Cardiovascular disease risk assessment in patients with rheumatoid arthritis: A scoping review.

Patients with rheumatoid arthritis (RA) have an increased risk of developing cardiovascular disease (CVD). Identification of at-risk patients is paramount to initiate preventive care and tailor treatments accordingly. Despite international guidelines recommending all patients with RA undergo CVD risk assessment, rates remain suboptimal. The objectives of this review were to map the strategies used to conduct CVD risk assessments in patients with RA in routine care, determine who delivers CVD risk assessments, and identify what composite measures are used. The Joanna Briggs Institute methodological guidelines were used. A literature search was conducted in electronic and grey literature databases, trial registries, medical clearing houses, and professional rheumatology organisations. Findings were synthesised narratively. A total of 12 studies were included. Strategies reported in this review used various system-based interventions to support delivery of CVD risk assessments in patients with RA, operationalised in different ways, adopting two approaches: (a) multidisciplinary collaboration, and (b) education. Various composite measures were cited in use, with and without adjustment for RA. Results from this review demonstrate that although several strategies to support CVD risk assessments in patients with RA are cited in the literature, there is limited evidence to suggest a standardised model has been applied to routine care. Furthermore, extensive evidence to map how health care professionals conduct CVD risk assessments in practice is lacking. Research needs to be undertaken to establish the extent to which healthcare professionals are CVD risk assessing their patients with RA in routine care. Key Points • A limited number of system-based interventions are in use to support the delivery of CVD risk assessments in patients with RA. • Multidisciplinary team collaboration, and education are used to operationalise interventions to support Health Care Professionals in conducting CVD risk assessments in practice. • The extent to which Health Care Professionals are CVD risk assessing their patients with RA needs to be established.

Quality assurance standards and their use in the preparation of parenteral systemic anticancer therapy products in healthcare establishments: a scoping review.

OBJECTIVES: The use of parenteral systemic anticancer therapy (SACT) has led to improved cancer survival. A quality assurance (QA) system of the aseptic compounding process is necessary to ensure safe and consistent production of parenteral SACT. This scoping review identifies international evidence and practice relating to QA standards in the preparation of parenteral SACT in healthcare establishments. METHODS: Standards relating to aseptic compounding in hospital pharmacies and literature exploring the aseptic compounding of parenteral SACT were included. Literature relating to the non-aseptic compounding of medicines and records specific to sterile manufacturing in industrial settings were excluded. A search of several electronic databases, trial registries, the grey literature and websites of key European hospital pharmacy groups and accreditation bodies was conducted on 16 March 2022. A narrative discussion was performed by country, and content analysis of articles was conducted. RESULTS: Thirty-seven records were included. Standards reviewed covered the work environment, the preparation process and the safety of the workers who are potentially exposed to hazardous chemicals. It was a common practice to include frequent audits to ensure adherence to standards. Some standards also recommended external inspections to allow for further learnings. Periodic reviews are encouraged to ensure standards maintain relevance. National standards of the countries reviewed were based on international standards, with minor adaptations for local conditions. CONCLUSIONS: The main limitation of this review is that it is limited to countries with a high human development index. The review shows that the use of an internationally recognised standard as a basis for national standards is best practice, and will allow for relevance into the future.

Advanced nurse and midwife practitioners' experience of interprofessional collaboration when implementing evidence-based practice into routine care: An interpretative phenomenological analysis.

