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Responsibilities of Associates Nurses in Health Care -NHS

University: University of Birmingham

  • Unit No: 8
  • Level: Post Graduate/University
  • Pages: 32 / Words 7966
  • Paper Type: Assignment
  • Course Code: NUR503
  • Downloads: 579
Question :

This assessment will cover following questions:

  • Critically analyse the key issues of chosen topic and develop findings with the help of qualitative and quantitative data.
  • Identify the common types of clinical treatments that intervenes to cure disease.
Answer :
Organization Selected : NHS


1.1 Background

Advance practice providers are group of people provide services in hospitals, emergency rooms etc. This includes physician or nurse both, they are educated and trained as well. They continuously work for creating a great environment where patient can get quality care services (Svavarsdottir and, 2018). Nursing associates are the people those who work as bridge between care assistants ad registered nurses. They get proper training of providing care services to patient. Nursing and Midwifery council (NMC) takes all the relevant responsibilities of associates nurses (Nursing associate, 2020.). They arrange training for them and give them authority to provide care services to patients. Assistant nurse are the college trained nurses those who get salaries as per paid 4 of NHS career framework UK. They deliver their care to patients and work to improve their health conditions. They have adequate skills and knowledge of treating care users; they work as support workers so that patient- nurse ratio can be maintained.

Recently shortage of nurses has become a major concern in United Kingdom, many hospitals are unable to find skilled, registered professional nurses. This has led to failure in meeting recommended nurse patient ratio that means nurses require to meet the health care need of patients or to have adequate number of nurses to meet patient's health care needs (Everything you need to know about nursing associates, 2019). Report of “faculty of intensive care medicine” reflect that hospitals need to maintain safe staffing in their critical care unit because it has great impact over patient health outcome (Bungay and, 2016).

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In order to meet the demand of nurses NHS is paying attention on involving associated nurses in care units (Kasat and, 2017). Associate Practitioners are different from registered nurses as registered nurses are responsible for providing medicines to patients and monitoring their condition whereas associated nurses can manage their delivery process ensure integrity care. But they maintain accountability in their work. These nurses have proper experience of working in this field, they provide support to patients in the absence of doctors (del Carmen Giménez-Espert, Valero-Moreno and Prado-Gascó 2019). Primary health care is known and considered as the key and backbone of healthcare delivery. It is the main entry point for all level of care (Kasat and, 2017). Hence if adequate staff will be available there then patients care needs will be meet soon. 

1.2 Justification

Over a period of time health issues have been increased in UK to great extent and there are lack of nurses available to meet that care demand hence this is burning issue hence researcher has selected this topic. This study helps the medical staff to meet the need of nurses by hiring associated nurses hence it will help in improving care services in country. This research is done by using authentic sources enhance adequate information are here about impact of assistant nurse's practitioners on patient outcome. Health care services plays an important role in protecting patients from any diseases and cure them. An effective health care services and having deep knowledge about it makes an individual able to make patients feel cured and happy. The main aim of developing this research and selecting this topic is to aware people about the importance of health care services as well as differences between services provided by assistant nursing staff. Skills and knowledge plays an important role in providing health care services and having knowledge of current health care (Recio‐Saucedo and, 2018).

This study will help NHS in knowing the actual demand of nurses in the health and social care sector and will give indications to the authorities that how they can manage demand by hiring or giving training to assistant nursing practitioners.

This systematic review adds to knowledge of the impact of assistant practitioner contribution to nursing in critical care services in UK

1.3 Aim

To identify the impact of assistant practitioners in UK NHS critical care units

1.4 Objectives

To discuss the history of nursing associates in UK

  • To evaluate role of nursing associates in health and social care
  • To explore the impact of nursing associates in hospital e
  • To appraise recent literature on nursing associates in critical care units in UK

1.5 Research Question

Research questions were framed using PICO framework.

Population: Infected patients

Intervention: Holistic care by nursing associates

Comparison: None

Outcome: Improved health outcome

Main research question of this study is:

What is the impact of nursing associates practicing in UK NHS critical care units?

1.6 Search key terms

ICU= Intensive care unit

CCU = Critical care unit

UK= United Kingdom

NMC= Nursing and midwifery council

NHS= National health service

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2.0 Introduction

Literature review can be defined as review of articles. In this section scholarly papers are reviewed. Literature review includes current knowledge about the topic, substantive findings, theoretical or methodological contribution that has been made till now to a particular topic. In this literature review impact of assistant practitioners in critical care unit will be analysed.

