Low- and lower middle-income countries advanced practice nurses: an integrative review.

AIM: To review published literature descriptions of advanced practice nurses' roles in low- and lower middle-income countries. BACKGROUND: Advanced practice nurse roles have the potential to address insufficient healthcare resources in low- and lower middle-income countries. INTRODUCTION: This integrative review highlights advanced practice nurses' roles in the delivery of healthcare services in low- and lower middle-income countries. METHODS: Three electronic databases PubMed, CINAHL complete and ProQuest Health & Medicine were searched. No limits by year or language were set. The names for low- and lower middle-income countries and combinations 'related to advanced practice nurses' titles were used to identify papers. In addition, a review of publication type was performed. Themes found within the publications were assessed against the advanced practice nurses' International Council of Nurses' characteristics. An integrative review facilitated an appraisal of the papers identified. RESULTS: The initial search identified 5778 publications in 16 languages. This number was reduced to 23, from 18 low- and lower middle-income once exclusion criteria were applied. Six publications were from 1977 to 1999, and six between 2000 and 2010, with the remaining 11 from 2011 to 2018. Zambia had the most publications. Notably, 63 countries were not represented. Of those meeting inclusion criteria, the majority addressed education with a lesser extent focusing on practice and regulation of advanced practice nurse's roles. The majority were published during the last decade. DISCUSSION: This review of the published literature identified advanced practice nurses' roles and function within some healthcare systems. However, not all components were reported. Examination of the grey literature could provide additional information about the actual and potential benefits of advanced practice nurses' in low- and lower middle-income countries. CONCLUSION: The published literature that referred to advanced practice nurses' identified their contribution to positive impacts on health care over the last 40 years. However, with only 11 publications identified in the last 7 years, further review is required to understand the advanced practice nurses' roles in these countries. IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY: Further development of advanced practice nurses' in low- and lower middle-income countries is supported by the lack of published literature.

Cellular and humoral immunogenicity of the COVID-19 vaccine and COVID-19 disease severity in individuals with immunodeficiency.

Background: A well-coordinated adaptive immune response is crucial for limiting COVID-19 disease. Some individuals with immunodeficiency are at a high risk of developing severe COVID-19. Therefore, the development of standardized methods for measuring different arms of the vaccine response in the setting of immunodeficiency is of particular interest. In this study, we compared the vaccine response of individuals living with immunodeficiency with healthy controls in terms of interferon gamma (IFN-γ) production and spike protein-specific antibody level post primary COVID-19 vaccination and booster vaccines. Additionally, the disease severity of those individuals who contracted COVID-19 was assessed. Methods: Whole blood was stimulated overnight from 71 participants and 99 healthy controls. Commercially available PepTivator® peptide pool and trimeric spike protein stimulation were used. ELISA was used to analyze IFN-γ levels. The total SARS-CoV-2 spike protein antibody titre was measured using a Roche Elecsys® S total antibody assay. Patient characteristics, COVID-19 infection status and IDDA 2.1 'Kaleidoscope' scores were recorded. Vaccine responses were scored from zero to three. Results: 99% of healthy controls, 89% of individuals with IEI and 76% with secondary immunodeficiency (SID) had an IFN-γ level above the validated reference range after peptide mix stimulation following primary vaccination. There was an increase in IFN-γ levels in patients with inborn errors of immunity (IEI) following the booster vaccine (p = 0.0156). 100% of healthy controls, 70% of individuals living with IEI and 64% of individuals living with SID had detectable spike protein-specific antibody levels following the primary vaccination. 55% of immunodeficiency patients who had mild COVID-19 and 10% with moderate/severe COVID-19 had detectable antibody and IFN-γ levels post vaccine. The mean pre-infection IDDA 2.1 scores were higher in individuals who developed moderate/severe COVID-19 (25.2 compared to 9.41). Conclusions: Covid whole-blood IGRA is a highly accurate, straightforward and robust assay and can be easily adapted to measure cellular response to COVID-19. A complete evaluation of the vaccine response may be particularly important for individuals living with immunodeficiency. A clinical immunodeficiency score and a validated vaccine response score may be valuable tools in estimating COVID-19 disease risk and identifying individuals living with immunodeficiency who may benefit from enhanced vaccination schedules.

Humanistic principles in relation to psychiatric nurse education: a review of the literature.

This paper addresses the topic of humanistic educative principles and examines it in the context of Irish psychiatric nurse education. Humanistic or existential philosophy influences the nursing curriculum profoundly, and yet a dichotomy continues to exist in relation to the epistemological basis informing nurse education. The dichotomy is manifested broadly in relation to the notion of individual choice and statutory responsibility as regulated professional governing bodies. Humanism is based on the notion that people are born 'blank slates' only to become who they are later. McKenna would describe the humanistic theory of learning as emphasizing feelings and experiences, leading to self-awareness, personal growth and individual optimization. A review of the literature indicates there are very few empirical studies relating to the area of the humanistic principles as applied to psychiatric nurse education. Most of the literature that was initially located referred to humanistic existentialism in the field of psychology, which although provided interesting reading and relevant, to a point, did not apply specifically to psychiatric nursing education. The emphasis of this paper is psychiatric nursing education and these studies do not apply to the area under investigation.

