RESUMO
Background: National nurse shortages, ongoing nurse faculty retirements, and a dearth of clinical sites make it challenging to prepare advanced practice registered nurses (APRNs) who are ready to transition into independent provider roles, especially in acute care settings. One of the most effective ways to address these experiential learning challenges is for academic institutions and healthcare systems to form collaborative academic-practice partnerships. However, many partnerships between schools of nursing and healthcare institutions have found numerous challenges, including time to devote to the partnership, funding of ideas, competing initiatives and needs, and sustainability. Objective: The University of Maryland School of Nursing (UMSON) set out to expand the traditional academic-clinical partnership approach with a new collaborative model. Methods: Rather than both parties coming to the table with their own goals, the partnership focused on intentional relationship building, transparency, measurable outcomes, and sustainability. This model, further called the Sustainable Academic-Clinical Alliance (SACA), assures that both sides of the partnership benefit. The SACA model was used to create an academic-practice partnership with the University of Maryland Upper Chesapeake Health System in order to increase APRN clinical practice sites and readiness of APRN students to provide care across the continuum in the state of Maryland. Results: Since July 2016, the SACA model has enabled over 40 clinical providers in over 20 different clinical areas to offer 329 different clinical and nonclinical experiences to APRN students from UMSON. At the end of the 5-year alliance, 150 unique UMSON APRN students completed 257 different clinical rotations. Conclusion: The SACA model effectively promotes the development and achievement of sustainable academic-practice partnerships by focusing on (a) intentional relationship building, (b) transparency in goal setting and alliance maintenance, (c) development of outcome measures, and (d) sustainability. Implications for Nursing: The components of the SACA model made sustainability more achievable, which has eluded previous academic-clinical partnerships. This model can serve as a blueprint for other academic and healthcare institutions to establish sustainable academic-practice partnerships.
Assuntos
Comportamento Cooperativo , Humanos , Maryland , Prática Avançada de Enfermagem/organização & administração , Prática Avançada de Enfermagem/educação , Feminino , Masculino , Adulto , Escolas de Enfermagem/organização & administraçãoRESUMO
Developing political engagement among nurses who care for rural and underserved communities can help mitigate health inequities. An experiential learning opportunity informed by Lobby Day was developed to prepare primary care advanced practice nursing students with the policy skills needed to actively serve as advocates for their patients and communities.
Assuntos
Prática Avançada de Enfermagem , Atenção Primária à Saúde , Estudantes de Enfermagem , Humanos , Prática Avançada de Enfermagem/organização & administração , Prática Avançada de Enfermagem/educação , Estudantes de Enfermagem/psicologia , Atenção Primária à Saúde/organização & administração , Aprendizagem Baseada em Problemas/organização & administração , PolíticaRESUMO
OBJECTIVES: To determine the profile of diabetes patients with neuropathic and neuro-ischaemic lesions who are referred to the advanced practice nurse (APN) in complex chronic wounds; to determine whether a training strategy aimed at primary care nurses and nursing homes that care for patients with diabetic foot disease influences the performance of professionals; and to assess the extent, follow-up and evaluation of diabetic foot disease in patients with neuropathic ulcers and neuro-ischaemic ulcers referred to the specialist APN before and after the training. METHODS: The characteristics of patients referred to the APN over a period of 6.5 years were analysed, as well as the numbers of amputations and deaths pre- and post-training. RESULTS: of the total of 103 patients, 78 were men; across both sexes the average age was 69 years. Fifty patients had neuropathic ulcers and 53 had neuro-ischaemic ulcers, with healing rates of 59%. There were 50 amputations and 37 deaths over the study period. CONCLUSION: Prevention of diabetic foot ulcers depends on having in place a fast, agile, practical clinical pathway between primary care and hospital, with the role of the APN, including the co-ordination of care between primary and secondary settings, being key.
