The role of the clinical nurse specialist in stoma care: A modified Delphi consensus.

INTRODUCTION: The role of the clinical nurse specialist is complex but is defined differently across the world. The role of clinical nurse specialist stoma care is undefined and it is uncertain what aspects of the role are included in the general day-to-day working role. AIMS: The aim was to gain consensus opinion to answer the research question: 'What is the role of the clinical nurse specialist in stoma care?' DESIGN: Delphi consensus. METHODS: Previous data gained from a scoping review and expert consultation was utilized to form role statements. At a UK conference the 13 statements and 173 sub-categories were voted upon. Consensus was agreed if 75% of voters voted agree or strongly agree. Two stages of voting occurred with results from the first vote being shared in the second voting session. RESULTS: All 13 statement and most (150/193) statement sub-categories reached consensus, with 20 sub-categories added during voting session one. CONCLUSIONS: The four pillars of advanced practice were met by the 13 statements with clinical and education reaching higher consensus and agreement than leadership/management and research. The results of the consensus study provide a clearer articulation of the clinical nurse specialist stoma care role, which is complex and multifaceted which has not been described previously. IMPLICATIONS FOR PRACTICE: Consideration of role evolution is made possible, to gain a greater expertise in the scope of practice it is necessary to include prescribing, management and research which could improve service delivery and optimize patient outcomes. There was no patient or public contribution, which in hindsight would have potentially improved the process but it was considered that patients might not recognize the full role of the nurse, understanding only aspects of the role that were patient-centred. PATIENT OR PUBLIC CONTRIBUTION: No patients or public were involved in any aspect of this paper-in hindsight this might have been useful.

Clinical Nurse Specialist: A Critical Member of the ICU Team.

OBJECTIVES: To describe the role of the clinical nurse specialist, an advanced practice registered nurse in the intensive care setting. The value and impact of the clinical nurse specialist role as a member of the ICU is presented along with a review of clinical nurse specialist education, licensure, and certification requirements as well as a description of the clinical nurse specialist role, scope of practice, and competencies. In addition, a selected review of clinical nurse specialist-led quality improvement and research that resulted in improved patient outcomes is provided. DATA SOURCES: Review of published medical and nursing literature and expert opinion guidance from a collaborative effort between the Society of Critical Care Medicine, American Association of Critical Care Nurses, and National Association of Clinical Nurse Specialists. STUDY SELECTION: Not applicable. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: Not applicable. CONCLUSIONS: The utilization of a clinical nurse specialist, an advanced practice role, in the ICU is a unique and valuable approach for organizations who strive to move evidence into sustainable practice and drive quality through an interprofessional approach. The valuable contributions made by the clinical nurse specialist efficiently and effectively meet the needs of patients, clinicians, and organizations while improving patient outcomes and optimizing cost avoidance strategies, which further lower economic demands on the healthcare system.

Effectiveness of the Non-Medical Surgical Assistant measured by patient outcome assessment.

AIMS: To investigate effectiveness of the nurse clinician as a Non-Medical Surgical Assistant compared with the Medical Surgical Assistant. BACKGROUND: Non-Medical Surgical Assistants are clinicians who are not medical practitioners. The surgical assistant works directly with the primary surgeon intraoperatively. DESIGN: A pragmatic, retrospective, observational study on patients undergoing Laparoscopic Inguinal Hernia Repair or Primary Unilateral Total Hip Arthroplasty. Each patient received intraoperative care from a consultant surgeon and a Medical Surgical Assistant or Non-Medical Surgical Assistant. All surgical assistants were registered with the Australian Health Practitioner Regulation Agency. METHODS: Data were collected between 01/07/2014 and 30/06/2017. The effect that surgical assistant choice had on patient outcomes was estimated using regression statistical models. Six dependent variables, including length of stay, for clinical outcome assessment were specified. RESULTS/FINDINGS: The groups were equivalent in age, gender, and American Society of Anaesthesiologists scores. There were more emergency procedures in the Medical Surgical Assistant group and more hip surgery in the Non-Medical Surgical Assistant group. Patient outcome assessment showed no statistically significant differences for surgical assistant types. CONCLUSION: The nurse clinician in the role of Non-Medical Surgical Assistant was shown to be effective with equivalent patient outcomes compared with the Medical Surgical Assistant.

