Health practitioner regulation and national health goals.

The role of health practitioner regulation in ensuring patient safety is well recognized. Less recognized is the role of regulation in addressing broader health system priorities. These goals include managing the costs, capacities and distribution of health professional education institutions; ensuring the competence and equitable distribution of health workers; informing workforce planning and mobilization; enabling the use of digital technologies; and addressing challenges related to the international mobility of health workers. Even where health practitioner regulation is designed to advance these goals, important gaps exist between the potential of regulatory systems and their performance. The response to the coronavirus disease 2019 (COVID-19) pandemic led many countries to introduce regulatory changes to allow more flexibility and innovations in the mobilization of health practitioners. Building on this experience, we need to critically re-examine health practitioner regulatory systems to ensure that these systems support rather than impede progress towards national health goals. We discuss the role of health practitioner regulation in contemporary health systems, highlighting recent regulatory reforms in selected countries, including during the COVID-19 pandemic. We identify the importance of dynamic, effective and flexible health practitioner regulatory systems in progress towards universal health coverage and health security.

Le rôle qu'exerce la réglementation relative aux professionnels de la santé pour la sécurité du patient est bien connu. En revanche, celui qu'elle joue dans la définition des grandes priorités du système de santé l'est moins. Elle comporte ainsi plusieurs objectifs, notamment: assurer la gestion des coûts, des capacités et de la distribution des établissements de formation des professionnels de la santé; garantir une répartition équitable d'agents de santé compétents; guider la planification et la mobilisation de la main-d'œuvre; permettre l'intégration des technologies numériques; et enfin, relever les défis liés à la mobilité internationale des acteurs du secteur. Même dans les endroits où une telle réglementation est conçue pour atteindre ces objectifs, des écarts considérables subsistent entre le potentiel des systèmes de réglementation et leurs performances réelles. La lutte contre la pandémie de maladie à coronavirus 2019 (COVID-19) a encouragé de nombreux pays à modifier les règles en vigueur en vue d'offrir une plus grande flexibilité et davantage d'innovations en matière de mobilisation des agents de santé. En nous fondant sur cette expérience, nous devons impérativement réexaminer les systèmes de réglementation propres aux praticiens afin qu'ils constituent un moteur, et non un frein, à la poursuite des objectifs nationaux en matière de santé. Dans le présent document, nous évoquons le rôle de la réglementation relative aux professionnels de la santé dans les systèmes de santé actuels, en mentionnant les récentes réformes entreprises par une série de pays dans ce domaine, y compris durant la pandémie de COVID-19. Nous soulignons également l'importance d'instaurer des systèmes de réglementation dynamiques, efficaces et flexibles pour les praticiens sur la voie menant à la sécurité sanitaire et à une couverture sanitaire universelle.

La función de la reglamentación de los profesionales sanitarios para garantizar la seguridad de los pacientes es bien conocida. Sin embargo, se reconoce menos la función de la reglamentación para atender prioridades más amplias del sistema sanitario. Estos objetivos incluyen: gestionar los costes, las capacidades y la distribución de las instituciones de formación de profesionales sanitarios; asegurar la competencia y la distribución equitativa de los trabajadores sanitarios; informar la planificación y movilización del personal; permitir el uso de tecnologías digitales; y abordar los retos relacionados con la movilidad internacional de los trabajadores sanitarios. Incluso en los casos en que la reglamentación de los profesionales sanitarios está concebida para promover estos objetivos, existen diferencias considerables entre el potencial de los sistemas de reglamentación y sus resultados. La respuesta a la pandemia de enfermedad por coronavirus de 2019 (COVID-19) llevó a muchos países a introducir cambios en la reglamentación para permitir una mayor flexibilidad e innovaciones en la movilización de los profesionales sanitarios. A partir de esta experiencia, es necesario volver a examinar de forma crítica los sistemas de reglamentación de los profesionales sanitarios para garantizar que estos sistemas apoyen y no impidan el progreso hacia los objetivos sanitarios nacionales. En este artículo se analiza la función de la reglamentación de los profesionales de la salud en los sistemas sanitarios contemporáneos y se destacan las recientes reformas reglamentarias introducidas en algunos países, en particular durante la pandemia de COVID-19. Asimismo, se destaca la importancia de que los sistemas de reglamentación de los profesionales sanitarios sean dinámicos, eficaces y flexibles para avanzar hacia la cobertura sanitaria universal y la seguridad sanitaria.

Ethical advocacy in the end-of-life nursing care: A concept analysis.

