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Introduction: The World Health Organization (WHO) called for the expansion of all nursing roles, including advanced practice nurses (APNs), nurse practitioners (NPs) and clinical nurse specialists (CNSs). A clearer understanding of the impact of these roles will inform global priorities for advanced practice nursing education, research, and policy. Objective: To identify gaps in advanced practice nursing research globally. Materials and methods: A review of systematic reviews was conducted. We searched CINAHL, Embase, Global Health, Healthstar, PubMed, Medline, Cochrane Library, DARE, Joanna Briggs Institute EBP, and Web of Science from January 2011 onwards, with no restrictions on jurisdiction or language. Grey literature and hand searches of reference lists were undertaken. Review quality was assessed using the Critical Appraisal Skills Program (CASP). Study selection, data extraction and CASP assessments were done independently by two reviewers. We extracted study characteristics, country and outcome data. Data were summarized using narrative synthesis. Results: We screened 5840 articles and retained 117 systematic reviews, representing 38 countries. Most CASP criteria were met. However, study selection by two reviewers was done inconsistently and language and geographical restrictions were applied. We found highly consistent evidence that APN, NP and CNS care was equal or superior to the comparator (e.g., physicians) for 29 indicator categories across a wide range of clinical settings, patient populations and acuity levels. Mixed findings were noted for quality of life, consultations, costs, emergency room visits, and health care service delivery where some studies favoured the control groups. No indicator consistently favoured the control group. There is emerging research related to Artificial Intelligence (AI). Conclusion: There is a large body of advanced practice nursing research globally, but several WHO regions are underrepresented. Identified research gaps include AI, interprofessional team functioning, workload, and patients and families as partners in healthcare. PROSPERO registration number: CRD42021278532. [ABSTRACT FROM AUTHOR]

Background: This manuscript describes an in-state nursing student global health-care experience. The 2021 Rio Grande Valley service learning team at Louise Herrington School of Nursing at Baylor University traveled from Dallas to McAllen, Texas to volunteer in a COVID vaccination clinic and refugee respite center on the U.S.-Mexican border. Method: A competency-based evaluation utilized the American Association of Colleges of Nursing's The Essentials: Core Competencies for Professional Nursing Education Featured Concepts , with a focus on social determinants of health, as a framework. Results: The evaluation of the service learning trip through the lens of social determinants of health and the Core Competencies can serve as a guideline for the design of future trips. Conclusion: The Rio Grande Valley service learning trip contributed to nursing students' self-reports of competency in global health education, in identifying the social determinants of health that characterized the immigrants and refugees, and in service and advocacy. [ABSTRACT FROM AUTHOR]

Aim: To evaluate how family support affects cardiometabolic outcomes. Design: Integrative literature review. Sources: PubMed, CINAHL, EMBASE and Scopus were searched for peer‐reviewed primary research published between 2016 and 2021. Methods: Independent screening of 1661 citations resulted in 17 international publications involving 16 experimental studies selected. Data were analysed using a constant comparison method. Results: While the interventions varied regarding target, duration, setting and the profession of the interventionists, all studies demonstrated some level of the effectiveness for family involvement and support in the management of cardiometabolic diseases. The studies found improvement in health behaviours and clinical/psychosocial outcomes for the patients and the family members. Conclusion: Based on the findings from this review, we recommend utilizing the following for future family interventions in the management of diabetes and/or hypertension: (1) broader definitions of family and structures; (2) a community participatory/action‐research method with embedded healthcare workers; (3) an interdisciplinary approach with attention to goal‐setting; (4) multimodal interventions including technology; (5) culturally tailoring interventions for relevance as needed; and (6) clear direction regarding support role and tools. [ABSTRACT FROM AUTHOR]

