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To investigate factors influencing the implementation of advanced practice nursing roles within healthcare organisations in seven European countries from the perspective of advanced practice nurses.
A cross-sectional survey was conducted between September 2021 and December 2022, involving advanced practice nurses from Belgium, Finland, Germany, Iceland, Ireland, Spain and the Netherlands. The countries were selected to represent different stages of implementing advanced practice nursing roles, from emerging to well-established.
A self-administered questionnaire was used to address five domains: patient care, practice patterns, policy and legal, educational and workforce-related factors. Descriptive statistics, chi-squared tests and correspondence analysis were employed to identify patterns and country-specific differences across these domains of implementation factors.
A total of 491 advanced practice nurses participated in the study. While almost three-quarters of the participants indicated satisfaction with their job, the study highlighted multifaceted factors influencing the implementation of advanced practice nursing roles across countries. The Netherlands, Ireland and Belgium reported mainly facilitators, whereas Finland, Iceland and Germany noted barriers or a lack of knowledge. Spain mostly reported neutral or moderate positions. Key challenges included role ambiguity, interprofessional collaboration gaps, limited managerial support, workload imbalances, limited mentorship and underutilised competencies. Results also indicated that advanced practice nurses are partially hindered by operating in isolation from other professions.
The findings emphasise the need for robust organisational support, interprofessional collaboration and clear role definitions to facilitate the integration of advanced practice nursing roles. Addressing professional isolation through networking and mentorship is crucial to sustaining the advanced practice nursing workforce.
Policy should prioritise support for advanced practice nursing, including structured mentoring and networking opportunities. Further research on advanced practice nurses' well-being and long-term role sustainability in Europe is recommended.
What problem did the study address? What were the main findings? Where and on whom will the research have an impact?
This study reported factors influencing advanced practice nurse role implementation across seven European countries with different levels of role development. Key challenges included role ambiguity, interprofessional collaboration gaps and limited support. The findings can guide healthcare managers and policymakers on the key factors to consider when integrating advanced practice nursing roles into their teams.
To explore the prescribing practices and behaviours of Advanced Practice Nurses (APN) and pharmacist prescribers in Singapore, assess their confidence in key prescribing competencies, examine their use of information sources, and understand their views on the consequences of prescribing errors.
Cross-sectional national survey.
A census survey of all registered APN and pharmacist prescribers in Singapore was conducted from February to May 2024 using a validated 96-item instrument. The survey assessed prescribing practices, confidence in prescribing competencies, use of information sources, and prescribing safety. Descriptive statistics were used for analysis.
Ninety-one prescribers (54 APNs, 37 pharmacists) responded (32% response rate), most of whom worked in public medical/surgical settings. Prescribing comprised a median of 75% of their practice. Most time was spent prescribing continued medications, with less on initiating new medicines. Participants reported high confidence in communication, therapeutic partnerships, and working within professional standards. Greatest confidence was seen in educating patients, legal prescribing, and monitoring treatment response. Lower confidence was noted in complementary medicine-related tasks. Professional literature and colleagues were the most valued information sources. Most participants acknowledged the serious consequences of prescribing errors, though many believed such errors would likely be intercepted.
APNs and pharmacists demonstrate strong competencies in safe, holistic prescribing. However, cultural factors may limit patient engagement, highlighting the need to strengthen shared decision-making and collaborative practice.
Refining governance structures, adopting tiered prescriber autonomy, and enhancing training in complex prescribing are essential. Standardising deprescribing, improving access to decision-support tools, and promoting interprofessional collaboration and patient involvement can strengthen care quality and team-based delivery.
This study offers the first national insight into Singapore's Collaborative Prescribing Framework and informs training, policy, and workforce development for non-physician prescribers locally and in similar international contexts.
STROBE checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
Hospital falls and associated injuries are a global issue associated with harm and significant costs to individuals and society, especially for older adults. Hospital standards specify the minimum level of care required to optimise patient safety, quality and outcomes. Standards are often used during hospital accreditation. This investigation analysed the content and quality of hospital falls standards across the globe.
Hospital standards were located by searching online databases (PubMed, CINAHL, Google Scholar, MEDLINE), ChatGPT, the grey literature via internet search engines, and websites of accreditation agencies, government agencies, and other relevant organisations. We searched for standards from the 60 largest countries by population plus the 60 countries with the highest gross domestic product (n = 82 after accounting for duplicates). For inclusion, hospital standards had to mention ‘fall/s’. Data were analysed using a deductive framework synthesis and content analysis to identify emergent themes.
