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The acute care nurse practitioner role in Canada.

https://arctichealth.org/en/permalink/ahliterature135437
Source
Nurs Leadersh (Tor Ont). 2010 Dec;23 Spec No 2010:114-39
Publication Type
Article
Date
Dec-2010
Author
Kelley Kilpatrick
Patricia Harbman
Nancy Carter
Ruth Martin-Misener
Denise Bryant-Lukosius
Faith Donald
Sharon Kaasalainen
Ivy Bourgeault
Alba DiCenso
Author Affiliation
Department of Nursing, Université du Québec en Outaouais, CHSRF/CIHR Program in Advanced Practice Nursing, St-Jérôme, QC.
Source
Nurs Leadersh (Tor Ont). 2010 Dec;23 Spec No 2010:114-39
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Acute Disease
Advanced Practice Nursing - education - organization & administration - standards
Canada
Clinical Competence
Curriculum
Delivery of Health Care - organization & administration
Educational Measurement
Educational Status
Focus Groups
Health Policy
Humans
Nurse Practitioners - education - organization & administration - standards
Nurse's Role
Quebec
Abstract
The acute care nurse practitioner (ACNP) role was developed in Canada in the late 1980s to offset rapidly increasing physician workloads in acute care settings and to address the lack of continuity of care for seriously ill patients and increased complexity of care delivery. These challenges provided an opportunity to develop an advanced practice nursing role to care for critically ill patients with the intent of improving continuity of care and patient outcomes. For this paper, we drew on the ACNP-related findings of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing. The synthesis revealed that ACNPs are working in a range of clinical settings. While ACNPs are trained at the master's level, there is a gap in specialty education for ACNPs. Important barriers to the full integration of ACNP roles into the Canadian healthcare system include lack of full utilization of role components, limitations to scope of practice, inconsistent team acceptance and funding issues. Facilitators to ACNP role implementation include clear communication about the role, with messages tailored to the specific information needs of various stakeholder groups; supportive leadership of healthcare managers; and stable and predictable funding. The status of ACNP roles continues to evolve across Canada. Ongoing leadership and continuing research are required to enhance the integration of these roles into our healthcare system.
PubMed ID
21478690 View in PubMed
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Administrative claims data analysis of nurse practitioner prescribing for older adults.

https://arctichealth.org/en/permalink/ahliterature149161
Source
J Adv Nurs. 2009 Oct;65(10):2077-87
Publication Type
Article
Date
Oct-2009
Author
Andrea L Murphy
Ruth Martin-Misener
Charmaine Cooke
Ingrid Sketris
Author Affiliation
School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada. andrea.murphy@dal.ca
Source
J Adv Nurs. 2009 Oct;65(10):2077-87
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Aged
Anti-Infective Agents - therapeutic use
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Drug Prescriptions - economics - nursing - statistics & numerical data
Female
Health Services Research
Health Services for the Aged
Humans
Insurance, Pharmaceutical Services - statistics & numerical data
Male
Nova Scotia - epidemiology
Nurse Practitioners - statistics & numerical data
Nurse's Practice Patterns - statistics & numerical data - trends
Pharmacoepidemiology
Retrospective Studies
Rural Population
Abstract
This paper is a report of a study to identify the patterns of prescribing by primary health care nurse practitioners for a cohort of older adults.
The older adult population is known to receive complex pharmacotherapy. Monitoring prescribing to older adults can inform quality improvement initiatives. In comparison to other countries, research examining nurse practitioner prescribing in Canada is limited. Nurse practitioner prescribing for older adults is relatively unexplored in the international literature. Although commonly used to study physician prescribing, few studies have used claims data from drug insurance programmes to investigate nurse practitioner prescribing.
Drug claims for prescriptions written by nurse practitioners from fiscal years 2004/05 to 2006/07 for beneficiaries of the Nova Scotia Seniors' Pharmacare programme were analysed. Data were retrieved and analysed in May 2008. Prescribing was described for each drug using the World Health Organization Anatomical Therapeutic Chemical code classification system by usage and costs for each fiscal year.
Antimicrobials and non-steroidal anti-inflammatory drugs consistently represented the top ranked groups for prescription volume and cost. Over the three fiscal years, antimicrobial prescription rates declined relative to rates of other groups of medications. Prescription volume per nurse doubled and cost per prescription increased by approximately 20%.
Prescription claims data can be used to characterize the prescribing trends of nurse practitioners. Research linking patient characteristics, including diagnoses, to prescriptions is needed to assess prescribing quality. Some potential areas of improvement were identified with antimicrobial and non-steroidal antiinflammatory selection.
PubMed ID
19674174 View in PubMed
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Advanced practice nursing in Canada: overview of a decision support synthesis.

