Barriers to end-of-life discussion with advanced cancer patient as perceived by oncologists, certified/specialized nurses in cancer nursing and medical social workers.

OBJECTIVE: The objectives of this study were to identify barriers to end-of-life discussion with advanced cancer patients and their families as perceived by oncologists, certified/specialized nurses in cancer nursing (hereafter, collectively referred to as 'nurses') and medical social workers, as well as to clarify their opinions about effective strategies to facilitate end-of-life discussion. METHODS: A questionnaire survey was distributed to 4354 medical professionals working at 402 designated regional cancer hospitals in Japan. Responses were obtained from 494 oncologists (valid response rate 30.7%), 993 nurses (46.7%) and 387 medical social workers (48.1%). RESULTS: Among the barriers to end-of-life discussion with advanced cancer patients, factors related to patients and families, such as 'Family members' difficulty accepting loved one's poor prognosis', were recognized as the most important issues, which was the common view shared across the three types of medical professionals who participated in this study. Nurses and medical social workers were significantly more likely than oncologists to recognize as important issues 'Health care team disagreement about goals of care' and 'Lack of training to have conversations for end-of-life discussion'. To facilitate end-of-life discussion, 'providing mental and emotional support for the patients and their families after end-of-life discussion' was needed most as perceived by the respondents regardless of their profession. CONCLUSIONS: Barriers impeding end-of-life discussion were factors related to patients and their families, and oncologists' close cooperation with nurses and medical social workers is important in providing emotional support for patients and families. To facilitate end-of-life discussion, it is important to share information on patients' prognosis and goals for treatment among oncologists and other medical professionals, as well as strengthen communication skill of these medical professions.

Factors associated with the job satisfaction of certified nurses and nurse specialists in cancer care in Japan: Analysis based on the Basic Plan to Promote Cancer Control Programs.

BACKGROUND: As the Japanese population ages, the number of cancer patients will likely increase. Therefore, qualified cancer health care providers should be recruited and retained. Nurse job satisfaction is influenced by numerous factors and may affect staff turnover and patient outcomes. OBJECTIVES: To evaluate the job satisfaction of certified nurses and nurse specialists in Japanese cancer care and elucidate factors associated with job satisfaction. METHODS: Participants in this cross-sectional study comprised 200 certified nurse specialists and 1,472 certified nurses working in Japanese cancer care. A chi-square test and logistic regression analysis were conducted to identify job satisfaction factors. RESULTS: Job satisfaction was present in 38.45% and 49.00% of certified nurses and nurse specialists, respectively. Certified nurses associated job satisfaction with cross-departmental activities (OR 2.24, p<0.001), positive evaluation from senior stuff (OR 4.58, p<0.001), appropriate staff allocation (OR 1.75, p<0.001), more than five years certified nurse experience (OR 1.91, p<0.001), and positive evaluation of the development of certified nurses (OR 2.13, p<0.01) and nurse specialists (OR 1.37, p<0.05). Low job satisfaction was associated with working on a ward (OR 0.51, p<0.001) and a capacity of more than 200 beds (OR 0.33, p = 0.00). Certified nurse specialists associated job satisfaction with palliative care team participation (OR 2.64, p<0.05), cross-sectional activities (OR 7.06, p<0.01), positive evaluation from senior stuff (OR 13.15, p<0.001), presence of certified nurses in radiation therapy (OR 2.91, p<0.05), positive certified nurse specialist development evaluation (OR 7.35, p<0.001), medical service fees (OR 3.78, p<0.01), and independent activities (OR 11.34, p<0.01). CONCLUSIONS: We identified factors related to activities, facilities, and the cancer care team associated with job satisfaction of certified nurses and nurse specialists in Japanese cancer care. Suggestions are provided to enhance job satisfaction through Japan's Basic Plan to Promote Cancer Control, which may help hospital administrators retain nursing staff.

Impact of having a certified nurse specialist in critical care nursing as head nurse on ICU patient outcomes.

