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A career ladder for nurses, including several levels of nursing practice and specific roles for advanced practice nurses, was introduced in Hong Kong around the start of the 21st century. To date no studies have distinguished the practices of advanced practice nurses in Hong Kong. This cross-sectional study, conducted between November 2020 and March 2021, aims to identify and differentiate the practice patterns of advanced practice nurses by utilizing the Advanced Practice Role Delineation tool. A total of 191 responses were obtained. Three roles were identified: nurse consultant, advanced practice nurse, and advanced practice nurse in management. Among the five advanced practice nursing domains, nurses were most frequently involved in Education and in Direct Comprehensive Care activities, while least active in Research and in Publication and Professional Leadership. Identifying activities in various nursing roles helps to differentiate their responsibilities and provides new insights for role utilization and support. Although the role characteristics are shaped by country contexts, research evidence on practice patterns may be used to support international discussion and efforts to promote role clarity and effective role introduction and optimization.

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.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.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.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.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.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.

Mentoring is highly valued in the nursing profession and essential to building an evidence-based practice (EBP) culture. However, many organizations have a limited number of EBP mentors, who have limited non-clinical time to engage in mentoring.This project aimed to test whether an e-mentoring approach to nursing inquiry could enhance EBP beliefs (EBPB), increase EBP Implementation (EBPI), and improve Organizational Culture and Readiness for System-Wide Implementation of EBP (OCRSIEP).A pre-experimental pilot intervention project was implemented utilizing a pretest-posttest design with Advanced Practice Registered Nurses' (APRNs) in clinical practice. The OCRSIEP, EBPB, and EBPI scales were used to measure organizational readiness for EBP implementation, individual beliefs regarding the value of EBP, and the extent to which nurses integrate scientific evidence into their clinical practice, respectively. The Wilcoxon-Signed Rank test was used to analyze the difference between pretest and posttest scores of an EBP E-mentoring program. A post-hoc analysis was performed to calculate effect sizes. [Correction added on 13 May 2022, after first online publication: The Methods section was revised to add additional details.] RESULTS: Eleven APRNs completed the pretest and posttest surveys. When comparing the pre-and post-intervention scores, the median EBPB scores increased from 61 (IQR: 56-69) to 70 (IQR: 64-73), median EBPI scores increased from 13 (IQR: 7-33) to 20 (IQR: 13-31), and median OCRSIEP scores increased from 88 (IQR: 73-97) to 99 (IQR: 90-113).A 12-week Nurse Inquiry E-mentoring Program can leverage the small number of EBP mentors in an organization to improve EBPB. A program lasting longer in duration may also significantly improve EBPI and OCRSIEP scores. By utilizing technology and leveraging economies of scale, exponentially more nurses can be mentored to create and enhance an EBP culture.

Aim To explore Master of Nursing students' perspectives toward the impact of coronavirus disease 2019 (COVID-19) on the advanced practice nurse preparatory education and practice. Background Like many nursing education programmes, the advanced practice nurse preparatory training was greatly affected and had to radically change to adapt to the disruptions caused by the pandemic. The COVID-19 pandemic has created a strain on the healthcare system and advanced practice nurses have been expected to modify their normal practice to provide care in unprecedented ways. Methods The study used a descriptive qualitative design. Semi-structured video-conference interviews were conducted in an autonomous university (June-July 2020). The recruitment of participants (n = 14) concluded upon data saturation. A thematic analysis was conducted. The COnsolidated criteria for REporting Qualitative research (COREQ) guidelines were used. Findings Three main themes were identified: (1) overcome adversity through innovation, (2) acceptance of remote learning and (3) versatility of advanced practice nurses in an ongoing pandemic. Each theme was further explained by two subthemes to further elucidate the impact of COVID-19 on the advanced practice nurse preparatory training and practice. Discussion The evolution of the advanced practice nurse preparatory education catalysed by the COVID-19 pandemic brought on innovation. The ability of advanced practice nurses to adapt to evolving healthcare needs was also highlighted. Conclusion Although face-to-face teaching and services are gradually returning, some innovations that arose during the pandemic may be worth keeping. Implications for nursing Nursing educators in higher education institutions can benefit from adopting technology to mitigate the challenges posed by the ongoing pandemic IMPLICATIONS FOR NURSING POLICY: Nurse leaders should review the role of advanced practice nurses to determine how best to capitalise on their practice to meet rising healthcare needs.

Background Stronger healthcare models are increasingly sought to address new population needs, health workforce inefficiencies and nursing shortages. One strategy is to focus on employees' strengths to capitalize on their competencies and maximize their scope of practice. Introduction Globally, there is an exponential demand for advanced practice nursing services. This study aimed to identify the roles and positions of nurses who align with APN defining criteria at all levels of care in Catalonia, Spain. Methods The first step of the study included the translation and validation to Catalan of the Advanced Practice Nurse Role Delineation Tool (IDREPA) and step 2 comprised a multicentre cross-sectional study, in which 126 healthcare centres participated: 1209 nurses were included in the study. The STROBE checklist was used to report this study. Results Transcultural equivalence and validation of the instrument showed a content validity index of 0.958 and the reliability of the questionnaire. The instrument identified 269 nurses who align with international APN defined criteria. They worked in specialized care, mental healthcare and primary and community care, especially in chronic conditions, ageing and end-of-life care. Discussion Most areas of Catalonia have access to nurses practicing at APN defining criteria. These nurses were developed as an optimal resource to respond to patient needs in the context of study. Both recognition and strategic implementation are necessary to apply their full competencies to solve healthcare problems. Conclusion Understanding the supply of services delivered by nurses practicing at an advanced level and their scope of practice may lay the foundations for effective workforce planning in a dynamic context. Nurses who align with APN defining criteria are working mainly in large acute services without regulation and recognition. Implications for nursing Advanced practice nurses show the value of their role and activities in healthcare services. Implications for health policy Promoting the establishment of APN defining criteria that includes credentialing and a regulatory framework within international guidelines should be a priority to make an impact on healthcare policy.