Definition of assistant practitioners

Assistant practitioners focus on delivering protocol based care and are fitted to particular wards, clinical areas, supervised by registered practitioners. Role of Assistant practitioners was intended to free nurses. So that they can use their professional skills in a better manner and can enhance overall outcome of their patients in a better manner.

2.1 The role of assistant nurses towards the practitioners in health and social care 

As per the views of the Abedi and, (2019) the existence of assistants nurses in the field of health care professionals in have the roper level of assistance over the various level of health care needs. The patient is considered to the under the direct supervisor which have the proper level of craving the certain cares facilities. The nurses have the major level of obligation over making the patient more level of comfortable with basic living activities. The author also added that For getting effective nursing knowledge, people or health care providers do several courses and attain several education programs which helps them out in understanding needs and requirements of different types of patients and the way of providing services to them. On the other hand the Bungay, Jackson and Lord, (2016.) contradicts that the in order to have the providence of the effective healths care it is not only important for nurse to have the taking care of them, but it is also considerer to important in the important level of implication and understanding their respective need to met the resurrection demand and obligation of heath care.

The author also stated that the due toe the personal nature of the job, the assistants nurse job description have the inclusion of basics skills which are related to people along with having to liability to enjoy with each other. The nurse major obligation in providing long term facilities. According to views of Bunn, Bennett and Burke, (2019), the assistants nurses are also capable of non-performing the other duties such as the medical technology such as billing software, health information software and the maintenance of other medical, record charting software. On the other hand the Craft and, (2017) contradicts that it have the major level of dependence of the level of assistant nurse in terms of the accurate level of training and experience which can be directly stated it the part state regulation in more perfect manner. They are successful be having the phenomenal level of communications skills as the have the recreation of job which have the in concerns of patients along with issues of their respective supervisor.

On the other hand, as per the views of the (del Carmen Giménez-Espert, Valero-Moreno and Prado-Gascó, and, 2018.) the nursing assistant is the one who is more often been refereed as the nurses aides or orderlies which have the major obligation in providing the basic level of patient areas in the hospitals along with nursing roles under the respective directions of supervisor or head nurses. The author contradicted that there is n major requirements of the formal degrees as the assistant are the typically ones who must have the nursing certificates along with passing of state competency exam. There are more roles which being implicated by the nursing assistant as the common role of transport. They play role of supporter or work as substitute of registered nurses. Assistant practitioners work in critical care units and support the professionals to provide quality care services to patients. These nurses are not professional but have proper experience of working in this field, they provide support to patients in the absence of doctors. As per the views of Bunn, Bennett and Burke, (2019) the major responsibility of assistants nurses to have the carrying of patient around the building or helps the patient to go to come form the surgery rooms. This services are more level been extended to the residential area facilitates as the safety transportation in accompanied as the major level for responsibility and obligation. As per the view of the Craft and, (2017) , Nursing is all concerned with the profession of nursing as well as procedure of educating nursing professionals related to the care to be taken about patients, their families and communities with the main aim to recover effective health conditions. It is also stated the assistant nurses are the professional protect, promote and optimize of health and abilities, treatment of human response etc. On the other hand., the Abedi and, (2019) contradistinction that the education of patient also plays an important role in providing the excellent level of support to nurses in order to have proper level of maintenance in term of hygiene. The assistant nurse have the small level of responsibility of treating the patient as small babies such as feeding with spoons and personal care needs of patients. The assistant have extended the services as the handling of the basic routines as such eating, bathing and dressing in significance order. These effective services and attitudes of nurses towards patients, increases morale of patients, and they feel comfortable to interact with health care providers and share their all feelings.

As per the views of the (del Carmen Giménez-Espert, Valero-Moreno and Prado-Gascó, and, 2018.), the role of assistant nurses is in more terms to be extended to have the proper level of monitoring over the patients who have the stays in hospitals or in the respective care homes. The services have the clears level of inclusion in terms of paying proper attentions in the signal and popery maintaining level of record for the further analysis. The author also state that the Aides normally report to nurses and doctors on duty if anything is out of the ordinary with a patient. Recognition of distress signals and basic first-aid training are commonly included in training and certification programs for assistants. Hence, it is major level of responsibility over the educate patients and make them aware about importance of better health care services and following all guidelines provided by healthcare professionals. These effective services and attitudes of nurses towards patients, increases morale of patients, and they feel comfortable to interact with health care providers and share their all feelings. They are also being taught to use and implement advanced technologies as it is a modern era in which most of the work and activities are being done with the help of tools and using technology. Nurse are had the proper level of training in term of the application of previous knowledges, learning abilities, styles and the leading need which is demanded to be proper diagnose with having proper education plan in more effective way.