Integration and Standardization of Clinical Nurse Specialists in a Multihospital System: Exemplars in Practice.

PURPOSES/OBJECTIVES: In 2013, our multihospital system began the process to integrate and standardize clinical nurse specialist (CNS) practice. The goal was to standardize work and to increase collaboration as part of one system. DESCRIPTION OF THE PROJECT/PROGRAM: An overall job description was established to provide a framework inclusive of the broad areas of practice. Clinical nurse specialists were positioned to support medical-surgical, critical care, or women and children's services offered at community-based hospitals. Main campus and community-based CNSs led significant system integration efforts such as the standardization of nursing policies and procedures across the health system. System CNSs were created to address the needs of specialties common to all hospitals. As an example, a system CNS collaborated with the main campus and community-based CNSs to improve the delirium screening process. OUTCOME: Clinical nurse specialists across the system have been integrated into a single team and report to 1 central director. Efforts to leverage expertise included the creation of a CNS-led practice council, increased communication via regular departmental meetings, and the sharing of resources using electronic platforms. There is now a CNS at hospitals that previously did not have one. The group values the structure and opportunities it provides as evidenced by favorable engagement surveys. CONCLUSION: Our integration efforts improved collaboration and could be modified to benefit other care settings.

Improving the care and health of populations through optimal use of clinical nurse specialists.

Patients with complex and chronic illnesses and those who have significant needs related to care coordination and transitions of care are dependent on access to healthcare providers who are skilled at meeting the distinct needs of these populations and are current in the latest evidence-based practices and guidelines. Clinical nurse specialists (CNSs) are uniquely qualified to care for patients with complex illnesses as well as having the skills to optimize care for entire populations with complex needs. The absence of consistent legislative advanced practice registered nurse recognition of CNSs prevents health care systems from optimal use of this advanced practice registered nurse role to improve and provide safe and quality care for these patients. Additional barriers in optimal utilization of CNSs include lack of consistency: in title protection and licensing from state to state; ensuring patient access through identification and tracking of CNS numbers across the United States in order to determine workforce and educational program requirements; and ensuring appropriate reimbursement for care provided by CNSs. Therefore, it is the position of the American Academy of Nursing that addressing public and private sector regulatory, legislative, and policy concerns related to CNSs is essential to achieving optimal population health outcomes across the nation.

Oncology Nurse Practitioner Competencies: Defining Best Practices in the Oncology Setting.

BACKGROUND: The oncology nurse practitioner (ONP) role has evolved since the first ONP competencies were published by the Oncology Nursing Society in 2007. An update was completed in 2019 to reflect the rapidly expanding role. OBJECTIVES: The purpose of this article is to describe the process of the ONP competency development and identify potential applications across a variety of oncology settings. METHODS: The team performed an extensive literature review of the research about ONP practice across the cancer care continuum. Peer and expert review were conducted to ensure the competencies were comprehensive and relevant. FINDINGS: The ONP competencies provide a solid, evidence-based benchmark to standardize the ONP role and practice, thereby ensuring that patients receive the highest-quality cancer care.

The Distinguished Nurse Clinician Academy: An Innovative Recognition Program for Frontline Clinicians.

The complexity and growth of healthcare systems provide nurse leaders an opportunity to recognize and facilitate professional development for experienced frontline clinicians and to create formal structures that give expert direct care nurses a stronger voice. The purpose of this article is to describe how one health system developed and implemented an innovative Distinguished Nurse Clinician Academy. This elite academy demonstrates the longitudinal impact of a health systems' Magnet culture.

Competency framework for specialist critical care nurses: A modified Delphi study.