INTRODUCTION The motivation to seek treatment for opioid use disorder (OUD) can increase during the perinatal period. However, several identified barriers, such as poor access to services, lack of trained providers, stigma, and legal ramifications of OUD, limit the ability for individuals with OUD to receive safe and supportive care during pregnancy and birth. During the birth hospital stay in particular, nurses provide the majority of care for pregnant and birthing families. We aimed to engage nurses, with experience caring for pregnant and postpartum individuals with OUD, in priority setting as a way to identify areas of need in the current health care systems. METHODS Using community-engaged priority setting methods, we recruited a sample of 47 nurses (phase 1) and 20 nurses (phase 2), including nurse-midwives and other advanced practice nurses, at a statewide nursing conference, who reported regularly providing care for pregnant and postpartum individuals with OUD. We invited participants to submit questions and concerns regarding the provision of care for individuals with OUD (phase 1). A selection of those who submitted questions attended a focus group to rank and prioritize submitted questions into a set of priorities for research, policy, and care improvement (phase 2). RESULTS In phase 1, participants submitted a total of 165 questions and concerns. In phase 2, participants prioritized the following: funding to support improvements in OUD care in the perinatal period, increased access to services, supportive housing for individuals in recovery, standardization of care for individuals with OUD, and efforts to destigmatize care. DISCUSSION Nurses who work with pregnant and postpartum individuals with OUD have a unique insight as to how health care providers, including midwives, can better support this community and should be engaged setting priorities for research, changes to policy, and improvement in care.

Approximately 23.2 million children in the United States attend day care; however, many of these children often lack access to health care. Given the potential for advanced practice nurses to address this gap in health care, the authors sought to gain a better understanding of healthcare consulting provided by nurses to day/child care centers. The purpose of this scoping review is to examine the extent, range, and nature of evidence regarding the role of nurse consultants in day and childcare settings.A scoping review was conducted in CINAHL and PubMed, to report and summarize relevant literature published before 2020. Search terms included day or child care, nurse consultants, healthcare consultants, and day or child care health consultants.The search produced 92 publications; 21 publications met the inclusion criteria and are included in the review. After independently reading the publications, the authors identified and agreed upon seven central themes. Themes included an analysis of the consulting process, description of the nurse consulting role in individual and large day and childcare settings, director's perceptions of health consultants, impact of nurse consultants, education and training, barriers to the healthcare consultant role, and political advocacy.Advanced nurse practitioner, particularly pediatric nurse practitioners (PNPs), possess the skill set in acute and chronic conditions, as well as health maintenance and promotion that can be translated and used in the role of the nurse consultant to day and child care centers. Having PNPs in this role may help to address primary healthcare needs of children.

Aim This paper describes the characteristics of the new advanced practice nursing roles in France, as well as their challenges and perspectives, and compares the French model with the recommendations of the International Council of Nurses. Background Advanced practice nursing is particularly well established in English-speaking countries. Since 2018, France has become the second French-speaking region to legalize and regulate advanced practice nurses. Source of evidence The International Council of Nurses and French government websites, and scientific databases (PubMed, CINALH, Cochrane Library) were explored. Feedback from French nursing academics was also requested. Discussion The advanced practice nursing model in France is described according to the scope and conditions of professional practice. The educational program leads to a State diploma with master's degree, which it is mandatory to be a registered nurse. Remuneration depends on the sector of practice in the public hospital, primary care or private sector. Although there is no national strategy for the implementation of advanced practice nursing roles, research projects are being initiated to guide and evaluate the practice. Based on concordance analysis with the recommendations of the International Council of Nurses, the French advanced practice nursing model appears to be similar to the nurse practitioner model. Conclusion Adjustments in the scope of practice and education can be expected as the implementation of these roles is evaluated. Implications for nursing practice This is a historical evolution of the nursing profession in France, for which communication with patients and healthcare professionals is essential. Implications for nursing policy The implementation of advanced practice nursing roles in clinical settings requires the development of national strategies to support initiatives and ensure the sustainability of these roles.

Advanced practice provider (APP) employment is becoming common in pediatric otolaryngology practices, though few studies have evaluated the consequences that APP-led clinics have on access to care. The objectives of this study were: 1) to investigate whether access to bilateral myringotomy with tympanostomy tube placement (BMT) for recurrent acute otitis media (RAOM) differed between patients seen in otolaryngologist and APP-led clinics 2) to compare clinical characteristics of patients seen by provider type.Retrospective cohort study at an academic, tertiary care pediatric otolaryngology practice. All children were18 years old and underwent evaluation for RAOM followed by BMT. We compared time in days from scheduling pre-operative appointment to appointment date and time from appointment to BMT between patients seen by APPs and otolaryngologists using Mann-Whitney U tests and multivariate linear regression models. We compared clinical characteristics by provider type using Mann-Whitney U tests and Fisher exact tests.A total of 957 children were included. Children seen by APPs had significantly shorter wait times for appointments (median 19 vs. 39 days, P .001) and shorter times from preoperative appointment to BMT (median 25 vs. 37 days, P .001). Patients seen by otolaryngologists had increased prevalence of craniofacial abnormalities, Down Syndrome, hearing loss, history of otologic surgery, and higher ASA physical status classification.Children seen by APPs received care more quickly than those seen by otolaryngologists. Patients seen by otolaryngologists tended to be more medically complex. Implementation of independent APP clinics may expedite and improve access to BMT for children with RAOM.3 Laryngoscope, 131:2133-2140, 2021.