On the other hand, as per the perspective of Craft and, (2017), assistant have the level of general providence in order to have the proper level of support to the doctor in more way of assisting the odt in signifiant way. This have the clears level of inclusiveness during respective level of treatments and procedure which is as needed. In more particular to hospital sitting, the assistants is more helpful in pitching the time of respective emergencies to have the proper follow up regarding the routine check in procedure at respective level. On the other hand the Rodger and Mahoney, (2017) contradicted that as per the respects to the population ages and the person who are actually disabled have the need to long terms care. The upside of the working of assistant nurses along with long care facility is terms as an important level of relationships in maintaining riper understanding between patient and job security.

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On the other hand, the Simpson, (2017) contradicted that nursings assistant have negative feeling that they are actually respected as appreciated by the medical departments. As this is reason they have come down towards disliking their jobs. In addition to that this feeling have lead to that level of inadequacy along with resentments which have resulted into the not more of performances the activities along with duties as per best ability. With addition to that the safety of nurses at the workplaces regarding the injury along the development of proper maintenances in terms of illness is considered as an important issue as they accomplished of their respective duty. The presence of healthy and well-rested nurses is critical to providing vigilant monitoring, empathic patient care, and vigorous advocacy. On the other hand the Mc Carthy and (2018.) also states that Many workplace stressors haver proper productiveness of diseased and injuries which are actually present in their nursing work environments. These stressors include factors related to the immediate work context, characteristics of the organization, and changes that are occurring external to the organization but throughout the health care industry. Hence, it can be concluded that is turning out to be the critical level of situation of the nurses to have the clears level of implication over properly taking care to ensure high quality nursing care for all age group, cultures and stages of patients. So, the main aim of nurses to pays major focus on curing patients in shorter period by providing them with better care. With increasing and continuous changes in health care services there is the need to more put more level of pressure on them to choose the best and ethical way to provide services to them. For Performing according to legislations, nurses are now required to more focus on their professional development along with analyse all those areas in which they are not good and require improving them. By improving and focusing on continuous development, they can improve their skills and compete with others and improve quality of their services.

So the above discussion of the different author, there us clear analysis that the role of the assistant nurse have the clear way of positive and negative impacts to deals of the various issues which are actually prevailing medical care department. But with the help of training, rewards and other programmes, educators can make them able to provide better services and remove all negative impacts in order to cure patients and improve living standards of societies.

Theme 2 The relationship between work of nurse practitioners and patient outcome alosng with factor which are effecting working at medical care.

As per the view of the Simpson, (2017), the safety and equality of care patients is considered to be an imparts aspects for the care patients which have clear level of dependence over the visibility of the services which is served my the medical environments. There are clears level of direct relationship between the assistant nurses and care patient in more level of have accurate level of decision making. On the other hand the Rodger and Mahoney, (2017.) contradict the Nurse practitioners have demonstrated to be effective and cost-effective providers in prior research; however, many states restrict their practice. The more level of strengthening the heaths care practitioner is considered to be an inessential part in more way of helping the health our nations. There is more way which clears being prolonged that to be more level of health cost effective along with quality cost effective manner. The nurses should have the clear understanding human behaviours and identify needs of their patients. Before providing any type of healthcare services, it is important for nurses to make patients feel comfortable and make them able to share their feelings and needs. When nurses understand needs and feelings of their patients in their critical situations then they are more likely to become a professional and getting qualitative results. On the other hand the Recio‐Saucedo and, (2018) contradicted that the there is need for the proper level of communication's skill required in assistants nurses in order to have effective establishment f the various strategies to overcome the issues. There is the different level of communication workplaces and different organizations but as for healthcare and nurses it is considered the key of the qualitative result. Health care providers and nurses have to communicate with patients as well as their families so, it is important for them to have this skill in order to make them understand the actual situation, making them aware and reducing the problem of miscommunication. On the other hand the Mc Carthy and (2018.) stated that there is more level f qualitative relationships as the assistant nurses have the capability to have the to have proper follow over different level of guidelines along with medical recommendation. This have resulted that qualitative results in patients case is highly depend on the way of interaction of nurses with patients. This have the clears level implication as the polite behaviour of nurse will be helpful will feel valued and respected, and he/she will more likely to follow prescription. It will directly impacts on its health. An effective communication and the way of talking does not only influence patients to follow all guidelines but also improve health to the great extent. On the other hand the Koo, (2018) contradicts that the case when the patient was successful in talking in more polite and effective manner by using the abusive and harsh words which will be resulted in reduction in morel of patient. They also do not prefer to follow medical guidelines or prescription given by nurses and doctors effectively. These type of patients are more likely to take time in healing themselves. So, it can be said that, the way of talking or communication is the key of the success of nurses in getting effective results.

