Advanced practices and patient safety: an integrative literature review

An integrative review study was conducted in the indexed databases of PubMed, EBSCO, Proquest and Web of Science from June to August 2018 to answer the guiding questions: (1) What studies in the national and international literature relate advanced practices and patient safety?; and (2) How can advanced practices in nursing contribute to patient safety? The inclusion criteria were: academic articles published in journals (abstract and full text) in Portuguese, English or Spanish, adopting an empirical method of investigation of the study subject. The study had no restriction regarding the publication year.

Results

The search in databases resulted in 91 references obtained at first; after analysis, the final sample consisted of 12 studies.

Conclusion

The results of this integrative review showed that advanced practices in nursing have a positive relation to patient safety.

Advanced nursing practice; Patient safety; Integrative review

Author/Year/Country	Title	Journal	Study objective	Methodology	Conclusion	Categorization	Contribution to safe care
Lee, Cho & Bakken⁽¹³13. Lee NJ, Cho E, Bakken S. Identification of hypertension management-related errors in a personal digital assistant-based clinical log for nurses in advanced practice nurse training [Korean Soc Nurs Sci]. Asian Nurs Res (Korean Soc Nurs Sci). 2010;4(1):19–31.⁾(2010) - USA	Identification of Hypertension Management-related Errors in a Personal Digital Assistant-based Clinical Log for Nurses in Advanced Practice Nurse Training	Asian Nurs Res (Korean Soc Nurs Sci)	Develop a taxonomy for detection of errors related to hypertension management and to apply the taxonomy to retrospectively analyze the documentation of nurses in Advanced Practice Nurse (APN) training	Quantitative and observational approach	The results provide an initial understanding of the nature of the errors associated with the diagnosis of hypertension and the management of nurses in APN training.	Area III	Support to develop educational interventions that promote the general skills of APN for patient safety.
Jones et al.⁽¹⁶16. Jones N, Long L, Zeitz K. The role of the nurse sedationist. Collegian. 2011;18(3):115–23.⁾(2011) - Australia	The role of the nurse sedationist	Collegian	Identify the benefits and the level of satisfaction for the role of nurse sedationists.	Qualitative and quantitative approach – interviews with and a questionnaire answered by patients and nurses	The results indicate the introduction of the role of nurse sedationist was positive, as it increases patient safety, generating a more collaborative approach to patient care, improving the work environment and strengthening multidisciplinary relationships. Patients also indicated a very high level of satisfaction with the service.	Area I	Increased ability to ensure standards of anesthetic practice, improving team relationships, patient satisfaction, and safety.
Schnall et al.⁽¹⁴14. Schnall R, Cook S, John RM, Larson E, Stone PW, Sullivan C, et al. Patient safety issues in advanced practice nursing students’ care settings. J Nurs Care Qual. 2012;27(2):132–8.⁾(2012) - USA	Patient safety issues in advanced practice nursing students’ care settings	Journal of Nursing Care Quality	Identify and characterize patient safety issues across advanced practice nursing (APN) care settings including ambulatory care visits.	Quantitative approach – questionnaire answered by 162 nurses from an APN training course.	The adoption of information technology can help improve patient safety issues in the APN settings.	Area I	Implementation of improvements in the information system to enhance communication and coordination of care so that patient care is safely performed.
Walton-Moss et al.⁽¹⁷17. Walton-Moss B, O’Neill S, Holland W, Hull R, Marineau L. Advanced practice nursing students: pilot test of a simulation scenario. Collegian. 2012;19(3):171–6.⁾(2012) - USA	Advanced practice nursing students: Pilot test of a simulation scenario	Collegian	Develop a simulation scenario for APN students from a graduate health assessment course - Use of realistic simulation in an APN training course.	Quantitative approach - simulation	Clinical simulations with high fidelity human patient simulators provide APN students with opportunities to demonstrate clinical skills and judgment in a safe supportive environment.	Area III	Improved clinical skills and judgment of AP students to ensure safe care.
Schnall e al.⁽¹⁵15. Schnall R, Larson E, Stone PW, John RM, Bakken S. Advanced practice nursing students’ identification of patient safety issues in ambulatory care. J Nurs Care Qual. 2013;28(2):169–75.⁾(2013) - USA	Advanced practice nursing students’ identification of patient safety issues in ambulatory care	J Nurs Care Qual	Identify and characterize patient safety and explore the predictive factors of patient safety in the perspective of nurses enrolled in an educational institution of APN.	Quantitative approach – questionnaire answered by 172 nurses from an APN training course.	EPA education nurses identified a large number of issues related to patient safety in the outpatient environment. Greater complexity of patients was a significant predictor of the identification of a diagnosis or treatment problem.	Area I	Introduction of improvements in the information system to increase the communication ability between the teams and proper entries in medical records to ensure a safe diagnosis.