This study was to determine if there is a greater difference in Advanced Practice student nurse self-reported transition towards practice and professional identity for an experimental group compared with a control group. The information gathered is expected to: (a) provide a curriculum baseline for focused clinical objectives as well as preceptor training, and (b) to meet these objectives in alignment with the expectations for graduation and subsequent post-graduation transition into practice.Pilot exploration using quasi-experimental, mixed methods included a quantitative five-point Likert Scale and a self-reported qualitative phenomenological analysis.This study evaluated responses from all participants through a series of three self-report periods during a 14-week clinical semester.Based on the self-reported data, the experimental group made minor additional progress with respect to their growth and professional identity transition compared with the control group.This study fostered the need for further studies to support residency programs that aid newly graduated nurse practitioners as they transition into the advanced practice role.The cost to replace these practitioners can be as high as twice their annual salary. The adjustment to an advanced practice role is difficult as postgraduate training is currently optional in many States. According to Brown, et al. (Nurse Educator, 2015, 40:148), novice Advanced Practice Nurses report being underprepared for this new role, particularly diagnostic interpretation skills. Supporting the advanced practitioner with a structured curriculum is imperative to achieve successful skills development, transition to practice, and professional identity.目的: 本研究旨在确定实验组与对照组在高级实习学生护士自我报告的实习和职业认同转变方面是否存在较大差异。经预计, 所收集的信息将: (a) 为重点临床目标和导师培训提供课程基础, 以及 (b) 可用于实现上述目标, 且与其毕业期望和毕业后的实践过渡相一致。 设计: 初步探索过程中, 采用准实验法及混合法, 包括定量五点李克特量表和自我报告的定性现象学分析。 方法: 本研究对参与者在为期14周的临床学期中的三个自我报告期限的反应进行评估。 结果: 根据自我报告数据, 相较于对照组, 实验组在成长和职业认同转变方面取得细微进步。 结论: 本研究需要进一步细化, 以便为住院医师的项目提供支持, 并帮助毕业不久的护士实践者过渡到高级实践角色。 影响: 如需更换此类实践者, 需要支付可能高达其年薪两倍的费用。当前, 研究生培训可在多个州选择, 因此实践者很难过渡到高级实践角色。Brown等人 (护士教育者, 2015,40:148) 表示, 新高级实践护士认为其无法胜任新角色, 特别是在诊断性解释技能等方面。因此, 需要为高级实践者提供结构化的课程, 此做法是成功发展技能、实践过渡和获得职业认同的关键。.

Pulmonary arterial hypertension is a chronic, progressive, and life-threatening disease in children with diverse causes of pulmonary arterial hypertension. The most severe cases of pulmonary arterial hypertension require aggressive treatments with systemic administration of continuous prostacyclin therapy, including treprostinil and epoprostenol. The successful use of continuous subcutaneous treprostinil therapy eliminates the need for an indwelling central venous catheter and its associated risks. However, pain at the subcutaneous infusion site, an expected side effect of this therapy, is often a deterrent to its widespread use. Effective subcutaneous treprostinil site maintenance and pain management is essential to achieve success with this therapy, but strategies surrounding site maintenance and pain control vary significantly between pediatric pulmonary hypertension treatment centers. In an attempt to standardize practice, a survey on the use of subcutaneous treprostinil and site maintenance and pain management strategies, as well as its perceived effectiveness, was disseminated to 13 pediatric pulmonary hypertension centers of the Pediatric Pulmonary Hypertension Network. Responses to the survey were collected and analyzed and were developed into a set of formalized strategies to facilitate knowledge sharing and standardization of practice.

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.

Background Stroke prevalence is rising internationally. Advanced practice nursing is established across many jurisdictions; however, its contribution to stroke services is under research. Aim To gain insights into the future scope and role of future advanced nurse practitioners in stroke care from the perspectives of key stakeholders. Design A qualitative descriptive approach. Methods Interviews were conducted in 2019 with a purposive sample of 18 participants, comprising stroke nurses, stroke unit managers, stroke survivors and their family carers, recruited in one UK healthcare trust. The research is reported in line with COREQ. Data were analysed in accordance with an inductive content analysis approach. Results The abstraction process generated four main themes. These were ‘The lynchpin of the acute stroke service’, ‘An expert in stroke care’, ‘Person and family focussed’ and ‘Preparation for the role’. Conclusion These findings offer new perspectives on the potential scope and role of advanced nurse practitioners in stroke service delivery. Further research should focus on how to address the challenges confronted by advanced nurse practitioners when endeavouring to engage in autonomous clinical decision‐making. Impact Study findings may advance postregistration education curricula, clinical supervision models and research directions. Relevance to clinical practice There is support for the implementation of advanced practice nursing in the hyperacute and acute stroke phases of the care pathway. An interprofessional model of clinical supervision has potential to support the developing advanced nurse practitioner in autonomous clinical decision‐making.