BACKGROUND: The specialist critical care nurse plays a vital role in the delivery of evidence-based practice, and specific competency guidance has been established to facilitate critical care nursing practice and education development in many developed countries. However, no research has been conducted to develop a competency framework for specialist critical care nurses in China. AIMS AND OBJECTIVES: To construct a competency framework specific to specialist critical care nurses in China. DESIGN AND METHODS: A two-phased procedure was implemented. In phase 1, a literature review and four focus groups were used to develop the initial competency framework, which consisted of 101 statements. During phase 2, three rounds of a modified Delphi process were conducted and involved a national panel of 30 experts, including physicians, specialist critical care nurses, managers, and educators, who responded to the survey using a 5-point Likert-type scale to indicate their level of agreement with the competency framework. A 75% threshold for each competency was used to achieve panel consensus. RESULTS: Experts in the field of critical care responded to rounds 1 (n = 29), 2 (n = 28), and 3 (n = 28). Seventy-eight competencies were agreed upon after round 1, increasing to 88 after round 2 and 92 after round 3. The final competency framework was classified into six domains: evidence-based practice, complex decisions, professionalism, communication and co-operation, education and development, and leadership. CONCLUSION: The output of this study is an expert consensus competency framework that provides a sound foundation for the assessment and training of specialist critical care nurses. RELEVANCE TO CLINICAL PRACTICE: The proposed competency framework should be used to assess nursing performance, promote continuing professional development, and further improve the delivery of quality health care and optimal patient outcomes.

A multilevel investigation of cultural competence among South Korean clinical nurses.

BACKGROUND: There is lack of empirical evidence on whether organisational variables affect the cultural competence of nurses. AIM: This study aimed to investigate individual and organisational characteristics associated with South Korean clinical nurses' cultural competence. METHODS: A descriptive cross-sectional research design was used. A convenient sample of 401 clinical nurses from 21 hospitals in South Korea was recruited between November 2015 and February 2016. Multilevel modelling was used to estimate the effects of individual- and organisation-level predictors. Data were analysed using the nlme package in R. RESULTS: Multilevel modelling indicated that professionalism (ß = 0.02, p < 0.001) and foreign language fluency (ß = 0.25, p = 0.012) were significant individual-level predictors. Education on foreign patient care was marginally significant at p = 0.069. At the organisational level, nurse-to-patient ratio (ß = 0.37, p = 0.038) and organisational cultural competence (ß = 0.02, p < 0.001) were significant predictors. In addition, hospital ownership and work environment were marginally significant at p = 0.054 and p = 0.050, respectively. Furthermore, there was a significant cross-level interaction between professionalism and hospital ownership (ß = 0.03, p = 0.003). CONCLUSION: To provide culturally competent care, nurse leaders should recognise the importance of organisational-level factors, such as nurse staffing and organisational cultural competence, and create an environment that is inclusive of diverse patients, as well as promote professionalism among individual nurses.

The Role of the Doctor of Nursing Practice in Promoting Nonpharmacologic Pain and Comfort Management.

In this article the author presents her vision for integration of nonpharmacologic treatments, many taken from whole systems of care (Verhoef et al., 2005), for both pain and comfort management. By combining the evidence-based practice expertise of the clinical nurse specialist role with the knowledge of innovation, systems thinking, health policy, and implementation science acquired in the Doctor of Nursing Practice program, she is engaging interprofessional teams to join her shared vision.

Competencias en enfermeras Especialistas y en Enfermeras de Práctica Avanzada / Competences of specialist nurses and advanced practice nurses