On the other hand the Khalil, Felemban and Tunker, (2019.) have the support to statement that the providence of different level of suggestion help them out in taking the best one and making an effective decision regarding patients healthcare services which can heal patients quickly and effectively. The assistant nurses at the time of working into ans effective teams will lead to have the increase their skills and take the best decision but also it makes them able to provide better services to patients because team working help them in reducing medical errors by selecting the best suggestion or decision. As the heaths care sector in order be more considered tie the part which is more level of turn over rat's ion along with effective work pressure. Positive attitude helps nurses in keeping them healthy and performing all activities efficiently.The nurses are also facing the major issues which regarding the safety of nurses at the workplaces regarding the injury along the development of proper maintenances in terms of illness is considered as an important issue as they accomplished of their respective duty. Hence, these relationships will be helping out to have greater level of dependence over making the supportive the each other in more respects to difficult time. So it can be more easily understood that there is positive level of relationship in promoting there for providing effective health care services to patients.

On the other hand the Kasat and, (2017) contraindicated as there is direct relationship, the bad level of impact n the nurses make them more level of frustrated which have more over direct impacts over the serviced which is provided to patents in more accurate manner. When they become frustrated then they use harsh words while talking to patients. It impacts on both patients and nurses' mental health more level of negative manner. So, improving relation with patients and making own-self healthy, it is important for nurses to become positive and having positive attitude in all situations. On the other hand there is more level of negative impacts of the change in behaviour in terms of the nurse in that they can disturb themselves as well as patients. It will directly impacts on the healthcare services which they provide to patients. On other the hand the more level of presence of positive impacts is that will have proper level of increases in terms of willingness of patient to have proper treatments in order to get well as soon as possible. This positive attitude have direct impact on patients. Nurses who posses this ability and skill, they influence patients and make them believe that they will be cured and healed soon which increases morale of both patients and nurses.

According to the view of the Simpson, K., (2017) patients there are many patient who are in critical situation and required to be treated at appropriate timings otherwise it may lead to death so, it is very important for nurses to posses time management skills and giving services to patients quickly without hurting other works. This will have the clear. level of results on the human behaviours along with identify needs of their patients. Before providing any type of healthcare services, it is important for nurses in order making the patients feel comfortable so that they will be able to share their feelings and needs. When nurses understand needs and feelings of their patients in their critical situations then they are more likely to become a professional and getting qualitative results.



3.1 Introduction

The main aim of research methodology is to identify the best method by which this research can be developed and identify the main reason of choosing this. This methodology will cover search strategy, both inclusion and exclusion criteria and data extraction. Systematic review plays an important role as it helps researcher in identifying methods of solving research problems (Kumar, 2019). It also promotes precision which helps decision makers in solving problem and taking the best decision. By making an effective use of PICO model, research is being developed.

3.2 Search strategy

It is all about PICO model which helps researcher in answering all research questions by breaking down them into 4 fragments. This model stands for population, intervention, comparison and outcome.

Population: This study is regarding the impacts of assistant nurse practitioners (ANPs) on critical care department:

Intervention: The nurse will be identified as the per the role, the level of relationship with the patient and the factor which is influencing the assistant nurse practitioners in critical care department.

Outcomes: Effective results or patients' outcomes, clients' safety, health improvements.