To address longstanding workforce shortages, increase efficiency and control the costs associated with the modern health‐care provision, there has been a worldwide policy to promote increased flexibility within the health‐care workforce. This is being done primarily by extending the ‘scope of practice’ of existing occupational roles into what is referred to as ‘advanced’ practice. The development of the advanced practice nurse (APN) has occurred within the context of a shortage of medical staff, and the need to control cost. However, the means by which substantially repurposed occupational groups such as these, are incorporated into complex, hierarchical organisations such as the UK national health service (NHS) remains poorly understood. Using modern sociological theory, the development of the APN role has been examined in terms of power, control, professional identity and gender relations. Each of the theoretical approaches used adds to the quality of the discussion, although none provide a comprehensive picture. However, when synthesised, they do provide an enhanced insight into the evolution of the role. It is argued here that by critically examining the development of the APN role, this will enable both a better understanding of, and the means to influence, its future direction of travel.

Aim To describe the practice doctorate scholarly approach to assess advanced nursing practice in Ireland to address healthcare and nursing policy initiatives. Background A global team from Ireland and the United States collaborated with stakeholders, using a practice doctorate approach to identify geographic healthcare needs, the current state of the education and the evolving roles of advanced nursing practice. In Ireland, current policy initiatives call for expanding the capacity for advanced nurse practitioners to meet healthcare needs in community settings. Sources of evidence Further assessment data were required from stakeholders to inform graduate nursing education to prepare advanced practice nurses to fulfil increasingly complex healthcare needs. The practice doctorate approach included review of literature, current policy and assessment with interviews, dialogue and the development of working relationships with policymakers, academics and practitioners. Discussion The current state and future vision of graduate nursing education are evolving. A force field analysis identified promoting and restraining factors to the desired state of development of the primary care advanced practice role. Relationship building with stakeholders and sharing of expertise was key to engage academia and policymakers to address identified restraining forces. Short-term outcomes included development of collaborative relationships between practice, academia and policymakers, curricular development for the primary care nurse practitioner and intentionally shared dissemination to promote community graduate nursing education. Implications for nursing practice This innovative practice scholarship approach was used to assess and promote advanced nursing practice impact and promote the nursing profession globally. Implications for policy Successful collaboration between two global partners was achieved to promote policy objectives for both nursing and health care, with the ultimate goal of improving health outcomes and population health.

Aims and objectives To evaluate the knowledge and attitudes towards sexual and gender minority (SGM) oncology patients' needs among advanced practice providers (APPs). Background SGM individuals experience health disparities, in part due to lack of access to knowledgeable providers. Despite the important role of APPs in cancer care, less is known about their attitudes and knowledge towards SGM cancer patients. Design Cross-sectional study. Methods A survey of APPs at a National Cancer Institute-Designated Comprehensive Cancer Center assessed self-reported demographics, attitudes, knowledge and postsurvey confidence in knowledge of SGM oncology patient needs. Reporting of this study adheres to STROBE guidelines. Results Knowledge of health needs was low with an average of 2.56 (SD = 1.27) items answered correctly out of 6. The majority of APPs self-reported being comfortable treating SGM patients (93.6% and 87.2%, respectively), but less confident in knowledge of their health needs (68.0% and 53.8%, respectively). Although less than half of APPs believed education should be mandatory (44.9%), 79.5% were interested in education about SGMs' unique health needs. Political affiliation, medical specialty, licensure, and having SGM friends or family were associated with various attitude items, but not knowledge. Moderation analyses indicated that APPs who had greater overall knowledge scores were more likely to agree, on average, that knowing sexual orientation, gender identity and sex assigned at birth are important to providing quality oncology care. Conclusion APPs report being comfortable providing care for SGMs with cancer, but knowledge gaps remain that may inhibit the quality of care provided. Given the interest in education, results would support the development of SGM-related healthcare training for oncology APPs. Relevance to clinical practice Targeted education for providers during training and continuing education is likely to improve the provision of quality care for SGMs with cancer.

Aims and objectives To explore patients' understanding of the role of an advanced practice nurse (APN). Background The increasing prevalence of multimorbidities among people living with cardiovascular disease (CVD) has increased the complexity of their clinical care. Implementing the role of APNs in new models of care has been shown to improve outcomes in the CVD population. However, the CVD population's understanding of and experiences with the APN role have not been examined in Singapore. Methods An exploratory descriptive qualitative design using semi-structured face-to-face individual interviews was undertaken (November 2017-March 2018). Fourteen participants were purposively sampled from an outpatient clinic in one of Singapore's national heart centres. Thematic analysis was undertaken. The COREQ guidelines were adhered to. Findings The multi-ethnic sample included ten males and four females. Two main themes were identified: (1) APNs play a complementary role to doctors and (2) the acceptance of the APN role takes time. Each theme was supported by three subthemes to further elucidate the role and acceptance of APNs. Conclusion A lack of understanding of the role of APNs is present, thereby causing the less than optimal patient acceptance of APNs. As patients with CVD experience improvements to their health through APN-led services, they may gain confidence in APNs' skills and knowledge. Relevance to clinical practice When introducing new roles, fully explaining these roles to the target population is pertinent as it will be facilitative to patient engagement and optimisations of care. The findings support the call for APNs to explain the value and essence of advanced practice nursing more effectively. There should be a greater emphasis on teaching APNs to introduce and explain the role of APNs through APN preparatory education and incorporating this practice in APN practice standards, especially in contexts where APN development is premature.

