scholarly journals A realist review protocol of the role and contribution of the advanced nurse practitioner (ANP) in gastroenterology nursing

2021 ◽  
Vol 4 ◽  
pp. 126
Author(s):  
Marlize Barnard ◽  
Mary Casey ◽  
Laserina O'Connor
Keyword(s):  
Patient Care ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Data Extraction ◽  
Realist Review ◽  
Programme Theory ◽  
Quality Patient Care ◽  
Education And Health ◽  
Review Protocol

Background: The role and contribution of advanced nurse practitioners (ANP) has been well researched and found to be of great value for improving quality patient care and enhancing patient outcomes through education and health promotion. However, the role and the contribution of the ANP to gastroenterology nursing have not been evaluated either nationally or internationally. A review to determine the role and contribution of the ANP in gastroenterology nursing will inform on the contribution of the role and whether the role makes a difference to patient outcomes and cost effectiveness of patient care. Objective: This review aims to investigate the nursing role and contribution of the advanced nurse practitioner in gastroenterology. Furthermore, improved understanding of the underlying causal mechanisms explaining how the ANP role in gastroenterology nursing works, will provide a deeper understanding of how, why, for whom and in what contexts the role and contribution of the ANP to gastroenterology nursing are most successful. Methods: A realist review will consolidate evidence on how, when why and where the ANP role in gastroenterology works or fails through identifying programme theories underlying to the role’s introduction. The following steps will be operationalised; locating existing theories, searching the literature, documenting literature selection, engaging in data extraction and synthesis and refining programme theory. As an iterative approach, review cycles will uncover explanatory and contingent theories through context-mechanism-outcome configurations (CMOCc). Due to the variation in context and mechanisms, different outcomes will be likely across different clinical settings although similar patterns may be identified. Conclusions: Due to the theory-oriented approach of realist reviews, the pragmatic consequences of the review, will lend itself to deeper understanding of how the role and contribution of the ANP in gastroenterology nursing works in practice.

scholarly journals Quality care metrics (QC-M) in nursing and midwifery care processes: a rapid realist review (RRR) protocol

2020 ◽  
Vol 3 ◽  
pp. 85
Author(s):  
Laserina O'Connor ◽  
Alice Coffey ◽  
Veronica Lambert ◽  
Mary Casey ◽  
Martin McNamara ◽  
...  
Keyword(s):  
Data Extraction ◽  
Quality Care ◽  
Realist Review ◽  
Care Process ◽  
Programme Theory ◽  
Ethical Approval ◽  
Local Reference ◽  
Review Protocol ◽  
Health Nursing ◽  
Rapid Realist Review

Background: In 2018, the Office of the Nursing and Midwifery Services Director (ONMSD) completed phase one of work which culminated in the development and launch of seven research reports with defined suites of quality care process metrics (QC-Ms) and respective indicators for the practice areas – acute care, midwifery, children’s, public health nursing, older persons, mental health and intellectual disability nursing in Ireland. This paper presents a rapid realist review protocol that will systematically review the literature that examines QC-M in practice; what worked, or did not work for whom, in what contexts, to what extent, how and why? Methods: The review will explore if there are benefits of using the QC-Ms and what are the contexts in which these mechanisms are triggered. The essence of this rapid realist review is to ascertain how a change in context generates a particular mechanism that produces specific outcomes. A number of steps will occur including locating existing theories on implementation of quality care metrics, searching the evidence, selecting relevant documents, data extraction, validation of findings, synthesising and refining programme theory. This strategy may help to describe potential consequences resulting from changes in context and their interactions with mechanisms. Initial theories will be refined throughout the process by the local reference panel, comprised of eight key intervention stakeholders, knowledge users such as healthcare professionals and an expert panel. Ethical approval is not required for this rapid realist review. Conclusion: It is anticipated that the final programme theory will help to explain how QC-Ms work in practice; for whom, why and in what circumstances. Findings of this review could help to give insights into realism as a framework and how nursing and midwifery QC-Ms have been implemented previously.

scholarly journals Motivation as a mechanism underpinning exercise-based falls prevention programmes for older adults with cognitive impairment: a realist review

