Implementation of advanced practice nursing for minor orthopedic injuries in the emergency care context – a non-inferiority study

Journal article

Boman, E., Duvaland, E., Gaarde, K., Leary, A., Rauhala, A. and Fagerstrom, L. (2021). Implementation of advanced practice nursing for minor orthopedic injuries in the emergency care context – a non-inferiority study. International Journal of Nursing Studies. https://doi.org/10.1016/j.ijnurstu.2021.103910
AuthorsBoman, E., Duvaland, E., Gaarde, K., Leary, A., Rauhala, A. and Fagerstrom, L.
Abstract

Aims
To evaluate the implementation of advanced practice nursing for patients with minor orthopedic injuries, including comparison of outcomes in relation to advanced practice nurse versus standard (physician-led) care models.

Design
A non-inferiority study was performed in an emergency department in Norway, where advanced practice nursing is in an initial stage of implementation. The non-inferiority design was chosen to test whether the new advanced practice nursing model does not compromise quality of care compared to the standard care model already in use.

Methods
Patients with minor orthopedic injuries were assessed and treated by either advanced practice nursing or standard (physician-led) care models. Participating patients were assigned to the professional available at presentation. In the nursing model, registered nurses worked at an advanced level/applied advanced practice nursing following in-house-training. Senior orthopedic specialists evaluated the diagnostic and treatment accuracy in both models. Data were collected in a tool developed for this study, from May to October, 2019.

Results
In total, 335 cases were included, of which 167 (49.9 %) were assessed and treated in the nursing model. Overall, correct diagnosis was found in 97.3 % (n = 326) of the cases, and correct treatment was found in 91.3 % (n = 306) of the cases. In comparison of missed diagnosis between advanced practice nurse and the standard (physician-led) care model showed inconclusive results (risk ratio: 0.29, 95% CI: 0.06-1.36). In comparison of treatment outcomes, the results showed that the advanced practice nursing model was non-inferior (risk ratio: 0.45, 95% CI: 0.21-0.97).

Conclusion
Advanced practice nursing care models can be used to diagnose and treat minor orthopedic injuries without compromising quality of care. Further implementation of the advanced practice nurse care model is encouraged.

Year2021
JournalInternational Journal of Nursing Studies
PublisherElsevier BV
ISSN0020-7489
Digital Object Identifier (DOI)https://doi.org/10.1016/j.ijnurstu.2021.103910
Publication dates
Online02 Mar 2021
Publication process dates
Accepted02 Mar 2021
Deposited22 Mar 2021
Accepted author manuscript
License
File Access Level
Open
Page range103910-103910
Permalink -

https://openresearch.lsbu.ac.uk/item/8w527

Download files

Accepted author manuscript
FinalOrthorANPNorway.pdf
License: CC BY-NC-ND 4.0
File access level: Open

  • 85
    total views
  • 23
    total downloads
  • 0
    views this month
  • 2
    downloads this month