Objetivo: Analizar la distribución de competencias avanzadas en enfermeras especialistas y enfermeras de práctica avanzada y evaluar su asociación con algunas características de su perfil profesional. Método: Estudio transversal analítico multicéntrico. Se incluyeron enfermeras que ejercían como Enfermeras de Práctica Avanzada y enfermeras Especialistas. Se midió su nivel de competencias avanzadas percibidas, así como variables de caracterización profesional. Resultados: Doscientas setenta y siete enfermeras participaron (149 ejercían práctica avanzada y 128 especialistas), con una media de 13,88 (11,05) años como especialista y 10,48 (5,32) años como Enfermera de Práctica Avanzada. Un 28,8% tenía nivel de máster o doctorado. El 50,2% ejercía en atención primaria, el 24,9% en hospitales y el 22,7% en salud mental. El nivel global autopercibido fue elevado en las distintas competencias, siendo las dimensiones más bajas las de investigación, práctica basada en la evidencia, gestión de la calidad y seguridad y liderazgo y consultoría. Las Enfermeras de Práctica Avanzada obtuvieron mayor nivel competencial de forma global y en las dimensiones de liderazgo y consultoría, relaciones interprofesionales, gestión de cuidados y promoción de salud. No hubo diferencias en función de la experiencia o la posesión de nivel de máster o de doctorado. En las Enfermeras de Práctica Avanzada el contexto de práctica no influía en los niveles competenciales, aunque en las enfermeras especialistas sí, a favor de las que ejercían en salud mental. Conclusiones: Las enfermeras especialistas y de práctica avanzada tienen competencias distintas que deberían ser gestionadas adecuadamente para el desarrollo de los servicios enfermeros avanzados y especializados

Objective: To analyse the distribution of advanced competences in specialist nurses and advanced practice nurses and to evaluate their association with some characteristics of their professional profile. Method: Multicentre analytical cross-sectional study. Nurses who worked as advanced practice nurses and specialist nurses were included. Their level of perceived advanced competences was measured, as well as sociodemographic and professional characterization variables. Results: A total of 277 nurses participated (149 practised as advanced practice nurses and 128 as specialists), with an average of 13.88 (11.05) years as a specialist and 10.48 (5.32) years as an advanced practice nurse. In the sample, 28.8% had a master's or doctorate level qualification, 50.2% worked in Primary Care, 24.9% in hospitals and 22.7% in Mental Health. The self-perceived global level was high in the different competences, the lowest dimensions being research, evidence-based practice, quality and safety management and leadership and consulting. The advanced practice nurses obtained a higher level of competence globally and in the dimensions of leadership and consulting, interprofessional relations, care management, and health promotion. There were no differences based on experience or possession of a master's degree or doctorate. In the advanced practice nurses, the practice context did not influence competence levels, although in the specialist nurses it did, in favour of those practicing in Mental Health. Conclusions: Specialist and advanced practice nurses have different competences that should be adequately managed for the development of advanced and specialist nursing services

"Our nurse is the glue for our team" - Multidisciplinary team members' experiences and perceptions of the gynaecological oncology specialist nurse role.

PURPOSE: To determine how members of gynaecological oncology multidisciplinary teams experience and perceive the specialist nurse role. METHODS: Members of gynaecological oncology multidisciplinary teams were recruited via two professional organisations to participate in an online qualitative survey. Survey responses were subjected to an inductive content analysis and categorised according to meaning. RESULTS: Sixty-six (n = 66) multidisciplinary team members participated in the online survey. Most participants worked in metropolitan areas and within the public health care system. 71% (n = 47) of participants had a specialist nurse working in their team. Participants without a specialist nurse in their team (n = 19) believed that this was a disadvantage to the women in their care except where other experienced nurses were able to fill this void. Key aspects of the specialist nurse role identified by multidisciplinary team members included: Contact, communication, and coordination; Support and advocacy; Knowledge and education; Assessment, referral and management. Concerns and disadvantages relating to the role identified by team members included the development of dependence on the specialist nurse, the impact of large workloads, and the oversight of what other nurses can offer the patients. CONCLUSIONS: This study has contributed the perspective of a key stakeholder, the multidisciplinary team, to our understanding of the gynaecological oncology specialist nurse role. Clearer definition of specialist nurse roles is required. Standardised nomenclature and guidelines for practice are recommended to ensure that the specialist nurse role and their scope of practice are clear to key stakeholders and over-dependence on the individual in the role is mitigated.