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e024982 ◽  
Author(s):  
Vicky Booth ◽  
Rowan Harwood ◽  
Jennie E Hancox ◽  
Victoria Hood-Moore ◽  
Tahir Masud ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Exercise Intervention ◽  
Data Extraction ◽  
Realist Review ◽  
Falls Prevention ◽  
Cochrane Library ◽  
Programme Theory ◽  
Eligibility Criteria ◽  
Prevention Programmes

ObjectivesThis review aimed to identify mechanisms underlying participation in falls prevention interventions, in older adults with cognitive impairment. In particular we studied the role of motivation.DesignA realist review of the literature.Data sourcesEMBASE, MEDLINE, CINAHL, the Cochrane Library, PsycINFO and PEDRO.Eligibility criteriaPublications reporting exercise-based interventions for people with cognitive impairment, including dementia, living in the community.Data extraction and synthesisA ‘rough programme theory’ (a preliminary model of how an intervention works) was developed, tested against findings from the published literature and refined. Data were collected according to elements of the programme theory and not isolated to outcomes. Motivation emerged as a key element, and was prioritised for further study.ResultsAn individual will access mechanisms to support participation when they think that exercise will be beneficial to them. Supportive mechanisms include having a ‘gate-keeper’, such as a carer or therapist, who shares responsibility for the perception of exercise as beneficial. Lack of access to support decreases adherence and participation in exercise. Motivational mechanisms were particularly relevant for older adults with mild-to-moderate dementia, where the exercise intervention was multicomponent, in a preferred setting, at the correct intensity and level of progression, correctly supported and considered, and flexibly delivered.ConclusionMotivation is a key element enabling participation in exercise-based interventions for people with cognitive impairment. Many of the mechanisms identified in this review have parallels in motivational theory. Clinically relevant recommendations were derived and will be used to further develop and test a motivationally considered exercise-based falls intervention for people with mild dementia.PROSPERO registration numberCRD42015030169.

scholarly journals Improving best practice for patients receiving hospital discharge letters: a realist review

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e027588 ◽  
Author(s):  
Katharine Weetman ◽  
Geoff Wong ◽  
Emma Scott ◽  
Eilidh MacKenzie ◽  
Stephanie Schnurr ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Best Practice ◽  
Data Extraction ◽  
Realist Review ◽  
Patient Choice ◽  
Programme Theory ◽  
Eligibility Criteria ◽  
New Information ◽  
Starting Point ◽  
Outpatient Settings

ObjectiveTo understand how different outcomes are achieved from adult patients receiving hospital discharge letters from inpatient and outpatient settings.DesignRealist review conducted in six main steps: (1) development of initial theory, (2) searching, (3) screening and selection, (4) data extraction and analysis, (5) data synthesis and (6) programme theory (PT) refinement.Eligibility criteriaDocuments reporting evidence that met criteria for relevance to the PT. Documents relating solely to mental health or children aged <18 years were excluded.AnalysisData were extracted and analysed using a realist logic of analysis. Texts were coded for concepts relating to context, mechanism, outcome configurations (CMOCs) for the intervention of patients receiving discharge letters. All outcomes were considered. Based on evidence and our judgement, CMOCs were labelled ‘positive’ or ‘negative’ in order to clearly distinguish between contexts where the intervention does and does not work.Results3113 documents were screened and 103 were included. Stakeholders contributed to refining the PT in step 6. The final PT included 48 CMOCs for how outcomes are affected by patients receiving discharge letters. ‘Patient choice’ emerged as a key influencer to the success (or not) of the intervention. Important contexts were identified for both ‘positive’ CMOCs (eg, no new information in letter) and ‘negative’ CMOCs (eg, letter sent without verifying patient contact details). Two key findings were that patient understanding is possibly greater than clinicians perceive, and that patients tend to express strong preference for receiving letters. Clinician concerns emerged as a barrier to wider sharing of discharge letters with patients, which may need to be addressed through organisational policies and direction.ConclusionsThis review forms a starting point for explaining outcomes associated with whether or not patients receive discharge letters. It suggests several ways in which current processes might be modified to support improved practice and patient experience.