Export as

Related outputs

Investigating the impact of financial concerns on symptoms of depression in UK healthcare workers: data from the UK-REACH nationwide cohort study.
McBride, M., Martin, C.A., Teece, L., Irizar, P., Batson, M., Lagrata, S., Papineni, P., Nazareth, J., Pan, D., Leary, A., Woolf, K., Pareek, M. and UK-REACH Study Collaborative Group (2023). Investigating the impact of financial concerns on symptoms of depression in UK healthcare workers: data from the UK-REACH nationwide cohort study. BJPsych open. 9 (4), p. e124. https://doi.org/10.1192/bjo.2023.520
Implementation and perceived impact of the SWAN model of end-of-life and bereavement care: a realist evaluation
Stewart-Lord, A., Baillie, L., Green, L., Murphy, F. and Alison Leary (2022). Implementation and perceived impact of the SWAN model of end-of-life and bereavement care: a realist evaluation. BMJ Open. https://doi.org/10.1136/bmjopen-2022-066832
Saved bed days: the ultimate currency.
Leary, Alison (2022). Saved bed days: the ultimate currency. BMJ (Clinical research ed.). 378, p. o1686. https://doi.org/10.1136/bmj.o1686
A thematic analysis of the prevention of future deaths reports in healthcare from HM coroners in England and Wales 2016–2019
Leary, Alison, Bushe, David, Oldman, Crystal, Lawler, Jessica and Punshon, G. (2021). A thematic analysis of the prevention of future deaths reports in healthcare from HM coroners in England and Wales 2016–2019. Journal of Patient Safety and Risk Management. 26 (1), pp. 14-21. https://doi.org/10.1177/2516043521992651
Examining the impact of Diabetes Inpatient Specialist Nursing in acute trusts in London
Leary, A., Cook, R., Lawler, J., Trevatt, P. and Ravinder, D. (2021). Examining the impact of Diabetes Inpatient Specialist Nursing in acute trusts in London. Journal of Advanced Nursing. https://doi.org/10.1111/jan.14917
Perceptions of the cancer care left undone in primary and community services: A mixed methods evaluation
Lawler, J., Leary, A., Lofton, Lydia and Bushe, Dave (2020). Perceptions of the cancer care left undone in primary and community services: A mixed methods evaluation. Health & Social Care in the Community. 28 (6), pp. 2117-2124. https://doi.org/10.1111/hsc.13022
Why won’t workforce policy makers tackle gender inequality in healthcare?
Leary, Alison (2020). Why won’t workforce policy makers tackle gender inequality in healthcare? BMJ: British Medical Journal.
Workforce experience of the implementation of an advanced clinical practice framework in England: a mixed methods evaluation
Lawler, J., MacLaine, K. and Leary, A. (2020). Workforce experience of the implementation of an advanced clinical practice framework in England: a mixed methods evaluation. Human Resources for Health. 18, p. 96. https://doi.org/10.21203/rs.3.rs-55503/v2
Guest editorial
Leary, A. (2020). Guest editorial. International Journal of Urological Nursing. 14 (3), pp. 104-105. https://doi.org/10.1111/ijun.12254
Do working practices of cancer nurse specialists improve clinical outcomes? Retrospective cohort analysis from the English National Lung Cancer Audit
Stewart, I., Leary, A., Khakwani, A., Borthwick, D., Tod, A., Hubbard, R., Beckett, P. and Tata, L.J. (2020). Do working practices of cancer nurse specialists improve clinical outcomes? Retrospective cohort analysis from the English National Lung Cancer Audit. International Journal of Nursing Studies. p. 103718. https://doi.org/10.1016/j.ijnurstu.2020.103718
In praise of professional judgement
Maxwell, E and Leary, A (2020). In praise of professional judgement. BMJ: British Medical Journal.
What does the future hold for the nursing associate role?
Hickman, S. and Leary, A. (2020). What does the future hold for the nursing associate role? Nursing Times.
The workload of the diabetes specialist nurse workforce in the UK
Lawler, J., Punshon, G., Leary, A., Walden, E. and Stainisstreet, D. (2020). The workload of the diabetes specialist nurse workforce in the UK. Journal of Diabetes Nursing. 24 (1).
Using knowledge discovery through data mining to gain intelligence from routinely collected incident reporting in an acute English hospital
Leary, A., Cook, R., Jones, S.J., Radford, M., Smith, J., Gough, M. and Punshon, G. (2020). Using knowledge discovery through data mining to gain intelligence from routinely collected incident reporting in an acute English hospital. International Journal of Health Care Quality Assurance. 33 (2), pp. 221-234. https://doi.org/10.1108/IJHCQA-08-2018-0209
Understanding the demand and unmet need of providing psychological cancer care in the community
Lawler, J., Lofton, L. and Leary, A. (2020). Understanding the demand and unmet need of providing psychological cancer care in the community. Cancer Nursing Practice. 19 (3). https://doi.org/10.7748/cnp.2020.e1680
