Advanced Practice Nurse Outcomes 1990-2008: A Systematic Review

University of Maryland School of Nursing, Baltimore, MD, USA.
Nursing economic$ (Impact Factor: 0.8). 09/2011; 29(5):230-50; quiz 251.
Source: PubMed


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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Available from: Robin Newhouse, Dec 30, 2013
    • "The volume of research papers, scholarly discussion and polemic debate in the peer-reviewed international literature relating to advanced practice nursing is vast, attesting to the quest to progress and refine knowledge about this evolving level of nursing service and its impact on patient outcomes (for example: Currie et al., 2007; Jones, 2005; Lowe et al., 2012; Newhouse et al., 2011; Pulcini et al., 2010; Thoun, 2011). Paradoxically, this international body of literature also contributes to perpetuating the confusion by continuing to assert its nature with scant attention to systematically debating the core issues. "
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    ABSTRACT: The size and flexibility of the nursing workforce has positioned nursing as central to the goals of health service improvement. Nursing's response to meeting these goals has resulted in proliferation of advanced practice nursing with a confusing array of practice profiles, titles and roles. Whilst numerous models and definitions of advanced practice nursing have been developed there is scant published research of significant scope that supports these models. Consequently there is an ongoing call in the literature for clarity and stability in nomenclature, and confusion in the health industry on how to optimise the utility of advanced practice nursing.
    No preview · Article · Dec 2015 · International journal of nursing studies
    • "Leadership, professional autonomy, and working in multidisciplinary teams are key to effective performance of the APN role (Dowling et al., 2013). Newhouse et al. (2011) concluded that a collaborative approach between APNs with physicians and other providers leads to higher quality of care and better health care systems. "
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    ABSTRACT: Objectives: To identify, assess and summarize available scientific evidence about the effect of interventions deployed by advanced practice nurses when providing care to older people in different care settings, and to describe the roles and components of the interventions developed by these professionals. Background: In older people, evidence of advanced practice roles remains dispersed along different contexts, approaches and settings; there is little synthesis of evidence, and it is not easy to visualize the different practice models, their components, and their impact. Design: Systematic review. Data sources: Sixteen electronic databases were consulted (1990-2014). The research also included screening of original studies in reviews and reports from Centers of Health Services Research and Health Technology Agencies. Review methods: Studies were assessed by two reviewers with the Cochrane risk of bias tool. They were classified depending on the type of follow-up (long and short-term care) and the scope of the service (advanced practice nurses interventions focused on multimorbid patients, or focused on a specific disease). Results: Fifteen studies were included. In long-term settings, integrative, multi-component and continuous advanced practice nursing care, reduced readmissions, and increased patients' and caregivers' satisfaction. Advanced practice nurses were integrated within multidisciplinary teams and the main interventions deployed were patient education, multidimensional assessments and coordination of multiple providers. Conclusion: Positive results have been found in older people in long-term care settings, although it is difficult to discern the specific effect attributable to them because they are inserted in multidisciplinary teams. Further investigations are needed to evaluate the cost-effectiveness of the two modalities detected and to compare internationally the interventions developed by advanced practice nurses.
    No preview · Article · Oct 2015 · International journal of nursing studies
    • "The review included studies on the impact of masters-prepared specialist nursing roles focused on care coordination to address the needs of specific patient groups, such as patients with diabetes or multiple sclerosis. Results from a further systematic review that included studies on the impact of gerontological nurse practitioners, also suggest that such roles can help reduce length of stay (Newhouse et al. 2011). A number of primary studies indicate a clear contribution by specialist nurses to interdisciplinary interventions shown to be effective in reducing length of stay. "
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    ABSTRACT: To identify the potential benefits of dementia specialist nursing and to inform the implementation of roles to support people with dementia during hospital admission. Extended stays and adverse events mean that hospital admissions are costly for people with dementia, and patient experiences and outcomes can be poor. Specialist nurses have been identified as having potential to enhance care quality, reduce excess stays and reduce costs, but the evidence base for dementia specialist nurse roles has not previously been synthesised. Scoping review. Cochrane Library, Campbell Collaboration, Clinical Evidence, Evidence-Based Medicine, York Centre for Reviews and Dissemination, PubMed, Medline, CINAHL and PsycInfo databases and internet searches and personal libraries/expert consultation to identify grey literature. Initial scoping searches were used to inform more focused systematic searches. Studies directly evaluating dementia nurse specialist roles or giving evidence of effectiveness of interventions/services that could be delivered by them to improve core outcomes were identified by one reviewer and verified by a second reviewer. While direct evidence for the effectiveness of these roles is lacking, a number of areas were identified in which a nurse specialist role could make a contribution, including preventing adverse events and improving patient experiences and outcomes. There is a considerable body of evidence for the effectiveness of these interventions although the volume of evidence for specific interventions is not always significant. The evidence indicates that a skilled dementia specialist nurse, undertaking a clearly defined role, and working directly with people with dementia and their carers for a significant proportion of the time, could benefit people with dementia in hospitals and their family carers. Clear guidance for the development and implementation of dementia specialist nurse roles in acute hospital settings. © 2014 John Wiley & Sons Ltd.
    No preview · Article · Dec 2014 · Journal of Clinical Nursing
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