Introduction: In 2020, the World Health Organization called for the expansion and greater recognition of all nursing roles, including advanced practice nurses (APNs), to better meet patient care needs. As defined by the International Council of Nurses (ICN), the two most common APN roles include nurse practitioners (NPs) and clinical nurse specialists (CNSs). They help ensure care to communities as well as patients and families with acute, chronic or complex conditions. Moreover, APNs support providers to deliver high quality care and improve access to services. Currently, there is much variability in the use of advanced practice nursing roles globally. A clearer understanding of the roles that are in place across the globe, and how they are being used will support greater role harmonization, and inform global priorities for advanced practice nursing education, research, and policy reform. Objective: To identify current gaps in advanced practice nursing research globally. Materials and methods: This review of systematic reviews will provide a description of the current state of the research, including gaps, on advanced practice nursing globally. We will include reviews that examine APNs, NPs or CNSs using recognized role definitions. We will search the CINAHL, EMBASE, Global Health, HealthStar, PubMed, Medline, Cochrane Library Database of Systematic Reviews and Controlled Trials Register, Database of Abstracts of Reviews of Effects, Joanna Briggs Institute, and Web of Science electronic databases for reviews published from January 2011 onwards, with no restrictions on jurisdiction or language. We will search the grey literature and hand search the reference lists of all relevant reviews to identify additional studies. We will extract country, patient, provider, health system, educational, and policy/scope of practice data. We will assess the quality of each included review using the CASP criteria, and summarize their findings. This review of systematic reviews protocol was developed following the PRISMA-P recommendations. PROSPERO registration number: CRD42021278532. [ABSTRACT FROM AUTHOR]

Introduction: Nurses work in global settings and must be prepared to enter practice and provide culturally appropriate care to diverse populations. As faculty we want to ensure the achievement of programmatic, national, and global competencies for our student's successful future practice. Methods: Aligning current programs with American Association of Colleges of Nursing's (AACN) New Essentials provides an opportunity to consider new approaches and address challenges. By merging the New Essentials with the Consortium of Universities for Global Health (CUGH) competencies, we facilitate the achievement of programmatic outcomes, mission, and values in nursing education. Results: Using an entrustable professional activities framework provides a clear measure of achieving priority competencies. We created an approach other faculty might find helpful. Discussion: Entrustable professional activities, well established in medical education, are emerging as a valuable tool to measure the achievement of competencies in the preparation of nurses. [ABSTRACT FROM AUTHOR]

Aim: To describe the mentoring process between the ICN Advanced Practice Nurse Network practice subgroup and the University of Pécs to support the emerging advanced practice role in Hungary, and explore the creation of a mentoring algorithm for faculty and other key stakeholders worldwide who wish to develop advanced practice nursing programs. Background: Advanced practice nurses provide comprehensive clinical care and expand access to care in more than 70 countries. In March of 2017, a representative of the Faculty of Health Sciences of the University of Pécs requested assistance in curricula development for the inaugural advanced practice nursing program in Hungary. Methods: A mixed‐methods single case study was undertaken. The sources of evidence include interviews, e‐mails, review of the literature, and related documents. Qualitative data were analyzed for content, and frequencies were calculated for quantitative indicators. Findings and discussion: The findings highlight the importance of clear communication, development of shared goals, and determination to see the project through. Enriching information was provided by colleagues from diverse global settings. Credibility was gained in Hungary from the support of national and international experts. Conclusion: The mentoring foundation and process facilitated the role development in Hungary and contributed to an increased understanding of advanced practice nurses' scope of practice. The intentional approach and the careful ongoing reflection may lead to future successful endeavors. Multinational engagement and collaborations will promote advanced practice nursing contributions globally. Implications for nursing policy: Mentoring can effectively empower nurses and advanced practice nurses to work to their full capacity. The shared experiences of international mentoring colleagues can contribute to and support the development and acceptance of national policies for the advanced practice nursing roles. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the impact of the COVID‐19 pandemic on the emotional and spiritual well‐being and resilience of a global sample of Advanced Practice Nurses. Design A web‐based cross‐sectional mixed methods study. Survey data were collected from Advanced Practice Nurses globally over a 2‐month period ending on 31 August 2020. Methods: The Warwick‐Edinburgh Mental Well‐being Scale, FACIT‐12 Spiritual Well‐being Scale and Connor‐Davidson Resilience Scale 10 were used to quantify emotional and spiritual well‐being and resilience of Advanced Practice Nurses' globally. The survey was distributed internationally using snowball sampling via a secure platform (Qualtrics). Results were analysed using various bivariate tests for associations and group differences. Results: Nine hundred and twenty‐eight Advanced Practice Nurses from 53 countries participated in the study. Study participants reported meaningfully lower scores in resilience and emotional well‐being compared with non‐pandemic scores. Participants from countries with well‐developed Advanced Practice Nurses roles reported lower resilience and well‐being scores compared with those from countries where Advanced Practice Nurses roles are still being developed. Each scale revealed significant positive associations with the other scales. Conclusions: Emotional and spiritual well‐being and resilience of Advance Practice Nurses has been significantly impacted during the COVID‐19 pandemic. Regardless of their work location, work hours, credential or demographics, the APNs in our study reported lower levels of resilience and mental well‐being compared with typical scores on the instruments. [ABSTRACT FROM AUTHOR]