3.3 Inclusion criteria

In this research, inclusion criteria is primary quantitative studies by which researcher identifies impacts of healthcare services provided by assistant nurse practitioners (ANPs). It will also identify impacts of their healthcare services on patients' health and outcomes. In this primary research and inclusion criteria, researcher compared skills and knowledge which are required assistant nurse practitioners (ANPs) to have the development of effective services to patients in more significant order in critical care.

3.4 Exclusion criteria

It includes all those articles which focuses on other factors which can influence and contribute in patient's outcomes and health care services rather skills, education and knowledge. It also includes studies that were out-rightly irrelevant to the review question and duplicated studies which were excluded. The main reason of this part is it is believed that there is no effective and valid source via which, researcher can get relevant informations and can make its project successful and effective (Fernández-Susavila and, 2017).

3.5 Critical appraisal

Critical appraisal means to review and analyse the study and quality of the study in both positive and negative manner. The main aim of researcher pf following this critical appraisal step is to access the major aspects of the study and make sure that it has been completed in a systematic manner, bias free as well as effective for inclusion in a review. The view of Gajbhiye, and, (2019) the main aim of critical appraise or reason of performing this step in methodology is minimize risks of conducting a review that is inconclusive. In this appraisal some elements include such as: design, participants etc. It is important for critical appraisal to have views of at-least 2 authors or article. Some authors have interpreted that it is important for scholar to work closely with their supervisors in order to make the study successful and reducing errors. It can also be said in this context that usually, a critical appraisal are being carried out by scrutinizing the study against a standard guideline by making an effective use of appraisal form. However, this study has adopted a guideline on which basis, critical appraisal is being completed and developed research.

It can also be said that it is important for researcher to manage and asses the quality of articles and in order to make a high standard of methodological rigor. Methodological rigour is ascertained by a certain level of evidence in hierarchical manner. As per the view of Berman, Bialek and Shaevitz, (2016) the aim and rule of hierarchy is to create a guideline for establishing the best as well as suitable research design for the study rather creating a rule which can be applied to all form of the study. So, in this context, it can be said that randomized control trials is the best source of evidence which is suitable and the most used type. In addition, it can also be said that cross-sectional survey can be beneficial for this study as with its help, researcher can have proper level of evaluation in terms of different level of perspective along with impacts of the assistant nurse practitioners (ANPs) on critical care department along with patients.

3.6 Data extraction

It also refers a procedure in which, researcher collects relevant informations from each of the study and then summaries it. For data extracting process, it is important for scholar to make sure that they have extracted accurate and reliable data from each of the study otherwise it may lead errors and unproductive research project. Data extracted is one of the important part of methodology which needs to be performed in effective manner otherwise it may hurt further steps as well. Data analysis is further stage which researcher follows just after the data extraction or collecting informations relevant to the topic. The main aim of data analysis is to make clear and reliable data for making the study successful. The more manner the quality of the research is in terms of article have the cleared establishments long with retaining the continues and the standard of the methodological rigours in more descriptive manner.



 The purpose of this section is to have the clear examinations of the methodological quality i9n critical manner which have the inclusiveness of the articles along with compensation of different result as which is been produced by a respective study against another in order t have assurances over the variability and reversibility .

The first article which was taken into considerateness is Woo, Lee and San Tam, (2017) as the objectiveness of the study is quite clear along with critical appraisal to the best availability of evidences towards the effective nursing appreciates in terms of quality of care, clinical outcomes along with patients satisfactions in terms of cost ans the critical care setting. This is objective have clearly defines the statements which is considered to more level of measurable and recommended as the any respective good quality of research. On the other hand more. There is establishment of the comprehensive and systematic search is been done on 9 electronic data bases alone with hand research over the two key journals form 2006 to 2016 in order to have the identification of the studies which is clearly evaluating the impact of advance practice of nursing. On the other the is involvement of the two authors which are evolving the selection of article on basis inclusion criteria. On the other hand there were the 121061 studies which were actually identified for research in which only 15 were choices for the appraisal of methodological quality which is considered to a very small number by the two independents author. The Abedi and, (2019) also stated that the 7 out of 15 setting have the clear the impact of the advanced nursing practice roles on the length of stay in the critical care setting. The positive aspects of the study was all the data for the study is being extracted by using standard tools in more respective manner. The article has the respective level of limitation as the meta analysis of the outcomes was not to the combines effects which have the clears estimations which the impacts of the advance nursing roles in terms of emergency as the critical care setting. On the Bungay, Jackson and Lord, (2016) also added that statement in sense of inappropriateness meta analysis the as the included studied were at heterogeneous level in term of designs, inventions and the outcome measures. The level of theoretical knowledge and clinical competence of the nurses might differ across the studies; hence, the comparison might not have been fair. On the other hand the () stated that despite of the all level of limitation and contradiction the nine international data bases the clear implementation of the NP/APN role in the emergency and critical care settings improves patient outcomes. The transformation of healthcare delivery through effective utilization of the workforce may alleviate the impending rise in demand for health services.

