Nursing practices on sexual health for people with neurological disorders: A narrative review.

AIMS: To identify and describe nursing practices on the sexual health of people with neurological disorders. DESIGN: Narrative review. METHODS: Data were extracted from 1 January 2002, to 20 May 2021. Inclusion criteria were nursing practices, sexual health and people with neurological disorders. The main outcome measures were: context of nursing practice implementation (assumptions, knowledge, strategies and skills), facilitators of and barriers to addressing and treating the sexual health of people with neurological disorders, and benefits of nursing practices in sexual health. PRISMA reporting guidelines were used. DATA SOURCES: PubMed, Embase, ScienceDirect and CINAHL. RESULTS: In total, 926 articles were identified and nine were included. The involvement of nurses was recommended in most studies. Assumptions about the impact of neurology on sexuality and nurse's role in sexual healthcare, biopsychosocial knowledge, and skills (ethical, interpersonal, and technical) were highlighted. We found that the modes of knowledge proposed by Carper were mobilized in an unequal way. Sexual difficulties were the key focus and eroticization concerns were not addressed in any of the articles. CONCLUSION: Several studies advocate nursing intervention; however, few accurately present, detail and evaluate sexual health nursing practices of patients with neurological pathologies. Literature describes practices structured around disorders rather than the potentials, fails to address the brake of eroticism and provides little information on the results of interventions. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Developing teaching programs on sexual health in nursing programs may be necessary if nurses are to support a diverse range of patients in an inclusive and positive manner. These programs should highlight the domain-specific knowledge that is mobilized. IMPACT: Sexual health is a fundamental human right. Alterations in the nervous system have shown to affect sexual health, however, it is not often discussed among patients with neurological disorders, who are rarely provided with sexual health counselling. Our findings may impact healthcare professionals engaged in care with these patients. REPORTING METHOD: PRISMA. No patient or public contribution.

The deployment of advanced practice nurses in the French health system: From clinics to professional networks.

AIM: The aim of this study is to contribute to an understanding of the role deployment of advanced practice nurses (APNs) in French healthcare settings. INTRODUCTION: The introduction of APNs was formalised in France by the decrees issued on 18 July 2018, which described the areas, activities and training of APNs. BACKGROUND: A qualitative study on the role implementation of APNs was conducted between July 2021 and May 2022 following a call for projects launched by the Île-de-France Regional Health Agency to evaluate the deployment of APNs in the area. METHODS: Data were collected through field observations and semi-structured interviews in order to explore both the APNs deployment processes in nine healthcare structures and the roles played by APN networks and associations with regard to the deployment of APN activities in their working environments. RESULTS: The projects proved to be evolutionary, and their development was marked by various forms of APN isolation and multiple obstacles that were specific to their professional practice settings. Some APNs relied on a variety of forms of mutual assistance and advocacy deployed throughout APN networks and associations. DISCUSSION: The deployment of APNs' role was impacted by diverse configurations of professional power relations and the nature of the obstacles that were structural for APNs in primary care. Their experience of isolation derived from the novelty of their role, the challenge they posed to the cohesion of the nursing profession and a lack of supportive policies for their deployment. Their participation in APN networks and associations enabled them to access advocacy and manage the uncertainties and unknowns related to the deployment of their activities. CONCLUSION: The results suggest that the formalisation of schemes for mutual assistance among APNs and advocacy should be integrated into the guidelines for the implementation of their role. IMPLICATIONS FOR NURSING POLICY: APN policy should strengthen a bottom-up approach, relying in particular on the development of different forms of collaboration and communication between APN networks and associations on the one hand and the public authorities on the other.

Deployment of advanced nursing practice in Île-de-France. / Le déploiement de la pratique infirmière avancée en Île-de-France.

Advanced practice nurses (APNs) are finding it difficult to establish themselves once they have completed their training. Nearly half (49%) of graduates interviewed in a survey said they were not working as APNs, which raises real questions about the future of new graduates and their establishment in local areas. Under such conditions, the future of IPAs sometimes seems compromised, especially those in private practice.

