School of Nursing, McMaster University, Hamilton, Ontario, Canada.
School of Nursing, McMaster University, Hamilton, Ontario, Canada.
Int J Nurs Stud. 2023 Dec;148:104608. doi: 10.1016/j.ijnurstu.2023.104608. Epub 2023 Sep 18.
Emergency departments play a critical role in healthcare systems internationally. Visits for emergency care continue to increase, related to poor access to primary care, the COVID-19 pandemic, and health human resource issues. International literature shows similar stressors in the emergency department. Extended wait times to see health providers lead to poor outcomes, and innovative models of care are needed to address emergency department overcrowding and to meet the needs of patients. Advanced practice nurses have the expertise and scope of practice to optimize and address primary and acute care needs and could be further integrated into the emergency healthcare systems. It is unclear what and how advanced practice nurses are functioning in emergency departments to improve patient and organization outcomes.
This scoping review was a comprehensive search of MEDLINE, EMCARE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and gray literature. Authors developed inclusion and exclusion criteria, performed title and abstract screening, and full text screening using review software. Data about models of care with advanced practice nurses were extracted and organized to understand patient, provider, and organizational outcomes. We also extracted information about the development and implementation of roles.
Of the 6780 records identified, 76 met inclusion criteria. Emergency department models of care, mainly using nurse practitioners, include fast-track, generalized emergency, minor injury, orthopedics, pediatrics, geriatrics, specific populations, and triage. Reported patient outcomes include improvement in key metrics specific to emergency departments, such as total length of stay, wait times to be seen by a provider, left without being seen rates, treatment for pain, costs, and resource use. When comparing nurse practitioners to other providers, outcomes were similar or better for patient and organizational outcomes.
Various models of care utilizing advanced practice nurses in emergency departments are present internationally and information about how they are developed, integrated, and utilized provides practical information to support and sustain new roles. There is an opportunity to expand the use of these roles into emergency departments as the nurse practitioner scope of practice grows. Given the current crisis across healthcare systems, there is need for innovation, and improving delivery of emergency services with these advanced practice nursing models of care can help to address important health policy priorities in Canada and other countries.
Advanced Practice Nurse models of care in emergency - Improved outcomes for patients and organizations - A review of the literature. @SamanthaH_RN.
急诊部门在国际医疗体系中发挥着关键作用。由于初级保健服务获取途径有限、COVID-19 大流行以及卫生人力资源问题，急诊就诊量持续增加。国际文献表明，急诊部门也存在类似的压力因素。延长等待医疗服务提供者的时间会导致不良结果，因此需要创新的护理模式来解决急诊部门过度拥挤的问题，并满足患者的需求。高级实践护士具备优化和满足初级和急性护理需求的专业知识和实践范围，并且可以进一步整合到急诊医疗保健系统中。目前尚不清楚高级实践护士在急诊部门中是如何发挥作用以改善患者和组织的结果的。
这是一项全面的文献检索，检索了 MEDLINE、EMCARE、EMBASE、护理学和联合健康文献累积索引以及灰色文献。作者制定了纳入和排除标准，使用文献回顾软件进行标题和摘要筛选以及全文筛选。提取并组织有关高级实践护士护理模式的数据，以了解患者、医护人员和组织的结果。我们还提取了角色开发和实施的信息。
在 6780 条记录中，有 76 条符合纳入标准。急诊护理模式主要包括使用执业护师的快速通道、综合急诊、轻伤、骨科、儿科、老年病科、特定人群和分诊。报告的患者结果包括改善与急诊部门相关的关键指标，例如总住院时间、等待医疗服务提供者的时间、未得到治疗离开的比例、疼痛治疗、成本和资源使用。当将执业护师与其他提供者进行比较时，在患者和组织结果方面，两者的结果相似或更好。
国际上存在各种利用急诊高级实践护士的护理模式，有关其发展、整合和利用的信息为支持和维持新角色提供了实用信息。随着执业护师实践范围的扩大，有机会将这些角色扩展到急诊部门。鉴于当前医疗体系的危机，需要创新，而利用这些高级实践护理模式改善急诊服务的提供可以帮助解决加拿大和其他国家的重要卫生政策重点。
急诊中的高级实践护士护理模式 - 改善患者和组织的结果 - 文献综述。@SamanthaH_RN。