Uncovering the hidden workload involved in providing cancer care in the community
Lawler, J., Leary, A., Lofton, L. and Bushe, D. (2020). Uncovering the hidden workload involved in providing cancer care in the community. Primary Health Care. 30 (2). https://doi.org/10.7748/phc.2020.e1610
Implementation of advanced practice nursing for orthopaedic patients in the emergency care context – A study protocol for outcome studies
Boman, E., Duvaland, Elisabeth, Gaarde, Kim, Leary, A. and Fagerström, L. (2020). Implementation of advanced practice nursing for orthopaedic patients in the emergency care context – A study protocol for outcome studies. Journal of Advanced Nursing. 76 (4), pp. 1069-1076. https://doi.org/10.1111/jan.14299
Staffing the NHS: Why we need to invest in the community workforce
Leary, A (2019). Staffing the NHS: Why we need to invest in the community workforce. in: Martinez, C (ed.) The NHS Winter Crisis Reform. pp. 6
Modelling the Multiple Sclerosis Specialist Nurse Workforce by determination of optimum caseloads in the United Kingdom
Punshon, G., Sopala, J., Hannan, G., Roberts, M., Vernon, K., Pearce, A. and Leary, A. (2019). Modelling the Multiple Sclerosis Specialist Nurse Workforce by determination of optimum caseloads in the United Kingdom. International Journal of MS Care. https://doi.org/10.7224/1537-2073.2019-058
An observational study on the rate of reporting of adverse event on healthcare staff in a mental health setting: An application of Poisson expectation maximisation analysis on nurse staffing data
Cook, R., Jones, S., Williams, G., Worsley, D., Walker, Ray, Radford, Mark and Leary, A. (2019). An observational study on the rate of reporting of adverse event on healthcare staff in a mental health setting: An application of Poisson expectation maximisation analysis on nurse staffing data. Health informatics journal. 26 (2), pp. 1333-1346. https://doi.org/10.1177/1460458219874637
Does the Diabetes Specialist Nursing workforce impact the experiences and outcomes of people with diabetes? A hermeneutic review of the evidence
Lawler, J., Trevatt, P., Elliot, C. and Leary, A. (2019). Does the Diabetes Specialist Nursing workforce impact the experiences and outcomes of people with diabetes? A hermeneutic review of the evidence. Human Resources for Health. 17 (65). https://doi.org/10.1186/s12960-019-0401-5
Nursing pay by gender distribution in the UK- does the Glass Escalator still exist?
Leary, A, Punshon, G, MacLaine, K, Radford, M, Trevatt, P and Shanley, O (2019). Nursing pay by gender distribution in the UK- does the Glass Escalator still exist? International Journal of Nursing Studies. https://doi.org/10.1016/j.ijnurstu.2019.02.008
Determining acute nurse staffing, a hermeneutic review of an evolving science.
Leary, A and Punshon, G (2019). Determining acute nurse staffing, a hermeneutic review of an evolving science. BMJ Open. 9 (3). https://doi.org/10.1136/bmjopen-2018-025654
The healthcare workforce should be shaped by outcomes, rather than outputs
Leary, A (2019). The healthcare workforce should be shaped by outcomes, rather than outputs. BMJ Opinion.
Turning data into useful knowledge to improve patient care
Leary, A (2018). Turning data into useful knowledge to improve patient care. Journal of Nursing Management.
Do lung cancer nurses relieve the burden of lung cancer? An outcomes study
Leary, A (2018). Do lung cancer nurses relieve the burden of lung cancer? An outcomes study. Cancer Services, Data and Outcomes Conference 2018. Manchester 20 - 21 Jun 2018
Are working practices of lung cancer nurse specialists associated with variation in peoples’ receipt of anti cancer therapy
Stewart, I, Khakwani, A, Hubbard, R, Beckett, P, Borthwick, D, Tod, A, Leary, A and Tata, LJ (2018). Are working practices of lung cancer nurse specialists associated with variation in peoples’ receipt of anti cancer therapy. Lung Cancer. 123, pp. 160-165. https://doi.org/10.1016/j.lungcan.2018.07.022
Modelling the Inflammatory Bowel Disease Specialist Nurse Workforce standards by determination of optimum caseloads in the United Kingdom.
Leary, A, Punshon, G and Mason, I (2018). Modelling the Inflammatory Bowel Disease Specialist Nurse Workforce standards by determination of optimum caseloads in the United Kingdom. Journal of Crohn's and Colitis. 12 (11), pp. 1295-1301. https://doi.org/10.1093/ecco-jcc/jjy106
Barriers to delivering advanced cancer nursing: A workload analysis of specialist nurse practice linked to the English National Lung Cancer Audit
Stewart, I, Leary, A, Tod, A, Borthwick, D, Khakwani, A, Hubbard, R, Beckett, P and Tata, LJ (2018). Barriers to delivering advanced cancer nursing: A workload analysis of specialist nurse practice linked to the English National Lung Cancer Audit. European Journal of Oncology Nursing. 36, pp. 103-111. https://doi.org/10.1016/j.ejon.2018.07.006
