Denise Bryant-Lukosius

• McMaster University

Background Oncology outpatients experience high levels of distressing cancer-related symptoms. Nurses can provide high-quality outpatient cancer symptom management following clinical practice guideline recommendations; however, these guidelines are inconsistently used in practice. Understanding contextual factors influencing implementation is neces...

Purpose/Aims To describe clinical nurse specialist practice in Québec, Canada, and propose a dashboard to track role dimensions and outcomes. Design Sequential mixed-methods study across 6 sites in Québec (June 2021 to May 2022). Methods Phase 1: Focus groups (n = 8) and individual interviews (n = 3) were conducted to adapt a time and motion tool...

Objective: Understanding both the positive and negative psychological outcomes among cancer patients during the pandemic is critical for planning post-pandemic cancer care. This study (1) examined levels of psychological distress and post-traumatic growth (PTG) among Canadian cancer patients during the COVID-19 pandemic and (2) explored variables t...

Background Lack of access to health care is a worldwide public health crisis. In primary care it has led to increases in the implementation of nurse practitioners and heightened interest in their patient panel capacity. The aim of this study was to examine factors influencing nurse practitioner patient panel size in team-based primary care in Ontar...

Background Experience‐Based Co‐Design (EBCD) is a multi‐stage participatory action research process which was developed originally to increase patient involvement in service improvement initiatives. This viewpoint article serves as a reflection on the researchers' experiences, focusing on the application and feasibility of participatory approaches,...

Aim To identify the barriers and enablers to the implementation of a national policy to increase and develop the advanced nurse practitioner (ANP) workforce in Ireland. Background The Department of Health (Ireland) introduced a policy to increase the number of ANPs to 2% of the nursing workforce. Evaluation provides information to inform successfu...

Objectives: To examine the advanced practice nurse workforce in Swiss cancer care and how their roles are being implemented (eg, role structures, processes) to achieve optimal outcomes for patients and their families , care organizations, and the broader health care system. Methods: A cross-sectional study was conducted. The sample included master-...

This chapter highlights how advanced practice nurses (APN) are uniquely positioned to participate in research, quality improvement, and evidence-informed decision-making because of their extensive knowledge of population health needs, collaboration with nurses and other healthcare providers, and detailed understanding of healthcare organisations an...

Advanced practice nursing (APN) has developed over many decades, beginning in English speaking countries such as the USA, Canada, Australia, New Zealand, the UK, and the Republic of Ireland, it is now developing worldwide. Advance practice nursing describes the various roles and interventions carried out by advanced practice nurses to influence cli...

Background Women with ovarian or endometrial cancer experience multiple symptoms during chemotherapy. Specialized cancer nurses possess specific knowledge and competencies to effectively monitor and manage treatment-related toxicities and provide self-management support. Objective To describe the conception and development of a comprehensive cance...

Aim: To identify the factors that influence the time nurse practitioners (NPs) in primary care, home care and long-term care spend on activities in two Canadian provinces. Background: Little is known about how patient, provider, and organizational characteristics influence the time NPs spend when caring for patients in primary care. Methods: Time a...

Background: Lack of access to health care is a worldwide public health crisis. In primary care it has led to increases in the implementation of nurse practitioners and heightened interest in their patient panel capacity. The aim of this study was to examine factors influencing nurse practitioner patient panel size in team-based primary care in Onta...

Background Virtual nurse-led care models designed with health care professionals (HCPs) and patients may support addressing unmet prostate cancer (PCa) survivor needs. Within this context, we aimed to better understand the optimal design of a service model for a proposed nurse-led PCa follow-up care platform (Ned Nurse). Methods A qualitative desc...

When patients are discharged from the hospital and return home, they are at risk of adverse events if the continuity of care is broken. So far, the evidence for transitional care models to reduce readmission rates has focused mainly on patients with a single condition. Based on this observation, we identified the population that may benefit the mos...

Aim Identify and map international evidence regarding innovations led by or involving advanced practice nurses in response to COVID‐19. Background COVID‐19 necessitated unprecedented innovation in the organization and delivery of healthcare. Although advanced practice nurses have played a pivotal role during the pandemic, evidence of their contrib...

Aims The aims of the study were to describe the processes used to introduce advanced practice nursing roles and factors that facilitated or hindered role implementation, examine the time advanced practice nurses (APNs) spend in role activities and how these activities relate to domains of advanced practice nursing and examine how implementation pro...