OBJECTIVES: This study evaluated the impact of the presence of a certified nurse specialist in critical care (CNS) as ICU head nurse in an open ICU on clinical outcomes. METHODS: The presence of a CNS as ICU head nurse was implemented in practice in April 2017. To evaluate the impact on patient outcomes before and after the implementation, patients were divided into two groups: before (April 2014 to March 2017; 1988 patients) and after (April 2017 to March 2019; 1664 patients). Patients' demographic data were collected from the ICU database. RESULTS: Multivariable logistic regression analysis revealed that the presence of a CNS as ICU head nurse was associated with lower ICU mortality (odds ratio (OR): 0.52, 95% CI: 0.36-0.73, p < .001) and fewer patients receiving mechanical ventilation in the ICU (OR: 0.20, 95% CI: 0.15-0.26, p < .001). CONCLUSION: CNSs are defined as one type of advanced practice nurses. Having a CNS as a head nurse in the ICU may have helped improve patient outcomes by leveraging these practical skills in nursing management.

Patient safety culture among European cancer nurses-An exploratory, cross-sectional survey comparing data from Estonia, Germany, Netherlands, and United Kingdom.

AIM: To explore the differences in perceived patient safety culture in cancer nurses working in Estonia, Germany, the Netherlands, and the United Kingdom. DESIGN: An exploratory cross-sectional survey. METHODS: In 2018, 393 cancer nurses completed the 12 dimensions of the Hospital Survey on Patient Safety Culture. RESULTS: The mean score for the overall patient safety grade was 61.3. The highest rated dimension was "teamwork within units" while "staffing" was the lowest in all four countries. Nurses in the Netherlands and in the United Kingdom, scored higher on "communication openness", the "frequency of events reported", and "non-punitive response to errors", than nurses from Estonia or Germany. We found statistically significant differences between the countries for the association between five of the 12 dimensions with the overall patient safety grade: overall perception of patient safety, communication openness, staffing, handoffs and transitions and non-punitive response to errors. CONCLUSION: Patient safety culture, as reported by cancer nurses, varies between European countries and contextual factors, such as recognition of the nursing role and education have an impact on it. Cancer nurses' role in promoting patient safety is a key concern and requires better recognition on a European and global level. IMPACT: Cancer Nursing Societies in any country can use these data as an indication on how to improve patient care in their country. Recognition of cancer nursing as a distinct specialty in nursing will help to improve patient safety.

Divisional review of the nurse specialist role.

Nurse specialists have been described as providing an optimal return on investment for income generation, patient safety, cost savings, and improvements in patient care and experience. However, there is often a lack of understanding of the nurse specialist role and how such nurses support improved patient outcomes. To assess the effect of the nurse specialist in a division of one large NHS trust, a review of the nurse specialist role was undertaken within eight specialties. This review profiled nurse specialists' roles in terms of their activity, income generation and quality, with the aim of producing specialist job plans to accurately reflect their roles. Nurse specialists were provided with a job-planning template and face-to-face sessions on how to complete it. The returned job plans were reviewed by a panel consisting of nursing management, lead clinical nurse specialists and representatives from finance. The results were used to generate three generic nurse specialist job plans that recognised the core elements of the role. The division intends to undertake a further review of nurse specialists, which aims to explore the role in further detail, including identifying their development needs. Having examined the effects of the nurse specialist role, the division needs to ensure that nurse specialists are resourced to reach their full potential.

Does improved postgraduate capacity shift the balance of power for nurse specialists in a low-income country: A mixed methods study.

AIM: To explore nurse specialists' experiences of change and influence on practice two years after graduating with a postgraduate degree. BACKGROUND: In the absence of further study opportunities for nurses in their own country, a master's degree was introduced to train the first group of nurse specialists in Mozambique. DESIGN: Within a hybrid evaluation framework an exploratory, sequential mixed methods design was followed. METHODS: Qualitative data from focus group interviews with nurse specialists (N = 12) led to five thematic data sets from which survey questions were formulated for the sequential quantitative component. FINDINGS: "Change expectations", "Ambiguous practice environments", "Feeling powerless", "Having some influence" and "Workplace support" were emergent themes from interview data. Areas of positive change occurred in research (100%) and the use of evidence (88.9%) and involvement in decision-making (77.8%). For some change did not happen as anticipated-reasons included lack of nurse mentors to support new graduates (55.6%); lesser respect compared with doctors (44.4%) and poor understanding of the value of a master's degree (44.4%). Improvements in service quality and elevating the status of nursing were areas of greatest influence (77.8%). CONCLUSION: Several enabling and limiting factors were identified in the experiences of change and influence on practice of newly qualified nurse specialists. Tacit change with respect to the value of the degree in improving the status of nursing seems not to have affected nurse specialists' own ability and power to influence practice. Improved postgraduate capacity on its own does not empower nurses in their role as specialists. IMPACT: The findings point to a two-tiered strategy to be developed to dismantle barriers to the empowerment and advancement of nurse specialists. The identification of designated nurse mentors is essential to induct and sustain newly graduated nurse specialists. A clear research policy should be developed that supports the conduct of relevant research and the use of evidence in specialist practice.

