Survivorship Fellowship: Evaluation and Evolution of a Program for Advanced Practice Providers.

A comprehensive cancer center in the midwestern United States implemented a stakeholder-engaged quality improvement process to extend its existing one-year advanced practice provider (APP) fellowship program consisting of general oncology education and clinical experience to include an additional survivorship clinical rotation. APP fellowship alumni and program stakeholders reported noticeable benefits and greater importance attributed to program participation, validating inclusion of a survivorship clinic rotation as part of the fellowship program.

Systematically Building a Model to Support and Unify Advanced Practice Providers.

Nursing leaders at the University of South Alabama (USA) Health collaborated to explore the need for a structured practice model for advanced practice providers (APP). The goal of this collaboration was to create an organizational structure where APPs could thrive clinically and professionally.

Fellowship Programs: Reflections of an Advanced Practice Nurse Fellow.

Newly graduated advanced practice nurses (APNs) often accept positions equipped only with brief, limited training and are expected to primarily learn on the job. APN fellowship programs, such as the oncology fellowship program at Sylvester Comprehensive Cancer Center (SCCC) in Florida, may be a solution to this problem; they provide in-depth training to APNs, offer support through open communication with preceptors, grant APNs opportunities to develop skills and confidence, and allow APNs the time to earn the trust of others at the institution and take on additional responsibilities. This article discusses such programs and focuses on the author's experiences as a fellow at SCCC.

Healthcare Provider Views on Transitioning From Task Shifting to Advanced Practice Nursing in Tanzania.

BACKGROUND: The Tanzanian health sector suffers from shortages of healthcare workers as well as uneven distribution of healthcare workers in urban and rural areas. Task shifting-delegation of tasks from professionals to other healthcare team members with less training, such as medical attendants-is practiced, compromising quality of care. Advanced practice nursing is underutilized. OBJECTIVE: The purpose of this study was to explore the views of nurses and physicians on current responses to shortages of healthcare workers and the potential for utilization of advanced practice nurses. METHODS: A descriptive, qualitative design was used. Purposeful sampling was used to select 20 participants. An in-depth interview guide was used to obtain information. Interviews were conducted in Swahili or English. Content analysis was used to identify themes. RESULTS: Shortage of human resources in rural primary healthcare facilities was identified as a major rationale for implementation of the advanced practice nurse practitioner role because the current health providers in rural health facilities are less trained and doctors are not ready to work in these settings. Opposition from physicians is expected during the course of implementing the nurse practitioner role. Professional bodies and government should reach consensus before the implementation of this role in such a way that they should agree on scope and standards of practice of nurse practitioners in Tanzania. CONCLUSION: Shortage of human resources for health is greater in rural primary healthcare facilities. Task shifting in Tanzania is neither effective nor legally recognized. Transition to advanced practice nursing roles-particularly the nurse practitioner role-can facilitate provision of optimal care. Nurse practitioners should be prepared to work in rural primary healthcare facilities.

Transformational Leadership: A Model for Advanced Practice Holistic Nurses.

Advanced Practice Holistic Nurse (APHN) leaders could provide a model of leadership to advance value based health care systems in the United States. The American Nurses Association has recognized Holistic Nursing as a specialty because of the emphasis placed on patient-centered care, the development of therapeutic relationships, interconnection, and holism. Transformational leadership is a framework that uses vision, inspiration and intellectual stimulation to motivate people toward needed change. The APHN is well positioned to use transformational leadership methods to lead teams placing the patient at the center of health care decision making and bring the essence of holism to the forefront of health care. Highlighted are methods for positive communication, inspiration, negotiation, and conflict resolution as tools the APHN could use to become a transformational leader. The purpose of this article is to discuss a framework for transformational leadership development and implementation to establish the holistic ideals of APHNs in the health care system.

Estrategias para la mejora del cuidado del paciente oncológico: Resultados del proyecto SHARE (Sesiones interHospitalarias de Análisis y Revisión en Enfermería) / Strategies for improving care of oncologic patients: SHARE Project results