Aim: To assess the extent to which Canadian undergraduate baccalaureate nursing programs have incorporated Canadian competencies for Registered Nurses in primary care into their curricula. Background: Canadian competencies for Registered Nurses in primary care have several benefits, including their ability to inform primary care education in und...

The retention of Canada's advanced practice nurses (APNs), including clinical nurse specialists and nurse practitioners, is a national health human resources issue. APNs are essential within the Canadian healthcare workforce for meeting patient and population health needs, often in underserved communities. A shortage of APNs will exacerbate barrier...

Background: Prostate cancer survivors (PCa) can experience a range of unmet needs over a long horizon of survivorship. Thin healthcare services and specialist-led follow-up care models may not adequately address these needs. Digitally mediated nurse-led virtual care models may help support PCa survivors who have unmet survivorship needs in current...

Background: Approximately one in eight Canadian males will be diagnosed with prostate cancer. Longer survivorship horizons and resource constraints are leading to increasing strain on current models of specialist-led follow-up care delivery. Nurse-led digital health innovations can reduce demand on specialists if co-designed with health care profes...

Aim: We aimed to differentiate the practice patterns of nurses in specialized and advanced roles in a cross-sectional study. Method: Canadian nurses completed a self-report questionnaire (June 2017-September 2017). Demographic data and time spent in five domains of advanced practice were compared across three nurse groups. Regression analysis ex...

Background: Cancer patients and their families play a central role in the self-management of the medical, emotional, and lifestyle consequences of cancer. Nurses with training in self-management support can enable cancer patients to better manage the effects of cancer and treatment. Methods: As part of a randomized controlled trial, we developed...

Background Determining the core competence of advanced practice nurses is foundational for promoting optimal design and implementation of advanced practice nursing roles. Core competencies specific to the contexts of the advanced practice nurse in Hong Kong have been developed, but not yet validated. Thus, this study aims to assess the construct va...

Background: Poorly managed cancer treatment toxicities negatively impact quality of life, but little research has examined patient activation in self-management (SM) early in cancer treatment. Methods: We undertook a pilot randomized trial to evaluate the feasibility, acceptability, and preliminary effectiveness of the SMARTCare (Self-Management an...

BACKGROUND Cancer and its treatment are a major cause of morbidity and health care costs worldwide. While systemic therapies are highly effective, they are associated with toxicities that can be life-threatening and disabling if not managed effectively. Digital technologies hold promise for enabling patient self-management of treatment-related toxi...

Background: Patients with cancer require adequate preparation in self-management of treatment toxicities to reduce morbidity that can be achieved through well-designed digital technologies that are developed in co-design with patients and end users. Objective: We undertook a user-centered co-design process in partnership with patients and other...

BACKGROUND Comprehensive models of survivorship care are necessary to improve access and coordination of care and to address the complexity of physical and psychosocial problems and long-term health needs experienced by patients following cancer treatment. Our group is building a nurse-led virtual clinic to support men living with prostate cancer (...

Background Comprehensive models of survivorship care are necessary to improve access to and coordination of care. New models of care provide the opportunity to address the complexity of physical and psychosocial problems and long-term health needs experienced by patients following cancer treatment. Objective This paper presents our expert-informed...

To coin a phrase from the lyrics of an old song, “what the world needs now” to improve global health is nursing leadership. Several policy reports from the World Health Organization1,2 and the Pan America Health Organization (PAHO)3 emphasize the strategic importance of nursing leadership and the strengthening of nursing leadership at all levels of...

A career ladder for nurses, including several levels of nursing practice and specific roles for advanced practice nurses, was introduced in Hong Kong around the turn of the century. To date no studies have distinguished the practices of advanced practice nurses in Hong Kong. This cross‐sectional study, conducted between November 2020 and March 2021...

Following publication of the original article [1], the authors identified a typesetting error in the third paragraph of the ‘Patient experience outcomes via PREMS’ subsection under the ‘Results’. The sentence originally read: For instance, Cherkin et al. [57] reported higher satisfaction (p<0.0) and higher perceived knowledge (p<0.001) for patients...

Background Globally, registered nurses (RNs) are increasingly working in primary care interdisciplinary teams. Although existing literature provides some information about the contributions of RNs towards outcomes of care, further evidence on RN workforce contributions, specifically towards patient-level outcomes, is needed. This study synthesized...