Assuntos
Pé Diabético , Papel do Profissional de Enfermagem , Humanos , Pé Diabético/enfermagem , Masculino , Feminino , Idoso , Prática Avançada de Enfermagem , Amputação Cirúrgica/enfermagem , Doença Crônica , Pessoa de Meia-Idade , CicatrizaçãoRESUMO
BACKGROUND: Caring for an increasingly older and multicultural patient population requires nurses and APNs who are able to integrate cultural competency in meeting the needs of their patients while decreasing health care disparities. A study-abroad immersion experience is one way to instill deep learning and cultural competency. PURPOSE: The purpose of this study was to understand the lived experience of baccalaureate nursing students and APN students working together in a study-abroad, service-learning experience. METHOD: Using Interpretive Phenomenological Analysis (IPA) (Smith & Osborn, 2003), we explored the lived experience of Baccalaureate and Advanced Practice Nursing Students in a service-learning, study-abroad experience in Belize. RESULTS: Emergent themes derived from students' journal transcripts were: (1) Allowing learning to take place; (2) Practicing nursing with limited resources (3) A different take on culture; and (4) Kinship with peers. From this theme two sub themes emerged: 1) students' connection with the people and the country, and 2) students' connection with each other. CONCLUSION: Cultural immersion prepared students to work in Belize with different patient groups, having varied perspectives related to their health. Students learned that the core values of dignity and caring require that we, as nurses, go where the patient is-not where we want the patient to be. This is tested when students are confronted with a culture not their own.
Assuntos
Competência Cultural , Currículo , Bacharelado em Enfermagem , Estudantes de Enfermagem , Humanos , Estudantes de Enfermagem/psicologia , Belize , Prática Avançada de Enfermagem , Intercâmbio Educacional Internacional , FemininoRESUMO
BACKGROUND: Literature on advanced practice providers (APPs) prescribing chemotherapy independently, without physician cosignature, is limited. OBJECTIVES: This project assessed safety and provider satisfaction for an existing independent APP chemotherapy prescribing privilege at a National Cancer Institute-designated comprehensive cancer center. METHODS: Rate of Reporting to Improve Safety and Quality events associated with APPs with independent chemotherapy prescribing privileges was compared to that of physicians during a three-year period. Satisfaction of APPs with independent chemotherapy prescribing privileges was evaluated. FINDINGS: The odds of a reported event were higher for physicians than for APPs. APP survey responses were positive for readiness, confidence, and satisfaction with independent chemotherapy prescribing privilege.
Assuntos
Antineoplásicos , Segurança do Paciente , Humanos , Segurança do Paciente/normas , Feminino , Antineoplásicos/uso terapêutico , Antineoplásicos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Adulto , Prescrições de Medicamentos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Neoplasias/tratamento farmacológico , Inquéritos e Questionários , Prática Avançada de Enfermagem/normas , Estados UnidosRESUMO
Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of numerous anticancer agents. CIPN can persist as chronic pain or sensory symptoms for months to years after discontinuation of the a.
Assuntos
Antineoplásicos , Doenças do Sistema Nervoso Periférico , Humanos , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/terapia , Antineoplásicos/efeitos adversos , Feminino , Masculino , Neoplasias/tratamento farmacológico , Pessoa de Meia-Idade , Enfermagem Oncológica/métodos , Enfermagem Oncológica/normas , Prática Avançada de EnfermagemRESUMO
This article examines the integration of a Clinical Nurse Reasoning (CNR) model into advanced nursing practice training to develop the clinical reasoning skills of advanced practice nurses. The article explores the contribution of Callista Roy's conceptual model of adaptation and presents a global analysis of a complex care situation that justifies the introduction of an CNR model paired with nursing knowledge to ensure comprehensive, quality nursing care.
