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Aim This article is a report of a study protocol designed to examine the effects of guided clinical reasoning on the quality of the Advanced Nursing Process—the evidence‐based version of the traditional nursing process. It aims to describe the theoretical framework—Kirkpatrick's evaluation model, the key concepts and the instruments for the planned study. Design A complex experimental intervention study using data and method triangulation is proposed. Methods Registered Nurses (N = 92), nursing records (N = 180) and 24 patients will be included. Nurses’ knowledge and attitude will be evaluated by questionnaires/tests, their clinical performance by observations. Patients’ perspective will be addressed by qualitative interviews and patient records by using the instrument Quality of Diagnoses, Interventions and Outcomes revised (Q‐DIO R). Discussion Kirkpatrick's model (including quantitative and qualitative methods) is providing evaluations from different perspectives on the quality of the Advanced Nursing Process and on intervention effects.

Aim This study aimed to assess (a) nurses' knowledge and their attitude towards the Advanced Nursing Process—nursing assessment, diagnoses, interventions, outcomes, (b) the quality of the Advanced Nursing Process and (c) relationships with patient characteristics. Design A cross‐sectional, descriptive correlational study was performed. Methods Ninety‐two registered nurses and ninety nursing records of six hospital wards were included. In January 2016, a knowledge test, a self‐assessment tool for measuring nurses' attitude (PND) and the Quality of Diagnoses, Interventions and Outcomes Revised instrument (Q‐DIO R) were applied. The correlations between nurses' knowledge, attitude, patient characteristics, organizational factors and the Advanced Nursing Process quality were investigated. Results Nurses demonstrated low levels of knowledge, positive attitudes and an average Advanced Nursing Process quality. Accurate nursing diagnoses were strong and highly significantly related to effective nursing interventions and better nursing‐sensitive patient outcomes. A higher proportion of registered nurses was related to better nursing outcomes.

Purpose To document the prevalence of the nursing diagnosis of anxiety in hospital patients, based on its level of severity, defining characteristics (DCs), and other related factors, and to identify the key DCs that serve as predictors of clinically significant anxiety (CSA). Design Cross‐sectional study. We enrolled 116 consecutive adult patients hospitalized from October 10 to 16, 2016, in medical‐surgical wards within the first 48 hr of admission. Methods The potential DCs and related factors of anxiety were collected based on the NANDA International terminology. Anxiety was considered clinically significant when presenting at moderate, severe, or panic level. The differences in DC prevalence among patients having or not having CSA were analyzed by unpaired student's t‐test. Multivariate analysis was used to examine the independent association between the DCs and CSA. Findings The prevalence of CSA was 36.2% and was significantly higher in patients who were older, female, and taking anxiolytic drugs, and among those who had cancer. The most frequent related factor for CSA was major change in health status. In the logistic regression, the presence of the DCs helplessness, altered attention or concentration, and anguish independently increased the odds of having CSA, whereas subjects presenting with Diminished ability to problem‐solve had about a 96% reduction in the likelihood to suffer from such a condition. Conclusions A high prevalence of CSA among medical‐surgical patients was shown. Furthermore, a critical cluster of DCs useful to identify CSA was found. Clinical Relevance The ability to accurately diagnose CSA should help prescribe and deliver the appropriate nursing interventions.

Named a 2013 Doody's Core Title! Named an AJN Book of the Year! \"This is an excellent and timely tool for advanced practice nurses.\" Score: 100, 5 stars -Doody's Medical Reviews Measuring the results of APN care has become increasingly important as a way to demonstrate the significant impact of APN nurses on practice outcomes. The third edition of this award-winning volume has been updated to provide the most current knowledge, perspectives, and research on assessing outcomes of APN care. It addresses not only the health outcomes of APN practice but the economic impact of APN care as well. Chapters discuss outcome measurement in all areas of advance practice nursing, including identifying outcomes in specialty areas and in community and ambulatory settings. The text provides detailed descriptions of how to conduct outcomes assessments, how to locate the most current instruments and measures for APN assessment, and perspectives on international initiatives in APN assessment. Examples of outcomes studies at the DNP level are culled from the most current published projects. Written by expert practitioners, educators, and researchers in APN outcomes assessment, this book will provide the essential information to help all APNs-regardless of specialty area or practice setting-to increase their skill level in designing outcomes-focused clinical research, selecting instruments, and analyzing outcomes data as critical components of their professional practice role. The third edition is completely updated and expanded to include: A new chapter on assessing outcomes at the DNP level through data gained from the most current research An expanded literature review on outcomes measurement research Guidelines for selecting assessment instruments Perspectives on an international initiative for the development of an APN research data collection toolkit New chapter objectives and critical discussion questions Updated web links

This study examined the effect of simulation on nursing students’ knowledge of advanced cardiac life support (ACLS), knowledge retention, and confidence in applying ACLS skills. An experimental, randomized controlled (pretest–posttest) design was used. The experimental group ( n = 40) attended an ACLS simulation scenario, a 4-hour PowerPoint presentation, and demonstration on a static manikin, whereas the control group ( n = 42) attended the PowerPoint presentation and a demonstration only. A paired t test indicated that posttest mean knowledge of ACLS and confidence was higher in both groups. The experimental group showed higher knowledge of ACLS and higher confidence in applying ACLS, compared with the control group. Traditional training involving PowerPoint presentation and demonstration on a static manikin is an effective teaching strategy; however, simulation is significantly more effective than traditional training in helping to improve nursing students’ knowledge acquisition, knowledge retention, and confidence about ACLS. [ J Nurs Educ. 2014;53(1):38–44.]