Introduction: Despite the availability of clinical practice guidelines for cancer symptom management, cancer care providers do not consistently use them in practice. Oncology nurses in outpatient settings are well positioned to use established guidelines to inform symptom assessment and management; however, issues concerning inconsistent implement...

Background Internationally, policy-makers and health administrators are seeking evidence to inform further integration and optimal utilization of registered nurses (RNs) within primary care teams. Although existing literature provides some information regarding RN contributions, further evidence on the impact of RNs towards quality and cost of care...

Registered nurses (RNs) provide abortion care in hospitals and clinics and support abortion care through sexual health education and family planning care in sexual health clinics, schools and family practice. Nurse practitioners (NPs) improve access to abortion not only as prescribers of medication abortion but also as primary care providers of cou...

Background: Health promotion is necessary to mitigate the negative consequences of colorectal cancer and its treatment. Rates of behavior modification are low in populations of cancer patients. Studies are needed to determine the factors, such as decisional conflict, which influence adoption of healthy behaviors following a cancer diagnosis. Obje...

Introduction Despite the availability of clinical practice guidelines for cancer symptom management, cancer care providers do not consistently utilize them in practice. Oncology nurses in outpatient settings are well-positioned to use established guidelines to inform symptom assessment and management; however, issues concerning inconsistent impleme...

Aim The aim was to analyse the psychometric properties of a patient-reported-experience measure, the Patient Enablement and Satisfaction Survey (PESS), when used to evaluate the care provided by Advanced Nurse Practitioners (ANPs) in terms of factor structure and internal consistency. The PESS is a 20-item, patient-completed data collection tool th...

In Canada, the clinical nurse specialist (CNS) role is recognized as an advanced practice nursing role focused on improving nursing practice and patient, population, and health system outcomes. The CNS role is multidimensional in nature involving the integration of knowledge, skills, and expertise in clinical care, leadership, consultation, collabo...

PurposePeople with cancer benefit from self-management support, but report limitations in the type/amount of support they receive from healthcare professionals during cancer treatment. To intervene in this critical period, our team is developing a web-based self-management system, called I Can Manage Cancer (ICMC). The purpose of this paper is to r...

Introduction Prostate cancer (PCa) is the most common cancer in Canadian men. Current models of survivorship care are no longer adequate to address the chronic and complex survivorship needs of patients today. Virtual care models for cancer survivorship have recently been associated with comparable clinical outcomes and lower costs to traditional f...

Introduction Improving the quality of self-management support (SMS) for treatment-related toxicities is a priority in cancer care. Successful implementation of SMS programmes depends on tailoring implementation strategies to organisational readiness factors and barriers/enablers, however, a systematic process for this is lacking. In this formative...

Background: Little research has focused on implementation of electronic Patient Reported Outcomes (e-PROs) for meaningful use in patient management in 'real-world' oncology practices. Our quality improvement collaborative used multi-faceted implementation strategies including audit and feedback, disease-site champions and practice coaching, core t...

Context: Immune-checkpoint inhibitors (ICI) have shown significant benefits for overall survival across various cancer types. Patient-reported outcomes (PROs) are assessed in clinical trials as a measure of efficacy. However, it remains unclear to what extent current PRO instruments capture symptoms specific to ICI toxicities. We conducted a syste...

Background The use of Patient-Reported Outcome Measures (PROMs) in routine clinical care can help ensure symptoms are identified, acknowledged and addressed. In 2007, the provincial cancer agency, Cancer Care Ontario, began to implement routine symptom screening with the Edmonton Symptom Assessment System (ESAS) for ambulatory cancer patients. Havi...

Background: Internationally, there is increasing demand for nurse practitioner (NP) and advanced practice nursing (APN) roles; however, high variability exists in how NP/APN roles are defined and understood. Purpose: The aim of this research was to improve our understanding of how the NP/APN is defined globally by: 1) examining role definitions,...

A Delphi (consensus) process was used to obtain national agreement on competencies for registered nurses (RNs) in primary care. A draft of competencies was developed by key informants. Following this, nurses with primary care experience/expertise completed a Delphi survey to rate the importance of competency statements on a six-point Likert scale....

A scoping review of published literature and dialogue with international nurse practitioner educators and researchers revealed the education of nurse practitioner students varied within and between countries. This lack of cohesiveness hinders nurse practitioner role development and practice nationally and internationally. A rapid review of grey lit...