AIM: To understand advanced nurse and midwife practitioners' experience of interprofessional collaboration in implementing evidence-based practice into routine care. DESIGN: A qualitative interpretative phenomenological analysis. METHODS: A purposeful sample of 10 Registered Advanced Nurse and Midwife Practitioners from a range of practice settings in the Republic of Ireland participated in semi-structured interviews over a 10-month timeframe. Interviews were transcribed verbatim and data were analysed using a multi-stage approach in line with guidance for interpretative phenomenological analysis. RESULTS: Six superordinate themes emerged: Understanding of advanced practice; 'Treated as an equal and as a "nurse"'; Nursing management support; 'A voice to implement anything new'; Confidence and Emotional intelligence. These factors impacted interprofessional relationships and the extent to which advanced practitioners could implement evidence-based practice. CONCLUSION: There is scope to improve advanced practitioners' ability to collaborate with the interprofessional team in implementing evidence-based practice into routine care. IMPACT AND IMPLICATIONS: The study findings demonstrate that enhancing understanding of the advanced practice role; increasing organizational support for advanced practitioners and augmenting specific practitioner skills and attributes will increase their ability to collaborate effectively and implement evidence-based practice. Supporting advanced practitioners in this important aspect of their role will positively influence health outcomes for patients. CONTRIBUTION TO THE WIDER GLOBAL CLINICAL COMMUNITY: As numbers of both nurse and midwife practitioners increase globally, this study provides timely evidence from a range of practice settings to guide the design of education programmes and policies governing advanced practice. Study recommendations have broad applicability to all healthcare professionals who are engaged in implementing evidence-based practice into routine care. REPORTING METHOD: Consolidated criteria for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Effectiveness of nurse-led clinics on healthcare delivery: An umbrella review.

BACKGROUND: Healthcare provision remains challenging leading to a focus on health service redesign including the development of nurse-led clinics. While there is a belief that nurse-led services positively impact on healthcare delivery, it is necessary to inform development through examination of the evidence. METHODS: A search was conducted of Cumulative Index of Nursing and Allied Health Literature, MEDLINE, EMBASE, Scopus and the Cochrane Library for systematic reviews evaluating the effectiveness of nurse-led clinics when compared with usual care published between 2015 and 2020. Outcomes of interest were clinical outcomes, patient satisfaction and patient access to health care. Study quality was appraised using the AMSTAR 2 tool (A MeaSurement tool to Assess Systematic Reviews). A narrative analysis was conducted. RESULTS: From 681 identified studies, nine were included, with reporting quality rated from very low to high quality. Patient clinical outcomes were reported as equal to or better than usual care across all studies included. There was evidence of high levels of patient satisfaction with nurse-led clinics across the included systematic reviews. While access to health care was the least reported variable, there were reports that access to health care increased or patient reliance on other healthcare providers reduced due to nurse-led clinics. CONCLUSIONS: Despite the heterogeneous nature of the systematic reviews, along with some quality issues in reporting, there was evidence that nurse-led services provided comparable or superior care to usual care with high levels of patient satisfaction. There was a lack of reporting on the impact of nurse-led clinics on patient access to health care; further research is required on this area. Health service managers should consider nurse-led clinics an effective innovation in health service provision.

Experiences of registered general nurses who care for patients presenting with self-harm to the emergency department in Ireland.

BACKGROUND: There are a substantial number of self-harm presentations to emergency departments (EDs) yearly throughout Ireland. Nurses often struggle with the psychosocial nursing interventions required when caring for patients who present following self-harm. AIM: To explore the experiences of registered general nurses (RGN) who care for patients presenting with self-harm to the ED in Ireland. METHOD: A qualitative descriptive study design was used to explore experiences of RGNs in caring for patients with self-harm in the emergency department. Data was collected using one to one interviews with a purposive sample of nine RGNs working in ED. Transcripts were analysed using Burnard's thematic content analysis framework. RESULTS: Three themes emerged: 1) waiting for assessment/treatment in an unsuitable environment 2) caring for self-harming patients from a nursing perspective and 3) nurses' perceptions of self-harming patients. CONCLUSION: Overall ED nurses hold a positive attitude towards patients who self-harm but acknowledge that barriers and challenges do exist when caring for this patient group. This study highlights the need for specific training on caring for patients who present to ED following self-harm.

Patient-reported experiences of consultation with an advanced nurse practitioner: Factor structure and reliability analysis of the patient enablement and satisfaction survey.