To explore Advanced Nurse Practitioners' (ANP) (Emergency) perceptions of their role, positionality and professional identity.Advanced nursing practice was formally established in the Republic of Ireland in 2001 with 336 ANPs currently registered, projection increasing to a critical mass of 750 by 2021. Advanced practitioners (Emergency) give full emergency care for a specific cohort of clients with unscheduled, undifferentiated and undiagnosed conditions.Qualitative narrative inquiry using Bourdieu's concepts of habitus, field and capital as the theoretical framework was undertaken.Data were collected in 10 in-depth interviews and thematic analysis applied.Five key themes emerged: participants' career pathways, personal and professional transitions, role dimensions and core concepts, and position in the organization and emergent professional identity. Role transitioning and a change in habitus, field and capital revealed the uniqueness of their nursing role. Minimizing waiting times, timely patient care and patient satisfaction were key performance indicators. A heightened awareness regarding higher-level decision-making, autonomy and accountability is integral to advanced practice.This study presents unique insights into the ANP role covering recruitment, organizational culture changes required and support to ease transition emerged.Better understanding the motivation to undertake the role, the transition experience and use of advanced practice skills sets will inform the targets for the future recruitment and retention of ANPs are met nationally and internationally. Dissatisfaction with previous management roles and wanting to be clinically close to patients were motivations to follow an advanced practice clinical career trajectory. Positionality and emergent professional identity are key enablers ensuring that advanced practitioners' roles demonstrate the attributes of advanced practice. Educators could use the findings to develop recruitment, retention and progression strategies. Disseminating the role and scopes of practice could positively influence collaborative models of service delivery and policy development.目的: 研究高级执业护士(急诊部)对其角色、定位和职业认同的认知。 背景: 爱尔兰共和国于2001年正式发布高级护理实践,目前共注册了336名高级执业护士,预计到2021年人数将增加至750名。高级执业医师(急诊部)为一组计划外、未分化和未确诊的情况的特殊病人提供全面的急诊护理。 设计: 采用布迪厄的惯习、场域和资本概念为理论框架开展定性叙事研究。 方法: 通过10次深入访谈和专题分析来收集数据资料。 结果: 共出现了五大关键主题:参与者的职涯路径、个人和职业转变、角色维度和核心概念,以及在组织中的地位和自发职业认同。角色转换和惯习、场域、资本的变化揭示了护理角色具备独特性。尽可能缩短等待时间、及时的患者护理以及患者满意度为关键绩效指标。提高对更高级别决策、自主性和问责制的认识是构成高级实践的一部分。 结论: 本研究对高级执业护士职业角色提出了独特的见解,内容涵盖了招聘、所需的组织文化变革以及对缓和转变的支持。 影响: 更深入地了解承担这一角色的动机、转变经验和使用高级实践技能,将在国家和国际层面为今后实现招聘和留用高级执业护士的目标提供信息。对先前管理角色的不满,并希望临床上接近患者是遵循高级临床实践职业轨迹的驱动因素。 定位和自发职业认同是确保高级执业人员角色展示高级实践特征的关键推动因素。教育工作者可利用研究发现结果来制定招聘、留用和晋升战略。传播实践的作用和范围可对提供服务和政策制定的协作模式产生积极影响。.

Background Advanced nursing practice continues to develop internationally. Previous studies suggest advanced practice may lack support within nursing, which may lead to underutilisation, retention and patient safety issues. However, the relationship between the wider nursing profession and advanced practice is poorly understood and the theory that professional identity creates cultural barriers to advanced practice has received little empirical attention. Aims and Objectives To consider the relationship between professional nursing identity and advanced practice by exploring intra-professional relationships between advanced nurse practitioners and nursing colleagues. Aims and Objectives To consider the relationship between professional nursing identity and advanced practice by exploring intra-professional relationships between advanced nurse practitioners and nursing colleagues. Design and Methods Ethnographic methodology was adopted. Fieldwork methods were participant observation and semi-structured interviews. Participants were advanced nurse practitioners (n=9) and nursing colleagues (n=5) across two primary care general practice organisations. Data were analysed thematically using framework analysis, underpinned a priori by professional identity theories. Reporting was guided by COREQ. Results Three themes were identified which indicated how intra-professional relationships were conducted: Conciliating Nursing, where advanced nurse practitioners took responsibility for developing positive relationships with other nurses; Vertical Discounting, where nursing colleagues were dismissive and undermined advanced nurse practitioners, who themselves behaved similarly towards other nurses; Lateral Othering, where advanced nurse practitioners undermined other advanced nurse practitioners. Vertical Discounting and Lateral Othering destabilised advanced practice. Conclusion Intra-professional relationships, and the broader nursing profession, shape advanced practice. We theorize this is underpinned by threats to professional identity, while weak professional identity among even established advanced practitioners exacerbates lack of support. Highlighting these issues allows space to develop alternative strategies to negotiate intra-professional relationships, informed by professional identity theories, which support rather than inhibit advanced practice. Relevance to Clinical Practice As advanced practice expands throughout primary and secondary care, and across allied health professions, the impact of professional identity and relationships on healthcare will likely increase and the importance of strong advanced practice identity will become increasingly relevant. Keywords • Advanced Nursing Practice • Advanced Nurse Practitioners • General practice • Intra-professional • Professional Identity • Positioning Theory • Primary Care • Social Identity Theory