El tratamiento oncológico supone una gran carga para el paciente y su entorno familiar que requiere una individualización por parte del personal sanitario. Las enfermeras son las responsables de la coordinación de los cuidados y las profesionales más cercanas al paciente y a su familia; sin embargo, en España no existen aún protocolos de actuación unificados para la atención a los pacientes oncológicos. La Sociedad Española de Enfermería Oncológica desarrolló entre el año 2012 y el 2014 el proyecto SHARE con el objetivo de establecer estrategias que mejoren la calidad de vida y los cuidados enfermeros en el paciente oncológico y su familia. Este proyecto se llevó a cabo en 3 fases. Primero, se realizó una búsqueda bibliográfica para identificar las estrategias, intervenciones y herramientas que mejoren el cuidado del paciente oncológico. En una segunda fase se consensuaron estas intervenciones y en una tercera fase otro grupo de expertos en cuidados oncológicos las categorizó, determinando las más prioritarias y factibles para su implementación. Se identificaron 3 acciones estratégicas: disponer de un profesional de Enfermería de referencia para el seguimiento de manera presencial o telefónica, diseñar programas de educación terapéutica con protocolos específicos y garantizar la formación específica de los profesionales. Estas acciones están orientadas a mejorar la atención sanitaria y la calidad de vida de los pacientes oncológicos y sus familias a través del desarrollo de roles enfermeros avanzados, con un mayor grado de autonomía. Esto sitúa a las enfermeras como gestoras y coordinadoras del cuidado integral del paciente oncológico

Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients’ care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients’ healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients

Classroom to clinic: incorporating adolescent spiritual/faith assessment into nurse practitioner education & practice.

Although nursing is well grounded in the conceptualization of person as body-mind-spirit, there is little evidence that advanced practice nurses routinely address the spirit in giving patient care, especially with adolescents in the outpatient setting. The neglect of spiritual aspects of care may be related to lack of a framework, or education/incorporation into nurse practitioner preparation. This article describes one method of integrating adolescent spiritual/faith assessment into a nurse practitioner clinical course. Readings, assignments, and a grading rubric are offered.

"On the scene": Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Cincinnati Children's Hospital Medical Center is transforming the way it cares for its patients by building a sophisticated model that focuses on accountable care across the continuum. As nurses from different parts of the organization, we act as change agents to develop an integrated structure built around the patient's needs, from prevention to self-management. We demonstrate how organizational structure, fluid staffing, professional practice, and healthy behaviors operationally catalyze the continuum of care, and how we utilize self-management, community-based programs, and care integration to change the outcome for our patients and families. While care coordination is taking on many forms in medical centers around the world, Cincinnati Children's is proud and passionate about sharing its best practices along the way.

Efficient and effective models for integrating advanced practice professionals into oncology practice.

Advanced practice professionals (APP), primarily nurse practitioners and physician assistants, are increasingly being integrated into oncology practices. The reasons are numerous, and models of care options are numerous as well. Models of care have developed without much forethought and are often the result of the relative interests of the physician, the APP, and the mutual "comfort" of practice style. The increasing complexity of oncology care, the pressures of the health care crisis and health care reform mean that it is necessary that we examine models of collaborative care in terms of both quality of care and productivity.

Integrated physical and mental health care at a nurse-managed clinic: report from the trenches.

The Health and Wellness Center (HWC), located in Joliet, Illinois, is a nurse-managed universally accessible primary health care center funded by a grant from the Health Resources and Services Administration. The goals of the HWC are to improve access to quality primary health care services for all patients, including those who are uninsured and underserved, and to develop and implement a model of nurse-managed primary health care that integrates both physical and mental health assessment and treatment. After 5 years of developing and using this model, it is clear that integration requires strategic supports from the financial, political, and professional sectors to be considered a cost-effective model of health care delivery. Recommendations for policy and practice change are offered based on the author's experiences of providing integrated health care at the HWC and the health care industry's responses to uninsured or underinsured patients' needs.

The role of nurse practitioners in hospital settings: implications for interprofessional practice.

Expansion of the nurse practitioner (NP) role worldwide indicates a need to understand how the role functions in interprofessional healthcare teams. Through the adoption of a mixed methods approach that gathered on-site tracking and observation, self-recorded logs of consultations and focus group interviews of team members and NPs, we describe the extent of role activity and the nature of interprofessional practices of 46 NPs and their team members in nine hospital sites across the province of Ontario, Canada. Findings outline the nature of the NP role activities, which largely focused on providing clinical care, with the support of their team, to a range of patients across the study settings. We discuss how 'embedding' the NP in this way appears to contribute to utilization of expertise of all professions as well as enabling team members to promote evidence-based practices. We argue that the use of NPs augments interprofessional role utilization through their desire to consult with a range of professionals and the capacity to perform holistic care for patients that is not limited to traditional nursing boundaries.

The nurse educator role in Australian hospitals: implications for health policy.

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.