The next study is taken of McDonnell and, (2015) as the aim of this study is clear which defines the statements which is considered to more level of measurable and recommended as the any respective good quality of research. This is with regard to have the proper level of evaluation of advances nursing practitioners as per the role of patients along with staff and the organisational outcome. The research design which is being uses is such as the collective case study which as undertaken the districts' hospital in England as conducting of differential interviews with strategic stakeholders which is being followed by three case study at respective level. On the other hand Bunn, Bennett and Burke, (2019) contradict has the respective study have only realizations of respected indicators which is being collected throughout interviews. There is inclusion of different stakeholders which are such as the patient, staff as well as clinical roles across the different range of profession. There is been risk theta the interviews have the representatives of all the stakeholders. The Craft and, (2017) also supported that statements as there us need more extensive study which is consolidated across range of organisation which would be helpful in strengthening the generosity of the respective finding.

 The next study is been carried out by the McMurray and, (2018.) which have the specification over having the clears and measurable aims in way to have the proper level of evaluation in context of different mechanism along with process of the nurse navigators practices after respective one year time. The research has the clears uses of the theoretical frameworks with having proper level of evaluation's and examining the relationships between context (the program), mechanisms and processes of enhancing patient access to care. The study was extended to have the focus groups with 7 of 8 nurses navigators along with 33 randomly selected patients. On the other the Craft and, (2017) contradicted that the survey was actually completed by the 55 general practitioner along with 19 practice nurses which is been done through the use of descriptive statistics along with content analysis of free text. The patient and nurses was there who are considered to be actually thematic analyse. The finding of the research that the General practitioners and practice nurses identified the importance of information, communication, coordination, advocacy, liaison and patients' positive health outcomes, with 73% of GPs and 84% of PNs reporting being satisfied with the NN role. There is expected the level of development.

The next study article is done by Kleinpell and, (2019) with the aim to the providence of the detailed understanding regarding the accurate care nurse practitioners in the critical care units. With the examinations being just over the 12 years old along with both role and examination is been considered. On the other, it has been contradicted by Bunn, Bennett and Burke, (2019) as the studies have the impact which is regarding the assistant practitioner in more way to critical care providing the rangers of the different advantages. These advantage are such as the decreased length of stay, decreased cost, increased reimbursement, and maintaining continuity of care. These study have inclusion of limitation one ACNP practicing in this study and a smaller MICU than most units with only 6- 8 patients treated during the study duration. There is also the limitation regarding the laws and regulation which have restriction practices which have the clear inclusion on perspective authority.

With relation the other next article which is included in the research is done by the Anderson Birks, and Adamson, (2019) with having respective clearance in terms of identify the pursue relationship between professional nursing identity and advanced practice by exploring intra‐professional relationships between advanced nurse practitioners (ANPs) and nursing colleagues. The nursing practices have been developed international as there is lack of supports within nursings which may led to the issues to under utilization retention and patients effective safety issues. On the other hand the Abedi and, (2019) the advanced practices is poorly understood as the theory of professionals identity in order to have creation of cultural barriers which have actually received with little empirical attention. The study has the clear implication of design ethnographic methodology which is having the fieldwork methods which is having participation were observation along with semi structure interview. Data were analysed thematically using framework analysis, underpinned a priori by professional identity theories. Reporting was guided by COREQ. Hence, the relevance to the research towards the clinical practices have the expansion of advance restricts throughout the primary and secondary case which have clear implication over the professorial identity and relationship on health cares, there are clears important of string advanced practices in more identity to became increasable relevant This positive attitude have direct impact on patients. Nurses who posses this ability and skill, they influence patients and make them believe that they will be cured and healed soon which increases morale of both patients and nurses.