To evaluate the implementation of advanced practice nursing in emergency care in Norway for patients with orthopaedic injuries, including hip fractures. The outcomes relate to quality of care and patient trust.A non-inferiority study comparing an advanced practice nursing care model with a standard (physician-led) care model.Data will be collected from patient records and through the Patient Trust Questionnaire, completed by patients. The data will be analysed by descriptive and inferential statistics. Funding for the research was granted in 2015 and the regional ethical committee approved the current study in February 2019.In Norway and the other Nordic countries, advanced practice nursing is still in its infancy, especially in the emergency care context. This study will evaluate advanced practice nursing in this new context.The study will add to knowledge on the quality of care provided for orthopaedic patients with minor orthopaedic injuries or hip fractures as delivered by advanced practice nurses and physicians, respectively. It will also evaluate how well-advanced practice nursing is accepted by patients in this new context.目的: 评价挪威急诊护理中对骨科伤患(包括髋部骨折患者)实施高级实践护理的情况。疗效与治疗质量和患者信任有关。 设计: 比较高级实践护理模式与标准(医师主导)护理模式的非劣效性研究。 方法: 从患者病历和患者填写的患者信任问卷中采集数据。通过描述性统计和推断性统计来分析采集的数据。于2015年拨款进行该研究,并且区域伦理委员会于2019年2月批准了该研究。 讨论: 在挪威和其他北欧国家,高级实践护理仍处于初级阶段,特别是在急救护理方面。该研究将在这一新背景下,对高级实践护理进行评估。 影响: 该研究将提高对高级实践护士和内科医生分别为骨科患者(轻微骨科损伤或髋部骨折)提供的治疗质量的认知,还将评价患者在这一新背景下如何接受高水平实践护理。.

Aims and objectives: (a) To describe and analyse advanced practice nursing students' self-assessment of their clinical competence and need for further training and (b) to analyse the possible predictive variables in their self-assessment.Background: The self-assessment of clinical competence in nursing education is im-portant for identifying professional development and educational needs to improve patient care.Design: A cross-sectional survey following STROBE guidelines was used.Methods: Ninety-nine students from three universities/university colleges in Norway participated in the study, and data were collected using a revised version of the Professional Nurse Self-Assessment Scale II. Descriptive, correlation and regres-sion analyses were performed.Results: The students gave the highest self-assessment ratings for their clinical compe-tence in taking full responsibility and for their need for further training in medication effects and interactions. Although the students gave themselves low ratings for the use of electronic devices, they assessed their need for further training in this area as average. Clinical work experience as a registered nurse and previous higher education level were not significant predictors of clinical competence nor the need for further training.Conclusion: The findings indicate that self-assessment is appropriate for students in advanced practice nursing programmes. This study implies that programmes in ad-vanced practice nursing need to familiarise students with the possibilities of informa-tion technology. It questions the entry requirement that stipulates that prospective students must have several years of clinical work experience as registered nurses before entering advanced practice nursing programmes. These programmes need to communicate that competencies other than direct clinical practice are also needed for students' future roles. Relevance to clinical practice: The study contributes to the exploration of how students self-assess own clinical competence and need for further training in advanced practice nursing programmes. Further research should evaluate the development of clinical competence. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

PROBLEM Despite knowing the importance of the early detection of adverse experiences, mental health disorders beginning or occurring during early childhood can be difficult to recognize. To address this gap, this manuscript describes the care of a parent-child dyad utilizing the nursing process in an illustrative case. METHODS This illustrative case provides a scenario that includes the early detection of infant mental health (IMH) in primary care with referral to a psychiatric mental health advanced practice nurse (PMHNP) and highlights how integrative care with PMHNP can facilitate the use of the nursing process to promote optimal early childhood growth and development and prevent long-term mental health problems. FINDINGS The collaboration between the primary care provider and PMHNP in addressing a common diagnosis observed in IMH (i.e., feeding disorder) where a 6-month-old infant presented with poor weight gain due to detached parenting, secondary to maternal depression, resulted in early infant-parent intervention that reduced maternal depression and normalized infant growth. CONCLUSIONS The screening of IMH in pediatric primary care promotes early referral and collaboration with the PMHNP to address IMH problems to promote optimal growth and social-emotional development in early childhood.

Aim We compared Japan nurse practitioner‐led care and physician trainee‐led care in terms of patients' length of stay in a secondary emergency department in Japan. Methods This was a retrospective observational study, utilizing medical records. Participants (n = 1419; mean age = 63.9 ± 23.4 years; 52.3% men) were patients transferred to the emergency department by ambulance between April 2016 and March 2018 in western Tokyo. Multiple linear regression analyses were performed, with length of stay as the dependent variable and factors related to the length of stay, including medical care leaders, as the independent variable. Results Approximately half of the patients (n = 763; 53.8%) received Japan nurse practitioner‐led care. Patients' length of stay was significantly shorter, by 6 min, in the Japan nurse practitioner‐led care group, compared with the physician trainee‐led care group (unstandardized coefficient: −6.81; 95% confidence interval: −13.35 to −0.26; p

Aims and objectives The aims of the review are to synthesise current evidence about advanced nurse practitioner clinical autonomy and consider how this may inform clinical practice and research. Background Clinical autonomy is one of the cornerstones of advanced nursing practice globally, yet there is limited synthesis of clinical autonomy in the literature. Design This is a narrative literature review. Data sources The databases Cumulative Index to Nursing and Allied Health Literature, EBSCO host, Cochrane Library, CINAHL and MEDLINE were searched for publications between 2005 and 2020 inclusive. Review methods A systematic approach was used to analyse the literature reviewed. Two reviewers undertook quality appraisal. Results Nineteen articles were selected. Four major themes emerged: (1) 'ANP Stepping Up'-moving into and accepting advanced nursing practice roles and clinical responsibilities; (2) 'ANP Living It'-ANPs' ability to act independently including an understanding of task mastery and self-determination; (3) 'ANP Bounce-back ability'-depicted in challenges that threaten their ability to practice clinically autonomously; (4) 'ANP Setting in Motion'-indirect care activities and service-level improvements. Conclusion A clearer understanding of advanced nurse practitioner clinical autonomy could help develop more in-depth knowledge. Research of advanced nurse practitioners' clinical autonomy would improve full utilisation in clinical practice.