The clinical nurse specialist (CNS) and nurse practitioner (NP) are the two types of advanced practice roles recognized in Canada. Leadership is an essential dimension of both roles, but many factors internal and external to the advanced practice nurse impact on leadership role enactment. This chapter summarizes research findings on advanced practi...

Globally, better utilization of nurse practitioners is recognized as an important strategy to address country needs for improved population health and increased access to high-quality care. This article examines the mobility of internationally educated nurse practitioners by comparing the regulatory requirements in 5 countries. Differences in healt...

Objetivos: (i) Delinear os passos e progressos realizados pelo Chile para implementar a prática avançada do papel da enfermagem usando o Enfoque PEPPA (Participatory Evidence-based Patient-focused Process) como guia, (ii) demonstrar a eficácia da estrutura do PEPPA para a identificação de barreiras e guiar o processo de implementação, e (iii) discu...

187 Background: PROMs capture the patient’s perspective on their health status and thus improve person-centred care. The Edmonton Symptom Assessment System has been the standard PROM used for all patients in Ontario. Recently, Cancer Care Ontario has chosen to expand the use of PROMs by adding cancer specific tools. The objective of this work was t...

Background Health systems worldwide struggle to identify, adopt, and implement in a timely and system-wide manner the best—evidence-informed—policy-level practices. Yet, there is still only limited evidence about individual and institutional best practices for fostering the use of scientific evidence in policy-making processes The present project i...

Purpose: To examine the exemplary practice of nurse consultants (NCs) and derive a model to illustrate the highest level of advanced nursing practice. Design: A descriptive study was conducted to examine the practice and outcomes of seven NC roles in varied clinical specialties in Hong Kong. Exemplary practice was examined in relation to compete...

SYNOPSIS Advanced practice nursing (APN) is a term used to describe a variety of possible nursing roles operating at an advanced level of practice. Historically, APN roles haves evolved informally, out of the need to improve access to health care services for at-risk and disadvantaged populations and for those living in underserved rural and remote...

Background: Advanced practice nurses (e.g., nurse practitioners and clinical nurse specialists) have been introduced internationally to increase access to high quality care and to tackle increasing health care expenditures. While randomised controlled trials and systematic reviews have demonstrated the effectiveness of nurse practitioner and clini...

182Background: The Improving Patient Experience and Health Outcomes Collaborative (iPEHOC) aims to improve health outcomes through uptake of electronic patient reported outcome measures (e-PROMs) in oncology practices in Ontario and Quebec. Building on screening with the Edmonton Symptom Assessment System (ESAS), e-PROMs were triggered based on cut...

Objective to examine advanced practice nursing (APN) roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. Method we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and...

Abstract To address increasing pressures for cancer survivorship care (CSC), provincial cancer agencies have introduced new models of post-treatment follow-up involving earlier transition of cancer survivors back to primary care (PC) providers. It is unknown how nurses in PC settings have responded to this practice change. The purpose of this quali...

Aim The aim of this study is to explore advanced practice nurses’ perceptions of their leadership capabilities. Design A qualitative descriptive methodology informed by a well‐established leadership framework was used to explore advanced practice nurses’ perceptions of their leadership. Methods Purposive sampling of advanced practice nurses worki...

Rationale: Clinical practice is the primary focus of advanced practice nursing (APN) roles. However, with unprecedented needs for health care reform and quality improvement (QI), health care administrators are seeking new ways to utilize all dimensions of APN expertise, especially related to research and evidence-based practice. International stud...

This 2016 special edition on advanced practice nursing (APN) roles in Canada builds on earlier role progress reported in the first special edition in 2010. Advancements in role development and innovative models that utilize APN roles are highlighted. The need for further efforts to support health systems integration of APN roles related to funding,...

Purpose/objective: There is a lack of research examining the relationship between role satisfaction and intent to remain in one's professional role from the perspective of nurses in advanced practice roles. The purpose of this study is to examine the strength of the relationship between clinical nurse specialist (CNS) role implementation, role sat...

Background Health system researchers must ensure that the products of their work meet the needs of various stakeholder groups (e.g., patients, practitioners, and policy makers). Evidence-based frameworks can support the uptake and spread of research evidence; however, their existence as knowledge translation tools does not ensure their uptake and i...