Forty-one standards used by at least 72 countries were identified from our search. Sixteen were excluded from detailed analysis because they did not mention falls and 3 could not be retrieved. A total of 22 standards were included in the final detailed analysis. Included standards showed wide variations in content and quality. Seven were assessed as high quality, 12 medium quality, and 3 were deemed to be of low quality. Some lacked details on hospital falls screening, assessment, prevention, and management. Consumer engagement in development, implementation, or evaluation was not mentioned in all standards. Procedures for falls data collection and reporting were seldom documented. Hospital standards infrequently referred readers to contemporary research or clinical practice guidelines.
There are variations in the quality and content of standards on hospital falls. International collaboration is recommended to increase the consistency and validity of hospital falls standards across nations, in order to optimise healthcare outcomes.
The findings of this global analysis of hospital falls standards have the potential to impact falls rates and fall-related injuries in hospital patients by providing data to inform the content, evidence base and use of hospital standards to optimise the safety and quality of care delivery. The findings inform the review, design and implementation of hospital accreditation procedures to improve patient outcomes, patient experiences, and service quality.
by Sizophila Gwala, Nompumelelo Mtshali, Sithembile Nene, Casey Stanley, Luther Lebogang Monareng
BackgroundHand rehabilitation, particularly splinting, is a key area in occupational therapy. However, existing literature suggests that students often feel inadequately prepared, particularly concerning splinting in hand rehabilitation. This highlights the need for further research and improvements. This research explored the perceptions held by undergraduate occupational therapy students regarding splinting in hand rehabilitation at the University of KwaZulu-Natal, with the aim of informing curriculum improvements. The novelty of this study lies in its focus on the University of KwaZulu-Natal, providing institution-specific insights that are currently underexplored in the literature, using Kolb’s Experiential Learning Theory, to contextualise this study.
MethodsThis qualitative study gathered data from 3rd and 4th year occupational therapy students at the University of KwaZulu-Natal using purposive sampling. The Consolidated Criteria for Reporting Qualitative Research (COREQ): a 32-item checklist for interviews and focus groups was followed. The data were collected through semi-structured interviews using a piloted question guide and thematic analysis was used to analyse the data. Ethical clearance was received for this research.
ResultsThis research comprised 16 participants: n = 5 males and n = 11 females, all of whom were undergraduates. The number of physical clinical fieldwork blocks completed by the participants ranged from two to three. The number of splints made during these blocks ranged from no splints to four or more. Four distinctive themes emerged: student readiness and preparedness, challenges in splinting, comparison of readiness in 3rd and 4th year, and suggested solutions to bridge the gaps.
ConclusionDespite acquiring theoretical knowledge, students felt underprepared and uncertain due to limited clinical opportunities, inadequate supervision, and minimal hands-on practice during fieldwork. This lack of confidence and competence may deter students from pursuing specialisation in hand rehabilitation. To address these gaps, students recommended strategies such as increasing practical time dedicated to splinting, introducing training earlier in the program, expanding the splinting curriculum to cover a broader range of splint types, and strengthening university support structures, which align with existing literature, that emphasises the crucial role of hands-on experience in fostering confidence and competence. These findings have implications for curriculum development and suggest the need for policy reforms prioritising clinical competency in undergraduate occupational therapy education.
To describe diagnostic categories and comorbidities associated with increased risk of readmission within 28 days among older adults.
Retrospective observational study of all hospital admissions following ED attendance by patients aged ≥ 60 years between July 2020 and June 2023. Index and subsequent 28-day readmission were identified using ED data and hospital discharge records. ED diagnosis, Australian Refined Diagnosis-Related Group (AR-DRG) discharge codes, and ICD-10-AM comorbidities were extracted. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations with 28-day readmission. The study and findings have been reported against the STROBE-RECORD guideline.
Of the 28,730 initial patient visits, 7.9% re-presented within 28 days. The most common ED diagnoses at initial and readmission were chest pain (5.4% vs. 4.6%), falls (5.2% vs. 4.1%), dyspnoea (3.5% vs. 3.1%), abdominal pain (3.1% vs. 3.3%) and cerebrovascular accident (1.7% vs. 1.7%). The most frequent AR-DRGs were respiratory infections/inflammations, kidney and urinary signs/symptoms, and other digestive system disorders. Key ICD-10-AM codes associated with a higher likelihood of readmission within 28 days were obstructive/reflux uropathy (OR 2.66, 95% CI 1.78–3.96), urinary retention (OR 1.84, 95% CI 1.38–2.46), chronic ischaemic heart disease (OR 1.57, 95% CI 1.10–2.25), delirium (OR 1.35, 95% CI 1.07–1.71) and disorders of fluid, electrolyte, and acid–base balance (OR 1.29, 95% CI 1.09–1.54).