Experiences of supervision during clinical education among specialised nursing students in Sweden: A cross-sectional study.

BACKGROUND: The importance of the clinical learning environment in nurse education has gained increasing attention over the last decades. However, there is a lack of research on the learning environment, its significance and meaning in specialist nurse education. OBJECTIVE: The objectives of the study were to investigate specialised nursing students' experiences of supervision during clinical practice and to compare students who were satisfied with the supervision with those who were dissatisfied with respect to a) organisation of supervision and number of preceptors, as well as time allocated by preceptors for b) supervision, c) reflection, d) discussion of intended learning outcomes, and e) assessments of students' performance by preceptors. DESIGN: This study used a cross-sectional design. SAMPLE AND SETTINGS: A convenience sample of specialised nursing students was derived from five Swedish universities in the years 2016 and 2017. METHODS: Data were collected using a questionnaire. Statistical analyses and a qualitative conventional content analysis were performed. RESULTS: While almost all specialised nursing students reported that there had been time for discussion on their performance assessment, almost half of the students reported not getting time for supervision, or time for reflections and discussions on intended learning outcomes with the preceptor. Students reporting having time allocated for supervision by preceptors were found to be more satisfied with supervision. It was described as important that the preceptor(s) acknowledged the students previous work experiences. Even though being a registered nurse, reflections and feedback were described as valuable for the students learning. Several preceptors were described as positive allowing a broader picture and different views regarding working as a specialist nurse. CONCLUSIONS: This study indicates that supervision, in terms of discussions and reflections, of specialised nursing students is significant for learning experiences and satisfaction during clinical placement.

Benefits of the epilepsy specialist nurses (ESN) role, standardized practices and education around the world.

Epilepsy, often considered as a stigmatizing disease, affects 65 million people worldwide and is frequently associated with comorbidities that increase both direct and indirect costs. The degree of impact on quality of life and the cost of care differs depending on the social and health care organizations in place, political, medico-economic and/or socio-cultural contexts. Across the globe, healthcare is provided by nurses in primary care, urgent or emergency care, and within specialized domains of practice. In Epilepsy the global care could be enhanced by developing standardized nursing education in close collaboration with other caregivers. The impact of epilepsy nursing care has been documented in some developed countries, but the diversity of nursing practices and professional education of nurses raise difficulties in generalizing these findings. Specialized education in epilepsy will improve access, treatment and ultimately the quality of life of patients.

Specialist ambulance nurses' experiences of births before arrival.

BACKGROUND: Working as an ambulance nurse means interacting with and caring for acutely ill and injured patients. It can even involve births before arrival to the hospital (BBA), which are rare but increasing due to the centralization of maternity wards. AIM: This study describes the experiences of specialist ambulance nurses with BBA. METHOD: A qualitative study was conducted, and nine specialist ambulance nurses who had assisted with one or more prehospital births were interviewed. Data were analysed with thematic content analysis. FINDINGS: The analysis revealed three categories that were compiled into a theme of feeling fright and exhilaration. The findings showed that BBA causes feelings of anxiety and stress. The experience is also associated with joy and relief when the baby is born. Childbirth is a situation for which specialist ambulance nurses feel less prepared, lack of knowledge, and wish for more education. CONCLUSION: Specialist ambulance nurses face challenges in the pre-hospital care environment during BBA, with long distances, a lack of equipment aboard the ambulance, and no assistance from midwives. To feel secure in the complex role that is required when assisting with a BBA, specialist ambulance nurses should be given the opportunity to receive scenario training.

