Same-day discharge after atrial fibrillation ablation under a nurse-coordinated standardized protocol.

AIMS: Same-day discharge (SDD) after atrial fibrillation (AF) ablation is an effective means to spare healthcare resources. However, safety remains a concern, and besides structural adaptations, SDD requires more efficient logistics and coordination. Therefore, in this study, we implement a streamlined, nurse-coordinated SDD programme following a standardized protocol. METHODS AND RESULTS: As a dedicated SDD coordinator, a nurse specialized in ambulatory cardiac interventions was in charge of the full SDD protocol, including eligibility, patient flow, in-hospital logistics, patient education, and discharge as well as early post-discharge follow-up by smartphone-based virtual visits. Patients planned for AF ablation were considered eligible if they had a left ventricular ejection fraction (LVEF) ≥35%, with basic support at home and accessibility of the hospital within 60 min also forming a part of the eligibility criteria. A total of 420 consecutive patients were screened by the SDD coordinator, of whom 331 were eligible for SDD. The reasons for exclusion were living remotely (29, 6.9%), lack of support at home (19, 4.5%), or LVEF <35% (17, 4.0%). Of the eligible patients, 300 (91%) were successfully discharged the same day. There were no major post-SDD complications. Rates of unplanned medical attention (19, 6.3%) and 30-day readmission (5, 1.6%) were extremely low and driven by femoral access-site complications. These were significantly reduced upon the introduction of compulsory ultrasound-guided punctures after the initial 150 SDD patients (P = 0.0145). Standardized SDD coordination resulted in efficient workflows and reduced the total workload of the medical staff. CONCLUSION: Same-day discharge after AF ablation following a nurse-coordinated standardized protocol is safe and efficient. The concept of ambulatory cardiac intervention nurses functioning as dedicated coordinators may be key in the future transition of hospitals to SDD. Ultrasound-guided femoral puncture virtually eliminated relevant femoral access-site complications in our cohort and should therefore be a prerequisite for SDD.

Review of advanced practice nurse role in infection throughout the hematopoietic stem cell transplant journey.

BACKGROUND: Prolonged periods of immunosuppression during hematopoietic stem cell transplant (HSCT) can result in serious infectious complications and contribute to transplant-related morbidity and mortality. Adherence to standardized pre and postinfection screening guidelines, prescribed medications, and early identification of infectious symptoms through comprehensive patient and family education are crucial to minimizing infectious complications. Advanced practice nurses (APNs) are key members of the multidisciplinary care team in the HSCT specialty, maintaining a specialized skillset and scope of practice which includes a holistic based, preventative medicine and risk mitigation approach. METHODS: This review sought to describe the role of the APN in HSCT care and to further examine existing APN led models of care which focus on infection prevention and education throughout the HSCT treatment journey. RESULTS: No studies specifically examined the APN role in infectious diseases risk assessment, screening, and management throughout the HSCT journey were identified throughout our review, however, there was considerable evidence to demonstrate the benefits of APN led care in the oncology and solid organ transplantation specialty which led to improvements in continuity of care, overall patient outcomes, and multidisciplinary team collaboration. The key themes identified in our review, were the role of the APN in the delivery of comprehensive patient and family education, the role of the APN in supporting, mentoring, and educating junior medical and nursing teams, the collaboration between the APN and the multidisciplinary care team, and the role of the APN in prompt recognition, triage, and management of treatment related complications, such as infection.

Trends in the geographic inequality of advanced practice nursing workforce in cancer care in Japan from 1996 to 2022: a panel data analysis.

