Nurse practitioner in Swedish municipal elderly care: A Delphi study of challenges and opportunities.

INTRODUCTION: Worldwide, countries are struggling with strained healthcare systems, especially due to the growing number of frail elderly. Developing the role of nurse practitioner in the care of the frail elderly is therefore of interest to make the care chain more efficient. In Sweden, the role is in an early development phase, but more research is needed. AIM: The aim was to investigate how stakeholders at the national level express the challenges and opportunities of the evolving nurse practitioner role in Swedish municipal elderly care. METHOD: A Delphi survey technique with three rounds of electronic questionnaires was used. Twenty-seven experts responded to the first questionnaire, containing two open questions; what opportunities respectively challenges do you see in developing and implementing the nurse practitioner role in municipal elderly care? The following questionnaires consisted of statements to rate using a four-grade Likert scale, and 20 and 17 responded to the second and third, respectively. The first round was analysed using content analysis, and the other two with descriptive statistics. RESULTS: Thirty-four statements about challenges and opportunities related to the nurse practitioner role in municipal elderly care were identified and rated as important. CONCLUSION: The findings provide knowledge that can contribute to discussions and decisions to refine the nurse practitioner role in Swedish municipal elderly care. The nurse practitioner role may contribute with much-needed competence to the elderly care. However, it is important to consider the challenges that need to be overcome before the development of the role. To solve this, it is necessary to have clear national guidelines concerning issues of education, title protection and the mandate and authority of the NP role.

Swedish stakeholders' views of the preparatory work needed before introducing the nurse practitioner role in municipal healthcare-A focus group study.

BACKGROUND: The nurse practitioner role has become important globally in handling the growing healthcare needs of older adults with chronic diseases. Nevertheless, research shows that introducing the role is a complex process, and more studies are needed to prepare for its introduction into different healthcare contexts, such as municipal healthcare. AIM: The aim is to investigate what Swedish stakeholders identify as the preparatory work needed before introducing the nurse practitioner role into municipal healthcare. METHODS: Data were collected through four focus group interviews conducted virtually on the TEAMS digital platform, with three to six participants in each group and 18 participants total. The transcribed interviews were analysed using a six-step thematic approach: familiarisation with the data, coding the data, generating initial themes, reviewing themes, defining and naming the themes and producing the report. FINDINGS: The findings are divided into two main themes, each with two sub-themes. In the first, clarifying why the nurse practitioner role is needed, participants stressed the importance of having a clear intention for introducing the role. The second, ensure a national framework to bolster the introduction at the local level, demonstrates the need for collaboration among national actors to clarify the role's mandate and authority before its introduction. CONCLUSIONS: Adding the nurse practitioner role to municipal healthcare can help increase the supply of nursing competence and the quality of patient care, but preparation for introducing the role requires extensive work. The development of the nurse practitioner role requires decision-makers and leaders to take primary responsibility for its introduction. This study can support countries in the early phase of developing the nurse practitioner role by identifying both best practices and pitfalls.

Advanced nurse practitioners in municipal healthcare as a way to meet the growing healthcare needs of the frail elderly: a qualitative interview study with managers, doctors and specialist nurses.

BACKGROUND: The number of frail elderly people with complex nursing and medical care needs is increasing, and consequently, the healthcare burden. The implementation of Advanced Nurse Practitioners globally has been shown to make healthcare more effective and increase patient safety, continuity of care and access to care. In Sweden, research about Advanced Nurse Practitioners is limited. Thus, this study aimed to investigate the opinions of managers, doctors and nurses in primary care and municipal healthcare about the role of ANPs in municipal healthcare as a way to meet the increasing healthcare needs of the frail elderly. METHODS: Managers, doctors and specialist nurses in primary care and municipal healthcare adopted a qualitative, descriptive design through 12 semi-structured interviews. The data were analysed using content analysis. RESULTS: The participants expressed both opportunities as well as challenges with Advanced Nurse Practitioners in municipal healthcare. This role considered to satisfy frail elderly people's healthcare needs and making the healthcare more effective as the doctors would have more time for other patients. The challenges mainly consist of doubts from the managers whether the nurses would be motivated to pursue further education to become an Advanced Nurse Practitioner if the role becomes a reality. The doctors were unsure if the nurses would consider taking the responsibility the role would imply. CONCLUSIONS: Advanced Nurse Practitioner is considered to be a valuable resource not only for the frail elderly but also for the nurses in the municipal healthcare and for the doctors in primary care as they probably would make healthcare more effective. They might be a way to meet the increasing healthcare needs of frail elderly, however there are also challenges to overcome before they can become a reality in a Swedish healthcare context. Consequently, this role deserves further investigation.