For a better understanding of the profile of nurses working in France who hold or are working toward a Ph.D: A quantitative descriptive study / Mieux connaître le profil des infirmières titulaires d'un doctorat en sciences ou doctorantes exerçant en France : une étude descriptive quantitative

Introduction: In 2009, the French Association de recherche en soins infirmiers (Nursing Research Association) counted fifty-four nurses holding a doctorate or working toward one. Recent developments in this area include the creation of section 92, for nursing sciences, in the National Council of Universities, making it possible for nurses in France to become professors with teaching and research responsibilities. Objectives: To update and complete the 2009 data by identifying the grades, fields of activity, and disciplines of nurses holding a doctorate or studying for one. Method: A quantitative descriptive study was carried out using an online questionnaire between December 1, 2021 and March 22, 2022. Results: the study involved 147 nurses working in France: seventy-five with a doctorate and 72 doctoral students. The majority of the respondents were women, held a supervisory position, and were working in the field of education. Among the doctorates obtained, education sciences accounted for the largest share. However, this disciple was less well represented among the doctoral candidates. Discussion: This study shows a change in the characteristics of nurses who are also doctoral candidates and in the disciplines in which they have obtained or are currently obtaining a doctorate, and an increase in the value of the degree, particularly in research, but little access to academic posts.

Introduction: En 2009, l'Association de recherche en soins infirmiers avait recensé 54 infirmières titulaires d'un doctorat et doctorantes. Parmi les intérêts récents de s'engager dans des cursus académiques figure la création, en 2019, de la section 92 « sciences infirmières ¼ au Conseil national des universités, rendant possible en France l'accès au corps d'enseignants-chercheurs à des infirmières. Objectifs: Actualiser et compléter les données de 2009 en identifiant les grades, les domaines d'activité, les disciplines des infirmières titulaires d'un doctorat ou doctorantes. Méthode: Une étude quantitative descriptive a été réalisée par un questionnaire en ligne, entre le 01/12/2021 et le 22/03/2022. Résultats: 147 participants, exerçant en France, ont été inclus, dont 75 infirmières titulaires d'un doctorat et 72 doctorantes. La majorité des répondants étaient des femmes, avaient un grade d'encadrement et exerçaient une activité professionnelle dans le domaine de la formation. Le plus grand nombre de doctorats a été obtenu en sciences de l'éducation ; cette discipline est moins représentée chez les doctorantes. Discussion: Cette étude montre une évolution des caractéristiques des infirmières doctorantes et des disciplines des doctorats obtenus ou en cours, une valorisation du diplôme notamment en recherche mais un faible accès aux fonctions académiques.

For a better understanding of the profile of nurses working in France who hold or are working toward a Ph.D: A quantitative descriptive study / Mieux connaître le profil des infirmières titulaires d'un doctorat en sciences ou doctorantes exerçant en France : une étude descriptive quantitative

INTRODUCTION: In 2009, the French Association de recherche en soins infirmiers (Nursing Research Association) counted fifty-four nurses holding a doctorate or working toward one. Recent developments in this area include the creation of section 92, for nursing sciences, in the National Council of Universities, making it possible for nurses in France to become professors with teaching and research responsibilities. OBJECTIVES: To update and complete the 2009 data by identifying the grades, fields of activity, and disciplines of nurses holding a doctorate or studying for one. METHOD: A quantitative descriptive study was carried out using an online questionnaire between December 1, 2021 and March 22, 2022. RESULTS: the study involved 147 nurses working in France: seventy-five with a doctorate and 72 doctoral students. The majority of the respondents were women, held a supervisory position, and were working in the field of education. Among the doctorates obtained, education sciences accounted for the largest share. However, this disciple was less well represented among the doctoral candidates. DISCUSSION: This study shows a change in the characteristics of nurses who are also doctoral candidates and in the disciplines in which they have obtained or are currently obtaining a doctorate, and an increase in the value of the degree, particularly in research, but little access to academic posts.

Introduction: En 2009, l'Association de recherche en soins infirmiers avait recensé 54 infirmières titulaires d'un doctorat et doctorantes. Parmi les intérêts récents de s'engager dans des cursus académiques figure la création, en 2019, de la section 92 « sciences infirmières ¼ au Conseil national des universités, rendant possible en France l'accès au corps d'enseignants-chercheurs à des infirmières. Objectifs: Actualiser et compléter les données de 2009 en identifiant les grades, les domaines d'activité, les disciplines des infirmières titulaires d'un doctorat ou doctorantes. Méthode: Une étude quantitative descriptive a été réalisée par un questionnaire en ligne, entre le 01/12/2021 et le 22/03/2022. Résultats: 147 participants, exerçant en France, ont été inclus, dont 75 infirmières titulaires d'un doctorat et 72 doctorantes. La majorité des répondants étaient des femmes, avaient un grade d'encadrement et exerçaient une activité professionnelle dans le domaine de la formation. Le plus grand nombre de doctorats a été obtenu en sciences de l'éducation ; cette discipline est moins représentée chez les doctorantes. Discussion: Cette étude montre une évolution des caractéristiques des infirmières doctorantes et des disciplines des doctorats obtenus ou en cours, une valorisation du diplôme notamment en recherche mais un faible accès aux fonctions académiques.