Nurse staffing levels and outcomes - mining the UK national datasets for insight.
Leary, A, Tomai, B, Swift, A, Woodward, A and Hurst, K (2017). Nurse staffing levels and outcomes - mining the UK national datasets for insight. International Journal of Health Care Quality Assurance. 30 (3), pp. 235-247. https://doi.org/10.1108/IJHCQA-08-2016-0118
Advancing Nursing Practice: The Emergence of the Role of Advanced Practice Nurse in Saudi Arabia
Hibbert, D, Aboshaiqah, A, Senko, K, Forestall, D, Harb, A, Yousuf, S, Kelley, P, Brennan, P, Serrant, L and Leary, A (2017). Advancing Nursing Practice: The Emergence of the Role of Advanced Practice Nurse in Saudi Arabia. Annals of Saudi Medicine. 37 (1), pp. 522-528. https://doi.org/10.5144/0256-4947.2017.522
Safety and service. Reframing the purpose of nursing to decision makers
Leary, A (2017). Safety and service. Reframing the purpose of nursing to decision makers. Journal of Clinical Nursing. 26 (23-24), pp. 3761-3763. https://doi.org/10.1111/jocn.13885
The experiences of specialist nurses working within the uro-oncology multidisciplinary team in the UK
Punshon, G, Endacott, R, Aslett, P, Brocksom, J, Fluere, L, Howdle, F, Masterson, M, O'Connor, A, Swift, A, Trevatt, P and Leary, A (2017). The experiences of specialist nurses working within the uro-oncology multidisciplinary team in the UK. Clinical Nurse Specialist: The Journal for Advanced Nursing Practice.
Emergency care patient driven solutions for severe asthma
Newell, K, Corrigan, C, Punshon, G and Leary, A (2017). Emergency care patient driven solutions for severe asthma. International Journal of Health Care Quality Assurance. 30 (7), pp. 628-637. https://doi.org/10.1108/ijhcqa-09-2016-0127
Variation in job titles within the nursing workforce.
Leary, A, Maclaine, K, Trevatt, P, Radford, M and Punshon, G (2017). Variation in job titles within the nursing workforce. Journal of Clinical Nursing. 26 (23-24), pp. 4945-4950. https://doi.org/10.1111/jocn.13985
Developing the next generation of specialist cancer nurses.
Leary, A, Whittaker, AJ and Hill, A (2017). Developing the next generation of specialist cancer nurses. Cancer Nursing Practice. 16 (9), pp. 25-30. https://doi.org/10.7748/cnp.2017.e1453
Crowd medical services in the English Football League: remodelling the team for the 21st century using a realist approach
Leary, A, Kemp, A, Greenwood, P, Hart, N, Agnew, J, Barrett, J and Punshon, G (2017). Crowd medical services in the English Football League: remodelling the team for the 21st century using a realist approach. BMJ Open. https://doi.org/10.1136/bmjopen-2017-018619
Which patients are assessed by lung cancer nurse specialists? A national lung cancer audit study of over 128,000 patients across england
Khakwani, A, Hubbard, R, Beckett, P, Borthwick, D, Tod, A, Leary, A, White, J and Tata, LJ (2016). Which patients are assessed by lung cancer nurse specialists? A national lung cancer audit study of over 128,000 patients across england. Lung Cancer. 96, pp. 33-40. https://doi.org/10.1016/j.lungcan.2016.03.011
Mining routinely collected acute data to reveal non-linear relationships between nurse staffing levels and outcomes
Leary, A, Cook, R, Jones, S, Smith, S, Maxwell, E, Punshon, G and Radford, M (2016). Mining routinely collected acute data to reveal non-linear relationships between nurse staffing levels and outcomes. BMJ Open. 6 (12). https://doi.org/10.1136/bmjopen-2016-011177
A systematic literature review comparing the psychological care needs of patients with mesothelioma and advanced lung cancer
Ball, H, Moore, S and Leary, A (2016). A systematic literature review comparing the psychological care needs of patients with mesothelioma and advanced lung cancer. European Journal of Oncology Nursing. 25, pp. 62-67. https://doi.org/10.1016/j.ejon.2016.09.007
Impact of proactive case management by multiple sclerosis specialist nurses on use of unscheduled care and emergency presentation in multiple sclerosis
Leary, A, Quinn, D and Bowen, A (2015). Impact of proactive case management by multiple sclerosis specialist nurses on use of unscheduled care and emergency presentation in multiple sclerosis. International Journal of MS Care. 17 (4), pp. 159-163. https://doi.org/10.7224/1537-2073.2014-011
The specialist nursing workforce caring for men with prostate cancer in the UK
Leary, A, Brocksom, J, Endacott, R, Fleure, L, Howdle, F, Masterton, M, O'Connor, A, Swift, A, Trevatt, P and Aslett, P (2015). The specialist nursing workforce caring for men with prostate cancer in the UK. International Journal of Urological Nursing. 10 (1), pp. 5-13. https://doi.org/10.1111/ijun.12104