Content in nurse practitioner education - A scoping review.

OBJECTIVE: Globally, the role of nurse practitioner is evolving to meet increased healthcare demands. Nevertheless, there are factors hindering the development of this role, one of which involves differences in nurse practitioner education worldwide. Therefore, the objective of the present study is to identify what is known in the research field on the content of nurse practitioner educational programmes. DESIGN AND DATA SOURCES: The literature scoping review follows a six-stage methodological framework including: i) formulate research questions, ii) identify relevant studies, iii) select studies, iv) chart data, v) collate, summarize and report the results, vi) consultations. Data bases searched included CINAHL, PubMed and ERIC and were followed by manual searching of reference list in the included papers. Of the 1553 papers identified, 16 met the aim of this study. REVIEW METHODS: To answer the research questions 'what is the content of curricula in nurse practitioner education?' a deductive content analysis was used. RESULTS: Two main categories emerged. The first was related to the professional nurse practitioner role and includes research and nursing theories, leadership and collaboration, and organizational, political, economic, regulatory and legislative issues. The second is related to becoming an autonomous practitioner and includes health promotion and disease prevention, and other medically oriented content. CONCLUSIONS: The content identified is consistent with the core competencies that nurse practitioners are expected to have after graduation, which have been described by the International Council of Nurses and by other researchers. Given the lack of recent research in nurse practitioner education, the results of the present study advance knowledge in this research field. Additionally, this study may be of practical value in developing new nurse practitioner educational programmes.

Curricula and learning objectives in nurse practitioner programmes: a scoping review protocol.

INTRODUCTION: Globally, nurse practitioner (NP) has become an important nursing role in the pursuit of a more efficient healthcare, possessing the necessary expert skills to work as autonomous practitioners. Nevertheless, there are barriers in the implementation of this role. One barrier concerns the different levels of education required for NPs. Previous studies demonstrate the importance of acting for a uniform international education. The aim of the scoping review was to compile research about education to become an NP, focusing on the content of curricula and learning objectives. METHODS AND ANALYSIS: The six-stage methodological framework by Arksey and O'Malley will guide the scoping review through the following stages: identifying the research questions; identifying relevant studies; study selection; charting the data; collating, summarising and reporting the results; and consultation. The research questions are as follows: What is the content of curricula in NP programmes? What are the learning objectives in NP programmes? The literature searches will be conducted between March and June 2019 in the following databases: PubMed, CINAHL and ERIC, followed by hand searching reference lists of key studies. Grey literature will be searched in Google Scholar, Libsearch, existing networks and relevant organisations. Two researchers will screen titles and abstracts. Included full-text articles will be screened by three researchers and assessed for their methodological quality by the use of the Critical Appraisal Skills Programme. The PreferredReporting Items for Systematic Reviews and Meta-Analyses flow diagram will be used to demonstrate included and excluded articles. The findings will be presented through a numerical summary of the included articles, followed by a thematic analysis. ETHICS AND DISSEMINATION: Research ethics approval is not required for a scoping review. The scoping review will be submitted to a peer-reviewed journal. Additionally, the findings will be disseminated to stakeholders representing political, educational, professional and union organisations through a Delphi study as part of the consultation stage of the Arksey and O'Malleys framework.