Nearly 8% of older adults are readmitted within 28 days. Our described approach offers a potential framework to identify at-risk groups and intervene to reduce avoidable representations and/or admissions.
The results reported here create the opportunity for clinicians to identify areas for improvement in clinical practice, care coordination, and service delivery. Our approach and methodology can be replicated in other health services.
No patient or public contribution.
To synthesise current evidence on the development and implementation of quality care metrics for nurses working in general practice.
A Scoping review guided by Arksey and O'Malley's framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR).
Articles included peer-reviewed primary research, published in English between 1989 and 2024, reporting on the development, implementation and evaluation of quality care nursing metrics in general practice settings. EndNote was used for citation management, while Covidence facilitated screening and data extraction by four reviewers. The Donabedian model of quality care assessment (2005) and the WHO tool for primary care nurse competencies (2020) were used to synthesise the findings.
A systematic search of PubMed, CINAHL, EMBASE and Web of Science databases was conducted between June 2022 and June 2024. The search strategy was developed using Population, Concept and Context criteria, with keywords including ‘Nurse’, ‘General Practice’, ‘Metric’ and ‘Indicator.’
Eleven studies conducted between 2005 and 2024 met the inclusion criteria. Five studies focused on quality care indicators or measures, and six examined nurse competencies or standards of care.
Quality care metrics are underutilised in general practice. There is ambiguity in metric terminology and nursing roles, education and primary care systems. Quality care metrics must align with nursing values, with digital technology and leadership as core enablers.
Adoption of nursing metrics in general practice provides insights into nursing contributions to patient care. Standardising the definitions of nursing care metrics will enable valid and reliable comparisons.
Quality care nursing metrics will enable the nurse's role to be manifested in general practice settings in relation to patient outcomes.
PRISMA reporting guidelines have been adhered to.
Understanding of the role of the nurse in general practice will support improved quality, safety, policy and governance in general practice settings.
No patient or public contribution.
To verify the efficacy of virtual reality compared to tablet games for pain and anxiety management in children undergoing percutaneous bone pin and/or suture removal procedures.
Randomised clinical trial using two parallel groups: (1) virtual reality or (2) tablet game.
Three-center, randomised pragmatic clinical trial, using a parallel design with two groups (experimental group: immersive virtual reality; active comparator: tablet games). Children aged 6–17 requiring percutaneous pins and/or sutures were recruited between 2020 and 2022 from three outpatient orthopaedic clinics in paediatric hospitals. Pain was measured with the Numerical Rating Scale and anxiety with the Child Fear Scale before and immediately after the procedure.
A total of 188 participants were assigned to either the virtual reality group (96 participants) or the tablet group (92 participants). At the first assessment, there was no noticeable difference between the two groups in terms of pain or anxiety levels. However, further analysis revealed that participants aged 13 and older in the virtual reality group experienced significantly lower anxiety.
Virtual reality was not more efficacious than games on a tablet for pain and anxiety of children undergoing removal of bone pins or sutures. However, virtual reality demonstrated a benefit in reducing anxiety for teenagers, particularly those aged 13-older.
Virtual reality games provide an immersive, non-pharmacological alternative of for anxiety management of teenagers during pins and/or sutures removal.
This study showed that a virtual reality game may help reduce anxiety during pins and/or sutures removal procedures in patients aged 13 years and older.
We adhered to the CONSORT checklist for reporting results.
A patient partner reviewed the study design, methods and final manuscript.
NCT03680625
Suicide is a leading cause of death in the USA, and its incidence has increased substantially in recent years. Observational studies have used large, linked databases to investigate risk factors for suicide, but data generally originate from a small number of similar sources. Prevention efforts may be strengthened by linking data from diverse sources across multiple sectors. The New Opportunities for Health and Resilience Measures for Suicide Prevention project aims to develop a resource for characterising key risk and protective factors for suicide outcomes by linking state-level death records with county-level data from 12 administrative sources, including medical, legal and social service records, among others.
Administrative records of death, emergency medical services, emergency department syndromic surveillance, homelessness services, psychiatric crisis services, jail stays, domestic violence referrals and Medicaid/Medicare claims will be obtained through partnerships with source agencies. Death records are available for Washington State, while all other records are available for residents of King County, Washington. Temporal availability varies, but records generally cover the years 2014 to 2023. An iterative machine learning paradigm will be used to link individuals across different records, and events will be harmonised and deduplicated.
This study has been approved by the Washington State Institutional Review Board, and data sharing agreements have been established with each contributing data source. Descriptive information will be disseminated via public data dashboards of suicide and non-fatal suicide behaviours. Analytic studies will be disseminated in peer-reviewed scientific journal publications.
FreshRSS 