BACKGROUND: Cancer was ranked as the second leading cause of global mortality in 2019, with an increasing incidence. An adequate workforce of healthcare professionals with special skills and knowledge in cancer care is vital for addressing the disparities in cancer prognosis. This study aimed to elucidate the trends in the advanced practice nursing workforce (APNW) in cancer care, which included certified nurse specialists (CNSs) and certified nurses (CNs) in each prefecture of Japan from the system's inception to the present. Further, it sought to analyze the regional disparities and compare these trends with other healthcare resources to identify contributing factors associated with the APNW in cancer care in each prefecture. METHODS: We performed a panel data analysis using publicly available data on the APNW in cancer care in each prefecture of Japan from 1996 to 2022. Gini coefficients were calculated to examine the trends in geographic equality. Univariate and multivariable fixed effect panel data regression models were used to examine regional factors associated with an APNW in cancer care. RESULTS: From 1996 to 2012, the APNW in cancer care increased from four to 6982 staff, while their Gini coefficients decreased from 0.79 to 0.43. However, from 2012 to 2022, the Gini coefficients decreased slightly from 0.43 to 0.41. The coefficient value was comparable to that for the disparity between hospital doctors (0.43) but more pronounced compared to those for other medical resources, such as hospitals (0.34), hospital nurses (0.37), and designated cancer care hospitals (0.29). The APNW in cancer care in each prefecture was significantly associated with a higher number of designed cancer care hospitals in the previous year (see first quartile, the coefficient for second quartile: 0.31, 95% confidence interval (CI) 0.21-0.40), and a fewer number of hospital doctors (- 1.89, 95%CI - 2.70 to - 1.09). CONCLUSIONS: The size of the APNW in cancer care has increased since the system was established in 1996 up till 2022. With the increase in numbers, geographic inequality narrowed until 2012 and has since then remained stagnant.

Healthcare professionals' perspectives towards the role of ward-based advanced practice nurses: A cross-sectional study.

AIMS: 1. To explore the perceptions of physicians, registered nurses (RN) and allied health professionals (AHP) towards the role of ward-based advanced practice nurse (APN). 2. To examine healthcare professionals' perception of APN role expansion in inpatient care. DESIGN: Cross-sectional study. METHODS: A 43-item survey comprising of five domains was conducted on healthcare professionals' perceptions towards ward-based APNs in five medical wards of a tertiary hospital from November 2022 to February 2023. The participants were recruited using convenience sampling via email and cross-platform messaging service. RESULTS: A total of 181 completed respondents including 26 physicians, 102 nurses and 45 AHPs. Statistical analysis was performed with IBM SPSS Version 28.0. APNs were perceived to be spending a great extent of time across all five domains, namely, 'direct comprehensive care', 'support of systems', 'research', 'education' and 'publication and professional leadership'. Significant differences were noted in perceptions based on prior experience with APNs and between different healthcare professions. The majority recognized APNs' positive impact on patient safety, efficiency and patient-centeredness. CONCLUSION: This study offers valuable insights into ward-based APNs' practice patterns, roles and impact, revealing a positive shift in their acceptance and expanding roles within inpatient general wards. It also highlights the valuable roles and impact of ward-based APNs in direct patient care, system support, research, education and leadership, despite ongoing challenges in role clarity, particularly in treatment planning and ward rounds. IMPLICATIONS FOR THE PROFESSION: APNs are highly regarded as competent and a consistent personnel in the wards. However, there are divided views on clinical activities that APNs undertake. IMPACT (ADDRESSING): What problem did the study address? ○ Role ambiguity for ward-based APNs. ○ Healthcare professionals' readiness and acceptance of APNs. What were the main findings? ○ APNs are perceived to have a strong involvement in direct patient care, support of system, research, education and leadership. ○ APNs are recognized for their significant impact on patient safety, efficiency and patient-centredness, but there were varied perceptions on the extent of time they spend in different practice domains. ○ The critical roles of APNs participating in daily ward rounds and initiating discharge plans were highlighted, emphasizing their importance in timeliness and continuity of care. Where and on whom will the research have an impact? ○ It will affect healthcare professionals including physicians, nurses, allied health professionals and healthcare administrators by providing insights into the roles and contributions of ward-based APNs. ○ The findings will guide policymakers and nurse leaders in making informed decisions about the implementation and development of APN roles, ultimately improving patient care and outcomes. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

«I can't imagine it without my nurse¼: Experiences of people with chronic kidney disease in the evaluation process as kidney transplant candidates.