O estresse no trabalho dos enfermeiros e enfermeiras em oncologia e os danos à saúde / Stress on the work of nurses in oncology and damages to health

O objeto de estudo foi o estresse relacionado ao trabalho e os danos à saúde em enfermeiros que atuavam em oncologia. O objetivo geral foi analisar a associação entre o estresse no trabalho e os danos físicos, sociais e psicológicos em enfermeiros e enfermeiras em oncologia. O pressuposto do estudo o estresse no trabalho em oncologia está associado ao adoecimento físico, social e psicológico dos enfermeiros. Material e Método: Estudo com delineamento transversal e abordagem quantitativa. A coleta de dados ocorreu entre os anos de 2017 e 2018. A amostra foi composta de todos os enfermeiros da equipe de enfermagem dos setores definidos para a coleta de dados no local da pesquisa. Participaram do estudo 212 enfermeiros, equivalendo a 87,96% da população elegível (241). O instrumento de coleta de dados consistiu em um questionário estruturado multidimensional, autopreenchível, que inclui questões referentes aos dados sociodemográficos, laborais e relacionados à saúde; a Escala de Avaliação do Estresse, do Inventário de Estresse em Enfermeiro (IEE) e a Escala de Avaliação de Danos Relacionados ao Trabalho (EADRT) quarta parte do Inventário Sobre Trabalho e Riscos de Adoecimento (ITRA). Os dados foram analisados no programa IBM SPSS Statistics (IBM, versão 23.0). Resultados: na avaliação entre o alto estresse no trabalho (IEE) e as variáveis sociodemográficas, laborais e relacionadas à saúde os resultados mostraram significância nas seguintes variáveis: o tipo de vínculo empregatício (p=0,001); apoio social no trabalho (p<0,001) e queixas de insônia (p=0,001). As dimensões do IEE que apresentaram maior fonte de tensão foram as Relações Interpessoais e Fatores intrínsecos ao Trabalho. A associação entre os danos e as variáveis sociodemográficas mostraram significância entre danos físicos com sexo (p<0,001), apoio social no trabalho (p=0,003); satisfação com a duração do sono (p<0,001) e queixas de insônia (p<0,001); danos sociais com presença de parentes (p=0,003) e pensa em abandonar a enfermagem (p<0,001); danos psicológicos com pensa em (p=0,002); queixas de insônia (p<0,001) e, consome bebida alcoólica (p=0,005) com avaliação mais negativa para Danos Físicos com presença de doença ocupacional. Na associação entre a exposição e o desfecho com base na Razão de Chance (RC) e respectivo intervalo de confiança (IC95%) observou- se forte significância com presença de doença para Danos Físicos (p=0,012) e (RC=4,32; IC95%: 1,38-13,54), Psicológicos (p<0,001) e (RC=7,46; IC95%: 2,42-23,00) e Sociais (p=0,003) e (RC=10,11; IC95%: 2,21-46-31). Conclusões: A hipótese testada para este estudo foi confirmada, uma vez que houve associação significativa entre o estresse no trabalho e os danos à saúde. Os dados obtidos revelaram aspectos importantes dos fatores de estresse a que estão expostos os enfermeiros em oncologia no cotidiano do trabalho e a presença de danos físicos, sociais e psicológicos oferecendo subsídios para a implementação de ações de promoção à saúde do trabalhador.