AIM: This concept analysis was conducted to identify and define the features and functions of ethical advocacy in the end-of-life nursing care. BACKGROUND: Ethical advocacy is key to the role of the nurse in delivering quality and competent care. Despite this, the dimensions of this concept are poorly understood. DESIGN/DATA SOURCE: Databases such as Google Scholar, Scopus, Web of Science, Science Direct, and PubMed were searched systematically. To search these databases, the following keywords were used: "patient advocacy," "nursing," "ethics," "end-of-life care," and their combinations. REVIEW METHODS: Walker and Avant's method was utilized as a comprehensive review of the literature to explore how ethical advocacy in nursing can be used to improve the quality of care. RESULTS: The defining attributes of the concept of ethical advocacy included adhering to ethical principles of nursing, championing social justice in the provision of healthcare, safeguarding and defending patient's rights by applying collective wisdom, and involving hospital ethics committees. Antecedents are organizational and personal power and ethical leadership. The optimal consequence of ethical advocacy can be getting the best ethical governance. CONCLUSION: Based on this analysis, the concept of ethical advocacy is one of the most important roles for nurses which requires their awareness of this concept.

A Nanosensor Toolbox for Rapid, Label-Free Measurement of Airway Surface Liquid and Epithelial Cell Function.

Ciliated lung epithelial cells and the airway surface liquid (ASL) comprise one of the body's most important protective systems. This system is finely tuned, and perturbations to ASL rheology, ASL depth, ASL pH, the transepithelial potential, and the cilia beat frequency are all associated with disease pathology. Further, these apparently distinct properties interact with each other in a complex manner. For example, changes in ASL rheology can result from altered mucin secretion, changes in ASL pH, or changes in ASL depth. Thus, one of the great challenges in trying to understand airway pathology is that the properties of the ASL/epithelial cell system need to be assessed near-simultaneously and without perturbing the sample. Here, we show that nanosensor probes mounted on a scanning ion conductance microscope make this possible for the first time, without any need for labeling. We also demonstrate that ASL from senescence-retarded human bronchial epithelial cells retains its native properties. Our results demonstrate that by using a nanosensor approach, it is possible to pursue faster, more accurate, more coherent, and more informative studies of ASL and airway epithelia in health and disease.

Beyond a Single Country's Borders: Trade in Services Uncovered Through Bibliometrics.

We live and work in an increasingly connected global environment where actions in one part of the world can have consequences for all of us. This article examines, through the use of bibliometric analysis, the extent to which nursing scholars are engaged in the policy debate surrounding trade in services. Results demonstrate that, in comparison to medical colleagues, the nursing profession is more regionally orientated, focused on more operational-based themes and orientated to Mode 4: Mobility of the Profession. However, with the impetus of initiatives such as Nursing Now, opportunities exist to increase nurses' contribution to policy in today's ever more connected supranational environment. To be effective, and if quantum rather than incremental progress is to be made, more scholarship on policy-oriented topics is needed. An increased output of PhD-prepared nurses is essential. Collaborative working in multidisciplinary policy teams must become the norm, so nurses can demonstrate their unique and essential contribution to addressing the many and complex challenges that health systems now face. This is what is required if nurses are to be equipped to make robust evidence-based arguments at national and supranational levels.

Evolution of physiotherapy scholarship: A comparative bibliometric analysis of two decades of English published work.

OBJECTIVES: To undertake a bibliometric analysis of the physiotherapy literature at two points in time to identify similarities, differences, and the evolution of scholarship over a 40-year time-frame. METHOD: To undertake a quantitative comparative analysis of the published and indexed scholarship literature contained within Scopus relating to physiotherapy over two 10-year time windows-1978-1987 and 2008-2017. The method used, bibliometrics, is capable of identifying the nature of scholarship, the key actors, and how the focus and methods used to conduct studies have changed. A specialized bibliographic analysis and visualization tool VosViewer (University of Leiden) was used to analyse the extracted results. RESULTS: There has been a more than 10-fold increase in the number of papers published across the two time-frames (3,384 from the 1978 to 1987 period and 38,434 from 2008 to 2017). The focus of publication has moved from a medical disease orientated approach to one more specifically looking at physiotherapy interventions aimed at addressing functional ability. In addition, a more diverse range of research approaches are being used as well as efforts to synthesize findings across multiple studies using systematic reviews and meta-analytical techniques. Authors now come from a much wider range of countries than they did 40 years ago, and they are more likely to be part of a large international collaborative research teams. CONCLUSIONS: This unique and comprehensive analysis of physiotherapy scholarship across two different timeframes has provided important insights into the evolution of the profession, its changing focus and methodological approaches as well as the dramatic increase in activity, growth in research teams and diversity of country origins. For anyone entering the profession at this time, it provides a perspective on the pace of change they are likely to experience in their career ahead.

A Spiral of Transitions Leading to Broader Influence and Action.

This article describes lessons learned through a reflective analysis of job transitions experienced by a registered nurse from the time of entry into the profession until the current point where the nurse is engaged in state, national, and international policy development work. The centrality and symbiotic nature of the link between policy and practice and the importance of evidence and leadership have emerged as key aspects of the expanding spiral of influence traversed as a result of various career moves. At every stage, lessons have been learned. Some of these are professional in nature, but on occasion, the lessons have been more personal. The importance of mentors cannot be underestimated in terms of the support and guidance they offer but also the challenges they bring to existing patterns of thought and behavior.