Nursing boundaries and work identity construction among nurses exercising an advanced role: A qualitative study.

Research on the deployment of advanced practice nurses (APNs) in healthcare settings highlights significant challenges for APNs transitioning to a broader, less well-defined nursing role in negotiating professional boundaries and a new work identity with other health workers. However, theories of boundary-work and professional identity have been rarely applied to APNs relationships with general nurses and colleagues in lower professional position such as nursing-assistants. APNs relationships with these colleagues remain poorly understood. This article aims to contribute to addressing this gap. It is based on qualitative research on a pilot-project prefiguring the introduction of APN (pre-APN) in the French Health system entitled the Prefiguration of Clinical Nurse Specialists (PrefICS). Data were collected through field observations and interviews with pre-APNs, general nurses, nursing-assistants, doctors and nursing hierarchy, to assess the implementation of PrefICS project in four hospitals, one health centre and one cancer control centre. The analysis shows that facing the risk of their role being limited to collaborations with doctors, pre-APNs engaged in different forms of boundary-work with general nurses and nursing-assistants, to negotiate new professional relationships with these colleagues. Some pre-APNs presented themselves as resource persons and led activities aimed at developing and sharing nursing knowledges and competencies with general nurses and nursing-assistants. Other pre-APNs shaped their work identity around a reformist role in terms of both the nursing profession and work environments. Pre-APNs boundary work with general nurses and nursing-assistants produced work spaces in which pre-APNs interwove their work identity with these colleagues by negotiating new professional ties and brokering knowledges between different professional worlds. Changes in levels of pre-APN self-categorization reflected different views of the nursing and nursing-assistant professions, from which pre-APNs started building new alliances for a shared reflective work on their practice and about caring.

Validation of the French version of the Multiple Sclerosis Intimacy and Sexuality Questionnaire 15 Tools which help nurse for assessing the effect of perceived multiple sclerosis symptoms on sexual activity and satisfaction.

AIM: To validate a French version of the Multiple Sclerosis Intimacy and Sexuality Questionnaire 15 which examines patients' perception of the effect of multiple sclerosis symptoms on their sexual activity. METHODS: After completing a translation/re-translation process to ensure linguistic and content validity, the Multiple Sclerosis Intimacy and Sexuality Questionnaire 15 French (MSISQ-15Fr) was completed by patients with multiple sclerosis. The validity of the construction, reliability, stability and reproducibility of the translation was evaluated. EXPLANATORY MIXED OBSERVATIONAL STUDY: Validation of a French assessment tool for sexual disorders (borrowed theoretical framework): the Multiple Sclerosis Intimacy and Sexuality Questionnaire 15 (MSISQ 15) RESULTS: The normed χ2 was 1.21, the root mean square error of approximation was 0.046 [0.00; 0.07], the comparative fit index was 0.974, and the standardized root mean square was 0.065. The calculated Cronbach's coefficients indicated strong internal coherence, and the intraclass correlation coefficient was satisfactory at 0.9. Translations of the Multiple Sclerosis Intimacy and Sexuality Questionnaire 15 (MSISQ-15) have already been validated in five languages. This French version is valid, stable and reproducible. It provides French-speaking nurses an accessible and appropriate tool that will enable them to play an active role in the sexual health strategy recommended by the World Health Organization.

Implementing advanced practice nursing in France: A country-wide survey 2 years after its introduction.