scholarly journals Nurse practitioner’s perceptions of the impact of the nurse practitioner-led clinic model on the quality of care of complex patients

2018 ◽  
Vol 19 (6) ◽  
pp. 553-560 ◽  
Author(s):  
Roberta Heale ◽  
Susan James ◽  
Elizabeth Wenghofer ◽  
Marie-Luce Garceau
Keyword(s):  
Quality Of Care ◽  
Patient Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Primary Healthcare ◽  
Primary Care Providers ◽  
Clinical Issues ◽  
Recruitment And Retention ◽  
Interprofessional Team

AimTo evaluate the organizational processes that influence the quality of care for patients with multimorbidity at nurse practitioner-led clinics (NPLCs).BackgroundPeople are living longer, most with one or more chronic diseases (mulitmorbidity) and primary healthcare for these patients has become increasingly complex. One response was the establishment of new models of primary healthcare. NPLCs are an example of a model developed in Ontario, Canada, which feature nurse practitioners as the primary care providers practicing within an interprofessional team. Evaluation of the extent to which the processes within NPLC model addressed the needs of patients with multimorbidity is warranted.MethodsEight nurse practitioners were interviewed to determine their perception of the quality of care provided to patients with multimorbidity at NPLCs. Interpretive description guided the analysis and themes were identified.FindingsThree themes arose from the analysis, each of which has an impact on the quality of care. The level of patient vulnerability at the NPLCs was high resulting in the need to address social and financial issues before the care of chronic conditions. Dynamics within the interprofessional team impacted the quality of patient care, including NP recruitment and retention, leaves of absence and turnover in staff at the NPLCs had an effect on interprofessional team functioning and patient care. Finally, coordination of care at the NPLCs, such as length of appointments, determined the extent to which attention was given to individual clinical issues was a factor. Strategies to address social determinants of health and for recruitment and retention of NPs is essential for improved quality of care. Comprehensive orientation to the interprofessional team as well as flexibility in care processes may also have positive effects on the quality of care of patients with complex clinical issues.

scholarly journals Cost-effectiveness of nurse practitioners in primary and specialised ambulatory care: systematic review

2021 ◽  
Author(s):  
Ruth Martin-Misener ◽  
Patricia Harbman ◽  
Faith Donald ◽  
Kim Reid ◽  
Kelley Kilpatrick ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
Usual Care ◽  
Ambulatory Care ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Randomised Controlled Trials ◽  
Controlled Trials ◽  
Randomised Controlled

Objective: To determine the cost-effectiveness of nurse practitioners delivering primary and specialised ambulatory care. Design: A systematic review of randomised controlled trials reported since 1980. Data sources: 10 electronic bibliographic databases, handsearches, contact with authors, bibliographies and websites. Included studies: Randomised controlled trials that evaluated nurse practitioners in alternative and complementary ambulatory care roles and reported health system outcomes. Results: 11 trials were included. In four trials of alternative provider ambulatory primary care roles,nurse practitioners were equivalent to physicians in all but care roles,nurse practitioners were equivalent to physicians in all but seven patient outcomes favouring nurse practitioner care and in all but four health system outcomes, one favouring nurse practitioner care and three favouring physician care. In a meta-analysis of two studies (2689 patients) with minimal heterogeneity and high-quality evidence, nurse practitioner care resulted in lower mean health services costs per consultation (mean difference: −€6.41; 95% CI −€9.28 to −€3.55; p<0.0001) (2006 euros). In two trials of alternative provider specialised ambulatory care roles, nurse practitioners were equivalent to physicians in all but three patient outcomes and one health system outcome favouring nurse practitioner care. In five trials of complementary provider specialised ambulatory care roles, 16 patient/provider outcomes favouring nurse practitioner plus usual care, and 16 were equivalent. Two health system outcomes favoured nurse practitioner plus usual care, four favoured usual care and 14 were equivalent. Four studies of complementary specialised ambulatory care compared costs, but only one assessed costs and outcomes jointly. Conclusions: Nurse practitioners in alternative provider ambulatory primary care roles have equivalent or better patient outcomes than comparators and are potentially cost-saving. Evidence for their cost-effectiveness in alternative provider specialised ambulatory care roles is promising, but limited by the few studies. While some evidence indicates nurse practitioners in complementary specialised ambulatory care roles improve patient outcomes, their cost-effectiveness requires further study.

