Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit, Stirling University, Scion House, Stirling FK9 4NF, United Kingdom.
Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, United Kingdom.
Int J Nurs Stud. 2020 Apr;104:103443. doi: 10.1016/j.ijnurstu.2019.103443. Epub 2019 Sep 27.
Workload and workforce issues in primary care are key drivers for the growing international trend to expand nursing roles. Advanced nurse practitioners are increasingly being appointed to take on activities and roles traditionally carried out by doctors. Successful implementation of any new role within multidisciplinary teams is complex and time-consuming, therefore it is important to understand the factors that may hinder or support implementation of the advanced nurse practitioner role in primary care settings.
To identify, appraise and synthesise the barriers and facilitators that impact implementation of advanced practitioner roles in primary care settings.
A scoping review conducted using the Arksey and O'Malley (2005) framework and reported in accordance with PRISMA-ScR. Eight databases (Cochrane Library, Health Business Elite, Kings Fund Library, HMIC, Medline, CINAHL, SCOPUS and Web of Science) were searched to identify studies published in English between 2002 and 2017. Study selection and methodological assessment were conducted by two independent reviewers. A pre-piloted extraction form was used to extract the following data: study characteristics, context, participants and information describing the advanced nurse practitioner role. Deductive coding for barriers and facilitators was undertaken using a modified Yorkshire Contributory Framework. We used inductive coding for barriers or facilitators that could not be classified using pre-defined codes. Disagreements were addressed through discussion. Descriptive data was tabulated within evidence tables, and key findings for barriers and facilitators were brought together within a narrative synthesis based on the volume of evidence.
Systematic searching identified 5976 potential records, 2852 abstracts were screened, and 122 full texts were retrieved. Fifty-four studies (reported across 76 publications) met the selection criteria. Half of the studies (n = 27) were conducted in North America (n = 27), and 25/54 employed a qualitative design. The advanced nurse practitioner role was diverse, working across the lifespan and with different patient groups. However, there was little agreement about the level of autonomy, or what constituted everyday activities. Team factors were the most frequently reported barrier and facilitator. Individual factors, lines of responsibility and 'other' factors (i.e., funding), were also frequently reported barriers. Facilitators included individual factors, supervision and leadership and 'other' factors (i.e., funding, planning for role integration).
Building collaborative relationships with other healthcare professionals and negotiating the role are critical to the success of the implementation of the advanced nurse practitioner role. Team consensus about the role and how it integrates into the wider team is also essential.
初级保健中的工作量和劳动力问题是扩大护理角色这一国际趋势的主要驱动因素。高级执业护师越来越多地被任命来承担传统上由医生执行的活动和角色。在多学科团队中成功实施任何新角色都很复杂且耗时，因此了解可能阻碍或支持初级保健环境中高级执业护师角色实施的因素很重要。
确定、评估和综合分析影响初级保健环境中高级执业护师角色实施的障碍和促进因素。
采用 Arksey 和 O'Malley（2005 年）框架进行范围综述，并按照 PRISMA-ScR 进行报告。在 Cochrane 图书馆、Health Business Elite、Kings Fund 图书馆、HMIC、Medline、CINAHL、SCOPUS 和 Web of Science 这 8 个数据库中进行搜索，以确定 2002 年至 2017 年间发表的英文研究。两名独立评审员进行了研究选择和方法评估。使用预试验提取表提取以下数据：研究特征、背景、参与者和描述高级执业护师角色的信息。使用经过修改的约克郡贡献框架对障碍和促进因素进行演绎编码。对于无法使用预定义代码进行分类的障碍或促进因素，我们使用归纳编码。通过讨论解决分歧。将描述性数据列于证据表中，并根据证据量，在叙述性综合中汇集了障碍和促进因素的关键发现。
系统搜索确定了 5976 条潜在记录，筛选了 2852 条摘要，检索了 122 篇全文。54 项研究（在 76 篇出版物中报告）符合入选标准。一半的研究（n=27）来自北美（n=27），25/54 项研究采用定性设计。高级执业护师的角色多种多样，跨越了生命周期，涵盖了不同的患者群体。然而，对于自主权的程度或日常活动的构成，几乎没有达成一致意见。团队因素是最常报告的障碍和促进因素。个体因素、责任线和“其他”因素（即资金）也经常被报告为障碍。促进因素包括个体因素、监督和领导以及“其他”因素（即资金、规划角色整合）。
与其他医疗保健专业人员建立协作关系并协商角色对于高级执业护师角色的成功实施至关重要。团队对角色的共识以及它如何融入更广泛的团队也是至关重要的。
