An international panel perspective: Exploring nursing scholarship in academia.

BACKGROUND: Boyer's framework of scholarship, the basis of many academic models for faculty promotion, is comprised of the components of discovery, teaching, integration, application, and engagement. Yet, the scholarship component of application (containing goal-based clinical practice) is undervalued by many academic models. PURPOSE: This study explores the nursing activities currently qualifying as scholarship in several international academic models. METHODS: Using the Delphi approach, an international nine-member panel from seven countries participated in a six-question, structured brainstorming session to explore the nursing activities qualifying as scholarship by academic models. Follow-up sessions were attended by six panel members. RESULTS: Panel members reported that the nursing activities, which most often were recognized as scholarship, fit the scholarship components of discovery, teaching and integration but few fit the components of application or engagement. Although this project originally focused on clinical practice, far more recommendations for an academic model targeted the scholarship component of engagement. CONCLUSION: Academic models' lack of appreciation for the scholarship components of application (goal-based clinical practice) and engagement (partnering with community groups) discourages faculty from participating in these activities. Yet, these nursing activities demonstrate scholarship and are essential for the continued development of the nursing profession and discipline.

Commentary: Investing in advance practice nurses is a global health system solution.

Investment and full utilization of advance practice nurses to maximize universal health coverage, optimize access to primary health care, and for building health workforce capacity and professional leadership is direly warranted globally. Funding advance practice nurse education programs, leadership opportunities, service delivery systems, and rewarding jobs regionally and nationally is a viable value-added solution for our communities, countries, and the nursing profession.

Reflections from a System Chief Nursing Executive: Intention to lead.

The integration and utilization of Chief Nurses (CNs) to lead and support complex health systems and health workforce optimization in governments, nongovernmental organizations, and across all health and social sectors is of paramount importance. At a time when the global nursing profession is challenged with a strained workforce and a growing leadership gap, it is essential that we examine and pay attention to the importance of the CN role. To attain universal health coverage, sustainable development goals, and global health, the need for the right number and a well-prepared nursing workforce is evident. While nursing recruitment and retention are key for system sustainability, it requires the right governance, leadership, infrastructure, and resources. A System CN can lead, advise, and impact the success of the nursing workforce in collaboration with senior leadership teams. At this time of major health challenges, too many health and social systems, both at government and nongovernmental levels, do not have a CN at all, or the role is delegated to a staff position with limited ability to impact the system on the local, regional, national, and global scale. Recruitment and investments targeting CNs are required to resuscitate, stabilize, and invigorate knowledgeable leaders who can transform, inspire, and maximize nursing contributions to assure access and quality healthcare. My personal and professional CN journey is highlighted here as an illustration for nurses who lead formally and informally, as they contemplate their own current and future ambitions and contributions.

Commentary: The Future of Advanced Practice Nursing: What's Next for Canada and the World?

Advanced practice nurses' (APNs') role definition, education, regulation, scope of practice, working conditions and integration vary worldwide. Clarity and alignment of foundational APN tenets can strengthen future workforce harmonization, innovation and models of care and data reliability for discussions and decision making. This global clarity and consistency can inform the design, delivery and leadership aspiring for health, education and socio-economic systems. Healthcare demands related to the COVID-19 pandemic, opioid crisis, aging population, non-communicable diseases, natural disasters and climate change have exposed glaring health needs and taxed workforces' and service capacity locally and globally. A fulsome deployment of nurse practitioners is one strategy that could help mitigate the impacts of these forces.

Implementing primary healthcare nurse practitioners in long-term care teams: A qualitative descriptive study.

AIM: To identify the conditions needed to implement nurse practitioners (NP) in long-term care (LTC) in Québec, Canada. DESIGN: A qualitative descriptive study was undertaken. METHODS: Semi-structured interviews (N = 91) and socio-demographic questionnaires were completed with providers and managers from May 2016-March 2017. Nurse practitioner activity logs were compiled at three sites. Content analysis was used. RESULTS: All sites initially implemented a shared care model but not all sites successfully implemented a consultative model. The progression was influenced by physicians' level of comfort in moving towards a consultative model. Weekly meetings with physicians and nurse managers and an office for NPs located near healthcare teams facilitated communication and improved implementation. Half-time NP positions facilitated recruitment. Improvements were noted in timely care for residents, family involvement and quality of documentation of the healthcare team. Regulatory restrictions on prescribing medications used frequently in LTC and daily physician presence at some sites limited implementation. CONCLUSION: The project fostered an understanding of the conditions needed to successfully implement NPs in LTC. An examination of the perspective of residents and families is needed.

Nonpharmacological approaches for behavioural and psychological symptoms of dementia in older adults: A systematic review of reviews.

AIMS AND OBJECTIVES: To review the evidence on nonpharmacological approaches to care for behavioural and psychological symptoms of dementia in older adults. BACKGROUND: Dementia is increasing in worldwide prevalence and can have severe and life-altering impacts on older adults. Behavioural and psychological symptoms of dementia can occur as a result of unmet needs and are distressing for family and caregivers. Many reviews have examined specific approaches to behaviours, but few have compared interventions for effectiveness and applicability across settings. DESIGN: Systematic review of reviews. METHODS: The search was limited to reviews that were published between October 2009-April/May 2015. Seven databases were searched, and reviews with a focus on nonpharmacological approaches to behaviours in older adults with dementia were included. All reviews were independently screened by two reviewers, quality appraised and data extracted. Results are reported through narrative synthesis. RESULTS: There were 18 international reviews that met inclusion criteria describing individual therapies, targeted interventions and organisational interventions. The organisational interventions of care planning using a consultation or dementia mapping process demonstrated modest benefits. The most conclusive evidence supported individual, sensory-focused interventions such as music therapy, interventions targeting pain, person-centred approaches and education for family caregivers. CONCLUSIONS: Although there remains a paucity of high-quality research in this area, the existing evidence indicates that behavioural and psychological symptoms of dementia require a range of nonpharmacologic sensory-focused approaches that are tailored to the individual. Further research is needed to determine the interventions best suited for specific behaviours and contexts, particularly inappropriate sexual behaviours. RELEVANCE TO CLINICAL PRACTICE: There is a need for nurses to be informed of best practices in order to effectively plan appropriate interventions to address behaviours in older adults with dementia. Care planning and tailored, sensory-focused, nonpharmacologic approaches are safe and effective options for nurses to consider in practice.

Diffusing Innovative Roles Within Ontario Hospitals: Implementing the Nurse Practitioner as the Most Responsible Provider.

Hospitals require identification of the most responsible provider (MRP) for care of admitted patients. Traditionally, the MRP has been a physician. However, legislation changes within Ontario authorize the nurse practitioner (NP) to admit and provide care for hospital in-patients. There is little evidence illustrating adoption of the NP-as-MRP model in Ontario. Reasons for a delayed adoption of this innovative model of care are unclear and warrant investigation. One hospital implemented the NP-as-MRP as an appropriate and beneficial model to maximize access to care for senior patients. Rogers' (2003) model of diffusion of innovation provides a framework to describe the processes undertaken that led to their adoption of the NP-as-MRP model. Detailed processes are highlighted for hospital leaders, hospital board members, and NPs. Other sites are encouraged to evaluate whether the NP-as-MRP model will be appropriate for specific populations; each site should undertake a process that is as detailed to ensure thorough preparation of all who will be affected by this change. Evaluation of the outcomes of the NP-as-MRP model is necessary and must be population- and institution-specific, as these provide new evidence in the early stages of this recent NP-related innovation in Ontario.