Alexandrou et al.⁽¹⁸18. Alexandrou E, Spencer TR, Frost SA, Mifflin N, Davidson PM, Hillman KM. Central venous catheter placement by advanced practice nurses demonstrates low procedural complication and infection rates—a report from 13 years of service. Crit Care Med. 2014;42(3):536–43.⁾(2014) - Australia	Central Venous Catheter Placement by Advanced Practice Nurses Demonstrates Low Procedural Complication and Infection Rates-A Report From 13 Years of Service	Critical Care Medicine	Report procedural characteristics and outcomes from a central venous catheter placement service operated by advanced practice nurses.	Quantitative - Observational approach	The results suggest that a service provided by APNs can be beneficial, potentially improving patient safety and promoting organizational efficiency.	Area I	Reduction of risks in the placement of peripherally inserted central catheters performed by APNs.
Powell-Cope et al.⁽¹⁹19. Powell-Cope G, Quigley P, Besterman-Dahan K, Smith M, Stewart J, Melillo C, et al. A qualitative understanding of patient falls in inpatient mental health units. J Am Psychiatr Nurses Assoc. 2014;20(5):328–39.⁾(2014) - USA	A qualitative understanding of patient falls in inpatient mental health units	J Am Psychiatr Nurses Assoc	Determine market segment-specific recommendations for prevention of falls in acute inpatient psychiatry.	Qualitative – Focus groups and interviews with 22 APNs, two physicians and one physical therapist.	Selling fall injury prevention to staff in psychiatric settings is similar to selling fall injury prevention to staff in other health care settings. Appealing to the larger construct of patient safety will motivate staff in psychiatric settings to implement best practices and customize these to account for unique characteristics of population needs.	Area I	Implementation of fall reduction measures for psychiatric patients, improving their safety.
Kirk et al.⁽²⁰20. Kirk AP, McGlinsey A, Beckett A, Rudd P, Arbour R. Restraint reduction, restraint elimination, and best practice: role of the clinical nurse specialist in patient safety. Clin Nurse Spec. 2015;29(6):321–8.⁾(2015) - USA	Restraint Reduction, Restraint Elimination, and Best Practice: Role of the Clinical Nurse Specialist in Patient Safety	Clin Nurse Spec	Describe effective evidence-based data to reduce injuries and falls with the use of monitored mechanical restraint with frequent evaluations and reevaluations.	Quantitative approach - Experiment	APN management of the causes of agitation reduces the need for patient restraint, protecting patients from injury and increasing patient satisfaction.	Area I	Implementation of protective actions to reduce patient fall and restraint, contributing to patient safety.
Chan, Adamson & Chow⁽²¹21. Chan WF, Bond TG, Adamson B, Chow M. Identifying core competencies of infection control nurse specialists in Hong Kong. Clin Nurse Spec. 2016;30(1):E1–9.⁾(2016) - Hong Kong	Identifying Core Competencies of Infection Control Nurse Specialists in Hong Kong	Clinical Nurse Specialist	Confirm a core competency scale for Hong Kong infection control nurses at the level of advanced practice nursing.	Quantitative approach – Questionnaire answered by 112 infection control nurses.	Essential core competency items of advanced practice for infection control nurses in Hong Kong were identified based on the measurement criteria of the Rasch model.	Area I	Identification of key APN competencies in infection control to reduce the risk of infection and ensure safe care.
Gore & Thomson⁽²²22. Gore T, Thomson W. Use of simulation in undergraduate and graduate education. AACN Adv Crit Care. 2016;27(1):86–95.⁾(2016) - USA	Use of Simulation in Undergraduate and Graduate Education	AACN Advanced Critical Care	Provide an overview of the use of simulation in undergraduate and graduate nursing education.	Quantitative approach - Simulation	High-quality simulation can increase opportunities for immersion and student learning.	Area III	Differentiated learning of AP students to develop skills for safer care.
Hsueh & Dorcy⁽²³23. Hsueh M, Dorcy K. Improving Transitions of care with an advanced practice nurse: a pilot study. Clin J Oncol Nurs. 2016;20(3):240–3.⁾(2016) - USA	Improving Transitions of Care With an Advanced Practice Nurse: A Pilot Study	Clinical Journal of Oncology Nursing	Analyze the role of the APNs to reduce the length of stay, readmission rates, delays and treatment gaps during transitions of oncologic patients from hospitalization to outpatient care.	Quantitative approach - Experiment	Coordination of APN care can minimize transition gaps, improve patient safety, and increase the quality of care delivery with effectiveness and efficiency. The pilot program reduced the length of stay and infection rates.	Area I	Reduced gaps in care transition, improving patient safety.
Gray-Miceli , Mazzia & Crane⁽²⁴24. Gray-Miceli D, Mazzia L, Crane G. Advanced practice nurse-led statewide collaborative to reduce falls in hospitals. J Nurs Care Qual. 2017;32(2):120–5.⁾(2017) - USA	Advanced Practice Nurse-Led Statewide Collaborative to Reduce Falls in Hospitals	Journal of Nursing Care Quality	Develop initiatives of advanced practices to reduce falls.	Quantitative approach - Experiment	A significant reduction was observed in patient fall rates.	Area I	Implementation of effective measures to reduce falls with a significant improvement in care safety.

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[1] Corresponding author. Liliana Rodrigues do Amaral http://orcid.org/0000-0002-0426-5984 E-mail: liliana.rodrigues@coppead.ufrj.br