Windows to the Future: Can the United Nations Sustainable Development Goals Provide Opportunities for Nursing?

Windows of opportunity are wide open for the nursing profession to actively participate and engage in the policy implementation, evaluation, and achievement of the United Nations Sustainable Development Goals. Nurses bring valuable perspectives as members of diverse governance structures and offer a range of solutions that can help governments pursue and achieve the Sustainable Development Goals and targets by 2030.

Mapping and changing informal nurse leadership communication pathways in a health system.

PURPOSE: Social network analysis (SNA) is increasingly being used to provide a visual and quantitative analysis of relationships among groups of staff and other subjects of interest. This paper examines the role SNA can play in identifying existing networks, and measures the impact of participation in brief task-focused project groups on the underlying communication pathways. METHODS: An SNA of a closed group of nurse leaders was conducted in a health system in Scotland, UK. Data were collected on two occasions 6 months apart. Analysis of both whole network and individual node-based (nurse leader) measures were undertaken. RESULTS: Analysis revealed that the initial network structure was related to functional departments. By establishing task and finish groups, network density and other key measures could be improved. CONCLUSIONS: SNA is a useful tool in mapping existing networks and evaluating how these can be strengthened through the use of task orientated project work. This easy-to-use technique can provide useful insights and a means of targeting management action to improve communication pathways in a moderately large and complex nurse leadership group. Further clinical and academic potential uses of the technique are suggested.

Professional regulation, public protection and nurse migration.

UNLABELLED: Nurse mobility, developments such as health tourism and the rapid expansion of health systems have increased the need for regulatory bodies to reach beyond their normal stakeholder groups so as to familiarize themselves with the legislation of other jurisdictions. PURPOSE: A systematic examination of a cross-section of nursing legislation, to ascertain the degree of consistency in the number of definitions specified as well as their underlying structure, was conducted to identify opportunities to strengthen public protection and reduce barriers to freedom of movement. METHOD: A purposeful sample of legislation, drawn to maximize differences, was subjected to documentary analysis to identify possible relationships between the variables of interest and the way terms and processes were defined in fourteen nurse practice acts. RESULTS: Potential relationships were identified between factors such as geographic region, legal tradition, administrative approach, regulatory model and economic status and the number and approaches used to specify definitions. A major weakness in the precision of definitions was discovered. DISCUSSION: Several international organizations have started to develop lexicons but all have weaknesses. By drawing upon these lexicons a more comprehensive and precise dictionary could be formulated to support the development of next-generation nurse practice acts. CONCLUSIONS: Current legislation lacks precision and, within the context of increased mobility of nurses, there is an urgent need to develop an authoritative source of definitions that can contribute to increasing public safety as well as reducing delays in the freedom of movement of nurses from one jurisdiction to another.

The global summit on nurse faculty migration.

As global demand for health care workers burgeons, information is scant regarding the migration of faculty who will train new nurses. With dual roles as clinicians and educators, and corresponding dual sets of professional and legal obligations, nurse faculty may confront unique circumstances in migration that can impact nations' ability to secure an adequate, stable nursing workforce. In a seminal effort to address these concerns, the Honor Society of Nursing, Sigma Theta Tau International, and the International Council of Nurses invited a diverse group of international experts to a summit designed to elucidate forces that drive nurse faculty migration. The primary areas of consideration were the impact on nurse faculty migration of rapid health care workforce scale-up, international trade agreements, and workforce aging. Long-term summit goals included initiating action affecting national, regional, and global supplies of nurse educators and helping to avert catastrophic failure of health care delivery systems caused by an inadequate ability to educate next-generation nurses.

Social network analysis: a tool for the identification of next generation trainers.

UNLABELLED: The International Council of Nurses developed and introduced the Leadership For Change, Programme in 1996. The programme has been delivered in over 60 countries and more than five, thousand nurse leaders have completed the highly adaptable learning experience. The programme, uses an action learning methodology and from an initial cohort of students trained by an expert trainer, approximately one third of the group goes on to participate in a train-the-trainers programme to, become certified to deliver the education to peers in their country. PURPOSE: This exploratory study investigates whether social network analysis has the potential to assist in, identifying candidates for the train-the-trainers programme. METHODS: The study uses a simple self-completion questionnaire relating to information seeking, information, provision and friendship behaviours amongst a 32 person cohort of students. Chi squared test of, association were used to identify whether there was a potential relationship between the individuals, identified by the traditional expert-opinion approach to train-the-trainer selection with those that, would have been identified through consideration of a set of social network analysis metrics (indegree, outdegree, degree connectedness, closeness centrality and betweenness). CONCLUSIONS: Social network analysis appears to offer an opportunity to bring some quantitative rigour to the, selection of next generation trainers. Specifically, indegree, outdegree and betweenness measures look, promising (p < 0.05) in augmenting the current selection process when data on information seeking, and information provision behaviours are considered.