefing. Debriefing sessions generally lasted between five to 10 minutes. Debriefing sessions reflected key content areas but it was not always possible to determine the influence of the debriefing session on participants' learning because of the limited information reported. DISCUSSION: Interest in short team interventions is recent. Single two-hour sessions appear to improve technical skills. Three to four 30- to 60-minute training sessions spread out over several weeks with structured facilitation and debriefing appear to improve non-technical skills. Monthly meetings appear to sustain change over time. CONCLUSION: Short team interventions show promise to improve team functioning. Effectiveness of interventions in primary care and the inclusion of patients and families needs to be examined. Primary care teams are structured differently than teams in acute care and they may have different priorities.