Roberta Heale

An international perspective of advanced practice nursing regulation.

BACKGROUND There is no common understanding about the role of the advanced practice nurse across the globe and there is wide variation in the regulation of advanced practice nursing roles as well as their educational, licensing and credentialing requirements. AIM The goal of this research was to examine the status of advanced practice nursing regulation globally. METHODS An online survey link was emailed to National Nursing Associations and nursing health policy makers worldwide from June to December 2011. Questions focused on regulation, education, scope of practice, and barriers and opposition. Analysis included frequency statistics and descriptive data for survey questions and content analysis for two open-ended questions. LIMITATIONS The survey was offered online and only in English. Therefore, technology and language barriers may have influenced the results. RESULTS There is wide variation in educational requirements, regulation and scope of practice of advanced practice nurses. The barriers to advanced practice nursing are often linked to the status of legislation and credentialing in specific jurisdictions. CONCLUSION A database of advanced practice nursing regulation and issues related to practice has the potential to become a valuable resource for individual countries. IMPLICATIONS FOR NURSING AND HEALTH POLICY Each country has unique challenges related to health policy for advanced practice nursing roles. International nursing organizations have established programmes for regulation development; however, a stronger focus on monitoring regulation and more effective dissemination of information about available supports may have a bigger impact on the development and revision of health policy related to advanced practice nursing.

Understanding triangulation in research

The term ‘triangulation’ originates in the field of navigation where a location is determined by using the angles from two known points.1 Triangulation in research is the use of more than one approach to researching a question. The objective is to increase confidence in the findings through the confirmation of a proposition using two or more independent measures.2 The combination of findings from two or more rigorous approaches provides a more comprehensive picture of the results than either approach could do alone.3 Triangulation is typically associated with research methods and designs. However, there are several other variations on the term. Triangulation may be the use of multiple theories, data sources, methods …

Self‐efficacy with application to adolescent smoking cessation: a concept analysis

AIM This paper is a report of a concept analysis of adolescent smoking cessation self-efficacy. BACKGROUND Smoking cessation is a key preventive care/health promotion strategy offered by nurses worldwide. Most programming is tailored to adults although the reasons for smoking, along with coping strategies, resources and developmental stage, differ in adolescence. Understanding of the concept of self-efficacy as it relates to the adolescent population will assist nurses in addressing smoking cessation behaviours with this population. DATA SOURCES The CINAHL and Proquest Nursing databases were searched for papers published between 1977 and 2007 using the keywords self-efficacy, adolescents and smoking cessation. The Walker and Avant method of concept analysis was applied. FINDINGS Adolescent smoking cessation self-efficacy is the confidence, perceived capacity and perceived ability that the teen possesses to quit smoking. Identified antecedents include developmental stage, past life support, emotional support, coping strategies, resources and emotional status. Consequences are smoking cessation: positive or negative. Empirical measures are identified. CONCLUSION Levels of self-efficacy have been shown to be an important consideration in the approach of nurses to smoking cessation counselling with the adolescent client. The theoretical definition for this concept will provide the basis for nurses to design appropriate interventions for use in smoking cessation programmes targeted to adolescents. This definition identifies the key attributes of this concept that should be addressed when caring for this population.

Overcoming barriers to practice: A nurse practitioner‐led model

Purpose: Nurse practitioners (NPs) in Ontario, Canada, experience many barriers to practice that negatively influence their ability to increase access to comprehensive primary healthcare services. A NP‐Led Clinic Model has helped to overcome many of the barriers and has had a real impact on access to care. Data sources: Legislative and regulatory documents from the government of Ontario were reviewed. Reflection upon the barriers to NP practice in Ontario and the positive impact of the new model of care is presented. Conclusions: NPs with a voice in the governance and operations of a workplace have the potential to reduce barriers to practice. Implications for practice: Lessons for NPs internationally can be learned from the experience of the Ontario NP‐Led Clinic Model.Abstract  Purpose: Nurse practitioners (NPs) in Ontario, Canada, experience many barriers to practice that negatively influence their ability to increase access to comprehensive primary healthcare services. A NP-Led Clinic Model has helped to overcome many of the barriers and has had a real impact on access to care. Data sources: Legislative and regulatory documents from the government of Ontario were reviewed. Reflection upon the barriers to NP practice in Ontario and the positive impact of the new model of care is presented. Conclusions: NPs with a voice in the governance and operations of a workplace have the potential to reduce barriers to practice. Implications for practice: Lessons for NPs internationally can be learned from the experience of the Ontario NP-Led Clinic Model.

Nurse practitioners' perceptions of interprofessional team functioning with implications for nurse managers.

