Article

Advanced practice nurse outcomes 1990=2008: A systematic review

University of Maryland School of Nursing, Baltimore, MD, USA.
Nursing economic$ (Impact Factor: 0.84). 09/2011; 29(5):230-50; quiz 251.
Source: PubMed

ABSTRACT Advanced practice registered nurses have assumed an increasing role as providers in the health care system, particularly for underserved populations. The aim of this systematic review was to answer the following question: Compared to other providers (physicians or teams without APRNs) are APRN patient outcomes of care similar? This systematic review of published literature between 1990 and 2008 on care provided by APRNs indicates patient outcomes of care provided by nurse practitioners and certified nurse midwives in collaboration with physicians are similar to and in some ways better than care provided by physicians alone for the populations and in the settings included. Use of clinical nurse specialists in acute care settings can reduce length of stay and cost of care for hospitalized patients. These results extend what is known about APRN outcomes from previous reviews by assessing all types of APRNs over a span of 18 years, using a systematic process with intentionally broad inclusion of outcomes, patient populations, and settings. The results indicate APRNs provide effective and high-quality patient care, have an important role in improving the quality of patient care in the United States, and could help to address concerns about whether care provided by APRNs can safely augment the physician supply to support reform efforts aimed at expanding access to care.

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    • "This study noted better BP outcomes with nurse-led interventions than doctorled care (Clark et al 2011). Another recent systematic review reported equivalent BP control and glucose control, better lipid control, equivalent levels of patient satis faction and selfreported perceived levels of health between APNs and physicians (Newhouse et al 2011). In New Zealand, nurse prescribers were found to provide safe, effective and clinically appropriate medication management for diabetic patients, with overall improvement of long-term blood sugar controls without adverse events or hospitalisations (Wilkinson et al 2012). "
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    ABSTRACT: The massive scarcity of physicians in India, mainly in rural areas, prompted the Union Ministry of Health and Family Welfare to propose a three-and-a-half year Bachelor of Rural Health and Care degree designed exclusively to serve rural populations. The fierce opposition by powerful medical lobbies forced the proposal to fade away. This paper emphasises the importance of "task shifting" and "non-physician prescribing" in the global context and argues that non-physician healthcare providers would not only increase availability and accessibility to rural healthcare, but also provide an empowered second line of authority, adding to the checks and balances to the exploitative prestige-based hierarchy that pervades this knowledge-intensive service. T he world is facing severe shortage of healthcare profes-sionals on the face of the ever-increasing burden of non-communicable chronic morbidities. The World Health Organisation (WHO) estimates that 57 countries are experien-cing alarmingly low levels of trained health personnel. 1 While a few Asian countries have the required doctor-patient ratio per 1,000 (Japan 2.1, Korea 2, Singapore 1.8 and China 1.4), India has only 0.69 doctors/1,000. 2 WHO estimates that India cannot achieve the recommended target of "one doctor per 1,000 people" till 2028 (Sinha 2012a). India has two healthcare professionals per 1,000 people against the WHO's recommendation of 2.8/1,000. The fi gure drops to 1.4/1,000 on removing census errors from self-reporting of false qualifi cations. Lancet suggests that the Indian health force, if adjusted for qualifi cation gaps, may be only a quarter of WHO targets (Rao et al 2011). While India is short of six lakh doctors, 10 lakh nurses, and two lakh dental surgeons, 40,000 Indian doctors are serving 50% of the British population, and around 50,000 Indian doc-tors are working in the United States (US). About 20% and 10% doctors in Australia and Canada, respectively have received their MBBS degree from India. Reports suggest that 1,157 Indian doctors migrated abroad between April 2010 and March 2011 (Duttagupta 2012; Sinha 2012b). Mass migrations appear to be a problem shared by developing nations as a whole; for instance, WHO reports that 34% of Zimbabwean nurses and 29% of Ghana's physicians are working abroad (Hooper 2008). More importantly, rural India, with 70% of the population, has only 0.39 doctors/1,000 people against 1.33 for urban. Of the available 6,77,000 doctors, 70% work in urban health-settings (Rao et al 2011). This uneven rural-urban distribution is worsened by a "prestige-based hierarchy" in which physi-cians dominate and undermine the potential contributions from non-physician healthcare professionals.
    Economic and political weekly 03/2013; XLVIII(13):112-117.
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    • "The volume of peer-reviewed literature relating to APN is vast (Thoun 2011). The scope of this body of work over recent years attests to the importance that APN service has to contemporary health care and also the extent to which researchers and writers are seeking to progress and refine knowledge about this evolving level of nursing service and the influence on patient outcomes (Newhouse et al. 2011). There is also a consistent theme in the international literature that APN as a description of a level and role in nursing service is ambiguous, lacks universal understanding, and is variously defined (Lloyd Jones 2005, Currie et al. 2007, Lowe et al. 2012). "
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    ABSTRACT: AIMS: To test a model that delineates advanced practice nursing from the practice profile of other nursing roles and titles. BACKGROUND: There is extensive literature on advanced practice reporting the importance of this level of nursing to contemporary health service and patient outcomes. Literature also reports confusion and ambiguity associated with advanced practice nursing. Several countries have regulation and delineation for the nurse practitioner, but there is less clarity in definition and service focus of other advanced practice nursing roles. DESIGN: A statewide survey. METHODS: Using the modified Strong Model of Advanced Practice Role Delineation tool, a survey was conducted in 2009 with a random sample of registered nurses/midwives from government facilities in Queensland, Australia. Analysis of variance compared total and subscale scores across groups according to grade. Linear, stepwise multiple regression analysis examined factors influencing advanced practice nursing activities across all domains. RESULTS: There were important differences according to grade in mean scores for total activities in all domains of advanced practice nursing. Nurses working in advanced practice roles (excluding nurse practitioners) performed more activities across most advanced practice domains. Regression analysis indicated that working in clinical advanced practice nursing roles with higher levels of education were strong predictors of advanced practice activities overall. CONCLUSION: Essential and appropriate use of advanced practice nurses requires clarity in defining roles and practice levels. This research delineated nursing work according to grade and level of practice, further validating the tool for the Queensland context and providing operational information for assigning innovative nursing service.
    Journal of Advanced Nursing 11/2012; 69(9). DOI:10.1111/jan.12054 · 1.69 Impact Factor
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