2 research outputs found
Advancing nursing practice : the emergence of the role of Advanced Practice Nurse in Saudi Arabia
Background: The roots of advanced practice nursing can be traced back to the 1890s, but the Nurse Practitioner (NP) emerged in Western countries during the 1960s in response to the unmet health care needs of populations in rural areas. These early NPs utilized the medical model of care to assess, diagnose and treat. Nursing has since grown as a profession, with its own unique and distinguishable, holistic, science-based knowledge, which is complementary within the multidisciplinary team. Today Advanced Practice Nurses (APNs) demonstrate nursing expertise in clinical practice, education, research and leadership, and are no longer perceived as โphysician replacementsโ or assistants. Saudi Arabia has yet
to define, legislate or regulate Advanced Practice Nursing.
Aims: This article aims to disseminate information from a Saudi Advanced Practice Nurse thought leadership meeting, to chronicle the history of Advanced Practice Nursing within the Kingdom of Saudi Arabia, while identifying strategies for moving forward.
Conclusion: It is important to build an APN model based on Saudi health care culture and patient population needs, while recognizing global historical underpinnings. Ensuring that nursing continues to distinguish itself from other health care professions, while securing a seat at the multidisciplinary health care table will be instrumental in advancing the practice of nursing
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58ยท0%) were male. Median gestational age at birth was 38 weeks (IQR 36โ39) and median bodyweight at presentation was 2ยท8 kg (2ยท3โ3ยท3). Mortality among all patients was 37 (39ยท8%) of 93 in low-income countries, 583 (20ยท4%) of 2860 in middle-income countries, and 50 (5ยท6%) of 896 in high-income countries (p<0ยท0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90ยท0%] of ten in low-income countries, 97 [31ยท9%] of 304 in middle-income countries, and two [1ยท4%] of 139 in high-income countries; pโค0ยท0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2ยท78 [95% CI 1ยท88โ4ยท11], p<0ยท0001; middle-income vs high-income countries, 2ยท11 [1ยท59โ2ยท79], p<0ยท0001), sepsis at presentation (1ยท20 [1ยท04โ1ยท40], p=0ยท016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4โ5 vs ASA 1โ2, 1ยท82 [1ยท40โ2ยท35], p<0ยท0001; ASA 3 vs ASA 1โ2, 1ยท58, [1ยท30โ1ยท92], p<0ยท0001]), surgical safety checklist not used (1ยท39 [1ยท02โ1ยท90], p=0ยท035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1ยท96, [1ยท41โ2ยท71], p=0ยท0001; parenteral nutrition 1ยท35, [1ยท05โ1ยท74], p=0ยท018). Administration of parenteral nutrition (0ยท61, [0ยท47โ0ยท79], p=0ยท0002) and use of a peripherally inserted central catheter (0ยท65 [0ยท50โ0ยท86], p=0ยท0024) or percutaneous central line (0ยท69 [0ยท48โ1ยท00], p=0ยท049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030