This qualitative study aimed to explore the experiences of 11 adults with chronic kidney disease (CKD) undergoing evaluation for kidney transplant (KT) and examine the role played by the nurse in the process. Employing a descriptive phenomenology approach, semi-structured interviews were conducted between October 2022 and July 2023. Thematic analysis, facilitated by Atlas. ti software, revealed a systemic management diagram with "The candidate for kidney transplant and their reality" at the center, followed by "The process of chronic kidney disease and kidney transplantation," and concluding with the most distal category centered on "The kidney transplant access nurse." This organizational framework provided insights into the layers of relationships between emerging themes. The findings underscored the complexity and multidimensionality of the CKD and KT process, emphasizing the nurse's pivotal role as a guide and protector throughout the evaluation process for accessing kidney transplantation. The convergence of results with existing literature highlighted the need to address challenges such as lack of time, resources, and emotional support to enhance the quality of care. Recognizing the nurse's crucial importance in this process, the study emphasizes the significance of addressing these challenges to improve patient care and calls for attention to the nurse's role in guiding individuals through the intricate journey of CKD and kidney transplantation.

Advanced practice nurses' evidence-based healthcare competence and associated factors: A systematic review.

BACKGROUND: Evidence-based healthcare (EBHC) enables consistent and effective healthcare that prioritises patient safety. The competencies of advanced practice nurses (APNs) are essential for implementing EBHC because their professional duties include promoting EBHC. AIM: To identify, critically appraise, and synthesise the best available evidence concerning the EBHC competence of APNs and associated factors. DESIGN: A systematic review. DATA SOURCES: CINAHL, PubMed, Scopus, Medic, ProQuest, and MedNar. METHODS: Databases were searched for studies (until 19 September 2023) that examined the EBHC competence and associated factors of APNs were included. Quantitative studies published in English, Swedish and Finnish were included. We followed the JBI methodology for systematic review and performed a narrative synthesis. RESULTS: The review included 12 quantitative studies, using 15 different instruments, and involved 3163 participants. The quality of the studies was fair. The APNs' EBHC competence areas were categorised into five segments according to the JBI EBHC model. The strongest areas of competencies were in global health as a goal, transferring and implementing evidence, while the weakest were generating and synthesising evidence. Evidence on factors influencing APNs' EBHC competencies was contradictory, but higher levels of education and the presence of an organisational research council may be positively associated with APNs' EBHC competencies. CONCLUSION: The development of EBHC competencies for APNs should prioritise evidence generation and synthesis. Elevating the education level of APNs and establishing a Research Council within the organisation can potentially enhance the EBHC competence of APNs. IMPLICATIONS FOR THE PROFESSION: We should consider weaknesses in EBHC competence when developing education and practical exercises for APNs. This approach will promote the development of APNs' EBHC competence and EBHC implementation in nursing practice. REGISTRATION, AND REPORTING CHECKLIST: The review was registered in PROSPERO (CRD42021226578), and reporting followed the PRISMA checklist. PATIENT/PUBLIC CONTRIBUTION: None.

Nurses' experiences and perceptions of running nurse-led clinics: A scoping review.

AIM: To explore what is known about nurses' experiences and perceptions of running nurse-led clinics. BACKGROUND: Nurse-led clinics were established to address health care needs. In collaboration with medical practitioners, advanced practice nurses may take a selected group of patients and manage their ongoing healthcare independently. Their experiences in running nurse-led clinics directly impact patient satisfaction and clinical outcomes. DESIGN: Scoping review of the peer-reviewed literature. DATA SOURCE: Systematic search through CINAHL, Medline, PsycINFO and Web of Science databases from January 2010 to September 2023. REVIEW METHODS: This scoping review is guided by the updated methodological guidance for the conduct of scoping review from Joanna Briggs Institute. RESULTS: Of 2747 retrieved articles, 15 were included in this review. Synthesis of the findings revealed that nurses believed implementing nurse-led clinics was beneficial to themselves, patients, and healthcare systems. However, they faced challenges in running nurse-led clinics, including insufficient support, teamwork obstacles and lack of role recognition. CONCLUSION: Nurses need to be proactive in promoting their clinics and overcoming challenges. Healthcare organizations are responsible for creating a positive culture to support nurse-led services. Future research should focus on ways to increase global awareness of nurse-led clinics.

The Williams and McCoy model of motivational spirited cognitive behavioral change communication.

