Pharmacist Prescribing Models for HIV Pre-exposure and Post-exposure Prophylaxis.

State strategies for pharmacist prescribing exist on a continuum from most restrictive to least restrictive. Using human immunodeficiency virus (HIV) pre-exposure prophylaxis and post-exposure prophylaxis as a case study, there are 3 viable pharmacist prescribing models: (1) population-based collaborative practice agreements; (2) government protocols; and (3) standard of care prescribing. The advantages and disadvantages of these 3 models are reviewed.

The effects of dental hygienist autonomy on dental care utilization.

We investigate the effects of regulations governing the practice autonomy of dental hygienists on dental care use with the 2001-2014 Medical Expenditure Panel Survey. We measure the strength of autonomy regulations by extending the Dental Hygiene Professional Practice Index to the years 2001-2014, allowing us to capture changes in regulations within states over time. Using a difference-in-differences framework applied to selected states, we find that relaxing supervision requirements to provide dental hygienists moderate autonomy results in an increase in total dental visits due to greater use of preventive dental care. However, the use of dental treatment decreases when states adopt the highest level of autonomy. Both sets of estimates increase in magnitude when we subset the sample to dental care provider shortage areas. In support of these findings, we show that dental visits shift to dental hygienists in shortage areas when states expand the scope of practice of hygienists, and that there is an increase in tasks performed by hygienists, such as cleanings and dental exams.

How do dental practices respond to changes in scope of practice regulations?

Regulations that restrict the tasks that credentialed workers are allowed to perform may affect a firm's input choices, output, and which part of the market the firm serves. Using dental practice survey data from 1989 to 2014 and a stacked difference-in-differences design, this paper examines the effects of state-level scope of practice regulations on the behavior of dental practices. Results suggest that scope of practice deregulation in regards to dental hygienists' ability to administer nitrous oxide or local anesthesia is associated with fewer dentist visits per week in the short-term, lower patient wait times, and an increased likelihood of treating lower revenue generating publicly insured patients. There is weak evidence that scope of practice deregulation alters a practice's labor inputs.

Paediatric emergency front-of-neck airway: issues of ethics, law, and philosophy.

Practitioners can face significant challenges when managing the airways of infants and neonates because of their unique anatomical and physiological features. The requirement for emergency airway management in this age group is rare. Details of emergency airway techniques in paediatric practice guidelines are missing or lack consensus, and it is known that outcomes for affected children can be poor. Ideally, these children should be managed by experienced paediatric airway practitioners working in a team. However, situations can arise where practitioners, unfamiliar and inexperienced with infants, find themselves in charge. So, what happens when such a practitioner encounters this life-or-death scenario and feels ill-equipped to act? The ethical and legal issues surrounding the management of this emergency are clearly defined, but they can be unknown or misunderstood by doctors. Compounding the extreme stress of the scenario is the moral and ethical dilemma of whether to act or not. The following discussion explores these issues and examines the philosophical and psychological perspectives.

Role delineation of advanced practice nursing: A cross-sectional study.

AIMS: To identify the roles and activities of nurses, including advanced practice nursing (APN), and to determine nursing practice patterns across health facilities in Saudi Arabia. METHODS: A descriptive cross-sectional design was used to collect data from 207 nurses working in the Saudi health sector between November 2021 and March 2022 through an online questionnaire. The Advanced Practice Role Delineation tool was used to measure and delineate nursing practice patterns and activities. Data were analysed using descriptive statistics and analysis of variance. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. RESULTS: Findings showed that participants, regardless of their current role, reported high scores across all domains of practice. The highest average score was obtained for the Clinical Care domain. Except for the leadership domain, findings showed that those reported working as advanced practice nurses had higher average scores across all domains than those working as staff nurses or being in managerial/administrative positions. There were significant differences in the average Clinical Care scores between advanced practice nurses and staff nurses. CONCLUSION: Advanced practice nursing roles and activities are being practised in Saudi Arabia; however, there is no clear delineation of these roles and activities according to a unified and national-level APN scope of practice. IMPACTS: Advanced practice nursing roles are evolving in Saudi Arabia; however, no study has examined the existing patterns of APN activities in Saudi Arabia. This study highlights the practice patterns of advanced practice nurses and adds to the international evidence base on the need for delineating APN activities under a unified scope of practice. The findings of this study are beneficial to practitioners, researchers, and stakeholders as well as the legislative and regulatory bodies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

A concurrent mixed-method study exploring the experiences of interprofessional collaboration among Canadian midwives and obstetricians.

