Expanded nursing practice in the care for people with cognitive impairment – a systematic review

Abstract

Background: The prevalence of people with cognitive impairment (PwCI) in hospital varies between 11 and 55 %. Person-centred care concepts are promising to meet the needs of PwCI. Implementing person-centred care is challenging, with local change agents considered essential for the implementation process. This role can be performed within the context of expanded nursing practice. The ENROLE-acute project aims to develop, implement and evaluate a complex person-centred care intervention with expanded practice nurses (EPNs) in acute hospitals.
Purpose: The aim is to describe the expanded roles and tasks of nurses in caring for PwCI and their relatives in acute hospitals to support the development of the EPN role for ENROLE-acute.
Methods: A Systematic Review of international literature is conducted, searching MEDLINE, CINAHL, Cochrane Library, Web of Science, ALOIS and Livivo without time limit. Original research studies are included at all levels of expanded nursing practice, from nurse-led concepts to roles and tasks within Advanced Nursing Practice (ANP). Quality appraisal is conducted by using the CASP tool. Data is extracted using the TIDieR checklist and clustered according to the competencies of the Hamric Model of ANP.
Results: The review is currently in the data extraction and analysis phase. 39 references were identified. Interim results from 29 studies show tasks in all competence areas of the Hamric model. A core component of EPN’s clinical practice is the assessment of cognitive impairment, taking on executive, guiding and advisory roles (15 reports). In addition, conducting training for staff (15 reports) and coaching patients and relatives (10 reports) and consultation (7 reports) are reported. Clinical leadership is evident in the context of monitoring staff (11 reports), developing and collaborating on procedural guidelines (6 reports) and coordinating interdisciplinary rounds (3 reports). Collaboration is carried out with other professional groups (6 reports), nursing staff (11 reports) and primary care clinicians (7 reports). Tasks related to ethical decision-making and research are rarely reported.
Conclusion / Significance: The results provide an overview of roles and tasks of EPNs in the care of PwCI. The heterogeneity of the different levels of EPNs is reflected in the identified tasks. Comparably lower levels of expanded nursing practice can be applied to the early stage of ANP development in Germany. The results are discussed and prioritised in participatory expert workshops to adapt the EPN’s roles for PwCI to the German context.