Monitoring and Investigating Certified Registered Nurse Practitioners in Pain Management

2003 ◽  
Vol 31 (1) ◽  
pp. 12-14
Author(s):  
Jean B. Lazarus ◽  
Belinda (Wendy) Downing
Keyword(s):  
Pain Management ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Registered Nurse ◽  
Controlled Substances ◽  
Prescriptive Authority ◽  
Pain Medications ◽  
Certified Registered Nurse ◽  
Improve Patient

Nurses are on the front lines of pain management, yet in Alabama and eleven other states they are not legally authorized to prescribe any controlled pain medications. In this survey of certified registered nurse practitioners in Alabama, 83 percent of the nurses responding to a question about the connection between prescriptive authority and pain management said that the lack of prescriptive authority for controlled substances delays pain management treatment, and 88 percent of those proffering an opinion about the importance of prescriptive authority said that expanding their prescriptive authority to include those medications would improve patient outcomes.At the same time, however, many nurses indicated that they are not adequately prepared to prescribe and manage pain medications. Fifty-five percent of the nurses responding to a question about whether they were prepared to make decisions when working under protocols related to controlled substances answered no. And 44 percent of the respondents to a question about the nurse practitioner educational curricula said that they did not feel their education had adequately prepared them for prescribing controlled pain medications.

scholarly journals Patient safety culture in a district hospital in South Africa: An issue of quality

Curationis ◽  
2015 ◽  
Vol 38 (1) ◽  
Author(s):  
Lorraine M. Mayeng ◽  
Jacqueline E. Wolvaardt
Keyword(s):  
Patient Safety ◽  
Patient Care ◽  
Nurse Practitioners ◽  
Safety Culture ◽  
Health Professionals ◽  
District Hospital ◽  
Patient Safety Culture ◽  
Safety Issues ◽  
Quality Patient Care ◽  
Quality Dimensions

Background: The Nursing Act 33 of 2005 holds nurse practitioners responsible for all acts and omissions in the delivery of quality patient care. But quality patient care is influenced by a number of factors beyond the control of nurse practitioners. Patient safety culture is one such factor and is seldom explored in hospitals in developing countries. This article describes the patient safety culture of a district hospital in South Africa.Objectives: The study identified and analysed the factors that influence the patient safety culture by using the Manchester Patient Safety Framework at the National District Hospital, Bloemfontein, Free State Province.Method: A descriptive cross-sectional study was conducted and included the total population of permanent staff; community service health professionals; temporarily employed health professionals and volunteers. The standard Manchester Patient Safety Framework questionnaire was distributed with a response rate of 61%.Results: Less than half of the respondents (42.4%; n = 61) graded their units as acceptable. Several quality dimensions were statistically significant for the employment profile: overall commitment to quality (p = 0.001); investigating patient incidents (p = 0.031); organisational learning following incidents (p < 0.001); communication around safety issues (p = 0.001); and team working around safety issues (p = 0.005). These same quality dimensions were also statistically significant for the professional profiles. Medical doctors had negative perceptions of all the safety dimensions.Conclusion: The research measured and described patient safety culture (PSC) amongst the staff at the National District Hospital (NDH). This research has identified the perceived inadequacies with PSC and gives nurse managers a clear mandate to implement change to ensure a PSC that fosters quality patient care.

scholarly journals Quality care process metrics (QCP-Ms) in nursing and midwifery care processes: a rapid realist review (RRR) protocol

2021 ◽  
Vol 3 ◽  
pp. 85
Author(s):  
Laserina O'Connor ◽  
Alice Coffey ◽  
Veronica Lambert ◽  
Mary Casey ◽  
Martin McNamara ◽  
...  
Keyword(s):  
Data Extraction ◽  
Quality Care ◽  
Realist Review ◽  
Care Process ◽  
Programme Theory ◽  
Ethical Approval ◽  
Local Reference ◽  
Process Metrics ◽  
Health Nursing ◽  
Rapid Realist Review