AIMS To determine the perceptions of nurse practitioners (NPs) about the level of functioning of their interprofessional teams. BACKGROUND Interprofessional teams are a global trend, and nurses play leadership roles in their management. Little is known about the impact of specific barriers to team functioning and the role of the nurse manager on team functioning. METHODS Ninety-eight NPs at a conference completed the Interprofessional Team Functioning Survey (ITFS). RESULTS The survey items with the lowest mean scores were related to organisational systems. These items included workplace policies that support interprofessional teamwork, in particular, orientation to the interprofessional team. Items that generated lower mean scores were adequate time to work as a member of the interprofessional team, team dynamics, collaboration among team members and the sharing of responsibility. CONCLUSION Organisational and team relational issues can be addressed through organisational management strategies. Nurse managers have an important role in facilitating high functioning interprofessional teams. IMPLICATIONS FOR NURSING MANAGEMENT Strategies for managers to support interprofessional team functioning emerged. These strategies include ensuring that there are appropriate policies, orientation of new members, allocation of time to support interprofessional teamwork, leadership to enhance team collaboration and clear delineation of responsibilities of each member.

Incorporating a Health Policy Practicum in a Graduate Training Program to Prepare Advanced Practice Nursing Health Services Researchers

Health services research benefits from the active engagement of researchers and policy makers from generation through to application of research-based knowledge. One approach to help graduate students learn about the policy world is through participation in a policy practicum. This is an opportunity to work for a defined period of time in a setting where policy decisions are made. This article focuses on the integration of the policy practicum into graduate nursing education for advanced practice nurses. Ten graduate students and two postdoctoral fellows who had recently completed their practicums and three policy makers who had recently supervised students in provincial, federal, and international practicum projects were invited to submit a narrative about the experience. Based on qualitative analysis of the narratives, this article outlines objectives of the practicum, the policy practicum journey, student learning, and finally, the benefits and challenges of the experience.

A group intervention for parents and children achieved greater weight loss in obese children than routine care.

M O Korppi Dr M O Korppi, Tampere University, Tampere, Finland; matti.korppi@uti.fi Is a group intervention for parents and children more effective than routine care for weight loss in obese school-age children? ### Design: randomised controlled trial. ### Allocation: concealed. ### Blinding: unblinded. ### Follow-up period: 6 months after the end of the intervention. ### Setting: schools and a university hospital paediatric outpatient clinic in Kuopio and area, Finland. ### Patients: families with an obese child 7–9 years of age (mean age 8 y, 60% girls) who attended school and had weight-for-height 120–200% (mean 142%, population mean 100%). Exclusion criteria included obesity because of disease or medication, movement disorder, mental disorder in child or parent, and family member participation in another weight management …

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

AimTo evaluate the organizational processes that influence the quality of care for patients with multimorbidity at nurse practitioner-led clinics (NPLCs). BACKGROUND: People 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. METHODS: Eight 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.

Characteristics of Nurse Practitioner Practice in Family Health Teams in Ontario, Canada

Nurse practitioners (NPs) in Ontario work in a number of settings, including physician-led, interprofessional Family Health Teams (FHTs). However, many aspects of NP practice within the FHTs are unknown. Our study aimed to describe the characteristics of NP practice in FHTs and the relationships between NPs and physicians within this model. This cross-sectional descriptive study analyzed NP service and diagnostic code data collected for every NP patient encounter from 2012 to 2015. Encounter data were linked to health administrative data housed at the Institute for Clinical Evaluative Sciences to allow for comparison with physician service and diagnostic codes. Findings demonstrated that NPs saw patients across all age groups for one to more than five problems per encounter and that NPs handled both acute and episodic care and chronic disease management issues. Patients with chronic conditions had more encounters with physicians than with NPs. In addition, compared to physicians, NPs saw more female than male patients. Our findings provide a snapshot of NP practice in FHTs and may be useful in informing other practice models in Ontario, elsewhere in Canada, and internationally. More evidence is needed, however, to clarify the responsibilities of the NPs in collaborative relationships with physicians and to embed policies that will ensure that NPs work to their full potential. In addition, applying service coding to all health care providers in FHTs could enhance data on interprofessional teams and the individual clinicians that comprise them.

Exploring Self-Perceptions of Anxiety among Nursing Students in the Clinical Setting and Select Demographics

Abstract Clinical learning experiences are essential in nursing education but they are often anxiety provoking for learners. Understanding the factors associated with the anxiety levels of nursing students in clinical placements has become more complex over the years with increasing heterogeneity within the nursing population. A correlational study was conducted to examine the relationships between nursing students’ self-perceived anxiety levels, as measured by the State-Trait Anxiety Inventory (STAI), and the students’ age, gender, previous employment, and previous education. The findings revealed that nursing students have a higher than average level of anxiety and that male nursing students reported higher levels of anxiety compared to female nursing students. No significant correlations were found between age, previous education, previous employment, and self-perceived anxiety levels. Findings from this study provide an opportunity for discussion by nursing educators and identify a need for future research and practice.