Aim To review published literature descriptions of advanced practice nurses' roles in low- and lower middle-income countries. Background Advanced practice nurse roles have the potential to address insufficient healthcare resources in low- and lower middle-income countries. Introduction This integrative review highlights advanced practice nurses' roles in the delivery of healthcare services in low- and lower middle-income countries. Methods Three electronic databases PubMed, CINAHL complete and ProQuest Health & Medicine were searched. No limits by year or language were set. The names for low- and lower middle-income countries and combinations 'related to advanced practice nurses' titles were used to identify papers. In addition, a review of publication type was performed. Themes found within the publications were assessed against the advanced practice nurses' International Council of Nurses' characteristics. An integrative review facilitated an appraisal of the papers identified. Results The initial search identified 5778 publications in 16 languages. This number was reduced to 23, from 18 low- and lower middle-income once exclusion criteria were applied. Six publications were from 1977 to 1999, and six between 2000 and 2010, with the remaining 11 from 2011 to 2018. Zambia had the most publications. Notably, 63 countries were not represented. Of those meeting inclusion criteria, the majority addressed education with a lesser extent focusing on practice and regulation of advanced practice nurse's roles. The majority were published during the last decade. Discussion This review of the published literature identified advanced practice nurses' roles and function within some healthcare systems. However, not all components were reported. Examination of the grey literature could provide additional information about the actual and potential benefits of advanced practice nurses' in low- and lower middle-income countries. Conclusion The published literature that referred to advanced practice nurses' identified their contribution to positive impacts on health care over the last 40 years. However, with only 11 publications identified in the last 7 years, further review is required to understand the advanced practice nurses' roles in these countries. Implications for nursing and/or health policy Further development of advanced practice nurses' in low- and lower middle-income countries is supported by the lack of published literature.

Advances in health care science and delivery, coupled with patient need for access to care, have driven expanded practice in midwifery for decades. The process for development and implementation of expanded practices for midwives and midwifery practices is described. Important components include assessment of need, identifying stakeholders and supporters, development of a program proposal, obtaining privileges, developing training programs, and conducting ongoing quality management and program evaluation. Examples of expanded practice in midwifery are presented.

OBJECTIVES We explored the differences in potentially avoidable/unavoidable hospital transfers in a retrospective analysis of Interventions to Reduce Acute Care Transfers (INTERACT) Acute Transfer Tools (ACTs) completed by advanced practice registered nurses (APRNs) working in the Missouri Quality Improvement (QI) Initiative (MOQI). DESIGN Cross-sectional descriptive study of 3996 ACTs for 32.5 calendar months from 2014 to 2016. Univariate analyses examined differences between potentially avoidable vs unavoidable transfers. Multivariate logistic regression analysis of candidate factors identified those contributing to avoidable transfers. SETTING Sixteen nursing homes (NHs), ranging from 120 to 321 beds, in urban, metro, and rural communities within 80 miles of a large midwestern city. PARTICIPANTS A total of 5168 residents with a median age of 82 years. MEASUREMENTS Data from 3946 MOQI-adapted ACTs. RESULTS A total of 54% of hospital transfers were identified as avoidable. QI opportunities related to avoidable transfers were earlier detection of new signs/symptoms (odds ratio [OR] = 2.35; 95% confidence interval [CI] = 1.61-3.42; P

(a) To explore the meanings of master's education in the professionalization of nursing; and (b) to describe the core attributes that nurses gained through master's study.Narrative inquiry.From June 2017 to June 2018, unstructured interviews were conducted with 12 master-prepared nurses at advanced nursing position with minimum 5 years of postregistration experience. Collaborative thematic narrative analysis was conducted on verbatim transcripts. Members checking, peer validation and audience validation assured verisimilitude and utility.There was a need to fit one's own assertion for professional growth in nursing career structure. Master's study equipped nurses with specialty skills and knowledge with enhanced reflexivity, which nurtured morality, problem-solving ability and capacity to collaborate inter-professionally. Master-prepared nurses demonstrated effective clinical leadership through acting as change agents.Master's level education and master-prepared nurses are instrumental to the professionalization of nursing by expanding the roles of nurses. Nursing career mentoring will maximize nurses' agency in healthcare system. Developing innovative inter-professional pedagogy will nurture the reflexivity of master-prepared nurses.目的: (a)探讨硕士教育对于护理专业化的意义;和(b)对护士通过硕士学习获得的核心属性进行说明。 设计: 叙事研究 方法: 从2017年6月到2018年6月,本研究对12名处于高级护理岗位的硕士预备护士进行了非结构式访谈。这些护士至少具有5年以上的工作经验。访谈过程逐字记录并对其进行了协同主题叙事分析。成员检查、对等验证和观众验证确保了该研究的真实性和实用性。 结果: 护理职业结构的专业成长需要满足个人主张的要求。硕士的学习使护士具备了专业技能和知识,自我反省意识得到增强,道德得到培养、解决问题的能力和专业间合作的能力得到提高。硕士预备护士通过扮演变革推动者的角色,显示出了高效的临床领导能力。 结论: 通过拓展护士的角色范围,硕士水平教育和硕士预备护士促进了护理专业化的发展。护理职业指导将最大限度地发挥护士在医疗系统中的作用。发展创新的专业间教学法将会培养硕士预备护士的自我反省意识。.