https://arctichealth.org/en/permalink/ahliterature135441
Source
Nurs Leadersh (Tor Ont). 2010 Dec;23 Spec No 2010:15-34
Publication Type
Article
Date
Dec-2010
Author
Alba DiCenso
Ruth Martin-Misener
Denise Bryant-Lukosius
Ivy Bourgeault
Kelley Kilpatrick
Faith Donald
Sharon Kaasalainen
Patricia Harbman
Nancy Carter
Sandra Kioke
Julia Abelson
R James McKinlay
Dianna Pasic
Brandi Wasyluk
Julie Vohra
Renee Charbonneau-Smith
Author Affiliation
Ontario Training Centre in Health Services & Policy Research, Nursing and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON.
Source
Nurs Leadersh (Tor Ont). 2010 Dec;23 Spec No 2010:15-34
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Advanced Practice Nursing - classification - methods - organization & administration
Canada
Decision Support Systems, Clinical - classification - organization & administration
Focus Groups
Health Care Surveys
Health Policy
Humans
Leadership
Nurse Clinicians - classification - organization & administration
Nurse Practitioners - classification - organization & administration
Periodicals as Topic - statistics & numerical data
Publishing - statistics & numerical data
Abstract
The objective of this decision support synthesis was to identify and review published and grey literature and to conduct stakeholder interviews to (1) describe the distinguishing characteristics of clinical nurse specialist (CNS) and nurse practitioner (NP) role definitions and competencies relevant to Canadian contexts, (2) identify the key barriers and facilitators for the effective development and utilization of CNS and NP roles and (3) inform the development of evidence-based recommendations for the individual, organizational and system supports required to better integrate CNS and NP roles into the Canadian healthcare system and advance the delivery of nursing and patient care services in Canada. Four types of advanced practice nurses (APNs) were the focus: CNSs, primary healthcare nurse practitioners (PHCNPs), acute care nurse practitioners (ACNPs) and a blended CNS/NP role. We worked with a multidisciplinary, multijurisdictional advisory board that helped identify documents and key informant interviewees, develop interview questions and formulate implications from our findings. We included 468 published and unpublished English- and French-language papers in a scoping review of the literature. We conducted interviews in English and French with 62 Canadian and international key informants (APNs, healthcare administrators, policy makers, nursing regulators, educators, physicians and other team members). We conducted four focus groups with a total of 19 APNs, educators, administrators and policy makers. A multidisciplinary roundtable convened by the Canadian Health Services Research Foundation formulated evidence-informed policy and practice recommendations based on the synthesis findings. This paper forms the foundation for this special issue, which contains 10 papers summarizing different dimensions of our synthesis. Here, we summarize the synthesis methods and the recommendations formulated at the roundtable.
PubMed ID
21478685 View in PubMed
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The clinical nurse specialist role in Canada.

https://arctichealth.org/en/permalink/ahliterature135436
Source
Nurs Leadersh (Tor Ont). 2010 Dec;23 Spec No 2010:140-66
Publication Type
Article
Date
Dec-2010
Author
Denise Bryant-Lukosius
Nancy Carter
Kelley Kilpatrick
Ruth Martin-Misener
Faith Donald
Sharon Kaasalainen
Patricia Harbman
Ivy Bourgeault
Alba DiCenso
Author Affiliation
School of Nursing and Department of Oncology, McMaster University, CHSRF/CIHR Program in Advanced Practice Nursing, Canadian Centre of Excellence in Oncology Advanced Practice Nursing at the Juravinski Cancer Centre, Hamilton, ON.
Source
Nurs Leadersh (Tor Ont). 2010 Dec;23 Spec No 2010:140-66
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Advanced Practice Nursing - education - organization & administration - standards
Canada
Clinical Competence
Credentialing
Decision Support Techniques
Delivery of Health Care
Educational Measurement
Educational Status
Focus Groups
Humans
Leadership
Nurse Clinicians - education - organization & administration - standards
Nurse's Role
Abstract
The clinical nurse specialist (CNS) provides an important clinical leadership role for the nursing profession and broader healthcare system; yet the prominence and deployment of this role have fluctuated in Canada over the past 40 years. This paper draws on the results of a decision support synthesis examining advanced practice nursing roles in Canada. The synthesis included a scoping review of the Canadian and international literature and in-depth interviews with key informants including CNSs, nurse practitioners, other health providers, educators, healthcare administrators, nursing regulators and government policy makers. Key challenges to the full integration of CNSs in the Canadian healthcare system include the paucity of Canadian research to inform CNS role implementation, absence of a common vision for the CNS role in Canada, lack of a CNS credentialing mechanism and limited access to CNS-specific graduate education. Recommendations for maximizing the potential and long-term sustainability of the CNS role to achieve important patient, provider and health system outcomes in Canada are provided.
PubMed ID
21478691 View in PubMed
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Clinical nurse specialists and nurse practitioners: title confusion and lack of role clarity.