PURPOSE: The Williams and McCoy Motivational Spirited Cognitive Behavioral Change Communication (MIS-CBC) is an innovative model combining the spirit of motivational interviewing (MI) communication, and cognitive behavioral therapy (CBT) as a patient-centered care model to improve continuity of care while enabling patients to progress during therapy. CONCLUSIONS: Incorporating this model into Psychiatric Mental Health Advance Practice Nurse practice allows for provision of best practice with populations experiencing low motivation and subject to dropout. The model aims to improve patient motivation and engagement of CBT to achievement "full dose" CBT with more flexibility to significantly improve patient outcomes, particularly with patient populations subject to interruptions in psychotherapy. PRACTICE IMPLICATIONS: The Williams and McCoy MIS-CBC model has implications in areas of both practice and academia addressing episodic psychotherapy in populations where interruptions and dropout frequently occur.

Stepping outside national borders: International active learning educational collaboration events.

AIM: This paper discusses the benefits of international collaborations for advanced practice nursing education. It identifies new perspectives and innovative practices to enhance cultural competency. BACKGROUND: Competent, well-trained advanced practice nurses (APNs) are necessary to provide high-quality and safe patient care, improve access to care, and address health disparities that are no longer geographically bound. In 2021, an international network of advanced practice educators established an active learning program to teach students their role in global citizenship and increase awareness of health disparities. APN students from Scotland, Wales, Minnesota, Houston, and Rotterdam participated in presentations, online discussions, and in-country scholarships. SOURCES OF EVIDENCE: Growing health disparities have created the need for efficient international collaboration to develop new concepts, approaches, and bidirectional exchange of experiences, culture, and knowledge. Integrating global health into curricula engages students' curiosity and integrates education, research, practice, and leadership while improving cultural competency. DISCUSSION: Forty-two students participated in the international presentations. The students strongly believed in the benefit of international collaboration and the need for a universal role for the advanced practice nurse. They responded positively to sharing cultural and clinical experiences. CONCLUSION: The recent global health challenge supported the development of innovative methods to deliver education and created an opportunity for advanced practice students to develop cultural competence and critical thinking. Collaborative solutions are essential to education and healthcare as we move forward in the 21st century. IMPLICATIONS FOR NURSING PRACTICE: Robust international collaborations have enabled the development of cultural competence and critical thinking. These are crucial elements for advanced practice roles.

Clinical nurse specialists in nutrition: A systematic review of roles and clinical experiences.

BACKGROUND/SCOPE: The Clinical Nurse Specialist in Nutrition is a professional capable of providing specialist clinical assistance and leadership-related clinical nutrition. To date, although their role has already been identified, there is still uncertainty about how this figure can actually fit into the various global health systems. The purpose of this review is to clarify and define the role of this professional aimed at analysing clinical experiences and data from nutrition scientific societies. METHODOLOGY: A systematic literature review was conducted using the Prisma Statement in the Cochrane Library databases and subsequently in PubMed, Embase, CINAHL, Scopus and Web of Science. In addition, a manual search of studies published in Google Scholar was conducted for the analysis of 'grey literature'. Out of 3,320 identified records, 20 studies were included in the present review. [Correction added on 06 June 2024, after first online publication: The preceding sentence has been corrected from "Out of 2,348 identified records, 21 studies were included in the present review." to "Out of 3,320 identified records, 20 studies were included in the present review" in this version.] RESULTS: The development of specific training, certification and qualification protection courses is contributing to the development of this professional in various hospital and community clinical contexts. The clinical experiences identified have shown that this figure is able to provide specialist assistance by offering high levels of safety, efficacy and quality of the care provided. CONCLUSIONS/ IMPLICATIONS FOR NURSING: The implementation of nurse nutrition specialist, to date, is still limited at the global level, and training programmes coordinated between scientific societies and nursing universities could be the basis for the development of this specialization in countries where today this figure is not yet present.

A country's efforts toward creating an advanced practice nurse in public health.

