A systematic review of evidence relating to clinical supervision for nurses, midwives and allied health professionals.

AIM: The aim of this study was to systematically review evidence relating to clinical supervision for nurses, midwives and allied health professionals. BACKGROUND: Since 1902 statutory supervision has been a requirement for UK midwives, but this is due to change. Evidence relating to clinical supervision for nurses and allied health professions could inform a new model of clinical supervision for midwives. DESIGN: A systematic review with a contingent design, comprising a broad map of research relating to clinical supervision and two focussed syntheses answering specific review questions. DATA SOURCES: Electronic databases were searched from 2005 - September 2015, limited to English-language peer-reviewed publications. REVIEW METHODS: Systematic reviews evaluating the effectiveness of clinical supervision were included in Synthesis 1. Primary research studies including a description of a clinical supervision intervention were included in Synthesis 2. Quality of reviews were judged using a risk of bias tool and review results summarized in tables. Data describing the key components of clinical supervision interventions were extracted from studies included in Synthesis 2, categorized using a reporting framework and a narrative account provided. RESULTS: Ten reviews were included in Synthesis 1; these demonstrated an absence of convincing empirical evidence and lack of agreement over the nature of clinical supervision. Nineteen primary studies were included in Synthesis 2; these highlighted a lack of consistency and large variations between delivered interventions. CONCLUSION: Despite insufficient evidence to directly inform the selection and implementation of a framework, the limited available evidence can inform the design of a new model of clinical supervision for UK-based midwives.

A model for upscaling global partnerships and building nurse and midwifery capacity.

AIM: To provide a unique model for use in guiding global collaboration and policy to upscale nursing and midwifery partnerships. BACKGROUND AND INTRODUCTION: Nurses and midwives across nations need skills reaching beyond the bedside and unit level in today's complex, global, multifaceted healthcare milieu. Thoughtful consideration, research and concomitant development of models to guide appropriate upscaling of nurse and midwifery capacity within and between nations are needed. DISCUSSION: This article explores an integrated global approach to upscaling nurse and midwifery capacity using examples of partnerships between nursing and midwifery programmes across multiple continents. CONCLUSION AND IMPLICATIONS FOR NURSING: Global nurse and midwifery capacity is effectively being developed using a myriad of approaches. A new model is presented to illustrate supports, strategies and activities to achieve intermediate and long-term goals for capacity building through strong and sustainable global partnerships. IMPLICATION FOR NURSING POLICY: Development of global skills can focus the nurse and midwife to influence policy-level decisions. Human resource planning that can impact countrywide provision of health care begins in the preservice setting for both nurses and midwives. A global experience can be a value-added component to the well-rounded education of future nurses. Education during preparation for entry into practice is a strategic way to develop a worldview. Incorporating reflective practice can build skills and shape attitudes to prepare the new nurse to be comfortable as a global healthcare provider. An expanded world view is the springboard to more robust and informed involvement and inclusion in policy-level discussions.

Integrating lay and nurse-midwifery into the U.S. and Canadian health care systems.

The integration of midwifery into the health care systems in the U.S. and Canada has invoked scholars to speak of a "rise of midwifery". Despite the gains that the profession of midwifery has made in both countries, there are some interesting differences in how midwifery is organized and practised in these two settings. Briefly, in the U.S. midwifery currently exists as a profession divided between nurse- and non-nurse-midwives, or "lay" midwives, with greater acceptance and legitimacy garnered by the former, whereas midwifery in some jurisdictions in Canada has gained legitimacy as a unified profession separate from nursing. An analysis of the differences in the development and organization of lay and nurse-midwifery in Canada and the U.S. highlights the importance of differences in the system of health professions in these two countries, the role of the state in this system, and the relationship between feminism, midwifery and the state on the outcome of efforts to integrate midwifery.

Advanced practice nursing: back to the future.

Advanced practice nursing has evolved during the last 25 years in important ways to become a central component of the new health care system. The quality of care and cost effectiveness of practice for various advanced practice roles has been well documented. New roles are being created as the demand-driven health care system presents opportunities for innovative practice models. It is incumbent on nursing to prove its ability to assume full accountability and responsibility so that full freedom to practice may be achieved.

Advanced practice nurses in integrated health care systems.

Changes in the health care delivery system are discussed with a view to those affecting the role and use of advanced practice nurses and particularly nurse practitioners who provide primary and reproductive care to women. Nurse practitioners are particularly well suited to function within integrated systems. They accomplish cost-containment strategies because of lower salaries or fees, fewer invasive procedures, greater compliance by patients, and increased nonpharmacologic treatments. They collaborate with all providers of primary care and enhance communication with patients. They develop clinical pathways for professionals and for patients and their families and support the use of guidelines and protocols to enhance standards of practice. It is suggested that women will become powerful consumers and that nurse practitioners are especially versed, not only in providing routine screening and episodic care, but also in teaching self-care, providing developmental and emotional support, and increasing compliance for health promotion and disease prevention. A high demand exists for education as an advanced practice nurse. Although many educational programs are moving to the master's degree, standardized educational levels are urged as a means for professionals and consumers to better understand advanced practice nursing roles. The need for nurse practitioners in the primary care market-place is demonstrated, but the system is in a state of flux, and the roles may not be used appropriately. Nurse practitioners should help to define new jobs and be assertive in negotiating for positions.

CNMs/CMs as primary care providers: scope of practice issues.

Since the proliferation of managed care organizations and the expansion of the central role of the primary care provider in the early 1990s, certified nurse-midwives and certified midwives have debated the merits and drawbacks of their inclusion in this category of provider. The present article explores the history of primary care and reviews the most commonly accepted definition of primary care. The boundaries of scope of practice in primary care and the legal and economic ramifications of certified nurse-midwives/certified midwives practice in this area are discussed.

Women's health. The role of advanced practice nurses in the 21st century.

Advanced practice nurses have the capability of providing a variety of services in women's health care. The role and functions of certified nurse midwives, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists are discussed. Current issues and barriers to advanced practice nursing are presented and include role definitions and regulations, second licensure, educational level, prescriptive authority, third party reimbursement, admitting privileges, and malpractice reform. Future directions and recommendations are provided.

Climbing higher.

A New York hospital builds a more equitable clinical ladder system to include nurse managers, clinical nurse specialists, nurse practitioners, and nurse-midwives. The system defines the nurses' roles and specific performance criteria.

The use of standard setting to improve maternity care.

High-quality care for mothers and babies is a priority for midwives. Achieving the best standards depends on systematic evaluation. This paper describes how staff at the Nottingham City Hospital Maternity Unit introduced standard setting in clinical areas and improved practice as a result.