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Investing in advanced nursing roles (AN) in social care is a strategic priority to address workforce challenges, create new career pathways, improve outcomes and future-proof the sector. However, there is limited understanding of these roles globally. This systematic scoping review maps the international presence and impact of post-qualification advanced practice roles for registered nurses (RNs) working in care homes and charitable organisations.
This review was conducted following the methodology established by the JBI and adhered to the PRISMA extension for scoping reviews checklist.
Studies were included if (1) they included RNs working in care homes, charities or not-for-profit health centres, (2) the RN was in a specialist, enhanced or advanced practice role and (3) if role details were provided. Studies were limited to those published in the English language between 2014 and 2024. Evidence was gathered from a comprehensive search of electronic databases (CINAHL, MEDLINE, Scopus, PubMed and Web of Science), grey literature, relevant webpages, and reference lists. Expert consultations were also conducted. Eligible full texts were reviewed in Covidence software by two independent researchers.
The search yielded 575 records, and 89 were taken forward for full-text screening. A total of 20 met the inclusion criteria: 19 were concerned with AN roles in care homes, and one focused on a charitable organisation. The majority of these studies (n = 12) were conducted in North America.
The literature on AN roles in care homes and charitable organisations is notably sparse. Despite this, the available evidence highlights substantial benefits, including improved care quality, enhanced resident outcomes and positive impacts on team dynamics. This review identifies four key themes: scope of practice, positive impacts, influencing factors and barriers, which provide a framework for policymakers, healthcare leaders and educators to optimise the contributions of this group within the evolving global social care sector.
Not undertaken because of the nature of scoping reviews.
This review highlights the crucial role of advanced nurses in enhancing care quality, resident outcomes, and workforce sustainability in care homes and charitable organisations. The findings provide direction for policymakers and health and social care leaders to further develop the role of nursing in social care settings globally.
Ankle Brachial Pressure Index (ABPI) measurement has long been considered the gold standard of vascular assessment for people with lower limb ulceration. Despite this, only around 15% of patients in the United Kingdom who require an ABPI measurement undergo the assessment. The Lanarkshire Oximetry Index (LOI) is a cheaper and arguably more accessible approach to vascular assessment and was initially proposed as an alternative to the ABPI in 2000. No synthesis of evidence related to the LOI has been performed since its introduction into the literature. Primary studies were sought to determine the clinimetric properties of the LOI and its level of agreement with ABPI assessments. Systematic searches of MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, BNI, ProQuest Health and Medicine, Science Direct, Google Scholar and the British Library (online search) were conducted. Reference lists of identified studies were also reviewed to identify additional studies. Three primary studies met the inclusion criteria, reporting data from 307 patients and 584 limbs assessed using both the LOI and ABPI. All three studies reported fair to moderate kappa values for interrater reliability (κ = 0.290–0.747) and statistically significant positive correlation coefficients (r = 0.37, p < 0.001 in two studies) between the LOI and ABPI. The combined data from the three studies indicated a sensitivity of 52% (41.78–62.1, 95% confidence interval [CI]) and specificity of 96.08% (93.4–97.9, 95% CI) for the LOI using the ABPI as a reference. Additional data are required to indicate the safety of the LOI in practice. Data are also required to determine if the LOI is more acceptable to clinicians compared to the ABPI and whether there are any barriers/enablers to its implementation in practice. Given the relatively low specificity of the LOI, it may be beneficial to combine measurement of the LOI with a subjective clinical risk assessment tool to improve the sensitivity of this alternative approach to vascular assessment.
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