OBJECTIVES: To examine the characteristics of the first Advanced Practice Nurses in France and to compare the French model to international standards. BACKGROUND: Common barriers and facilitators to their integration in healthcare provision have been identified internationally. In France, the legislative framework was introduced in 2016, and the first graduates entered the workforce in 2019. METHODS: The French model was examined in comparison with Hamric's conceptual framework and to the International Council of Nurses' guidelines and definitions. A cross-sectional survey was also conducted, using three self-administered online questionnaires. Two were distributed to 2019 and 2020 graduates and a third to the accredited programme directors. The characteristics of advanced practice nursing graduates were described and compared based on employment status and field of practice (primary vs secondary/tertiary care). RESULTS: Although the French model of advanced practice nursing meets Hamric's primary criteria and core competencies, it does not differentiate between Nurse Practitioner and Clinical Nurse Specialist roles. Of the 320 students enrolled in one of the 11 accredited training programmes 165 participated in the survey. Mean age was 40, and mean prior nursing experience was 15 years. By February 2021, 30% of respondents were still employed as Registered Nurses. Barriers to practice included insufficient income generation (primary care), the lack of position creation (secondary/tertiary care), the physician-dependent patient referral process and delays in prescription credentials approval. CONCLUSIONS: The implementation of advanced practice nursing in France faces several barriers. Legislative adjustments and greater financial incentives to practice seem warranted. RELEVANCE TO CLINICAL PRACTICE: as in other countries, France introduced advanced practice nursing to respond to the Public Health challenge of improving access to quality health care in the context of increasing chronic disease prevalence and limited resource allocation. Facilitating its integration in the healthcare provision landscape seems paramount.

Préfigurer l'exercice de la pratique infirmière avancée : une coconstruction à l'œuvre en milieu de soins.

INTRODUCTION: Advanced nursing practice is the subject of a growing number of studies. To date, however, few of them have analyzed the local processes used to implement the functions of advanced practice nurses (APNs). The research presented in this article concerns a pilot project on the precursors of APNs (pre-APNs) in the French healthcare system. PURPOSE OF THE RESEARCH: This article analyzes the major obstacles to and levers for the development of pre-APNs’ functions in the light of their active role in the implementation process. RESULTS: The obstacles include confusion of the function of pre-APN with other nursing functions on the part of their colleagues and superiors, partial assimilation to the medical profession, restriction of the practice of pre-APN under the control of physicians in highly ambivalent interprofessional relationships. Physicians also played a leveraging role in interprofessional mentoring to promote the introduction of pre-APN. They adopted strategies for negotiating their competencies, providing information and raising awareness about their function while asserting a professional identity based on their competence as nurses expert in nursing care in their field of practice (the elderly, mental health and psychiatry, support for chronic or cancer patients, primary care). CONCLUSION: The development of advanced nursing practice can only partially derive from formal structures and regulatory frameworks. The various initiatives to publicize, build and install these functions are illustrative of a process of co-construction in practice settings.

When primary care providers and smokers meet: a systematic review and metasynthesis.

Primary Care Providers (PCPs) often deal with patients on daily clinical practice without knowing anything about their smoking status and willingness to quit. The aim of this metasynthesis is to explore the PCPs and patients who are smokers perspectives regarding the issue of smoking cessation within primary care settings. It relies on the model of meta-ethnography and follows thematic synthesis procedures. Twenty-two studies are included, reporting on the view of 580 participants. Three main themes emerge: (i) What lacks, (ii) Some expectations but no request, and (iii) How to address the issue and induce patients' motivation. Our results reveal a global feeling of a lack of legitimacy among PCPs when it comes to addressing the issue of tobacco and smoking cessation with their patients, even though they have developed creative strategies based on what is at the core of their practice, that is proximity, continuity, long-term and trustworthy relationship.

Le savoir expérientiel : exploration épistémologique d'une expression répandue dans le domaine de la santé.

Among the different forms of knowledge, experiential knowledge is widely used in certain activities in the field of health. Most often connected to patients, it is also discussed in relation to health professionals, but less frequently. This article offers some points of reference and clarifies what underlies experiential knowledge. These points of reference are based on definitions of experience and knowledge, as well as work on the type of knowledge created by experience. An exploration of the contexts in which “experiential knowledge” has emerged and the focus of the disciplines that discuss it finds few epistemological connections between knowledge and experience. In the humanities and social sciences, experiential knowledge is most often connected to patients or adults in educational situations. With regard to nursing knowledge, the analysis of Carper and Lechasseur’s work on the nature of nursing knowledge reveals how the characteristics of experience are integrated into their typologies, particularly when it comes to artistic and personal knowledge. The explicit absence of experience in these typologies is then questioned with regard to the scientific imperatives that nursing science, at this particular period in its construction, is determined to promote.

Nurse coordinator roles in the management of patients with hepatocellular carcinoma: A French national survey.