Full text

Expanded nursing practice in the care for people with
cognitive impairment –a systematic review
Verena von der Lühe1, Marcelina Roos1, Sophie Peter2,3, Nadine Scholten2, Sascha Köpke1, Martin N. Dichter1
1University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Nursing Science
2University of Cologne, Faculty of Medicine and University Hospital Cologne, Faculty of Human Sciences, Institute for Medical Sociology, Health Services Research, and Rehabilitation Science
3Chair of General Practice II and Patient-Centredness in Primary Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University
•The prevalence of people with cognitive impairment (PwCI) in hospital varies between 11 and 55 % [1-3].
•Person-centred care concepts are promising to meet the needs of PwCI [4]. Implementing person-
centred care is challenging, with local change agents considered essential for the implementation
process [5-6].
•This role can be performed within the context of expanded nursing practice.
•The ENROLE-acute project purposes to develop, implement and evaluate a complex person-centred care
intervention with expanded practice nurses (EPN) in acute hospitals.
•Aim: To describe the expanded roles and tasks of nurses in caring for PwCI and their relatives in acute
hospitals to support the development of the EPN role for ENROLE-acute.
•Systematic Review of international literature
•Databases: MEDLINE, CINAHL, Cochrane Library, Web of Science, ALOIS, and
Livivo searched from inception in December 2021
•Inclusion criteria: Original research studies, all levels of expanded nursing
practice (from nurse-led concepts to Advanced Nursing Practice), PwCI ≥65
years
•Quality Appraisal: Joanna Briggs Institute checklists
•Data extraction: TIDieR-checklist for description of intervention [7]
•Data synthesis: Core competencies of Advanced Practice Nursing (APN) [8]
References
1. Pinkert C, Holle B: [People with dementia in acute hospitals. Literature review of prevalence and reasons for hospital admission]. Z Gerontol Geriatr 2012, 45(8):728-734.
2. Bui NA, Adeola M, Azad R, Swan JT, Agarwal KS, Sharma M, Liebl MG, Taffet GE: Prevalence of Cognitive Impairment Among Elderly Patients Upon Hospital Admission Using Mini-Cog™ Assessments Performed by Advanced
Pharmacy Practice Experience Students. J Pharm Pract 2020, 33(1):21-29.
3. Reynish EL, Hapca SM, De Souza N, Cvoro V, Donnan PT, Guthrie B: Epidemiology and outcomes of people with dementia, delirium, and unspecified cognitive impairment in the general hospital: prospective cohort study of
10,014 admissions. BMC Med 2017, 15(1):140.
4. National Institute for Health and Care Excellence: Dementia: assessment, management and support for people living with dementia and their carers. . NICE guideline [NG97] 2018.
5. Quasdorf T, Riesner C, Dichter MN, Dortmann O, Bartholomeyczik S, Halek M: Implementing Dementia Care Mapping to develop person-centred care: results of a process evaluation within the Leben-QD II trial. J Clin Nurs
2017, 26(5-6):751-765.
6. Santana MJ, Manalili K, Jolley RJ, Zelinsky S, Quan H, Lu M: How to practice person-centred care: A conceptual framework. Health Expect 2018, 21(2):429-440.
7. Hoffmann T C, Oxman A D, Ioannidis J P, Moher D, Lasserson T J, Tovey D I et al. Enhancing the usability of systematic reviews by improving the consideration and description of interventions BMJ 2017; 358 :j2998
doi:10.1136/bmj.j2998
8. Hamric, Ann B., Judith A. Spross, and Charlene M. Hanson. Advanced Practice Nursing: An Integrative Approach. 4th ed. St. Louis, Mo.: Saunders/Elsevier, 2019.
The heterogeneity of the different levels of EPN is reflected in the identified tasks. Comparably lower levels of expanded nursing practice can be applied to the early stage of Advanced Nursing
Practice development in Germany. The results will be discussed and prioritised in participatory expert workshops of the ENROLE-acute project, aiming to adapt the EPN’s roles for PwCI to the
German context.
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Direct
Clinical Practice
Guidance
and Coaching
Consultation
Leadership
Collaboration
Ethical
Decision Making
Evidence
-Based-Practice
Core Competencies
Study
Funded by
1. Background & Aim 2. Methods
3. Preliminary results
4. Discussion
Direct Clinical
Practice
Nursing screening and assessment: n = 23
studies
Specific patient interventions (e.g. promoting
mobilisation): n = 21 studies
Identfication of goals and development of care
plans: n = 3 studies
Building a relationship: n = 2 studies
Guidance and
Coaching
Education for health care staff: n = 24 studies
Guidance and coaching for patients and
relatives: n = 18 studies
Consultation
Providing consultation: n = 10 studies
Initiating referrals to other professions: n = 2
studies
Contact ENROLE-acute
Verena von der Lühe
Institute of Nursing Science
verena.von-der-luehe@uk-koeln.de
Leadership
Clinical Leadership (e.g. role model
and resource): n = 19 studies
Systems Leadership (e.g.
guidelines and policies on system
level): n = 7 studies
Collaboration
With interdisciplinary teams: n =
11 studies
With nursing staff: n = 6 studies
With reasearch teams: n = 2
studies
With primary care: n = 2 studies
Ethical Decision
Making
Advance Care Planning: n = 2
studies
Managing conflicts in teams: n = 1
study
EBP*
Use of evidence to evaluate
practice: n = 4 studies
Use of evidence to change
practice: n = 2 studies
Use of evidence in individual
practice: n = 1 study
Figure 1: Roles and tasks of expanded nursing practice across studies according to the Core Competencies of APN
Figure 2: Roles and tasks of expanded nursing practice within studies according to the Core Competencies of APN, *Evidence-Based-Practice
We screened 4,312 records, of which 41 publications representing 37 studies were included in this review. Most of the studies were from North America (n = 17), followed by Europe (n = 14),
Asia (n = 3) and Australia (n = 3). An experimental design was reported in 28 papers and 13 papers used a non-experimental design. The tasks in Direct Clinical Practice and Guidance and
Coaching are reported in most studies. Ethical Decision Making and Evidence-Based-Practice tasks are rarely reported (Figure 1). The results provide an overview of roles and tasks of EPN in the
care of PwCI (Figure 2).