ABSTRACT
BACKGROUND: Advanced clinical practice roles, usually filled by nurses, have had positive effects on clinical effectiveness, including in patient satisfaction, but their benefits for other stakeholders (such as employers, health professionals, education providers and commissioners and professional/regulatory bodies) are less clear. AIM: This study aimed to identify UK research on the potential benefits of advanced clinical practice and evaluate the evidence base for key stakeholders in this field. METHOD: A mixed-methods systematic literature review was carried out to inform a narrative interpretive synthesis. FINDINGS: 44 articles of mixed quality were identified. Consensus was found regarding the definition of and barriers and facilitators to advanced clinical practice. This role is split into substitution (eg, of doctors) and supplementation (eg, adding value) aspects, and the clinical practice element dominates. Training for the role varies, as do scope of practice and regulation. CONCLUSION: There are several barriers to the implementation of advanced clinical practice and therefore the realisation of its benefits for key stakeholders. Areas requiring attention include training, support from others for role expansion and organisational issues.
Subject(s)
Health Personnel , Physicians , Humans , Health Personnel/education , Qualitative Research , Patient SatisfactionABSTRACT
Patients in intensive care units (ICUs) are at a greater risk of developing hospital-acquired infections (HCAIs). Decontamination, which usually includes a regimen of body washing with an antimicrobial skin cleanser, is used to prevent HCAIs. Approaches can be: targeted, where carriers are identified and decontaminated; or universal, where all patients undergo a decontamination regimen. Universal rather than targeted decontamination is more effective at reducing infection rates and is more cost-effective. Decontamination in the ICU can lower HCAI rates across the entire hospital. Microbial resistance to chlorhexidine, however, which is the main active agent used for decontamination is increasing, and there are also adverse effects, leading to interest in octenidine as an alternative. This article explores the use of octenidine-containing single-use wash mitts in ICUs, which have been positively evaluated regarding antimicrobial activity, and ease and effectiveness of use.
Subject(s)
Anti-Infective Agents , Cross Infection , Anti-Infective Agents/pharmacology , Anti-Infective Agents/therapeutic use , Critical Care , Cross Infection/prevention & control , Humans , Imines , PyridinesABSTRACT
Vikki-Jo Scott discusses some of the barriers that prevent advanced clinical practitioners from achieving their full potential and how these difficulties can be overcome.