Hepatocellular carcinoma (HCC) mostly occurs in patients with chronic liver disease (CLD). HCC treatment may have a direct impact on CLD prognosis. HCC management can therefore become complex, involving multiple health care providers, such as oncologists, hepatologists, radiologists, and surgeons. In France, dedicated nurses have been involved in patient care pathways. Their impact is poorly documented. PURPOSE: To determine the country-wide distribution of HCC nurse coordinators in French health care settings and to describe their roles and responsibilities. PATIENTS AND METHODS: A survey using a multi-item questionnaire (including center characteristics, nurse coordinator characteristics, and quality indicators such as patient care pathway initiation timeline, scheduled length of hospital stay, diagnostic disclosure process) was conducted. All French liver cancer centers planning to participate in a prospective national cohort study for patients with HCC (CHIEF Cohort) were invited to take part in the survey. Bivariate analysis compared centers with a nurse coordinator to those without. RESULTS: Among the 42 of 72 centers that replied, 14 treated fewer than 75 HCC patients. Treatment mostly took place in hepatology units (34/42). Sixteen nurse coordinators were part of the health care team in 13 of the 42 centers. Among these 13 centers, 11 were university hospitals and 11 followed more than 75 patients per year. The median number of patients followed in these centers was 300 (min-max 44-600) in 2017. All nurse coordinators were involved in providing patient information and counseling. Other roles included treatment monitoring (13/16), care coordination (12/16), psychological support (12/16) and treatment planning (11/16). Thirteen nurse coordinators conducted diagnostic disclosure nurse consultations; seven conducted initial patient contact consultations; and six held outpatient nurse consultations, with wide heterogeneity between centers. The presence of a nurse coordinator was associated with completion of the full diagnostic disclosure process (p = 0.045). CONCLUSION: In France, nurse coordinators for HCC patient pathway management are present mainly in university hepatology units with a caseload of more than 75 patients per year. All provide patient information and counseling but their roles in care coordination, patient support and holistic assessment are heterogeneous and not standardized.

Benzodiazepine and Z drug cessation in elderly patients: A qualitative study on the perception of healthcare providers and the place of advanced practice nurses.

Sedative-use disorder can occur in elderly individuals, but remains a taboo subject. France is the second top-consuming country of benzodiazepines (BZDs) and Z drugs in Europe, with 38% of women >80 years old using these drugs. Despite the recommendations of the French National Authority for Health (HAS) to general practitioners, deprescription remains rare. The aim of this study was to understand the perception of healthcare providers towards BZD or Z drug withdrawal within a psychogeriatric unit and to provide insights from advanced practice nurses (APRNs) on this topic. Eight healthcare providers from different professions in a psychogeriatric unit were interviewed. The interviews were recorded and transcribed verbatim, and the data were analysed following the interpretive phenomenological approach. The COREQ statement was used as a guide in the reporting of the study. Four themes were identified in the interview transcripts: (i) problems specific to the elderly; (ii) problems specific to BZD or Z drug consumption; (iii) present care; and (iv) envisioned practice. While the healthcare providers interviewed appeared to have knowledge on the adverse effects of BZDs, it appears difficult to taper the use of BZDs outside crisis periods of behaviour disorders in elderly patients. Caregivers recommend an evolution of practices, such as introducing BDZ and Z drug withdrawal programs that could involve the emerging profession of APRNs in general practice in France. APRNs could be a valuable resource to screen for BZD-related disorders and to manage withdrawal strategies in complex cases.

La clinique infirmière : manière singulière de penser et d'agir dans le champ de la santé.

Clinical practice, generally identified as a medical activity, is also a feature of other professions. Anecdotal evidence generally shows that nurses, but also the people they work with and the recipients of care, do not identify their "bedside" activity as "clinical practice." However, from the initial training stage onward, teaching and learning center on providing people with care. Professional practices focus essentially on clinical activity with the acquisition and mobilization of knowledge produced by various disciplines, including nursing.Clinical practice can be approached in various ways depending on the field of study and/or the objectives pursued. To better understand nursing clinical practice, considered as a whole, we focus in particular on its purpose, language, phases, and the substance of each stage.Clarification of nursing clinical practice is of value both epistemologically and in relation to social utility : this latter by making it possible to standardize the modalities of exposure to nursing care situations, making visible the activities of care conception and practice by nurses.This article aims to lay the foundations for reflecting on a vast and complex field. Clarifying nursing clinical practice and considering it in its entirety constitutes a change of perspective. It allows us to see it as a whole and in its constituent parts, to situate each element according to its purpose and function, to carry out critical analyses, and to contribute to the development of knowledge. Understanding of nursing clinical practice and its related issues, notably in terms of structure and language, has begun to emerge, but also poses a challenge for nursing.