 The last article is considered to the clear level of peer review which have the implementation of the advanced practitioners in the emergency care units. It has been clears understood that the expansion of the advanced practitioner roles, such as advanced clinical practitioners, in emergency departments (EDs) in recent years, with the assumption that they will positively affect the provision and quality of emergency care. This article has the aim in more way to identifying the different level of evidences on the effects of the advanced practitioner in the emergency care. There is major concern in terms of the lacks of clarity in terms of education skills, competency in order to have the addressing the implementation of such roles. Hence, it has been identified that There is clearly an urgent need for further research, but with careful consideration and implementation, advanced clinical practitioners, like the established emergency nurse practitioner role, can positively affect emergency care provision and help address the challenges faced by EDs across the UK.



5.1 Introduction

This chapter will have clear focus of the discussing, the results while have the comparison it with other in reference of relevant studies in an attempt to answer the following question in more appropriate way.

The purpose it to have clears study to have determination of the impacts of assistants practitioner on the critical care. There are 6 qualitative and quantitative studies which were adjusted as the good level of reviews. This is made it easier to have the effective results of the respective studies by comparing and contrasting in more effective way. Hence, they are said to be homogeneous. Moreover, the studies are evidently paying major focus on the respective stated aims as the applied questionnaire as to have appropriates data collections which is considered to a realisable student. However, there has been noticeable methodological flaws in the respective individual studies which have the clear effects the quality of this review.

THEMES 5.2 The impacts of the assistants practitioners role on quality of care along with clinical outcomes and patient satisfactions. 

In this article, the results have been dewan form the narrative systems which is understood to have the respective summarization of report findings. This reviews have clearly demonstrated that the respective involvement of the nurses in the advance level for practices in emergency ans critical care. There are improvements in the length stays along with the time to have proper consultation along with normality, patients, satisfaction ans the cost saving to respective level. Hence, these the contributions of capitalizing the nurses in more advance practices in order to have the increases in number of patients which have access to emergency along with critical care appealing. There are reviews to have the proper level of implementation of the advances practices in the nursling roles in the emergency with critical care setting. The sense of transformation on the healthcare delivery have done through effective utilization of workforces. They have proper alleviates to have impending rises in the respective demand of health services. Nevertheless, it is just necessary to have the first prepare the respective context to have the effects over sustainable changes in more way to have the proper for length of stay, time to consultation/treatment, mortality, patient satisfaction, and cost savings.

THEME 5.3 The implementation of the advance nurse practitioner as per the roles' ion the acute hospitable setting 

As from the above article, the finding were as the such as the assistant practiser have positive level of impacts in relational to the patient experience along with outcome and safety. The assistants are responsible to have the self-improvement of the staff knowledge along with skills and competences. This will be helpful in the enhancing the quality of work life. This will have also clear inclusion of total distribution of the workload along with team working. This is helpful in contributing to have the achievements of the organisational proprieties along with targets and development of respective policy.

At last there is the true understanding in terms of sense of responsibilities along with proper level of obligation which is more order performs by the assistant practitioners. This will be helpful in taking the positive impacts along with range of limited indicators which is reactional to patients along with staff members' ans the outcome of organization which is considered to be highly relevance to the nursing profession.

THEME 5.4 The primary health care nurse of the future: Preliminary evaluation of the Nurse Navigator role in integrated care

As this study have the clear aims to have the proper level of valuation's in terms of context, mechanism ans the process of the nurses' navigator practices after the respective time of 1 years. As the result alls the patients were considerer as the highly stratifies to their nurse navigator. There are the contractile of actual themes which have the effective development of nurse navigator with respective inclusion. There are major drawbacks along with contrast which is related workload, variability and time; desire for a professional ‘voice', and issues with the technological environment. The assistants' practitioner along with practice nurses have been identified as the importance in formation, communication's, coordinator along with advocacy, liaison and the positive health outcomes of patient in more positive way. Hence, the role is considered to more effective which is enhancing the access level of cares in terms of patient who are suffering form the chronic disease. They are considered to be bridging the gaps between the primary and secondary care in more effective way. This expertise will be helpful in formation of collaborative liaison by achieving the multidisciplinary health professionals has been well accepted by General Practitioners, Practice Nurses, patients and the nurse navigators themselves. On the further hand sue to respective level of development the role of assistance practitioners is excerpted to be overtime to have impression of impacts on the outcome of patients along with value of health system which is considered to be ongoing evaluation's.

