Barriers and facilitators to the implementation of the advanced nurse practitioner role in primary care settings: a scoping review

Background: Workload and workforce issues in primary care are key drivers for the growing international trend to expand nursing roles. Advanced nurse practitioners are increasingly being appointed to take on activities and roles traditionally carried out by doctors. Successful implementation of any new role within multidisciplinary teams is complex and time-consuming, therefore it is important to understand the factors that may hinder or support implementation of the advanced nurse practitioner role in primary care settings. Objectives: To identify, appraise and synthesise the barriers and facilitators that impact implementation of advanced practitioner roles in primary care settings. Methods: A scoping review conducted using the Arksey and O’Malley (2005) framework and reported in accordance with PRISMA-ScR. Eight databases (Cochrane Library, Health Business Elite, Kings Fund Library, HMIC, Medline, CINAHL, SCOPUS and Web of Science) were searched to identify studies published in English between 2002 and 2017. Study selection and methodological assessment were conducted by two independent reviewers. A pre-piloted extraction form was used to extract the following data: study characteristics, context, participants and information describing the advanced nurse practitioner role. Deductive coding for barriers and facilitators was undertaken using a modified Yorkshire Contributory Framework. We used inductive coding for barriers or facilitators that could not be classified using pre-defined codes. Disagreements were addressed through discussion. Descriptive data was tabulated within evidence tables, and key findings for barriers and facilitators were brought together within a narrative synthesis based on the volume of evidence. Findings: Systematic searching identified 5976 potential records, 2852 abstracts were screened, and 122 full texts were retrieved. Fifty-four studies (reported across 76 publications) met the selection criteria. Half of the studies (n=27) were conducted in North America (n=27), and 25/54 employed a qualitative design. The advanced nurse practitioner role was diverse, working across the lifespan and with different patient groups. However, there was little agreement about the level of autonomy, or what constituted everyday activities. Team factors were the most frequently reported barrier and facilitator. Individual factors, lines of responsibility and ‘other’ factors (i.e. funding), were also frequently reported barriers. Facilitators included individual factors, supervision and leadership and ‘other’ factors (i.e. funding, planning for role integration). Conclusion: Building collaborative relationships with other healthcare professionals and negotiating the role are critical to the success of the implementation of the advanced nurse practitioner role. Team consensus about the role and how it integrates into the wider team is also essential

Pilot investigation of a virtual gastric band hypnotherapy intervention

This was a pilot investigation of 30 men and women with a BMI > 27kg/m² over a 24 week period. It aimed to determine whether virtual gastric band (VGB) hypnotherapy has an effect on weight loss in overweight adults, compared to relaxation hypnotherapy and a self-directed diet. Levels of weight loss and gain ranged from -17kg to +4.7kg in the VGB hypnotherapy group and -9.3kg to +7.8kg in the relaxation group. There was no significant difference between VGB hypnotherapy as a main effect on weight loss (Chi²=0.67, p=0.41, df=1) and there was no evidence of differential weight loss over time (Chi²=4.2, p=0.64, df=6). Therefore, this study concludes that there was no significant difference between VGB hypnotherapy and the relaxation hypnotherapy

Virtually hidden: a theoretical framework for understanding and conceptualising online drug use pornography

Online drug use pornography has been freely available through websites on the open internet for at least 7 years. Surprisingly there is almost no exploration of its nature, character or impacts on both performers and those engaging with this type of content within the research literature. Nor is it an issue that has engaged health care providers and other statutory and non-statutory agencies even though it may have implications within their respective domains. A preliminary scoping of the online environment is used to propose a theoretical framework that combines Goffman’s performance theory with that of Turner and Schechner’s positioning of ritual theory within performance theory, Butler’s concept of performativity online and Luppichi’s concept of the ‘technoself’. Utilising the proposed theoretical framework, it is postulated that the presence, performance and engagement of online drug use pornography is a social boundary testing and possibly breaking performance centred on iterative relationships between performer and consumers of this content.info:eu-repo/semantics/publishedVersio