Background: In 2018, the Office of the Nursing and Midwifery Services Director (ONMSD) completed phase one of work which culminated in the development and launch of seven research reports with defined suites of quality care process metrics (QCP-Ms) and respective indicators for the practice areas – acute care, midwifery, children’s, public health nursing, older persons, mental health and intellectual disability nursing in Ireland. This paper presents a rapid realist review protocol that will systematically review the literature that examines QCP-Ms in practice; what worked, or did not work for whom, in what contexts, to what extent, how and why? Methods: The review will explore if there are benefits of using the QCP-Ms and what are the contexts in which these mechanisms are triggered. The essence of this rapid realist review is to ascertain how a change in context generates a particular mechanism that produces specific outcomes. A number of steps will occur including locating existing theories on implementation of quality care metrics, searching the evidence, selecting relevant documents, data extraction, validation of findings, synthesising and refining programme theory. This strategy may help to describe potential consequences resulting from changes in context and their interactions with mechanisms. Initial theories will be refined throughout the process by the local reference panel, comprised of eight key intervention stakeholders, knowledge users such as healthcare professionals and an expert panel. Ethical approval is not required for this rapid realist review. Conclusion: It is anticipated that the final programme theory will help to explain how QCP-Ms work in practice; for whom, why and in what circumstances. Findings of this review could help to give insights into the use of a rapid realist review as a framework and how nursing and midwifery QCP-Ms have been implemented previously.

Leader empowering behaviour: relationships with nurse and patient outcomes

2020 ◽  
Vol 33 (4) ◽  
pp. 397-415
Author(s):  
Karen Cziraki ◽  
Carol Wong ◽  
Michael Kerr ◽  
Joan Finegan
Keyword(s):  
Patient Care ◽  
Performance Management ◽  
Patient Outcomes ◽  
Turnover Intentions ◽  
Interprofessional Collaboration ◽  
Job Turnover ◽  
Content Type ◽  
Experienced Nurses ◽  
Quality Patient Care ◽  
The Impact

Purpose This study aims to test a model examining the impact of leader empowering behaviour on experienced nurses’ self-efficacy, interprofessional collaboration, job turnover intentions and adverse patient outcomes. Design/methodology/approach Structural equation modelling in Mplus was used to analyse cross-sectional survey data from experienced nurses in Alberta, Ontario, and Nova Scotia, Canada (n = 478). Findings The results supported the hypothesized model: (164) = 333.021, p = 0.000; RMSEA = 0.047; CFI = 0.965; TLI = 0.959; SRMR = 0.051. Indirect effects were observed between leader empowering behaviour and nurses’ assessment of adverse events and leader empowering behaviour and nurses’ job turnover intentions through interprofessional collaboration. Research limitations/implications Leader empowering behaviour plays a role in creating collaborative conditions that support quality patient care and the retention of experienced nurses. Practical implications The findings will be of interest to academic and hospital leaders as they consider strategies to retain experienced nurses, such as nurse manager selection, development and performance management systems. Originality/value The influx of new graduate nurses to the nursing profession and changing models of care requires the retention of experienced nurses in the workforce. The findings suggest that leader empowering behaviour and interprofessional collaboration are important factors in supporting quality patient care and stabilizing the nursing workforce.

Nursing and Patient Outcomes: It's Time for Healthcare Leadership to Respond

2005 ◽  
Vol 18 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Wendy Nicklin ◽  
Elan Graves
Keyword(s):  
Patient Care ◽  
Patient Outcomes ◽  
Morbidity And Mortality ◽  
High Quality ◽  
Healthcare Leadership ◽  
Skill Mix ◽  
Staffing Ratios ◽  
Quality Patient Care ◽  
Healthcare Leaders

An increasing body of research confirms the link between nursing variables (e.g. staffing ratios, skill mix) and patient outcomes including morbidity and mortality. This article presents the key themes that have emerged in this research and translates them into action for senior healthcare leaders. Immediate action is required in order for hospitals to effectively recruit and retain nurses, and to provide high quality patient care that minimizes risk.

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