Aim
To identify the evidence on factors that impact delegation practices by Registered Nurses to Assistants in Nursing in acute care hospitals.
Design
An integrative review.
Data Sources
Database ...searches were conducted between July 2011 and July 2021.
Review Methods
We used the 12‐step approach by Kable and colleagues to document the search strategy. The (Whittemore & Knafl. 2005. Journal of Advanced Nursing, 52(5), 546–553) integrative review framework method was adopted and the methodological quality of the studies was assessed using Joanna Briggs critical appraisal instruments.
Results
Nine studies were included. Delegation between the Registered Nurse and the Assistant in Nursing is a complex but critical leadership skill which is impacted by the Registered Nurse's understanding of the Assistant in Nursing's role, scope of practice and job description. Newly qualified nurses lacked the necessary leadership skills to delegate. Further education on delegation is required in pre‐registration studies and during nurses' careers to ensure Registered Nurses are equipped with the skills and knowledge to delegate effectively.
Conclusion
With increasing numbers of Assistants in Nursing working in the acute care environment, it is essential that Registered Nurses are equipped with the appropriate leadership skills to ensure safe delegation practice.
The World Health Organization recommends that abortion can be provided at the lowest level of the healthcare system. Training mid-level providers, such as midwives, nurses and other non-physician ...providers, to conduct first trimester aspiration abortions and manage medical abortions has been proposed as a way to increase women's access to safe abortion procedures.
To assess the safety and effectiveness of abortion procedures administered by mid-level providers compared to doctors.
We searched the CENTRAL Issue 7, MEDLINE and POPLINE databases for comparative studies of doctor and mid-level providers of abortion services. We searched for studies published in any language from January 1980 until 15 August 2014.
Randomised controlled trials (RCTs) (clustered or not clustered), prospective cohort studies or observational studies that compared the safety or effectiveness (or both) of any type of first trimester abortion procedure, administered by any type of mid-level provider or doctors, were eligible for inclusion in the review.
Two independent review authors screened abstracts for eligibility and double-extracted data from the included studies using a pre-tested form. We meta-analysed primary outcome data using both fixed-effect and random-effects models to obtain pooled risk ratios (RR) with 95% confidence intervals (CIs). We carried out separate analyses by study design (RCT or cohort) and type of abortion procedure (medical versus surgical).
Eight studies involving 22,018 participants met our eligibility criteria. Five studies (n = 18,962) assessed the safety and effectiveness of surgical abortion procedures administered by mid-level providers compared to doctors. Three studies (n = 3056) assessed the safety and effectiveness of medical abortion procedures. The surgical abortion studies (one RCT and four cohort studies) were carried out in the United States, India, South Africa and Vietnam. The medical abortion studies (two RCTs and one cohort study) were carried out in India, Sweden and Nepal. The studies included women with gestational ages up to 14 weeks for surgical abortion and nine weeks for medical abortion.Risk of selection bias was considered to be low in the three RCTs, unclear in four observational studies and high in one observational study. Concealment bias was considered to be low in the three RCTs and high in all five observational studies. Although none of the eight studies performed blinding of the participants to the provider type, we considered the performance bias to be low as this is part of the intervention. Detection bias was considered to be high in all eight studies as none of the eight studies preformed blinding of the outcome assessment. Attrition bias was low in seven studies and high in one, with over 20% attrition. We considered six studies to have unclear risk of selective reporting bias as their protocols had not been published. The remaining two studies had published their protocols. Few other sources of bias were found.Based on an analysis of three cohort studies, the risk of surgical abortion failure was significantly higher when provided by mid-level providers than when procedures were administered by doctors (RR 2.25, 95% CI 1.38 to 3.68), however the quality of evidence for this outcome was deemed to be very low. For surgical abortion procedures, we found no significant differences in the risk of complications between mid-level providers and doctors (RR 0.99, 95% CI 0.17 to 5.70 from RCTs; RR 1.38, 95% CI 0.70 to 2.72 from observational studies). When we combined the data for failure and complications for surgical abortion we found no significant differences between mid-level providers and doctors in both the observational study analysis (RR 1.36, 95% CI 0.86 to 2.14) and the RCT analysis (RR 3.07, 95% CI 0.16 to 59.08). The quality of evidence of the outcome for RCT studies was considered to be low and for observational studies very low. For medical abortion procedures the risk of failure was not different for mid-level providers or doctors (RR 0.81, 95% CI 0.48 to 1.36 from RCTs; RR 1.09, 95% CI 0.63 to 1.88 from observational studies). The quality of evidence of this outcome for the RCT analysis was considered to be high, although the quality of evidence of the observational studies was considered to be very low. There were no complications reported in the three medical abortion studies.
There was no statistically significant difference in the risk of failure for medical abortions performed by mid-level providers compared with doctors. Observational data indicate that there may be a higher risk of abortion failure for surgical abortion procedures administered by mid-level providers, but the number of studies is small and more robust data from controlled trials are needed. There were no statistically significant differences in the risk of complications for first trimester surgical abortions performed by mid-level providers compared with doctors.