AIM: The study goal was to inform the creation of a blueprint for an advanced practice nurse (APN) in public health. BACKGROUND: No internationally accepted standard for an APN in public health exists. Activities of public health nurses (PHN) traditionally have centered on health promotion and disease prevention, but many have added other population-based activities such as chronic and acute disease treatment. INTRODUCTION: An APN in public health is needed to address the global challenges threatening the physical, social, and mental health of populations worldwide. METHODS: This qualitative study was comprised of six focus groups, each containing a different group of stakeholders (n = 40). Study results followed the requirements of the consolidated criteria for reporting qualitative research (COREQ). FINDINGS: Two major themes emerged: the APN role in public health and core expectations. From the APN role theme, four subthemes emerged on APN domains of public health practice and functions. From the core expectations theme, nine subthemes emerged on the APN's qualifications and behaviors. DISCUSSION: Agreement among stakeholders was found in the nine core expectations; however, among the four different visions of an APN in public health, two fit a population-based model rather than the traditional PHN model. CONCLUSIONS: A single APN role in public health is insufficient to address the breadth and complexity of today's global challenges as detailed by the sustainable development goals. Due to the interaction between health and the biopsychosocial environments, we need APNs with different areas of expertise. IMPLICATION FOR NURSING POLICY: Nurses working at universities, in public health services, and as healthcare policymakers are needed to create a multistage strategy that gradually introduces several different types of APNs in public health.

[Healthcare professionals' perception of advanced nursing practice in Ehpad with regard to the risk of drug iatrogenicity in heart failure patients]. / Perception des professionnels de santé sur la pratique avancée infirmière en Ehpad au regard du risque d'iatrogénie médicamenteuse chez l'insuffisant cardiaque.

Medication iatrogenia is a real public health problem. Elderly people are particularly at risk, due to their multiple pathologies, including heart failure; residents of residential care facilities for the dependent elderly (Ehpad) are no exception. Studies show that this risk is avoidable in 60% of cases, and that advanced practice nurses (APNs) can play a pivotal role in preventive measures. How would the role of the APN be perceived by other healthcare professionals working with these heart failure patients institutionalized in Ehpad?

Advancing Palliative Care through Advanced Nursing Practice: A Rapid Review.

Objectives: This study addresses the growing demand for palliative care (PC) by exploring the role of advanced nursing practice (ANP) within the multidisciplinary team. The purpose is to outline the background of ANP in PC, its interest, training needs, and some recommendations for its establishment in the Moroccan healthcare system. Materials and Methods: A rapid review of relevant studies was carried out through databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards, edition (2020). The inclusion criteria focussed on studies published within the nursing domain between 2012 and 2022, with a preference for the English language. Results: Study selection allowed to obtain eight relevant studies. The studies agreed that ANP improves the quality of care provided. It has a major role to play in the multidisciplinary team by mobilising all the knowledge required to offer a complete range of care for patients with needs. Nevertheless, its implementation is fraught with challenges. Conclusion: ANP will be able to address the complexity of patient and family needs and serve as cost-effective medical care coordinators for patients and families with both chronic and life-limiting illnesses, to reduce suffering and improve the quality of living and dying across the lifespan. Advanced practice nurses execute assigned authorisations by mobilising the knowledge acquired through university training. The establishment of this cadre in the healthcare system is subject to many challenges that Morocco must anticipate.

[Portrait of an IPA PSM specialising in suicide prevention]. / Portrait d'un IPA PSM spécialisé en prévention du suicide.

Suicide prevention is a major public health issue, both nationally and internationally. The management of suicidal patients leaving emergency departments is crucial to preventing the risk of suicidal recurrence. Advanced practice nurses in psychiatry and mental health can provide real added value thanks to their specialist training, their ability to carry out a comprehensive and detailed clinical assessment, their mastery of medicinal and non-medicinal therapeutic interventions, their skills in coordinating the various players involved in the care pathway, their commitment to prevention and their skills in supporting the development of the skills of care and research teams.

[A survey of psychiatry and mental health IPAs]. / Une enquête auprès des IPA parcours psychiatrie et santé mentale.

A survey was conducted in June 2022 among the graduate RPNs in the field of psychiatry and mental health. 48 people responded and gave their views on their implementation and job satisfaction. The results were generally positive.

[Working in a CSAPA, care through relationships]. / Travailler en CSAPA, le soin par la relation.

In a medical-social setting, the work of addiction care providers is somewhat unusual. Drawing on the teachings of Carl Rogers and his person-centred approach, and Hildegard Peplau and her theory of care based on the interpersonal relationship, this article explores the possibilities of welcoming a user to an addictology care, support and prevention center that is trying to rethink its operations at a time when advanced practice nurses are being deployed.

