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Type: Theses
Title: The experience and effectiveness of nurse practitioners in orthopaedic settings: a comprehensive systematic review
Author: Taylor, Anita Carol
Issue Date: 2015
School/Discipline: School of Translational Health Science
Abstract: Background: There is commonality amongst the definition and characteristics of Nurse Practitioner (NP)/Advanced Practice Nurse (APN) role and practice internationally in terms of education, practice standards and regulation; operationally there is variability. The NP role has been implemented internationally; at least 70 countries are considering some form of APN role.ICN/APN network 2012 cited in(1) NPs provide advanced clinical care and were implemented as part of health service reform to improve access and timeliness of healthcare.(2) Whilst much has been written on advanced practice nursing roles per se, there has been little focus specifically on the orthopaedic nursing context. This review will focus on orthopaedic nurse practitioners (ONP) in an international context. Objective: To appraise and synthesise the best available evidence on the experience and effectiveness of the role and practice of ONPs. Inclusion Criteria: Types of Participants ONP/APN in acute care or sub-acute orthopaedic settings. Types of Interventions Interventions of ONP specific care. Phenomena of Interest The experience of becoming or being an ONP in relation to role development, role implementation and (ongoing) role evaluation. Types of Studies This comprehensive systematic review looked at both quantitative and qualitative studies together with narrative text and opinion papers. Quantitative study designs included in this review included observational cohort/case control studies and descriptive case report/series. Phenomenology was the qualitative study design included. Mixed method studies were also included in this review. Types of Publications The textual component of this review considered publications of expert opinion, discussion papers, position papers and other relevant text where there existed a particular focus on the ‘orthopaedic’ aspect of NP practice. Types of Outcomes A range of outcome measures were included but were not limited to primary patient outcomes: occasions of service/numbers seen, length of stay (LOS), wait times, patient satisfaction, readmission, and other patient encounter data or relevant nurse-sensitive outcome data that characterised ONP practice. Secondary and related outcomes data relative to process indicators/outcomes such as: NP satisfaction, key stakeholder (other health professional) satisfaction, knowledge, LOS, cost benefit were considered. Search Strategy: Both published and unpublished English language studies were considered from individual database inception and searched up to December 2012. The search was repeated in early 2013 to ensure no recent papers had been published. A three step search strategy was employed for each component of this review. Methodological Quality: All retrieved studies and opinion papers were assessed by two independent reviewers using the standardised Joanna Briggs Institute critical appraisal tools. Any disagreements that arose between the reviewers were resolved through discussion, or with a third reviewer. Data Collection Quantitative data was extracted using the JBI-MAStARI tool. The data extracted included details about the interventions, populations, study methods and outcomes of significance to the review question. Qualitative data was extracted using the JBI-QARI tool. The data extracted included details about the methodology, method, phenomena of interest, participants, data analysis and relevant findings. Textual data was extracted using JBI-NOTARI tool. The data extracted included the type of text, stated allegiance or position, setting, geographical and cultural influences and messages and conclusions located within the publication. Data Analysis/Synthesis: Quantitative data was analysed using JBI-MAStARI. Meta-analysis of the quantitative data was not possible due to a lack of clinical and statistical heterogeneity; findings were presented in narrative format including tables to aid in data representation. As only one qualitative study was included, meta-synthesis by meta-aggregation was not possible. Textual data were synthesised using the Joanna Briggs Institute approach of aggregation using JBI-NOTARI. Results A total 31 studies and publications were included in the review. Nineteen quantitative studies were included, 10 comparable cohort and 9 descriptive studies. Seven broad review outcomes measures were identified: Three of which were patient related (primary) outcomes and three nurse related (secondary) outcomes. Three sub category patient-related outcomes focussed on (1) specialist care interventions, (2) patient satisfaction/acceptance, (3) wait times and access to care. Another four sub category nurse-related or process-related review outcomes focussed on (4) education, (5) length of stay, (6) other cost-related issues and (7) barriers. One unpublished qualitative thesis discussed four themes: (1) having knowledge, (2) being in and outside the role, (3) being an advocate and (4) being in control with decision making & anticipation as sub themes. The author concluded that advanced practice is a continuum. Eleven text and opinion publications were included where 39 conclusions were identified. From these conclusions eight categories emerged and three synthesised findings. The synthesised findings related to ‘Duality’, ‘Role & Relationships’ at a personal, organisational and professional level with an emphasis on collaboration, and ‘Moving Forward’ with an emphasis on resources needed to support the NP in this. Conclusions: The findings of this comprehensive review demonstrate the experience and effectiveness of NPs in orthopaedic settings is influenced by multiple factors from within and external to the individual. Overall the results derived from quantitative evidence indicated that NPs in orthopaedic settings provide comparable care when compared to conventional methods of health care delivery. However the results showed better outcomes in specific units where care is led by Clinical Nurse Specialists, NP management of distal radius fracture, and NP screening for developmental hip dysplasia. Decreased length of stay, improved patient wait times & access and patient satisfaction were demonstrated across the evidence, generally. Caution is required however when interpreting the results due to the lower quality of study designs. The qualitative and textual evidence demonstrated that the role of the ONP is multidimensional with confidence, knowledge and experience as essential elements to deal with complex and challenging situations. The experience of becoming or being an ONP is relational and collaborative at a personal, organisational and professional level. A ‘duality’ of purpose for ONP’s emerged from the textual evidence with interplay between benefits and barriers to ONP practice. Barriers as an outcome emerged from both quantitative and textual evidence. The experience of ONP is characterised by moving forward along a continuum – where the continuum represents the entire journey/career/professional life of the NP. From the comprehensive evidence on the effectiveness and experience of NPs in orthopaedic settings this review identified four ‘shared findings’ across the evidence base: Acceptance, Collaboration, Education/Knowledge/Experience, Duality.
Advisor: Porritt, Kylie Amanda
Kralik, Debbie Lynne
Dissertation Note: Thesis (M.Clin.Sc.) (Research by Publication) -- University of Adelaide, School of Translational Health Science, 2015.
Keywords: Orthopaedic nurse practitioner
advanced practice nurse
extended practice
expert nurse
systematic review
Research by Publication
Provenance: This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at:
DOI: 10.4225/55/5ac43bc2f8b96
Appears in Collections:Research Theses

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