Aims To describe nurse practices during acute event nursing consultations in Primary Health Care settings and analyse whether these professionals demonstrate the competencies proposed for Advanced Practice Nurses within a care management scope. Design A multicenter, exploratory, cross‐sectional study employing both quantitative and qualitative analysis. Methods Data were collected through direct non‐participatory observations (film footage of nursing consultations) and medical record analysis. The study included 28 nurses and 203 patients from 17 primary care units across four municipalities in Brazil. Descriptive statistical analysis was applied to quantitative data, while qualitative data underwent content analysis. Results Challenges were observed in performing the nursing process and clinical communication during nursing consultations. Some of the proposed competencies for Advanced Practice Nurses were partially applied within a care management framework in Primary Health Care settings. The competencies related to the focus on care (61.11%), care provision (41.20%) and assessment and diagnosis (40.50%) were notable, with an overall average of 47.60% competency identification across all three dimensions. Although some general advanced practice nurse competencies were observed, their application was often limited or inconsistent. Conclusion This study identified limitations in nursing consultations for acute events in Primary Health Care, particularly regarding the nursing process and the application of Advanced Practice Nurse competencies. Notable gaps were observed in areas such as cultural diversity and advanced assessment skills. Future efforts should focus on developing educational programmes, providing resources and creating clinical guidelines to enhance current nursing practices and facilitate the implementation of Advanced Practice Nursing in Brazil. Impact The results provide empirical evidence to inform policy decisions, educational programmes, nursing practices and planning for advanced practice nursing implementation in Brazil. These findings are particularly relevant for healthcare educators, researchers, regulatory institutions and managers aiming to enhance the effectiveness of nursing consultations for acute events. Reporting Method This paper adheres to the COREQ and STROBE checklist. Patient or Public Contribution No patient or public contributions.

Advanced practice registered nurses have assumed an increasing role as providers in the health care system, particularly for underserved populations. The aim of this systematic review was to answer the following question: Compared to other providers (physicians or teams without APRNs) are APRN patient outcomes of care similar? This systematic review of published literature between 1990 and 2008 on care provided by APRNs indicates patient outcomes of care provided by nurse practitioners and certified nurse midwives in collaboration with physicians are similar to and in some ways better than care provided by physicians alone for the populations and in the settings included. Use of clinical nurse specialists in acute care settings can reduce length of stay and cost of care for hospitalized patients. These results extend what is known about APRN outcomes from previous reviews by assessing all types of APRNs over a span of 18 years, using a systematic process with intentionally broad inclusion of outcomes, patient populations, and settings. The results indicate APRNs provide effective and high-quality patient care, have an important role in improving the quality of patient care in the United States, and could help to address concerns about whether care provided by APRNs can safely augment the physician supply to support reform efforts aimed at expanding access to care.

Introduction Insight into nurse practitioners’ (NPs’) role transition can help NP students and new graduates in taking on new responsibilities in a changing and demanding healthcare context. The aim of the research was to explore the role transition from nurse to NP using the components of Meleis's Framework of Transitions. Method A qualitative descriptive design was used. Individual interviews (n = 9) and two focus group discussions (n = 12) were held with NPs. Data were analyzed with the directed content analysis method. Findings The Framework component transitions’ nature was characterized by changes in the healthcare system, combined with professional and educational role changes. Transition conditions showed that the respondents felt distressed after they became accountable for a patient's care and well‐being. Although the respondents were authorized to do medical procedures, they initially lacked nursing role models and NP protocols. Process indicators showed ongoing transition; the respondents were still developing clinical competencies and confidence in patient care while relying on earlier acquired nursing competencies. Outcome indicators showed that the respondents found themselves successful in the medical extension of two different nursing roles: continuity of medical care for hospitalized patients in acute and intensive care settings, and being responsible for continuity of care for chronic patients in outpatient clinics. Conclusions Role transition was characterized by coping with feelings of distress at the cost of time and effort. The respondents’ strategies to adapt to new expectations, combined with organizational support, determined the outcomes as well as the start of new transitions. Clinical Relevance NPs’ role transition in hospital care implies a dynamic ongoing process that needs to be supported, with the ultimate goal to improve patient outcomes.

The objective of this study is to describe the impact of the Advanced Practice Nurse role on the clinical practice and patient benefit, as well as to provide reasons for its implementation and expansion in Spain. Through the scoping review method, this study has been carried out according to five thematic blocks: life quality, cost-effectiveness, health results, satisfaction, and accessibility. The critical appraisal was performed with the Critical Appraisal Skills Programme (CASP) tool and the level of evidence and strength of recommendation have been analysed following the Oxford Centre for Evidence-Based Medicine (OCEBM) system. The results show that it is possible to formally implement advanced practice nursing in the Spanish context. The analysis of the Spanish regulatory framework reveals that the generalisation of the Case Manager Nurse is the starting point for the development of advanced practice nursing in Spain. This implementation would have a positive impact on patients in terms of health results, satisfaction, and life quality, given that the advanced practice nurse performs a more effective follow-up of chronic patients with a better control of risk factors, symptoms and health outcomes, and an earlier detection of complications. Considering these results, regional governments should promote the role of the Advanced Practice Nurse to contribute to its expansion.