https://arctichealth.org/en/permalink/ahliterature135434
Source
Nurs Leadersh (Tor Ont). 2010 Dec;23 Spec No 2010:189-201
Publication Type
Article
Date
Dec-2010
Author
Faith Donald
Denise Bryant-Lukosius
Ruth Martin-Misener
Sharon Kaasalainen
Kelley Kilpatrick
Nancy Carter
Patricia Harbman
Ivy Bourgeault
Alba DiCenso
Author Affiliation
Affiliate Faculty, Daphne Cockwell School of Nursing, Ryerson University, CHSRF/CIHR Program in Advanced Practice Nursing, Toronto, ON.
Source
Nurs Leadersh (Tor Ont). 2010 Dec;23 Spec No 2010:189-201
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Advanced Practice Nursing - organization & administration
Attitude of Health Personnel
Awareness
Canada
Curriculum
Focus Groups
Health Policy
Humans
Nurse Clinicians - organization & administration
Nurse Practitioners - organization & administration
Nurse's Role
Social Perception
Abstract
Title confusion and lack of role clarity pose barriers to the integration of advanced practice nursing roles (i.e., clinical nurse specialist [CNS] and nurse practitioner [NP]). Lack of awareness and understanding about NP and CNS roles among the healthcare team and the public contributes to ambiguous role expectations, confusion about NP and CNS scopes of practice and turf protection. This paper draws on the results of a scoping review of the literature and qualitative key informant interviews conducted for a decision support synthesis commissioned by the Canadian Health Services Research Foundation and the Office of Nursing Policy in Health Canada. The goal of this synthesis was to develop a better understanding of advanced practice nursing roles and the factors that influence their effective development and integration in the Canadian healthcare system. Specific recommendations from interview participants and the literature to enhance title and role clarity included the use of consistent titles for NP and CNS roles; the creation of a vision statement to articulate the role of CNSs and NPs across settings; the use of a systematic planning process to guide role development and implementation; the development of a communication strategy to educate healthcare professionals, the public and employers about the roles; attention to inter-professional team dynamics when introducing these new roles; and addressing inter-professionalism in all health professional education program curricula.
PubMed ID
21478694 View in PubMed
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Collaborative practice in health systems change: the Nova Scotia experience with the Strengthening Primary Care Initiative.