Purpose: Hypertension is prevalent in Uganda and achieving treatment goals remains a challenge. Our aim was to assess the impact of a bundled nurse‐led intervention on hypertension physiologic measures and lifestyle modification, and to explore perceptions of the interventions to enhance sustainability. Design and setting: We employed a sequential explanatory mixed‐method design. The study was conducted at a large urban private hospital in Uganda from September 2018 to May 2019. Sample: Participants were clinic patients with hypertension currently under care. A total of 54 participants were enrolled in two study groups. Two focus groups with 16 participants and 2 nurse‐educator interviews were conducted. Methods: Blood pressure and weight were measured at baseline, three, six, and nine months. The Self‐Care of Hypertension Inventory was used to assess lifestyle modification. Monthly education and group‐support with text‐message follow‐up were implemented. Two focus‐groups and nurse‐educator interviews were conducted to assess perceptions post‐implementation. The analysis included descriptive statistic, multivariate analysis and qualitative analysis for themes and subthemes. Findings: Overall, participants had a mean weight loss of 7.7 kg (p = 0.001) and a mean reduction in systolic blood pressure (SBP) of 9.5 mm Hg (p = 0.001). Improvement in biometric outcomes was associated with lifestyle modification such as taking medicine as prescribed (p = 0.008), eat lots of fruit and vegetables (p = 0.043), and control your body weight (p = 0.015). Thematic analysis yielded the following themes: Knowledge and understanding, Attitude change, Adherence—a real struggle, and Adapting to what suits us. Participants found group support, shared learning, and knowledge reinforcement enhanced their knowledge and self‐efficacy. Nurse educators were motivated by the patients' favorable responses to the Bundled Education and Support with Text (BEST) intervention. Conclusion: Findings support the use of nurse‐led interventions to enhance the achievement of hypertension treatment goals. To sustain the achieved lifestyle modification and blood pressure outcomes, participants expressed a desire for continued support, information access, and inclusion of patients as champions for knowledge dissemination. Future studies need to explore the provision of enabling structures to support nurse‐led interventions in routine non‐Communicable disease (NCD) care. Clinical relevance: Hypertension knowledge‐gaps exist among patients and may reflect missed opportunities for patient engagement and education for behavior change. Bundled nurse‐led hypertension interventions can significantly improve lifestyle modification and enhance hypertension outcomes. Persons supported and empowered with knowledge can act as conduits to wider communities in championing knowledge dissemination. [ABSTRACT FROM AUTHOR]

Aim: Globally, the rapid increase of hypertension is particularly prevalent in low‐ and middle‐income countries. Hypertension is the most significant modifiable risk factor for stroke and ischaemic heart disease, the leading cause of mortality in Vietnam. The aim of this study was to gain insight into the provision of hypertension care in Vietnam by exploring provider perceptions. Methods: A sequential exploratory mixed‐method design was selected to allow for the initial qualitative interview findings to be incorporated into the development of the hypertension education workshop. Data were collected through semistructured interviews of 15 Vietnamese clinicians involved in the care of patients with hypertension. Results: Anxiety related to diagnosis of hypertension and specifically fear of having a stroke was mentioned by half of the participants. Several themes also emerged regarding barriers to implementing lifestyle modification to improve patient hypertension outcomes. There were contradictory opinions on the nurse's role in providing patient education across clinical settings. A lack of systematic structure and evidence‐based teaching resources was also noted. Conclusions: Gaining the provider's perspective increases understanding of the regional culture and context of hypertension care. The increased understanding can be used to improve provider education and enhance hypertension population outcomes. SUMMARY STATEMENT: What is already known about this topic? There is an increasing global prevalence of hypertension, the leading modifiable risk factor for cardiovascular morbidity and mortality.Lifestyle modifications are first‐line treatment to attaining hypertension goals and improving patient outcomes.Strengthening nursing intellectual capital by building nurse skills and knowledge can maximize their contribution and enhance population health. The implications of this paper: Awareness of patient culture strengthens patient education and enhances uptake of lifestyle modifications.Nurses, when appropriately equipped and supported, are ideally situated to significantly improve hypertension outcomes.Appropriately educating nurses and clarifying role expectations would develop nursing intellectual capital and add value to the health‐care system in Vietnam. [ABSTRACT FROM AUTHOR]