WHAT IS KNOWN ON THE SUBJECT?: Internationally, systematic reviews have identified evidence of equal or improved clinical outcomes comparing advanced practitioner treatment with medical treatment as usual, across a range of specialities. Studies of nurse consultants in the United Kingdom have largely been non-empirical. Most studies specifically related to nurse consultant roles in mental health services are case studies or reports of views on this role. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The study demonstrates that nurse consultant numbers vary over time and by clinical specialty. This is influenced by the value invested in the role by local nursing leadership and by national policy change. A lack of role clarity affects the uptake and sustainability of advanced practice roles internationally and is also an issue for the nurse consultant role in England's mental health services. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Successfully introducing advanced practice nursing roles in mental health services requires role clarity and support from local nurse directors. The continued absence of robust evidence as to the clinical/cost-effectiveness of nurse consultant roles in mental health settings places an onus on individual posts to generate data to justify the role at a time of financial constraint. Detailed post holder characteristics reported in this paper provide a basis for future comparison with other advanced practice roles in mental health services and other specialties nationally and internationally. Abstract Introduction The nurse consultant is an advanced practice role providing expert clinical practice, consultancy and professional leadership. To date, few studies have examined this role within mental health services and none have described the professional characteristics of post holders. Aims The main aims of the study were to identify changes in nurse consultant numbers in mental health services, identify post holder characteristics and factors influencing number of posts. Method We used a triangulated mixed methods approach comprised of a longitudinal examination of national workforce data, a national cross-sectional survey of post holder characteristics and semi-structured interviews with directors of nursing. Results Of 58 mental health organizations, 51 (88%) responded, identifying 123 nurse consultant posts, and a range of 0-12 posts per organization. One in 229 mental health nurses and 1 in 186 learning disability nurses were nurse consultant. An average of 40% of nurse consultants' work time was reported as being in clinical practice. Themes identified as important in relation to role sustainability were cost and value, contribution of individual post holders, role clarity and domains of work. Discussion Nurse consultants are represented to a greater extent in the mental health service workforce than in nursing generally, but their roles often lack clarity. Attitudes of local professional leaders and national policies are likely to affect post numbers. Implications for practice Developing and sustaining nurse consultant roles requires role clarity and active support from nurse leaders. Roles need to demonstrate their value to the clinical systems in which they work.

Aim To develop and validate a predictive model for falls in hospitalized adult clinical and surgical patients, assessing intrinsic (i.e. patient-related) and extrinsic factors (i.e. care process-related). Background To identify factors predictive of falls and enable appropriate management of fall risk it is necessary to understand patient and environmental factors, along with care delivery processes. Design A matched case-control study. Methods This study was conducted in the medical and surgical wards of a Brazilian teaching hospital. The sample included 536 patients, with data collected in 2013-2014. Data analysis included descriptive statistics and conditional logistic regression. Cases of patients aged 18 years or older who fell while hospitalized were included. One patient who did not fall during hospitalization, matched by sex, ward and admission date, was selected as a control for each included case. Results The SAK Fall Scale (Severo-Almeida-Kuchenbecker) was developed and validated. The scale includes seven variables: disorientation/confusion, frequent urination, walking limitations, lack of caregiver, postoperative status, previous falls and number of medications administered within 72 hr prior to the fall. This scale showed acceptable predictive accuracy. Conclusions The newly developed SAK Fall Scale includes five intrinsic and two extrinsic variables and differs from other predictive scales for falls. The findings of this study are broad and the scale, which is easy to apply, can be used worldwide by nurses in health services. In advanced practice, the testing of a new model for fall risk contributes to preventive interventions and thus has an impact on patient safety.

Aim To develop and validate learning domains, competencies, and evaluation tool for graduate-level experiential nursing global health programs. Background Standard competencies have not been synthesized and delineated nor have evaluation tools been developed for global health programs at the graduate level. Design A combination of a documentary literature review and expert consensus panel to validate results was used as a design for this study. Methods The NLM and CINAHL databases were searched for articles published between 2007 - 2017 relevant to graduate-level global health nursing programs. Data were extracted and coded, from which themes regarding learning domains, competencies and evaluation items were derived. We then used a three-step expert panel to refine and form a statistical representation (>0.78 agreement on importance, relevance and clarity) of the learning domains, competencies, and evaluation items. Results Relevant articles (N = 26) were included for the documentary review, 18 concerning learning domains of global health immersion programs and eight concerning interdisciplinary global health competencies specific to nursing. These learning relationships were then formatted into a table subdivided between learning categories for expert panel consensus. After expert panel review, a compendium of learning domains, competencies, and evaluation items resulted. Conclusion Global health clinical learning practicums are essential for graduate-level preparation of nurses. Learning domains, competencies, and evaluation tools need to be adopted and empirically tested by international and national nursing associations. The results of this study need further testing to aid these associations.