Assuntos
Prática Avançada de Enfermagem , Raciocínio Clínico , Teoria de Enfermagem , Estudantes de Enfermagem , Humanos , Prática Avançada de Enfermagem/educação , Competência Clínica/normas , Modelos de EnfermagemRESUMO
BACKGROUND: Despite available training programs for neonatal advanced practice providers (Neo APP), including neonatal nurse practitioners and physician assistants, it is difficult to meet the demand for these providers. There are no publications regarding training models with greater than 1 Neo APP learner per mentor. PURPOSE: To create and measure outcomes of a 12-month program to educate Neo APP "Super-Mentors" able to train 2 Neo APP learners simultaneously. METHODS: Super-Mentors were selected and attended monthly classes to learn mentorship concepts and receive support. Learners received didactic content and support through a Fellowship program. Quantitative data regarding recruitment and retention, as well as Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS) results were compared pre- and postprogram. Qualitative satisfaction measures via survey from 21 stakeholders were analyzed through a phenomenological approach. RESULTS: Six Super-Mentors trained 14 Neo APPs, as compared to 7 in the previous year. One Neo APP left after training. Summative preprogram MNPJSS scores were better (5.1 ± 0.37) than postprogram (4.7 ± 0.47) ( P < .001). The most important preprogram subscale item was "vacation" versus "quality of assistive personnel" postprogram. Both pre- and postprogram scores reflected positive job satisfaction so differences may not be clinically significant. Qualitative program benefits included faster and increased onboarding, stronger relationships, and dedicated time. Challenges included role clarity among other stakeholders, learning culture, and spacial/technological logistics. IMPLICATIONS FOR PRACTICE: Super-Mentors can train twice the number of Neo APP learners, with optimal preparation and support of all stakeholders, adequate space, and appropriate technology.
Assuntos
Mentores , Profissionais de Enfermagem , Humanos , Mentores/psicologia , Profissionais de Enfermagem/educação , Assistentes Médicos/educação , Satisfação no Emprego , Enfermagem Neonatal/educação , Enfermagem Neonatal/métodos , Prática Avançada de Enfermagem/educação , Prática Avançada de Enfermagem/métodos , Feminino , Recém-Nascido , MasculinoAssuntos
Readmissão do Paciente , Atenção Primária à Saúde , Acidente Vascular Cerebral , Sobreviventes , Humanos , Readmissão do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/tendências , Acidente Vascular Cerebral/terapia , Sobreviventes/estatística & dados numéricos , Sobreviventes/psicologia , Prática Avançada de Enfermagem/métodos , Prática Avançada de Enfermagem/normas , Prática Avançada de Enfermagem/tendências , Fatores de TempoRESUMO
ABSTRACT: A virtual book club (VBC) was created for advanced practice registered nurses (APRNs) to foster engagement, connect with peers, and apply readings to their personal and professional development. Microsoft Teams virtual platform was used. Books chosen focused on professional development and health care-related topics. As a quality-improvement project, 60 participants completed an anonymous Likert-scale survey about their perception of the VBC. Respondents survey completion rate was 71%. Sixty survey evaluations stated that they agreed or strongly agreed (mean 4.78-4.82/5) that the VBC encourages peer engagement, professional applicability, intention to read professional books, and willingness to invite peers to future VBCs. Participants were neutral (mean 3.25/5) about reading professional or health care-related books outside of the VBC. Virtual book clubs offer opportunities for APRNs to socially connect with peers and apply readings to both their personal and professional development. The results from this project may be applied to help encourage connection with other APRNs during these times of provider burnout.
Assuntos
Livros , Melhoria de Qualidade , Humanos , Inquéritos e Questionários , Prática Avançada de Enfermagem/métodos , Adulto , Feminino , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: to validate the Brazilian version of the Modified Scale for Delineating Advanced Practice Nursing Roles. METHODS: this was a methodological study for the clinical validation of an instrument, conducted with 207 nurses working in primary care. Exploratory and confirmatory factor analysis, Cronbach's alpha test, and z-test for proportion comparison were used. RESULTS: the internal reliability of the scale was 0.944, with alpha greater than 0.80 in most domains, except for Education (0.786). In the exploratory factor analysis, considering the criterion of eigenvalue greater than one, eight factors were identified, explaining 79.38% of the variance. In the comparison of proportions, the adequate responses (≥ 2) in the domain of Comprehensive Direct Care, in both analyzed groups, were statistically equal. This domain had the highest score of adequate responses, followed by Education and Systems Support. Insufficient scoring was observed in the domains of Publication and Professional Leadership. CONCLUSIONS: the instrument demonstrated stability and reliability to be used in the evaluation of advanced nursing practice.
