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 Under a Creative Commons license Open access • What is already known about this topic? •Previous randomized control trials and systematic reviews identify that nurse-led care (as a substitute for physician-led care) can improve overall patient care and service outcomes delivery. •Consistently reported positive outcomes include greater patient satisfaction, improved access to health advice, and better chronic disease self-management. •Previous reviews, of this nature, have focused on evaluating the impact of nurses working as substitutes for doctors in the primary care setting. This review differs in that it explores the role and capacity of Advanced Nurse Practitioners (ANPs) - in primary, secondary and specialist care settings involving both adult and pediatric populations. •Previous reviews focus on the study outcomes of specific nurse-led care interventions. This review evaluates studies that explore the comparable effect of advanced nurse practitioners-led care programes as they directly compare to physician-led/usual care programes. •This paper highlights the need for more high-quality randomized control trials design studies to further explore this clinical concept - given the notable existence of methodological flaws in the current research literature. AbstractAimTo evaluate the effectiveness of the role of advanced nurse practitioners compared to physicians-led/ usual care (care managed by medical doctors or non-advanced nurse practitioners) BackgroundAdvanced nurse practitioners contribute to the improvement of quality patient care and have substantial potential to optimise the health of people globally. Since the formal recognition of advanced nurse practitioners by the International Council of Nurses, among others, the role has been adopted across most departments and clinical specialties, particularly in high-income countries. DesignSystematic review of primary research evidence Data SourceMEDLINE, EMBASE, CINAHL, Cochrane registry, Cochrane trials, and Cochrane EPOC (PDQ Evidence) were searched for randomised controlled trials (RCTs) of patient care and health resource utilisation outcomes associated with advanced nurse practitioners. Review MethodsThe review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The chosen articles were restricted to full-text English language trials published in the last 20 years, incorporating comparators of usual care. Search terms were limited to variations of advanced nurse practitioner role and practice. The eligible studies were bias risk assessed and quality assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Clinical and service outcomes were analysed using narrative synthesis as the marked heterogeneity between studies precluded meta-analysis. ResultsThirteen RCTs were reviewed. All of them were conducted across high-income countries within primary care and hospital settings involving paediatric and adult patients. Five trials were assessed as high quality, and eight were of low to moderate quality. Positive effects were demonstrated for the impact of advanced nurse practitioners on usual care; for indigestion, mean difference [MD] 2.3: 95% CI 1.4, 3.1]), perceptions of health status [ (MD –140.6; 95% CI –184.8, –96.5)], satisfaction levels [ (MD ranged from –8.79; 95% CI –13.59, –3.98 to 0.61; 95% CI –4.84, 6.05)], physical function (1.58 [SD 0.76] v. 1.81 [SD 0.90]), and blood pressure control (systolic [133 [SD 21] v. 135 [SD 19] mmHg p = 0.04] and diastolic [77 [SD 10] v. 80 [SD 11] mmHg p = 0.007]) were looked at. Positive effects related to service provision included improved patient satisfaction and reductions in waiting times and costs, which significantly favored advanced nurse practitioners (all p < 0.05). ConclusionThe evidence of this review supports the positive impact of advanced nurse practitioners on clinical and service-related outcomes: patient satisfaction, waiting times, control of chronic disease, and cost-effectiveness especially when directly compared to medical practitioner-led care and usual care practices - in primary, secondary and specialist care settings involving both adult and pediatric populations. KeywordsAdvanced nursing practice Advanced nurse practitioner Clinical impact Service improvement Care quality Patient care Cited by (0)© 2021 The Author(s). Published by Elsevier Ltd. What is the most common reaction of many parents to their child's hospitalization quizlet?What is the most common reaction of many parents to their child's hospitalization? Helplessness, fear, anxiety, and frustration are common responses of parents when a child becomes ill or is hospitalized.
What type of play is especially helpful for a child who is hospitalized to express their anger and fear?Child Life, Education and Creative Arts Therapy
Play allows children to express themselves in a way that is familiar to them. Medical play allows children to work out (or "play" out) their feelings or anxieties regarding medical experiences. Angry or aggressive feelings may surface during play.
Why is play important for children in the hospital?Play can help children and young people in hospitals build resilience which helps them to cope and be better engaged with treatment. Play can help give children their sense of control and autonomy back, which is often lost through illness and hospitalisation. Play can also strengthen family wellbeing and relationships.
What are some environmental stressors for the child and family in the pediatric intensive care unit?Environmental stressors for the child and family in the pediatric intensive care unit include unfamiliar sounds from monitors, telephones, suctioning, and other equipment and constant lights which disturb day and night rhythms.
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Which would the nurse teach the child and family about the distinctive features of ambulatory or outpatient care settings?
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