THEME 4 Nurse Practitioners and Physician Assistants in Acute and Critical Care: A Concise Review of the Literature and Data 2008-2018

The study have reviewed the following aspects of the study which is tended to have the clears' intensification in terms of the abstracted, and analysed: study population, study design, study aims, methods, results, and relevant implications for critical care practice. It has been analysed than over the past 10 years the there is number is studies which impacting the advanced proactive providers with reactional meritocratic sate setting. This is considered to e an effective consubstantiality over increases. On the other hand collectivity this study have the clear indemnification of respective values of advanced practice providers in patient care management, continuity of care, improved quality and safety metrics, patient and staff satisfaction, and on new areas of focus including enhanced educational experience of residents and fellows.

Theme 5 Exploring the relationship between nursing identity and advanced nursing practice: An ethnographic study

The study is havering the advanced practices is poorly understood as the theory of professionals identity in order to have creation of cultural barriers which have actually received with little empirical attention. The study has the clear implication of design ethnographic methodology which is having the fieldwork methods which is having participation were observation along with semi structure interview. Data were analysed thematically using framework analysis, underpinned a priori by professional identity theories. Hence, the relevance to the research towards the clinical practices have the expansion of advance restricts throughout the primary and secondary case which have clear implication over the professorial identity and relationship on health cares, there are clears important of string advanced practices in more identity to became increasable relevant This positive attitude have direct impact on patients.

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One of the main limitation of this project that was experienced by the researcher was in secondary data collection. It was quite difficult for the researcher to identify articles or journals that can be used by researcher for building a base of the research as there were various kinds of articles available some of them were relevant and some of them were not. Inclusion and exclusion criteria's helped the researcher in secondary data collection. Other than this usage of key words also helped the researcher is finding relevant research papers that they had used for interpretation of data and answering research questions in a much better manner. However, there is a probability that researcher might have missed some other relevant articles. Another limitation faced by the researcher was restricted word count because of which researcher faced some difficulties to explore answers of all the research questions.

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This secondary data analysis has helped the researcher to identify the impact of assistant practitioners in UK NHS critical care units. This review included evaluation of nursing associates role in health and social care and impact that nursing associates have on hospitals. In order to answer the research questions various kinds of articles and journals were considered and included in the study to be compared in order to answer the research question. The collected secondary data was analysed using thematic data analysis framework. From the above study it has been summarized that nurses have major obligation level in making patient more comfortable with basic living activities. Assistant nurse's role is much more other than patient monitoring. Assistant nurses helps in maintaining relationship and understanding between patients and job security. There is proper level of relationship between assistant nurses and patient carte that further helps in appropriate level of decision making. Assistant nurses are majorly involved in critical care or emergency units. It was also analysed that there was a requirement to expand role of assistant nurses in emergency departments, advance clinical practitioners. Assistant nurses demand in health care sector has increased in a drastic manner as they help in enhancing patient satisfaction, saving cost and enhances care provided to critical care patients. It was also identified that there is a need of further research in order to analyse impact of assistant nurses in critical care unit.


  • In order to enhance positive impact of assistant practitioners in provision of critical care service to the patients, proper training and induction should be provided to assistant practitioners. So that they care clear about their roles and responsibilities and can work on enhancing their knowledge and skills so that they can provide excellent service or care to critical care unit patients.
  • Both internal and external inspection and auditing should be conducted so that all kinds of issues faced by assistant practitioners or loopholes can be identified and on the basis of which further improvement can be brought.


  • Abedi, A.A. and, 2019. Baccalaureate prepared nurses as the new entry-level nursing cadre in Uganda: A qualitative study of BSN student and faculty perspectives in two universities. Nurse education today. 76. pp.131-136.
  • Anderson, H., Birks, Y. and Adamson, J., 2019. Exploring the relationship between nursing identity and advanced nursing practice: An Ethnographic Study. Journal of Clinical Nursing.
  • Bungay, H., Jackson, J. and Lord, S., 2016. Exploring assistant practitioners' views of their role and training. Nursing Standard. 30(30).
  • Bungay, H., Jackson, J. and Lord, S., 2016. Exploring assistant practitioners' views of their role and training. Nursing Standard. 30(30).
  • Bunn, M., Bennett, A. and Burke, P.J., 2019. In the anytime: Flexible time structures, student experience and temporal equity in higher education. Time & Society. 28(4). pp.1409-1428.
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