Assuntos
Prática Avançada de Enfermagem , Psicometria , Brasil , Humanos , Prática Avançada de Enfermagem/métodos , Prática Avançada de Enfermagem/normas , Reprodutibilidade dos Testes , Feminino , Masculino , Adulto , Inquéritos e Questionários , Psicometria/instrumentação , Psicometria/métodos , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem/psicologia , TraduçãoRESUMO
INTRODUCTION: The World Health Organization (WHO) called for the expansion of all nursing roles, including advanced practice nurses (APNs), nurse practitioners (NPs) and clinical nurse specialists (CNSs). A clearer understanding of the impact of these roles will inform global priorities for advanced practice nursing education, research, and policy. OBJECTIVE: To identify gaps in advanced practice nursing research globally. MATERIALS AND METHODS: A review of systematic reviews was conducted. We searched CINAHL, Embase, Global Health, Healthstar, PubMed, Medline, Cochrane Library, DARE, Joanna Briggs Institute EBP, and Web of Science from January 2011 onwards, with no restrictions on jurisdiction or language. Grey literature and hand searches of reference lists were undertaken. Review quality was assessed using the Critical Appraisal Skills Program (CASP). Study selection, data extraction and CASP assessments were done independently by two reviewers. We extracted study characteristics, country and outcome data. Data were summarized using narrative synthesis. RESULTS: We screened 5840 articles and retained 117 systematic reviews, representing 38 countries. Most CASP criteria were met. However, study selection by two reviewers was done inconsistently and language and geographical restrictions were applied. We found highly consistent evidence that APN, NP and CNS care was equal or superior to the comparator (e.g., physicians) for 29 indicator categories across a wide range of clinical settings, patient populations and acuity levels. Mixed findings were noted for quality of life, consultations, costs, emergency room visits, and health care service delivery where some studies favoured the control groups. No indicator consistently favoured the control group. There is emerging research related to Artificial Intelligence (AI). CONCLUSION: There is a large body of advanced practice nursing research globally, but several WHO regions are underrepresented. Identified research gaps include AI, interprofessional team functioning, workload, and patients and families as partners in healthcare. PROSPERO REGISTRATION NUMBER: CRD42021278532.
Assuntos
Prática Avançada de Enfermagem , Humanos , Saúde Global , Pesquisa em Enfermagem , Revisões Sistemáticas como AssuntoRESUMO
Medication iatrogenia is a real public health problem. Elderly people are particularly at risk, due to their multiple pathologies, including heart failure; residents of residential care facilities for the dependent elderly (Ehpad) are no exception. Studies show that this risk is avoidable in 60% of cases, and that advanced practice nurses (APNs) can play a pivotal role in preventive measures. How would the role of the APN be perceived by other healthcare professionals working with these heart failure patients institutionalized in Ehpad?
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Prática Avançada de Enfermagem , Insuficiência Cardíaca , Humanos , Insuficiência Cardíaca/enfermagem , Idoso , Instituição de Longa Permanência para Idosos , Atitude do Pessoal de Saúde , Doença Iatrogênica/prevenção & controle , Masculino , Feminino , França , Casas de Saúde , Inquéritos e QuestionáriosRESUMO
The Impact program aims to structure the care provided by advanced practice nurses (APNs) for people with chronic illnesses, based on the humanistic health partnership model. This model, based on patient partnership, is enriched by measurement tools that take into account four determinants of adaptation to chronic illness. Impact aims to improve patient partnership, individualize care and integrate IPAs into a research dynamic.
Assuntos
Participação do Paciente , Humanos , Doença Crônica/terapia , Doença Crônica/enfermagem , Modelos de Enfermagem , Prática Avançada de Enfermagem/organização & administração , Relações Enfermeiro-PacienteRESUMO
In the context of the introduction of advanced practice nurses in emergency departments (APNs), the Collège de Médecine d'Urgence du Nord-Pas-de-Calais teamed up with the Unité de Formation et de Recherche des Sciences de la Santé et du Sport at the University of Lille to conduct a survey of emergency department management teams, with the aim of gaining a better understanding of their needs. The results revealed a number of obstacles and levers to the implementation of APNs, and led to a better understanding of the patient pathways in these departments. As a result, the content of the university teaching program could be reviewed with a view to meeting the needs expressed in the field.