Purpose/objectives: The aim of this study was to examine the influence of structure and process on clinical nurse specialist (CNS) role implementation. Design: We conducted a secondary analysis of cross-sectional survey data. Setting: The study was performed in Canada. Sample: The authors included 445 of 471 questionnaires (94.5%) of graduat...

The objective of this systematic review was to synthesize the evidence of the effectiveness and cost-effectiveness of clinical nurse specialists (CNSs) and nurse practitioners (NPs) working in alternative or complementary roles in inpatient settings. Those in alternative roles substitute for another provider and deliver similar services. Those in c...

Purpose: To address the gap in evidence-based information required to support the development of advanced practice nursing (APN) roles in Switzerland, stakeholders identified the need for guidance to generate strategic evaluation data. This article describes an evaluation framework developed to inform decisions about the effective utilization of A...

There is a high need for research mentorship among Canadian oncology nurses. E-mentorship is an effective vehicle for linking oncology nurses with experienced researchers across the country who can help them navigate the road and increase their engagement in research. E-mentorship also has the potential to build research capacity more broadly by st...

Clinical nurse specialists (CNSs) are major providers of transitional care. This paper describes a systematic review of randomized controlled trials (RCTs) evaluating the clinical effectiveness and cost-effectiveness of CNS transitional care. We searched 10 electronic databases, 1980 to July 2013, and hand-searched reference lists and key journals...

A limited number of randomized controlled trials (RCTs) including economic analysis have supported the cost-effectiveness of nurse practitioners and clinical nurse specialists delivering care in a variety of settings. Our objective was to examine the quality of economic evaluations in this body of literature using the Quality of Health Economic Stu...

To determine the cost-effectiveness of nurse practitioners delivering primary and specialised ambulatory care. A systematic review of randomised controlled trials reported since 1980. 10 electronic bibliographic databases, handsearches, contact with authors, bibliographies and websites. Randomised controlled trials that evaluated nurse practitioner...

Vascular access site (VAS) bruising is common following invasive cardiac procedures. The extent of VAS bruising is underreported because of the lack of reliable measurement methods. This study examined the reliability of linear measurement and planimetry to measure VAS bruise size. There were 40 participants with VAS bruising after invasive cardiac...

The transfer of health-related research knowledge between producers and users is a complex, dynamic and iterative process. There has been little research describing the preferred knowledge transfer strategies used by different stakeholder groups, including healthcare providers, policymakers and administrators. The purpose of the survey was to gain...

Objectives To determine the cost-effectiveness of nurse practitioners delivering transitional care. Design Systematic review of randomised controlled trials. Data sources Ten electronic databases, bibliographies, hand-searches, study authors, and websites. Review methods We included randomised controlled trials that compared formally trained nur...

Triangulation refers to the use of multiple methods or data sources in qualitative research to develop a comprehensive understanding of phenomena (Patton, 1999). Triangulation also has been viewed as a qualitative research strategy to test validity through the convergence of information from different sources. Denzin (1978) and Patton (1999) identi...

Background. Improved quality of care and control of healthcare costs are important factors influencing decisions to implement nurse practitioner (NP) and clinical nurse specialist (CNS) roles. Objective. To assess the quality of randomized controlled trials (RCTs) evaluating NP and CNS cost-effectiveness (defined broadly to also include studies mea...

Rationale, aims and objectivesIncreasing numbers of clinical nurse specialists (CNSs) are working in outpatient settings. The objective of this paper is to describe a systematic review of randomized controlled trials (RCTs) evaluating the cost-effectiveness of CNSs delivering outpatient care in alternative or complementary provider roles.Methods We...

Purpose/Objectives: To examine healthcare providers' (HCPs') perceptions of the supportive care needs of men with advanced prostate cancer (APC). Research Approach: A qualitative, descriptive study. Setting: Healthcare facilities caring for men with APC in a south-central region of Ontario. Participants: 19 nurses, physicians, and allied health pro...

Clinical nurse specialists (CNSs) are advanced practice nurses. They contribute to the quality and safety of patient care by providing an advanced level of clinical care to patients and families and by supporting healthcare team members to deliver evidence-based care. CNSs help to reduce healthcare costs when the roles are fully deployed and all th...

In Canada, adolescent survivors of cancer are treated mainly at pediatric centers, while young adults are treated at adult centers. Both care environments are reported as being inappropriate and do not fulfill the needs of adolescents and young adults (AYA). The purpose of this study was to investigate supportive care needs (SCN) of AYA survivors o...