The aim of the study was stress related to the work and damages to health in nurses that worked in oncology. The general aim was to analyze the association between stress at work and physical, social and psychological harm in nurses in oncology. The study hypotesis was that stress at work in oncology is associated to physical, social and psychological harm in nurses. Material and method: Cross-sectional study with quantitative approach. Data collection happened between the years of 2017 and 2018. Sample was composed by all nurses in the nursing staff of defined sectors to data collection where the study took place. 212 nurses participated in the study, equivalent to 87,96% of the elegible population(241). The data collection instrument consisted in a structured multidimensional self-priming questionnaire that included work and health related sociodemographic data. Beyond that, it includes the Stress Evaluation Scale, Stress Inventory in Nursing (IEE) and Evaluation scale of harm related to work, the forth part of Inventory about work and risk to sickening. Data were analyzed in the software IBM SPSS Statistics (IBM, version 23.0). Results: in evaluation of stress and work and work and health related sociodemographic variables, results showed significance in the folowing variables: type of employment relationship (p=0,001); social support at work (p<0,001) and complaints about insomnia (p=0,001). The dymations of IEE that presented a great source of tension were Interpersonal Relationships and Intrinsic factors to work. The association between harms and the sociodemographic variables showed significance between physical damage with sex (p<0,001), social support at work (p=0,003); satisfaction with sleep duration (p<0,001) and complaints of insomnia (p<0,001); social harm with presence of relatives (p=0,003) and thinks about abandoning nursing (p<0,001); psychological damage with thinks about abandoning nursing (p<0,001), satisfaction with sleep duration (p=0,002); complaints of insomnia (p<0,001) and, drinking alcohol (p=0,005) with negative evaluation to Physical Harm with presence of occupational disease. On association between exposure and outcome based on Odds Ratio (OR) and respective confidence interval (IC95%) it was observed a strong significance with presence of disease for Physical Harm (p=0,012) e (OR=4,32; IC95%:1,38-13,54), Psychological Harm (p<0,001) e (OR=7,46; IC95%:2,42-23,00) and Social Harm (p=0,003) e (OR=10,11; IC95%:2,21-46-31). Conclusions: The hypothesis tested for this study was confirmed, since there was a significant association between stress at work and damage to health. The data obtained revealed important aspects of the stress factors to which nurses are exposed in oncology in the daily life of the work and the presence of physical, social and psychological damages offering subsidies for the implementation of actions to promote occupational health.

El objeto de estudio fue el estrés relacionado al trabajo y los daños a la salud en enfermeros que actuaban en oncología. El objetivo general fue analizar la asociación entre el estrés en el trabajo y los daños físicos, sociales y psicológicos en enfermeros y enfermeras en oncología. La hipótesis del estudio fue que el estrés en el trabajo en oncología está asociado a las enfermedades físicas, sociales y psicológicas de los enfermeros. Material y Método: Estudio con diseño transversal y abordaje cuantitativo. La coleta de datos ocurrió entre los años 2017 y 2018. La amuestra fue compuesta de todos los enfermeros de la equipa de enfermería de los sectores definidos para la coleta de datos en el hogar de la investigación. Participaron del estudio 212 enfermeros equivaliendo 87,96 de la población escogida (241). El instrumento de coleta de datos consistió en un cuestionario estructurado multidimensional, auto administrado, que incluyó cuestiones referentes a los datos sociodemográficos, laborales y relacionados a la salud. Además, incluyó la Escala de Evaluación del Estrés, Inventario del Estrés en Enfermero (IEE) y la Escala y Evaluación de Daños Relacionados al Trabajo (EDRT) cuarta parte del Inventario sobre Trabajo y Riesgos de Enfermedad (ITRE). Los datos fueran analizados en le programa IBM SPSS Statistics (IBM, versión 23.0). Resultados: en la evaluación entre el alto estrés en el trabajo (IEE) y las variables sociodemográficas laborales y relacionados a la salud los resultados demostraron significancia en las siguientes variables: l tipo de vinculación en el empleo (p=0,001); apoyo social en el trabajo (p=0,001) y quejas de insomnio. Las dimensiones del IEE que presentaron mayor fuente de tensión fueron las Relaciones Interpersonales y Factores Intrínsecos al Trabajo. La asociación entre los daños y las variables sociodemográficas demostraron significancia entre daños físicos y sexo (p=0,001), apoyo social en el trabajo (p=0,001), satisfacción con la duración del sueño (p=0,002), quejas de insomnio (p=0,001) y consume bebida alcohólica (p=0,005) con evaluación más negativa para Daños Físicos con presencia de enfermedad ocupacional. En la asociación entre la exposición y el desfecho con base en la Razón de Chance (RC) y respectivo intervalo de confianza (IC95%) se observó fuerte significancia con presencia de en enfermedad para Daños Físicos (p=0,012) e (RC=4,32; IC95%: 1,38-13,54), Psicológicos (p<0,001) e (RC=7,46; IC95%: 2,42-23,00) y Sociales (p=0,003) e (RC=10,11; IC95%: 2,21-46-31). Conclusiones: La hipótesis testada para este estudio fue confirmada una vez que hubo asociación significativa entre el estrés en el trabajo y los daños a la salud. Los datos obtenidos revelaron aspectos importantes de los factores de estrés a que están expuestos a los enfermeros en oncología en el cotidiano de trabajo y la presencia de daños físicos, sociales y psicológicos ofreciendo subsidios para la implementación de acciones de promoción de salud del trabajador.