Global Leadership Initiative Capstone

The opioid epidemic kills 47,600 people in the United States annually on average, which accounts for approximately 67% of all fatal overdoses. In addition to receiving medical treatment for addiction, opioid addicts require behavioral treatment as well. A peer support network, a system of peer mentors who help give emotional stability to addicts and maintain accountability, provide this crucial but often unattainable aspect of behavioral treatment. Mentorship support offers a long lasting relationship, in which recovering addicts will have continued support and are less likely to relapse, helping them to stay clean during and after medical treatment is completed. In this capstone, we will analyze existing peer support systems and develop a network platform that is transferable to government agencies and rehabilitation facilities in both the U.S. and other nations. We will design a website where opioid users, friends, family members, and members of a community affected by the crisis can find resources and connect with a network. We will develop a podcast highlighting the successes of the peer networking system in different use cases and health-related programs around the world. Opioids kill more people in the United States than any other drug, and while the heaviest casualties of the epidemic are in the U.S. and Canada, the research we have conducted suggests that this is a growing crisis in many other nations, from Australia to Egypt. Therefore it is imperative not only in American society, but within the global community as well, to develop exceptional rehabilitation programs to treat the rising number of addicts

How knowledge of the gastrointestinal absorption of elements could be used to predict transfer to milk

The quality and quantity of data used to derive transfer parameter values for milk are variable and there are many data gaps for elements/radionuclides which may need to be considered for risk assessment of the agricultural foodchain. There has been a recent focus on critically evaluating current methods to fill data gaps and on identifying extrapolation methods to derive suitable values for the elements, and particularly radioisotopes, with no or sparse data. The relationship between fractional absorption of elements in the ruminant gastrointestinal tract and transfer to milk has been explored to determine whether knowledge of the former can be used to predict the latter. A relationship has been derived between fractional absorption of elements and two empirical ratios commonly used to quantify transfer to milk; transfer coefficients (element concentration in milk divided by element daily intake) and concentrations ratios (concentration in milk divided by concentration in feed). We propose that fractional absorption may be used to predict the order of magnitude of the transfer to milk of elements/radionuclides for which no relevant data have yet been identified or collated

Technical Training and Readiness University for the Disabled

Technical Training and Readiness University (TTRUD) is a school for the disabled that would equip them with the 21st century skills needed for them to excel in the workforce. Skills include those such as technical skills, how to handle social encounters in the workplace, and basic training to be prepared to function for the job field they want to enter. To qualify, the applicant must be on disability, and would go through a thorough application process. TTRUD would be a non-profit organization and would rely mostly on donations, grants, and other government funding. We also plan to collaborate with any business or corporation that would like to hire any graduates of the program. In exchange for future workers, they would help fund TTRUD to keep the program alive. TTRUD’s ultimate goal is to increase the nation\u27s workforce while simultaneously decreasing the population’s dependence on disability

Estimating Costs and Benefits Associated with Evidence-Based Violence Prevention: Four case studies based on the Fourth R program

Teen violence in dating and peer relationships has huge costs to society in numerous areas including health care, social services, the workforce and the justice system. Physical, psychological, and sexual abuse have long-lasting ramifications for the perpetrators as well as the victims, and for the families involved on both sides of that equation. An effective violence prevention program that is part of a school’s curriculum is beneficial not only for teaching teenagers what is appropriate behaviour in a relationship, but also for helping them break the cycle of violence which may have begun at home with their own maltreatment as children. The Fourth R program is an efficacious violence prevention program that was developed in Ontario and has been implemented in schools throughout Canada and the U.S. Covering relationship dynamics common to dating violence as well as substance abuse, peer violence and unsafe sex, the program can be adapted to different cultures and to same-sex relationships. The program, which gets its name from the traditional 3Rs — reading, ’riting and ’rithmetic — offers schools the opportunity to provide effective programming for teens to reduce the likelihood of them using relationship for violence as they move into adulthood. The federal government has estimated that the societal costs of relationship violence amount to more than $7 billion. These costs can continue to be incurred through the legal and health-care systems as the ripple effects of violence play out over the years, even after a relationship has ended. Other types of violence are also costly to society and not just in terms of dollars, but in young lives diverted into criminal activity. Up to 15 per cent of youth who become involved with the justice system grow into serious adult offenders who develop lengthy criminal careers. Yet, research shows that if prevention programs such as the Fourth R can deter just one 14-year-old high-risk juvenile from a life of crime, up to$5 million can be saved in costs to society