AIM: This study explores the experiences of interprofessional collaboration of Canadian midwives and obstetricians from midwives' perspective. DESIGN: A concurrent mixed-methods approach that combined a small validation study and qualitative thematic analysis was used to provide evidence of the nature and importance of collaboration between Registered Midwives (RMs) and obstetricians. METHOD: Eighteen RMs across Canada completed a demographic survey and the Midwifery-Obstetrician Collaboration (MOC) scale in 2023. The quantitative analyses were conducted to assess the reliability of the Midwifery-Obstetrician Collaboration (MOC) and accumulate preliminary evidence to support its validity. Semi-structured interviews were conducted with 13 participants. After completing the interviews, themes were identified using thematic analysis. RESULTS: The primary themes identified were knowledge of midwifery scope affects collaboration, collaboration is necessary for effective patient care, midwife-physician collaboration is impacted by power differentials and hierarchies, and proposed methods to improve physician-midwife collaboration. Although a small sample size did not permit extensive statistical testing, the quantitative results supported the reliability of the MOC scale. In addition, a strong correlation between the MOC and the communication subscale of the Inter-Professional Collaboration (IPC) scale provided evidence of the MOC's concurrent validity as a measure of collaboration between midwives and physicians. CONCLUSION: This study provides support for the Midwifery-Obstetrics Collaboration (MOC) Scale as an assessment tool to evaluate collaboration between midwives and OB/GYNs in obstetrics care. While the 18 RMs recruited for this study provided a fulsome analysis for the qualitative portion, a larger study is necessary to provide more extensive quantitative analysis to validate the MOC scale for continued use among RMs and OBs. IMPLICATIONS: The implications of this study are to foster strong interprofessional relationships between midwives and OBs and to improve the health outcomes of pregnant women and newborns. REPORTING METHOD: The authors adhered to Consolidated criteria for reporting qualitative research (COREQ).

The what, the when and the how: A qualitative study of allied health decision-maker perspectives on factors influencing the development and implementation of advanced and extended scopes of practice in Australia.

BACKGROUND: Health workforce supply is critical to ensuring the delivery of essential healthcare and may be enhanced via mechanisms which alter the scopes of practice of health professions. The aim of this paper is to study the collective perspectives of allied health decision-makers on factors which influence their development and implementation of advanced and extended scope of practice initiatives, and how they contribute to scope of practice change. The reasoning for the selection of each factor will also be examined. METHODS: A grounded-theory, qualitative study of the experiences of allied health directors and senior managers across two Australian State/Territory jurisdictions. RESULTS: Twenty allied health decision-makers participated in the study. Data coding of interview transcripts identified 14 factors specific to scope of practice change, spanning rational (n = 8) and non-rational (n = 6) decision-making approaches. Leadership, Governance, Needs of organisational leaders, Resourcing, Knowledge, skills & experience - clinical, Supporting resources, Knowledge & skills - change and Sustainability were identified as being rational and enabling in and of themselves, with Leadership seen as being most influential. Comparatively, the non-rational factors of Socio-economic & political environment, Perceived patient need, Organisational environment, Change culture & appetite, Perceived professional territorialism and Actual professional territorialism were more varied, and primarily influenced the timing/catalyst and application of decision-making. The complex interplay between these factors was conceptually represented as a decision-making construct. CONCLUSION: Allied health decision-makers hold a complex, systems-level understanding of scope of practice change. Whilst rational decision criteria were predominant and seen to enable scope change, non-rational influences reflected greater variation in decision timing/catalyst and application, thus emphasising the human dimensions of decision-making. Further research is required to better understand how decision-makers integrate and weight these decision-making factors to determine their relative importance and to inform the development of structured decision tools.

Nurse practitioner led telehealth services: A scoping review.