Associations Between 30-Day Mortality, Specialist Nursing, and Daily Physician Ward Rounds in a National Stroke Registry.

Background and Purpose- Well-organized stroke care is associated with better patient outcomes, but the most important organizational factors are unknown. Methods- Data were extracted from the Sentinel Stroke National Audit Programme of adults with acute stroke treated in stroke hospitals in England and Wales between April 2013 and March 2015. Multilevel models with random intercepts for hospitals were used to estimate the association of each variable with 30-day mortality to estimate the impact of admission to differently organized hospitals. Results- Of the 143 578 patients with acute stroke admitted to 154 hospitals, 14.4% died within 30 days of admission. In adjusted analyses, admission to hospitals with higher ratios of nurses trained in swallow screening was associated with reduced odds of death ( P=0.004), and admission to hospitals with daily physician ward rounds was associated with 10% lower odds of mortality compared with less-frequent ward rounds (95% CI, 0.82-0.98; P=0.013). Number of stroke admissions and overall ratio of registered nurses on duty at weekends were not found to be independently associated with mortality after adjustment for other factors. Conclusions- If these associations are causal, an extra 1332 deaths annually in England and Wales could be saved by hospitals providing care associated with a ratio of nurses trained in swallow screening of at least 3 per 10 beds and daily stroke physician ward rounds.

Variation in job titles within the nursing workforce.

AIMS AND OBJECTIVES/BACKGROUND: The work of specialist nursing has been under scrutiny for many years in the UK due to a perception that it is not cost-effective. A common issue is the lack of consistency of job titles, which causes confusion to the public, employing organisations, colleagues and commissioners of services. Lack of consistency has implications for the wider perception of advanced specialist practice in the worldwide community and the workforce more generally. This study aims to understand the variation in job titles in the UK population. METHODS: A pre-existing data set of accrued studies into the work of nurses working in specialisms was mined for insight (N = 17,960). This study used knowledge discovery through data and descriptive statistics to perform secondary analysis. RESULTS: Mining these data revealed 595 job titles in use in 17,960 specialist posts once the specialism had been removed. The most commonly used titles were Clinical Nurse Specialist, Nurse Specialist/Specialist Nurse, Advanced Nurse Practitioner and Nurse Practitioner. There were three other primary groupings. These were variants with a specialist or technical prefix of suffix, for example Nurse Endoscopist, variants of seniority such as trainee, senior nurse for [specialism] or variants of function such as Nurse Prescriber. The clustering was driven primarily by pay band. A total of 323 posts were recorded as holding titles such as Advanced Nurse Practitioner or Specialist Nurse who were not registered with the Nursing & Midwifery Council. RELEVANCE TO CLINICAL PRACTICE: In this data set, there is a large array of titles, which appear to have little relationship with other factors like education. This is confusing to the public, employers and those commissioning services. It also demonstrates that the previous assumptions by Council for Healthcare Regulatory Excellence that advanced practice labels are associated with career progression are unsound and should be addressed by the regulator.

The key role of clinical and community health nurses in pharmacovigilance.