https://arctichealth.org/en/permalink/ahliterature179280
Source
Nurs Leadersh (Tor Ont). 2004 May;17(2):33-45
Publication Type
Article
Date
May-2004
Author
Ruth Martin-Misener
John McNab
Ingrid S Sketris
Lynn Edwards
Author Affiliation
School of Nursing, Dalhousie University, Halifax, NS.
Source
Nurs Leadersh (Tor Ont). 2004 May;17(2):33-45
Date
May-2004
Language
English
Publication Type
Article
Keywords
Cooperative Behavior
Family Practice - organization & administration
Health Care Reform - organization & administration
Humans
Interprofessional Relations
Liability, Legal
Malpractice
Medical Records Systems, Computerized - organization & administration
National health programs - organization & administration
Nova Scotia
Nurse Practitioners - organization & administration - psychology
Nurse's Role
Organizational Innovation
Organizational Objectives
Patient Care Team - organization & administration
Personnel Selection
Primary Health Care - organization & administration
Abstract
Recently attention has been focussed on the significance of primary care to the Canadian healthcare system. Nova Scotia. Like other provinces, is seeking ways to improve the healthcare that it provides within a financially constrained publicly funded system. The Strengthening Primary Care Initiative in Nova Scotia (SPCI) was a primary care demonstration project to evaluate specific goals related to primary care. Although the provincial government conceived the SPCI, the approach to its planning and implementation was participatory and consultative. Funded through the federal Health Transition Fund (HTF) (Health Canada 2002) and the government of Nova Scotia, the SPCI involved changes in four communities over a three-year period (2000-2002). These changes included the introduction of a primary healthcare nurse practitioner in collaborative practice with one or more family physicians; remuneration of the family physician(s) with methods other than a solely fee-for-service (FFS) arrangement; and the introduction and utilization of a computerized patient medical record. The SPCI was committed to a consultative process with stakeholders, and this gave rise to several challenges. Initially there was disagreement on the requirement for nurse practitioners at each of the demonstration sites. The Minister of Health confirmed that a nurse practitioner was a required component at each demonstration site. Differences in perspectives on the role of allied health professionals in the SPCI were encountered, and the significance of the role pharmacists have in primary care was not fully appreciated until after the SPCI had started. At the time the SPCI began there was no legislation for nurse practitioners in Nova Scotia; therefore, an approval mechanism for nurse practitioner practice was authorized through the provincial regulatory bodies for nursing and medicine. Malpractice and liability issues, particularly on the part of providers who had never worked with nurse practitioners before, were an initial concern. Recruitment of nurse practitioners into the three rural sites mirrored the difficulties with recruitment of healthcare providers encountered in other parts of rural Canada. The authors discuss their perspectives on the challenges related to interdisciplinary collaboration in health systems change that were encountered during the planning and implementation of the SPCI. Although nurse practitioner Legislation has existed in Ontario and Newfoundland and Labrador for several years, many provinces are grappling with the challenges associated with the introduction of nurse practitioners and collaborative practice. This paper conveys the experience of one province and will be of interest to administrators, educators and practitioners elsewhere in Canada who are engaged in primary healthcare renewal.
Notes
Comment In: Nurs Leadersh (Tor Ont). 2004 May;17(2):45-615239316
PubMed ID
15239315 View in PubMed
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Continuing education for primary health care nurse practitioners in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature121649
Source
Nurse Educ Today. 2013 Apr;33(4):353-7
Publication Type
Article
Date
Apr-2013
Author
Pamela Baxter
Alba DiCenso
Faith Donald
Ruth Martin-Misener
Joanne Opsteen
Tracey Chambers
Author Affiliation
School of Nursing, McMaster University, 1280 Main Street West, Room HSC 3N28C, Hamilton, ON, Canada L8S 4K1. baxterp@mcmaster.ca
Source
Nurse Educ Today. 2013 Apr;33(4):353-7
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Consumer Satisfaction
Cross-Sectional Studies
Education, Distance
Education, Nursing, Continuing
Female
Humans
Internet
Male
Needs Assessment
Nurse Practitioners - education
Ontario
Primary Health Care - manpower
Abstract
The Council of Ontario University Programs in Nursing offers a nine-university, consortium-based primary health care nurse practitioner education program and on-line continuing education courses for primary health care nurse practitioners. Our study sought to determine the continuing education needs of primary health care nurse practitioners across Ontario, how best to meet these needs, and the barriers they face in completing continuing education. Surveys were completed by 83 (40%) of 209 learners who had participated in continuing education offered by the Council of Ontario University Programs in Nursing between 2004 and 2007. While 83% (n=50) of nurse practitioners surveyed indicated that continuing education was extremely important to them, they also identified barriers to engaging in continuing education offerings including; time intensity of the courses, difficulty taking time off work, family obligations, finances and fatigue. The most common reason for withdrawal from a continuing education offering was the difficulty of balancing work and study demands. Continuing education opportunities are important to Ontario primary health care nurse practitioners, and on-line continuing education offerings have been well received, but in order to be taken up by their target audience they must be relevant, readily accessible, flexible, affordable and offered over brief, intense periods of time using technology that is easy to use and Internet sites that are easily navigated.
PubMed ID
22889580 View in PubMed
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Creating a supportive environment for living with stroke in rural areas: two low-cost community-based interventions.

https://arctichealth.org/en/permalink/ahliterature149856
Source
Top Stroke Rehabil. 2009 Mar-Apr;16(2):147-56
Publication Type
Article
Author
Joanne M Newell
Renee Lyons
Ruth Martin-Misener
Cindy L Shearer
Author Affiliation
Dalhousie University School of Nursing, Yarmouth, Nova Scotia, Canada.
Source
Top Stroke Rehabil. 2009 Mar-Apr;16(2):147-56
Language
English
Publication Type
Article
Keywords
Aged
Caregivers
Cost of Illness
Female
Humans
Information Dissemination
Male
Middle Aged
Narration
Needs Assessment
Nova Scotia - epidemiology
Rural Health Services - statistics & numerical data
Rural Population - statistics & numerical data
Social Class
Social Support
Stroke - epidemiology - rehabilitation
Survivors
Abstract
With the growing burden of chronic illness affecting aging populations, rural health systems are faced with unique challenges to support and promote health in their communities. The Yarmouth Stroke Project was a 5-year initiative aimed at improving health care services for stroke survivors in rural Nova Scotia, Canada. A needs assessment indicated a lack of support to self-manage stroke during community re-integration. The needs reported by stroke survivors and their caregivers included informational and emotional support. A logic model approach was used to frame program planning leading to the design of two low-cost interventions. The first, a Community Resource Guide, was developed to address informational needs and enable stroke survivors to access community-specific resources. The second intervention, designed to address the emotional support needs of stroke survivors and their caregivers, involved collection and publication of local narratives. The stories described the experiences of community members affected by stroke, offering practical knowledge and messages of hope. The resource guide and stories represent two low-cost strategies for supporting and promoting the health of people living with stroke in rural settings.
PubMed ID
19581201 View in PubMed
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Defining the role of primary health care nurse practitioners in rural Nova Scotia.