The Clinician Guideline Determinants Questionnaire was developed and validated to support tailored implementation planning.

OBJECTIVES: The purpose of this research was to generate and validate a questionnaire that identifies determinants of guideline use from the clinician perspective. STUDY DESIGN AND SETTING: From January 2017 to March 2018, a seven-member six-country multidisciplinary team used a five-step multimethod design to search for and compile determinant frameworks, map items to determinants (content validity), select the best items for each determinant (content validity), refine wording of determinants and items (face validity), merge or separate items (construct validity), and review the final questionnaire. RESULTS: The Clinician Guideline Determinants Questionnaire includes four sections: clinician demographic information (including two determinants: attitudes about/experience with guidelines), 26 close-ended items reflecting clinician- and guideline-specific determinants, four open-ended items reflecting enablers and barriers perceived as most important, and three items on learning style (preferred sources of guideline information). CONCLUSION: The Clinician Guideline Determinants Questionnaire is a comprehensive, validated instrument that addresses multiple potential determinants specific to guideline use from a clinician perspective. The Questionnaire can be used at multiple time points in the guideline development cycle to assess determinants of the use of new, updated, or adapted guidelines and before and after interventions to assess their impact on the determinants of guideline use. In future research, we will establish psychometric properties of the new questionnaire.

The Admiral Nurse Competency Framework: Encouraging Engagement and Putting It Into Practice.

BACKGROUND: Admiral Nurses undertake complex work with families living with dementia. Dementia UK commissioned The Association for Dementia Studies to refresh the Admiral Nurse Competency Framework and enable Admiral Nurses to articulate and critically reflect on their own practice progression. The Admiral Nurses were involved throughout the process to refresh the framework to ensure it was evidence based. METHOD: To encourage engagement with the framework, The Association for Dementia Studies worked with the Admiral Nurses during a roll-out phase. An exercise was developed to initiate critical reflective discussion. Critiquing a colleague's practice is a skill, provoking defensiveness if not facilitated thoughtfully. RESULTS: An exercise combining art cards with case study analysis worked well, promoting critical reflective dialogue between Admiral Nurses as peers. Engagement and feedback were positive, and the neutrality of the exercise provided a safe environment with the flexibility to allow in-depth and meaningful discussions. CONCLUSION: This technique could benefit work-based learning, facilitating creative critical reflection within practice. [J Contin Educ Nurs. 2019;50(5):205-210.].

Distribution of the EQ-5D-5L Profiles and Values in Three Patient Groups.

BACKGROUND: The distribution of EQ-5D-3L values (health state profiles, weighted by value sets) often shows two distinct groups, arising from both the distribution of profiles and the characteristics of value sets. To date, there is little evidence about the distribution of EQ-5D-5L values. OBJECTIVES: To explore the distribution of EQ-5D-5L profiles; to compare the distributions of EQ-5D-5L values arising from the English value set (EVS) and a 'mapped' value set (MVS); and to develop further the methods used to investigate clustering within EQ-5D data. METHODS: We obtained data from Cambridgeshire Community Services NHS Trust containing EQ-5D-5L profiles before treatment for three patient groups: community rehabilitation (N=6919); musculoskeletal physiotherapy (N=19999); and specialist nursing services (N=3366). Values were calculated using the EVS and MVS. Clusters were examined using the k-means method and Calinski-Harabasz pseudo-F index stopping rule. RESULTS: We found no evidence for clustering of EQ-5D-5L values arising from the classification system and no strong or consistent evidence of clustering arising from the EVS. There was clearer evidence of clustering using the MVS, with two being the optimal number of clusters. The clusters that were found for the EVS were very different from the MVS clusters. CONCLUSIONS: Unlike the EQ-5D-3L, clustering of EQ-5D-5L values does not seem to be driven by clustering of its profile. This suggests the EQ-5D-5L is superior in that it is less likely to generate artefactual clusters - however, clusters may still result from using value sets such as MVS that have the tendency to generate them.