PURPOSE: The reporting of suspected adverse drug reactions (ADRs) is starting to become routine to nurses. The aim of this review is to underline the role of clinical and community health nurses in pharmacovigilance and to promote their effective participation in ADR reporting in different countries and for patients of different ages. METHODS: The PubMed, Scopus and ISI Web of Science databases were searched for research articles published between January 1985 and April 2017 using the search items "pharmacovigilance" AND "nurse;" "adverse drug reaction report" AND "nurse;" "community health nurse" AND "adverse drug reaction." RESULTS: A total of 987 articles were identified using our search strategy, of which 180 articles remained over after the removal of duplicate articles. Of these 180 studies, upon full review we identified 24 which met the inclusion/exclusion criteria and included these in our review. ADR reports by clinical nurses in some countries are comparable in quality and number to those submitted by physicians or pharmacists. Data on ADRs reported by community nurses are currently not available. However, numerous publications emphasized the challenges faced by nurses in reporting ADRs and the need to include pharmacovigilance training in both clinical and community health nurse academic education. CONCLUSIONS: Nurses are central actors in pharmacovigilance activities, particularly in identifying ADRs which remain outside the reach of other healthcare providers and in being fundamental to the preservation of the health of patients and of the entire community, with attention to the more vulnerable patients, such as children and the elderly.

Consensus on an Australian Nurse practitioner specialty framework using Delphi methodology: results from the CLLEVER 2 study.

AIM: The aim of this study was to achieve profession-wide consensus on an Australian nurse practitioner specialty framework. BACKGROUND: Since its introduction in 1998, the Australian nurse practitioner profession has grown to over 1300 endorsed practitioners, representing over 50 different specialties. To complement better a generalist learning and teaching framework with specialist clinical education, prior research proposed a broad framework of Australian nurse practitioner specialty areas termed metaspecialties. DESIGN: This study employed an online three-round modified Delphi method. METHOD: Recruitment using purposive sampling and snowballing techniques identified an eligible sample from a population of nurse practitioners with at least 12 months' postendorsement experience (n = 966). Data were collected using online survey software from September 2014-January 2015 and analysed using descriptive statistics and content analysis. The Content Validity Index and McNemar's Test for Change were used to determine consensus on the nurse practitioner metaspecialties. RESULTS: One-fifth of the total eligible population completed the study. Participants achieved high consensus on four metaspecialties, including: Emergency and acute care, primary health care, child and family health care and mental health care. Two metaspecialties did not achieve consensus and require further investigation. CONCLUSION: A large sample of nurse practitioners achieved consensus on an Australian metaspecialty framework, increasing the likelihood of widespread acceptance across the profession. This technique may be appropriate for use in jurisdictions with smaller populations of nurse practitioners. Ongoing research is needed to re-evaluate the metaspecialties as the profession grows.

An international survey: the role of specialist nurses in adult respiratory extracorporeal membrane oxygenation.

BACKGROUND: The last decade has seen an increase in the number of centres able to provide venovenous extracorporeal membrane oxygenation (VV-ECMO) internationally across different health care systems. To support this growth, a variety of staffing arrangements have been adopted depending on local need and availability of resources, both in terms of manpower and finances to safely meet the complex needs of the patient and circuit management. AIM: The aim of the survey was to describe current staffing arrangements of care provision for adult patients on VV-ECMO, with a focus on understanding the professional roles and responsibilities of staff managing the circuit in order to inform further discussion around different approaches to staffing. METHODS: We conducted a cross-sectional international survey using an electronic questionnaire emailed to 177 worldwide ECMO centres treating adult patients with acute respiratory failure. The survey questions were generated through an internal and external iterative process and assessed for clarity, content and face validity. RESULTS: The response rate was 82%. Respondents managed extracorporeal oxygenation for adult respiratory alone (75%) or in combination with adult cardiac (67%), paediatric respiratory (62%) and paediatric cardiac (58%). The specialist nurse to patient ratio was 1:1 in 59% of centres, with 24-h/day presence in 74%. Overall, the specialist nurse provided the 24-h/day management of the circuit, including interventions. Perfusionists were responsible for the technical aspects of circuit management. CONCLUSIONS: A specialist nurse with perfusion backup is the staffing arrangement implemented by most centres and likely reflects the most efficient use of the professional competences available. RELEVANCE TO CLINICAL PRACTICE: Staffing for adult respiratory extracorporeal support has important implications for the planning of workforce, training and education, quality of service and the number of ECMO beds available.

Patients with Parkinson's cannot access nurse specialists.

While most people with Parkinson's disease have specialist nurses, many struggle to access them between appointments, according to a national survey.