AIM: To explore the educational preparation of nurse practitioners to deliver telehealth services and their impact on access to care. DESIGN: Scoping review. METHODS: A search was undertaken 4 April 2022. Primary studies that focused on nurse practitioners and their patients/clients engaging in telehealth services in any healthcare setting or clinical area within Australia, New Zealand, United States, Canada, United Kingdom, and Ireland, published between 2010 to 2022, were included. Study findings were analysed using the Levesque et al. (2013) access to care framework and the Patterns, Advances, Gaps, Evidence for Practice and Research Recommendations framework (Bradbury-Jones et al., 2021). The PRISMA-ScR checklist was used to guide reporting. DATA SOURCES: CINAHL, Medline, Scopus, and Embase databases. RESULTS: Forty-two studies were included. Studies (n = 28) relating to access to care focused on appropriateness/ability to engage (n = 14), affordability/ability to pay (n = 1), and availability/ability to reach (n = 13). High levels of telehealth satisfaction were reported, including reduced travel time and costs, and appointment flexibility. Telehealth satisfaction was reduced when a perceived need for physical assessment, or privacy concerns were present. Service providers reported decreased emergency presentations, fewer missed appointments and improved consumer engagement. Fourteen studies related to nurse practitioner education, using a range of approaches such as didactic education modules, simulations and clinical experiences, all published within the past 3 years. CONCLUSION: Findings suggest that nurse practitioner-led telehealth has improved access to care. High levels of satisfaction indicate patients accept nurse practitioner-led telehealth. Impacts to healthcare service use and patient engagement further support the viability of nurse practitioner-led telehealth. The recent increase in telehealth education studies reflects the rapid uptake of telehealth care in the mainstream. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Patients perceive telehealth as acceptable and appropriate to meet their healthcare needs and improve access to care. Telehealth is likely to be a mainstay in ongoing healthcare delivery, therefore, nurse practitioners must have educational preparation to provide telehealth. IMPACT: This scoping review provides insight into the ways nurse practitioners deliver telehealth services, how they are educated to provide telehealth services, and their impact on access to care. Nurse practitioner-led telehealth improves access to care across service provision and consumer perspective domains. Nurse practitioner telehealth education is an emerging topic. This research is valuable for nurse practitioners using telehealth, nurse practitioner educators and telehealth policy decision makers. REPORTING METHOD: Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Post-operative nursing activities to prevent wound complications in patients undergoing colorectal surgeries: A scoping review.

AIMS: To identify postoperative interventions and quality improvement initiatives used to prevent wound complications in patients undergoing colorectal surgeries, the types of activities nurses undertake in these interventions/initiatives and how these activities align with nurses' scope of practice. DESIGN: A scoping review. DATA SOURCES: Three health databases were searched, and backward and forward citation searching occurred in April 2022. Research and quality improvement initiatives included focussed on adult patients undergoing colorectal surgery, from 2010 onwards. Data were extracted about study characteristics, nursing activities and outcomes. The 'Dimensions of the scope of nursing practice' framework was used to classify nursing activities and then the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework was used to synthesise the review findings. RESULTS: Thirty-seven studies were included. These studies often reported negative wound pressure therapy and surgical site infection bundle interventions/initiatives. Nurses' scope of practice was most frequently 'Technical procedure and delegated medical care' meaning nurses frequently acted under doctors' orders, with the most common delegated activity being dressing removal. CONCLUSION: The full extent of possible interventions nurses could undertake independently in the postoperative period requires further exploration to improve wound outcomes and capitalise on nurses' professional role. IMPACT STATEMENT: Nurses' role in preventing postoperative wound complications is unclear, which may inhibit their ability to influence postoperative outcomes. In the postoperative period, nurses undertake technical activities, under doctors' orders to prevent wound infections. For practice, nurses need to upkeep and audit their technical skills. New avenues for researchers include exploration of independent activities for postoperative nurses and the outcomes of these activities. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: There may be opportunities to broaden nurses' scope of practice to act more autonomously to prevent wound complication. REPORTING METHOD: Scoping Reviews (PRISMA-ScR) checklist. PATIENT OR PUBLIC CONTRIBUTION: A health consumer interpreted the data and prepared the manuscript.

Exploring paramedic perspectives on emergency medical service (EMS) delivery in Alberta: a qualitative study.

PURPOSE: Emergency Medical Services (EMS) in Alberta are facing critical challenges. This qualitative study aims to describe and understand the frontline perspective regarding system level issues and propose provider-informed policy recommendations. METHODS: 19 semi-structured one-on- one interviews were conducted with Primary or Advanced Care Paramedics (PCP/ACP) across Alberta. Participants were asked to share their perspectives, experiences and recommendations in relation to EMS response times and the working environment. Interviews were analyzed using thematic analysis to identify themes and subthemes. RESULTS: Two core themes were identified as areas of concern: poor response times and the EMS working environment, which each influence and impact the other. Within response times, paramedics highlighted specific difficulties with ED offloading, a lack of resources, low-acuity calls, and rural challenges. In terms of the EMS working environment, four subthemes were apparent including attrition, unhealthy culture, organizational barriers and the need for paramedic empowerment. Providers made many recommendations including creating and expanding emergency mobile integrated health (MIH) branches, sharing 811 and 911 responses, and enforcing ED target offload times amongst other suggestions. CONCLUSIONS: While response times are a key and highly visible problem, there are many critical factors like the EMS working environment that degrade patient care and cause concern amongst frontline practitioners. Multifaceted policy changes are to be explored to reduce disfunction within EMS services, enhance the well-being of the workforce and deliver improved patient care. Specific EMS-oriented policies are important for moving forward to reduce transfers to EDs, but the broader health system which is over capacity is causing downstream effects into EMS must be addressed by government and health administrators.