AIM: The aim was to analyse the psychometric properties of a patient-reported-experience measure, the Patient Enablement and Satisfaction Survey (PESS), when used to evaluate the care provided by Advanced Nurse Practitioners (ANPs) in terms of factor structure and internal consistency. The PESS is a 20-item, patient-completed data collection tool that was originally developed to measure patient experience and enablement following consultation with nurses in general practice. DESIGN: Cross-sectional survey; validity and reliability analysis. METHODS: The sample in this study consisted of 178 patients who consulted with 26 ANPs working in four different specialities. Data were collected between June and December 2019. An exploratory factor analysis of the PESS was conducted to determine convergent validity which was supported by parallel analysis and the traditional Kaiser criterion. The internal consistency of individual PESS items was determined via Cronbach's alpha, McDonald's omega, the Average Variance Extracted tests and item-subscale/total score correlations. RESULTS: A three-factor structure (PESS-ANP) was found through exploratory factor analysis and this was supported by parallel analysis, the traditional Kaiser criterion and the percentage of variance explained criterion. A high degree of internal consistency was reported across all factors. One question was omitted from the analysis ('Overall Satisfaction') following the identification of problematic cross-loadings. The three factor solution was identified as: patient satisfaction, quality of care provision and patient enablement. CONCLUSION: The findings of this study propose a three-factor model that is sufficiently reliable for analysing the experience and enablement of patients following consultation with an ANP. IMPACT: Increasingly, patient-reported experience measures are being used to evaluate patients' experience of receiving care from a healthcare professional. The PESS was identified to be reliable in evaluating the experience of patients who receive care from an ANP while a three-factor structure was proposed that can capture specific attributes of this care.

Nurse Practitioners' Implementation of Evidence-Based Practice Into Routine Care: A Scoping Review.

BACKGROUND: Implementation of evidence-based practice (EBP) is essential for ensuring high-quality health care at minimum cost. Although all nurses have a responsibility to implement EBP at an individual patient level, nurse practitioners (NPs) as clinical leaders have additional responsibilities in leading and collaborating with transdisciplinary teams to implement EBP across patient groups and embed practice change into routine care. AIM: To explore the factors affecting the implementation of EBP into routine care by NPs. Specifically, to examine NP beliefs, levels of EBP implementation, and barriers and enablers to EBP implementation into routine care. METHODS: A scoping review was conducted using the Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) framework. The electronic databases CINAHL, Medline, and PsycINFO were searched for studies published between 2009 and 2018 along with gray literature and reference lists of included articles. Abstracts and studies were screened using predefined eligibility criteria. Data extraction was undertaken using a standardized framework and data synthesis completed. RESULTS: Seven studies were included in the review. Findings indicated NPs valued EBP and believed it to be important in standardizing patient care. NPs' implementation of EBP was found to be relatively low overall. It was not possible to fully determine the extent to which NPs implemented EBP into routine care. NPs experienced similar barriers to EBP implementation as do nurse generalists such as lack of time, lack of EBP competence, lack of support from colleagues and managers, and inadequate resources. In particular, NPs identified collaborative practice issues as factors affecting EBP implementation. Identified barriers included physician-driven practice and the need to maintain professional and political boundaries. Supportive collaborative relationships and having professional confidence were identified facilitators. LINKING EVIDENCE TO ACTION: An exploration of NPs' experience of interprofessional collaboration when implementing EBP into routine care is needed to identify requirements for support in this area.

A descriptive study on emergency department doctors' and nurses' knowledge and attitudes concerning substance use and substance users.

AIM: The aim of this study was to determine emergency department doctors' and nurses' knowledge and attitudes regarding problematic substance use and substance users. METHODS: Data were collected using an adapted survey questionnaire and the Substance Abuse Attitude Survey (SAAS). By means of convenience/opportunistic sampling all emergency department doctors and nurses (N=145) working in three university teaching hospitals in Ireland were asked to fill out the knowledge and attitudes questionnaire. RESULTS: A response rate of 46%, N=66 was achieved. Results indicate that participants' current level of knowledge about alcohol and drug misuse in general, is satisfactory. A particular knowledge deficit in relation to intervention strategies, and other substances was identified. The majority of participants have never received any specific training regarding substance use and this suggests that substance using patients are managed inadequately. The SAAS results indicate that participants exhibited near-optimal attitudes for constructive working with substance using patients. CONCLUSION: There is an urgent need for further in-service training programmes and the development of standard protocols/guidelines for the identification and management of substance using patients who present in the emergency department.