https://arctichealth.org/en/permalink/ahliterature142342
Source
Can J Nurs Res. 2010 Jun;42(2):30-47
Publication Type
Article
Date
Jun-2010
Author
Ruth Martin-Misener
Sandra M Reilly
Ardene Robinson Vollman
Author Affiliation
School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
Source
Can J Nurs Res. 2010 Jun;42(2):30-47
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Advanced Practice Nursing - organization & administration
Attitude of Health Personnel
Chi-Square Distribution
Diffusion of Innovation
Female
Governing Board
Health services needs and demand
Humans
Male
Models, Nursing
Nova Scotia
Nurse Practitioners - organization & administration - psychology
Nurse's Role - psychology
Nursing Evaluation Research
Nursing Methodology Research
Primary Health Care - organization & administration
Professional Autonomy
Qualitative Research
Questionnaires
Rural health services - organization & administration
Abstract
This article reports on a mixed methods study to define the role of nurse practitioners (NPs) in rural Nova Scotia, Canada, by collecting the perceptions of rural health board chairpersons and health-care providers. Qualitative data were collected in telephone interviews with health board chairpersons. Quantitative data were collected in a survey of NPs, family physicians, public health nurses, and family practice nurses.The authors describe participants' perspectives on the health needs of rural communities, the gaps in the current model of primary health care services, the envisaged role of NPs in rural communities, and the facilitators of and barriers to NP role implementation. Optimizing the benefits of the NP role for residents of rural communities requires attention to the barriers that impede deployment and integration of the role.
PubMed ID
20608235 View in PubMed
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Development of a scale to measure health professions students' self-efficacy beliefs in interprofessional learning.

https://arctichealth.org/en/permalink/ahliterature128822
Source
J Interprof Care. 2012 Mar;26(2):92-9
Publication Type
Article
Date
Mar-2012
Author
Karen Mann
Judith McFetridge-Durdle
Lynn Breau
Joanne Clovis
Ruth Martin-Misener
Tanya Matheson
Hope Beanlands
Maria Sarria
Author Affiliation
Dalhousie University, Halifax, Nova Scotia, Canada. karen.mann@dal.ca
Source
J Interprof Care. 2012 Mar;26(2):92-9
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Canada
Health Occupations - education
Humans
Interdisciplinary Studies
Interprofessional Relations
Patient-Centered Care - organization & administration - standards
Pilot Projects
Reproducibility of Results
Self Efficacy
Students, Health Occupations - psychology
Abstract
A need exists for measures to evaluate the impact of interprofessional education (IPE) interventions. We undertook development and evaluation of a scale to measure self-efficacy perceptions of pre-licensure students in medicine, dentistry and health professions. The scale was developed in the context of a project entitled, "Seamless Care: An Experiential Model of Interprofessional Education for Collaborative Patient-Centered Practice". As self-efficacy perceptions are associated with the likelihood of taking on certain tasks, the difficulty of those tasks, and perseverance in the face of barriers, we reasoned that understanding changes in students' perceptions and their relation to other outcomes was important. A 16-item scale was developed from a conceptual analysis of relevant tasks and the existing literature. Content validity was assessed by six Canadian IPE experts. Pre-licensure students (n = 209) participated in a pilot test of the instrument. Content validity was rated highly by the six judges; internal consistency of the scale (Cronbach's a = 96) and subscales 1 (a = .94) and 2 (a = .93) were high. Principal components analysis resulted in identification of two factors, each accounting for 34% of the variance: interprofessional interaction, and interprofessional team evaluation and feedback. We conclude that this scale can be useful in evaluating IPE interventions.
PubMed ID
22166126 View in PubMed
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26 records – page 1 of 3.