Hypertension is the most significant contributor to premature death globally. As embedded providers, nurses have valuable insight on how to improve hypertension outcomes. A sequential mixed-method study was conducted in Zambia to explore provider perceptions of hypertension care and develop contextually relevant education for nurses. The Zambian and US nurse researchers interviewed 15 nurses and provided a hypertension education workshop. Thematic evaluation identified categories of infrastructure and belief & behaviors with a shared subcategory of medication. A statistically significant result was found in the health care providers knowledge and attitude toward hypertension, one of two pre and post-tests analysis (z = –2.17, p < 0.05, r = –.33) and (z = -.41, p =.67). Developing efficient and effective solutions to increase hypertension care must be made at the policy level and incorporate locally relevant information. Nurses, who have cultural and contextual expertise, are ideally situated to reach population health goals. [ABSTRACT FROM AUTHOR]

There is a philosophical connection between elements of travel and elements of spirituality. Nurses can develop spiritual intelligence, hone transcultural skills, and develop cultural humility through travel. Concepts of spiritual intelligence are incorporated to distinguish spirituality from religion. This discussion is to describe the spiritual attributes of travel through exploration of unique cultural sameness and differences, stepping out of one’s routine, experiences of solitude, and the application to nursing. Venues such as study abroad, mission trips, cultural exchange opportunities, and service learning projects all can provide meaningful times of transformation, spiritual growth, learning new ways of doing things, and of being in the world. Nurses who integrate these practices into the care they provide daily will be enriched personally and rewarded with improved outcomes. [ABSTRACT FROM AUTHOR]

Purpose To describe selected common health beliefs and practices among Mexican American immigrants with type II diabetes. Data sources Selected clinical trials, qualitative studies, and systematic reviews. Conclusions The Hispanic folk illness belief susto refers to an episode of severe fright, and Mexican American immigrants hold varying views on its relation to diabetes. Culturally and in the research, susto has also been linked with depression. Sabila (aloe vera) and nopal (prickly pear cactus) are herbal remedies that have had widespread, longstanding use in Mexican culture and while this is not the gold standard of research, it does provide ample evidence and a strong cultural belief that these therapies work. There is some evidence in the literature to support their efficacy as glucose-lowering agents, but lack of Food and Drug Administration (FDA) regulation, potential side effects, and a dearth of rigorous clinical trials preclude aloe vera and nopal from being recommended therapy. Implications for practice Awareness about susto beliefs, commonly used herbal remedies, and development of culturally sensitive communication skills are essential for nurse practitioners to effectively assist patients in this population achieve their glycemic goals. Research on the effects of nopal and aloe vera on diabetes is needed to guide clinical decisions. [ABSTRACT FROM AUTHOR]

Aim: To describe practical experiences before, during and after gaining entry into research fields in Kenya and Uganda. Background: Planning, conducting and implementing international research can be an arduous task. Novice researchers need practical guides to accessing international fields and mitigating challenges met in the field. Data sources: The researchers conducted three different studies in two developing nations. Review methods: This paper reviews challenges encountered when conducting international research. Solutions used to overcome these challenges are discussed. Discussion: Establishing and maintaining effective partnerships is critical to the success of international research efforts. Researchers must be tactful, flexible and creative when handling methodological, ethical and logistical challenges encountered in settings poor in resources. Conclusion: International research provides opportunities for increasing dedication, building cross-cultural competence and advancing health professional practice globally. Implications for research/practice This paper contributes to nursing scholarship by highlighting the practical challenges of conducting international research. Illustrations aimed at lending insight and encouraging others to expand their dedication to conducting international research are offered. [ABSTRACT FROM AUTHOR]