Assuntos
Prática Avançada de Enfermagem , Enfermagem em Emergência , Serviço Hospitalar de Emergência , Humanos , França , Serviço Hospitalar de Emergência/organização & administração , Enfermagem em Emergência/educação , Atitude do Pessoal de SaúdeRESUMO
Suicide prevention is a major public health issue, both nationally and internationally. The management of suicidal patients leaving emergency departments is crucial to preventing the risk of suicidal recurrence. Advanced practice nurses in psychiatry and mental health can provide real added value thanks to their specialist training, their ability to carry out a comprehensive and detailed clinical assessment, their mastery of medicinal and non-medicinal therapeutic interventions, their skills in coordinating the various players involved in the care pathway, their commitment to prevention and their skills in supporting the development of the skills of care and research teams.
Assuntos
Prática Avançada de Enfermagem , Enfermagem Psiquiátrica , Prevenção do Suicídio , Humanos , França , Comunicação Interdisciplinar , Currículo , Colaboração IntersetorialRESUMO
Community-based palliative care (CBPC) models address the growing needs of patients and caregivers with chronic and serious illnesses. From pediatrics to geriatrics, individuals prefer to receive care within their local community and at home. Delivering care at the community level and within the home improves health outcomes, reduces disparities, and supports local economic activity. Various models of CBPC have developed through partnerships with existing services, such as home health agencies, but ongoing challenges and barriers exist for further expansion of specialty palliative care. Advanced practice registered nurses increasingly manage chronic and serious illnesses and are essential for all health care teams, particularly for CBPC. As trusted providers within the community, advanced practice registered nurses create lasting relationships that allow for meaningful exchanges with patients and caregivers. This article reviewed the concept and features of CBPC offered within the United States and describes an advanced practice registered nurse-led embedded palliative care program for advanced lung disease.
Assuntos
Prática Avançada de Enfermagem , Pneumopatias , Cuidados Paliativos , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/tendências , Prática Avançada de Enfermagem/métodos , Prática Avançada de Enfermagem/tendências , Pneumopatias/enfermagem , Pneumopatias/terapia , Serviços de Saúde Comunitária/métodos , Serviços de Saúde Comunitária/tendências , Estados UnidosRESUMO
BACKGROUND: Globally, there is a growing shortage of primary care professionals, including those who serve residents in long-term care facilities (LTCFs). In recent decades, numerous new care models have been implemented to improve these residents' care. Many incorporate Advanced Practice Nurses (APNs) into interprofessional healthcare teams. In Switzerland, little is known about how these models function, and few facilities have integrated APNs. This study aims to explore the everyday practice of APNs employed at a medical centre in the Bernese Seeland region delivering care to LTC residents and collaborating with LTCFs staff. METHODS: This qualitative study uses the "Interpretive Description" methodology, which builds on existing knowledge and examines phenomena interpreted through a social constructivist approach. We conducted six semi-structured individual interviews, one semi-structured focus group interview, and an examination of secondary data. Our thematic analysis followed Braun and Clarke's guidelines for data analysis. RESULTS: In LTCFs, APNs perform tasks similar to those of primary care physicians, e.g., patient visits and therapy adjustments, within the limits set by their supervising physicians. In addition, they contribute significantly to facility-wide quality improvement. We identified three fundamental elements for successful collaboration between APNs and LTCF staff: 1) clarifying roles and responsibilities; 2) establishing well-defined communication methods and pathways; and 3) building and maintaining trust. Together with LTCF staff, APNs provide multidimensional, person-centred care that focuses on medical, social, and nursing issues with the goal of maintaining the residents' best possible quality of life. CONCLUSIONS: Our results suggest that integrating APNs into the LTCF care system improves care quality for residents and increases staff members' job satisfaction.
Assuntos
Prática Avançada de Enfermagem , Assistência de Longa Duração , Atenção Primária à Saúde , Pesquisa Qualitativa , Humanos , Suíça , Feminino , Masculino , Grupos Focais , Casas de Saúde , Pessoa de Meia-Idade , Adulto , Entrevistas como AssuntoRESUMO
Androgen deprivation therapy (ADT) is standard, first-line therapy for many aspects of prostate cancer treatment. Although ADT can be an effective treatment to inhibit androgen-fueled cell growth in prostate cancer, suppressi.