[Addictions in the elderly: the viewpoint of an IPA working in EMPSA]. / Les addictions chez le sujet âgé : regard d'une IPA exerçant en EMPSA.

Many elderly people live well and at home, but some require somatic and psychiatric care. Mobile psychiatric teams for the elderly are called upon to intervene with people aged 65-70 and over who are experiencing psychological distress. Among senior citizens, addictive disorders are very common, and are associated with psychiatric and geriatric co-morbidities. Alcohol, tobacco and benzodiazepine use disorders require holistic, individualized care, based on identification, prevention and referral, as well as training and coordination of professionals and caregivers.

Perceptions of general practitioners towards the services provided by advanced practice nurses: a cross-sectional survey in France.

BACKGROUND: New healthcare professions are emerging due to scarce medical resources. The appearance of a new healthcare profession, advanced practice nurses (APNs), has raised questions about how general practitioners interrelate with them as primary care providers. The objective of this study was to explore the perceptions general practitioners have towards the services rendered by APNs to patients, to general practice and the role they play in the healthcare system. METHODS: A survey-based, cross-sectional study was conducted throughout the Grand Est region of France which covers 57,333km2 and has a population of approximately 5,562,651. The survey was compiled using pre-existing questionnaires and was carried out from July to September 2022 via email. Variables collected were rate of acceptability and socio-demographic characteristics. RESULTS: In total, 251 responses were included. The mean age of general practitioners was 41.7 years, most were women (58.2%) and worked in rural areas of the region (53.8%). Over 80% of respondents practiced in group structures (defined as either multi-professional health centers (n = 61) or in group practices (n = 143)). Most respondents (94.0%) were familiar with the APN profession and did not consider that APNs improved access to care (55.8%, percent of responders with score ≤ 3/10). Moreover, most did not believe that APNs were useful as a primary care provider for patients (61.8%). However, being a member of a territorialized healthcare community, known as Communautés Professionnelles Territoriales de Santé (CPTS), was associated with a positive appraisal of APNs' services (OR = 2.116, 95%CI: 1.223 to 3.712; p = 0.007). CONCLUSIONS: Encouraging shared and networked practice within a healthcare community may promote a positive perception of new actors. Further studies need to be conducted to show whether the integration of APNs into healthcare networks improves quality of care.

Advanced practice nurse case managers improve efforts by US hospitals to address patient social needs.

AIMS: US hospitals are focussing more than ever on meeting important patient social needs. Patients often make multiple trips to hospitals related to nonmedical issues that could likely be averted through the increased integration of case management strategies. Although the percentage of hospitals using advanced practice nurses (APNs) in this role is still relatively low, we explore the idea that employing APN case managers improves hospitals' abilities to alleviate hospital overusage. DESIGN: The study used a cross-sectional design. METHODS: We used the 2021 American Hospital Association data set, which includes 5855 hospitals, of which 4315 were general medical hospitals. RESULTS: Using descriptive statistics and Poisson regression, we discovered that employing APN case managers in US acute care hospitals is associated with an increased likelihood that hospitals will implement strategies addressing patient social needs. CONCLUSIONS: When hospitals screen patients for social needs and formulate and implement internal and external strategies designed to meet patient social needs, many stakeholders stand to benefit. Should more hospitals observe such benefits when utilizing an APN case manager model, it will likely proliferate, and demand for APNs could accelerate further. IMPACT: Following the reduction in unnecessary patient visits and readmissions, hospitals' scarce resources are freed up to offer timely care to patients that are truly medically in need. Furthermore, financial performance improves under this scenario. APNs play a critical role in enabling hospitals to realize such benefits. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. We used archival data in this study.

Dr. Loretta C. Ford: A pioneer in healthcare.

Dr Loretta C. Ford is a true pioneer. Her work in public health launched the nurse practitioner movement. Together with Dr Henry Silver in 1965, Dr Ford co-founded the first expanded or advanced role to educate nurses to: assess, diagnose and treat common pediatric problems in primary care. Since then, there has been an increase in the number of specialty programs and an acknowledged global need for advanced practice nurses. She transformed our understanding of health and illness, the education of nurses, and the practice of humane patient care.