Psychiatric nurses' perceptions of the constituents of the therapeutic relationship: a grounded theory study.

Psychiatric nursing is invariably linked with a therapeutic role; however, the question remains unanswered in relation to the extent psychiatric nurses perceive the importance of the constituents of the therapeutic relationship. The aim of this research is to ascertain the nature and comprehension psychiatric nurses assign the development of this therapeutic relationship. Grounded theory methodology was utilized to develop these conceptualizations to elicit a theory relating to what comprises the therapeutic relationship. Semi-structured depth interviews were conducted with 6 registered psychiatric nurses who have 2-10 years of experience. The main findings of the research related to how psychiatric nurses learn to form these relationships and what skills are utilized within the relationship. The research discovered that the therapeutic relationship is therapeutic, but the degree of positive change is difficult to measure. The results of the study indicate that the process of developing therapeutic relationships is a combination of a learned experience through the acquiring of interpersonal skills; however, these skills are redundant if the individual has not acquired sufficient life experience to intuitively appreciate the therapeutic aspect of the relationship.

[A new approach for transfusion of neocytes: the Neocel system]. / Une nouvelle approche pour la transfusion de néocytes: le système Néocel.

Young red cells (neocytes) were prepared in a double transfer pack having a long, narrow separation bag that allows for a density gradient column to be established during centrifugation. The lighter fraction of red cells (neocyte fraction) was then expressed into a second delivery bag. Phthalate ester density distribution curves showed that 87.1% of the neocyte units had greater than 85% enrichment, i.e. more than 85% of the cells had densities lower than the midpoint density of the original red cell unit, thalassemic patients receiving neocytes had an average decrease of 21.1% in red cells per kg/yr as compared to their frozen red cell requirement, and an average of 6.9% fewer transfusions.

A new approach to neocyte transfusion: preliminary report.

A method has been developed using phthalate oils to quality control units of young red cells (neocytes). Neocytes prepared by the NEOCEL system have a mean young red cell enrichment of 90% with only 3.4% less than 80%. Neocytes prepared in a blood cell processor have an average enrichment of 81% with 27% less than 75%. Based on a 12 month period, the patients as a group have received an average of 14% fewer transfusions and an 18% decrease in red cells per kg/yr as compared to frozen red cells.

Active immunization of heifers against a synthetic fragment of bovine inhibin.

Two experiments were conducted in cyclic beef heifers to determine whether active immunization against bovine inhibin alpha 1-26 Gly-Tyr (bINH) affected follicular dynamics, hormone concentration or ovulation rate. In Expt 1, heifers (n = 9) were actively immunized against bINH conjugated to human alpha globulins (HAG) using bis-diazotized benzidine in non-ulcerative Freund's adjuvant (NUFA; primary on day 0; booster injections on days 53, 84 and 116 using conjugated bINH and on days 176 and 366 using unconjugated bINH; ten heifers were used as controls). Ovaries were examined daily using ultrasound scanning (days 70-155 and 384-391) and corresponding blood samples were collected for bINH antibody titre, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and oestradiol determinations. Four treated and four control heifers were injected with 10 micrograms gonadotrophin-releasing hormone (GnRH) on day 386 (day 2 of the oestrous cycle). Although bINH-immunized heifers had variable antibody titres ranging from 4 to 50% I125-labelled bINH bound to serum diluted 1:2000, ovulation rate was unaffected. In oestrous cycles with three dominant follicles, the ovulatory follicles grew faster (2.5 +/- 0.2 versus 1.6 +/- 0.3 mm day-1; mean +/- SEM), had shorter durations of growth (5.7 +/- 0.8 versus 9.6 +/- 1.6 days) and duration of detection (7.5 +/- 0.8 versus 12.0 +/- 2.4 days) in immunized heifers. Mean concentrations of FSH, LH and oestradiol were unaltered in most cases during oestrous cycles in bINH-immunized compared with control heifers. There was no significant difference in the percentage increase in FSH or LH, after GnRH injection, between control and immunized heifers. As ovulation rate was unaltered in the first experiment, a second similar study was designed using a different immunization protocol. In Expt 2, heifers were immunized with bINH conjugated to human serum albumin using glutaraldehyde with the following doses: 0.0 (control; n = 7), 0.33 (n = 7), 1.0 (n = 8) and 3.0 (n = 7) mg. Three booster immunizations were given 33, 66 and 209 days after primary immunization. Immunization increased the number of oestrous cycles with multiple ovulations (42 of 132 (32%) oestrous cycles examined) compared with controls (1 of 30 (3.3%) oestrous cycles examined). Neither titre nor ovulation rate was affected by dose of bINH used. In summary, following bINH immunization, ovulation rate was not increased despite changes in follicular dynamics in Expt 1, but was increased in 32% of oestrous cycles in Expt 2.(ABSTRACT TRUNCATED AT 400 WORDS)