MESSAGE FROM THE PRESIDENT Hernandez, Lisa Childers
The dental assistant (1994),
11/2023, Volume:
91, Issue:
6
Journal Article
Peer reviewed
...Juliette had a vision that one day dental assistants would come together from across the country and form a professional organization. Here we are 99 years later planning our 100th Annual Session ...of the oldest and largest professional association dedicated to the dental assisting profession. If you are hosting, speaking, or attending any meetings, be sure and send pictures and information to info@adaausa. org so it can be shared on our social media.
Aims
To evaluate the effects of substituting nurse practitioners, physician assistants or nurses for physicians in long‐term care facilities and primary healthcare for the ageing population (primary ...aim) and to describe what influences the implementation (secondary aim).
Background
Healthcare for the ageing population is undergoing major changes and physicians face heavy workloads. A solution to guarantee quality and contain costs might be to substitute nurse practitioners, physician assistants or nurses for physicians.
Design
A systematic literature review.
Data sources
PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL, Web of Science; searched January 1995–August 2015.
Review methods
Study selection, data extraction and quality appraisal were conducted independently by two reviewers. Outcomes collected: patient outcomes, care provider outcomes, process of care outcomes, resource use outcomes, costs and descriptions of the implementation. Data synthesis consisted of a narrative summary.
Results
Two studies used a randomized design and eight studies used other comparative designs. The evidence of the two randomized controlled trials showed no effect on approximately half of the outcomes and a positive effect on the other half of the outcomes. Results of eight other comparative study designs point towards the same direction. The implementation was influenced by factors on a social, organizational and individual level.
Conclusion
Physician substitution in healthcare for the ageing population may achieve at least as good patient outcomes and process of care outcomes compared with care provided by physicians. Evidence about resource use and costs is too limited to draw conclusions.
With the development of deep connections between humans and Artificial Intelligence voice‐based assistants (VAs), human and machine relationships have transformed. For relationships to work it is ...essential for trust to be established. Although the capabilities of VAs offer retailers and consumers enhanced opportunities, building trust with machines is inherently challenging. In this paper, we propose integrating Human–Computer Interaction Theories and Para‐Social Relationship Theory to develop insight into how trust and attitudes toward VAs are established. By adopting a mixed‐method approach, first, we quantitatively examine the proposed model using Covariance‐Based Structural Equation Modeling on 466 respondents; based on the findings of this study, a second qualitative study is employed to reveal four main themes. Findings show that while functional elements drive users' attitude toward using VAs, the social attributes, being social presence and social cognition, are the unique antecedents for developing trust. Additionally, the research illustrates a peculiar dynamic between privacy and trust and it shows how users distinguish two different sources of trustworthiness in their interactions with VAs, identifying the brand producers as the data collector. Taken together, these results reinforce the idea that individuals interact with VAs treating them as social entities and employing human social rules, thus supporting the adoption of a para‐social perspective.
Because of workforce needs and demographic and chronic disease trends, nurse practitioners (NPs) and physician assistants (PAs) are taking a larger role in the primary care of medically complex ...patients with chronic conditions. Research shows good quality outcomes, but concerns persist that NPs' and PAs' care of vulnerable populations could increase care costs compared to the traditional physician-dominated system. We used 2012-13 Veterans Affairs data on a cohort of medically complex patients with diabetes to compare health services use and costs depending on whether the primary care provider was a physician, NP, or PA. Case-mix-adjusted total care costs were 6-7 percent lower for NP and PA patients than for physician patients, driven by more use of emergency and inpatient services by the latter. We found that use of NPs and PAs as primary care providers for complex patients with diabetes was associated with less use of acute care services and lower total costs.
This study investigates whether social- versus task-oriented interaction of virtual shopping assistants differentially benefits low versus high Internet competency older consumers with respect to ...social (perceived interactivity, trust), cognitive (perceived information load), functional (self-efficacy, perceived ease of use, perceived usefulness), and behavioral intent (website patronage intent) outcomes in an online shopping task. A total of 121 older adults (61–89 years) participated in a laboratory experiment with a 2 (digital assistant interaction style: (social-vs. task-oriented) × 2 (user Internet competency: low vs. high) × 2 (user exchange modality: text vs. voice) between-subjects design. The results revealed that users' Internet competency and the digital assistant's conversational style had significant interaction effects on social, functional, and behavioral intent outcomes. Social-oriented digital assistants lead to superior social outcomes (enhanced perceptions of two-way interactivity and trust in the integrity of the site) for older users with high Internet competency, who need less task-related assistance. On the other hand, low-competency older users showed significantly superior cognitive (lower perceived information load) and functional outcomes (greater perceived ease and self-efficacy of using the site) when the digital assistant employed a task-oriented interaction style. Theoretical and agent design implications are discussed.
•Investigation of social-vs. task-oriented interaction style of digital assistants.•Differential benefits for low vs. high task-competency older adults.•Low competency users benefit from task- than social-oriented interaction style.•High competency users benefit from social- than task-oriented interaction style.
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