School of Nursing, University of Auckland, Auckland, New Zealand.
School of Nursing, Massey University, Palmerston North, New Zealand.
J Adv Nurs. 2024 Oct;80(10):3899-3914. doi: 10.1111/jan.16093. Epub 2024 Feb 6.
To develop a framework to guide the successful integration of nurse practitioners (NPs) into practice settings and, working from a social justice lens, deliver comprehensive primary healthcare which advances health equity.
Integrative review.
The integrative review was informed by the Whittemore and Knafl's framework and followed the Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines. Quality was assessed using the Johns Hopkins Research Evidence Appraisal Tool. Findings were extracted and thematically analysed using NVivo. A social justice lens informed all phases.
Databases, including CINAHL, PubMed, Scopus and Web of Science, were searched for peer-reviewed literature published in English between 2005 and April 2022.
Twenty-eight articles were included. Six themes were identified at the individual (micro), local health provider (meso), and national systems and structures (macro) levels of the health sector: (1) autonomy and agency; (2) awareness and visibility; (3) shared vision; (4) leadership; (5) funding and infrastructure; and (6) intentional support and self-care. The evidence-based framework is explicitly focused on the components required to successfully integrate NPs into primary healthcare to advance health equity.
Integrating NPs into primary healthcare is complex and requires a multilevel approach at macro, meso and micro levels. NPs offer the potential to transform primary healthcare delivery to meet the health needs of local communities. Health workforce and integration policies and strategies are essential if the contribution of NPs is to be realized. The proposed framework offers an opportunity for further research to inform NP integration.
Nurse practitioners (NPs) offer the potential to transform primary healthcare services to meet local community health needs and advance health equity. Globally, there is a lack of guidance and health policy to support the integration of the NP workforce. The developed framework provides guidance to successfully integrate NPs to deliver comprehensive primary healthcare grounded in social justice. Integrating NPs into PHC is complex and requires a multilevel approach at macro, meso and micro levels. The framework offers an opportunity for further research to inform NP integration, education and policy.
What problem did the study address: The challenges of integrating nurse practitioners (NPs) into primary healthcare (PHC) are internationally recognized. Attempts to establish NP roles in New Zealand have been ad hoc with limited research, evidence-informed frameworks or policy to guide integration initiatives. Our review builds on existing international literature to understand how NPs are successfully integrated into PHC to advance health equity and provide a guiding framework. What were the main findings: Six themes were identified across individual (micro), local health provider (meso) and national systems and structures (macro) levels as fundamental to NP integration: autonomy and agency; awareness and visibility of the NP and their role; a shared vision for the direction of primary healthcare utilizing NP scope of practice; leadership in all spaces; necessary funding and infrastructure; and intentional support and self-care. Where and on whom will the research have an impact: Given extant health workforce challenges together with persisting health inequities, NPs provide a solution to delivering comprehensive primary healthcare from a social justice lens to promote healthcare access and health equity. The proposed evidence-informed framework provides guidance for successful integration across the health sector, training providers, as well as the NP profession, and is a platform for future research.
This integrative review adhered to the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) method.
No patient or public contribution.
制定一个框架，以指导护士从业者（NPs）成功融入实践环境，并从社会正义视角出发，提供全面的初级医疗保健，推进健康公平。
综合审查。
综合审查以 Whittemore 和 Knafl 的框架为依据，并遵循系统评价和荟萃分析的首选报告指南。使用约翰霍普金斯研究证据评估工具评估质量。使用 NVivo 提取和进行主题分析研究结果。社会正义视角指导所有阶段。
包括 CINAHL、PubMed、Scopus 和 Web of Science 在内的数据库，检索了 2005 年至 2022 年 4 月期间以英语发表的同行评审文献。
共纳入 28 篇文章。在卫生部门的个体（微观）、当地卫生提供者（中观）和国家系统和结构（宏观）层面确定了六个主题：（1）自主权和能动性；（2）意识和可见度；（3）共同愿景；（4）领导力；（5）资金和基础设施；（6）有针对性的支持和自我保健。该循证框架明确侧重于成功将 NPs 整合到初级医疗保健中以推进健康公平所需的组成部分。
将 NPs 整合到初级医疗保健中是复杂的，需要在宏观、中观和微观层面采取多层次方法。NPs 提供了从社会正义视角转变初级医疗保健服务以满足当地社区健康需求的潜力。如果要实现 NPs 的贡献，就必须制定卫生人力和整合政策和战略。拟议的框架为进一步研究提供了机会，以告知 NP 整合。
护士从业者（NPs）提供了从社会正义视角转变初级医疗保健服务以满足当地社区健康需求并推进健康公平的潜力。在全球范围内，缺乏支持 NP 劳动力整合的指导和卫生政策。制定的框架为成功整合 NPs 提供了指导，以提供基于社会正义的综合初级医疗保健。将 NPs 整合到 PHC 中是复杂的，需要在宏观、中观和微观层面采取多层次方法。该框架为进一步研究提供了机会，以告知 NP 整合、教育和政策。
研究解决了什么问题：将护士从业者（NPs）整合到初级医疗保健（PHC）中的挑战在国际上得到认可。新西兰尝试建立 NP 角色的做法是临时性的，缺乏研究、循证框架或指导整合举措的政策。我们的综述建立在现有的国际文献基础上，以了解如何成功将 NPs 整合到 PHC 中以推进健康公平并提供指导框架。主要发现是什么：在个体（微观）、当地卫生提供者（中观）和国家系统和结构（宏观）层面确定了六个主题，这些主题是 NP 整合的基础：自主权和能动性；NP 及其角色的意识和可见度；利用 NP 实践范围的初级医疗保健方向的共同愿景；各级领导；必要的资金和基础设施；有针对性的支持和自我保健。研究将在何处以及对谁产生影响：鉴于现有的卫生人力挑战以及持续存在的健康不平等，NPs 提供了从社会正义视角提供全面初级医疗保健的解决方案，以促进医疗保健获取和健康公平。拟议的循证框架为整个卫生部门的成功整合、培训提供者以及 NP 专业人员提供了指导，并为未来的研究提供了一个平台。
本综合审查遵循系统评价和荟萃分析的首选报告（PRISMA）方法。
没有患者或公众的贡献。
