Impact of Assistant Practitioners in Critical Care Units

This dissertation explores the impact of assistant practitioners in critical care units in the UK NHS. It discusses the role of assistant practitioners, their contribution to patient outcomes, and the need for their involvement in healthcare. The study aims to provide insights into the demand for nurses and the potential benefits of hiring assistant nursing practitioners.

DISSERTATION

TABLE OF CONTENTS
CHAPTER 1: INTRODUCTION....................................................................................................4
1.1 Background............................................................................................................................4
1.2 Justification............................................................................................................................5
1.3 Aim........................................................................................................................................5
1.4 Objectives..............................................................................................................................5
1.5 Research Question.................................................................................................................5
Population: Infected patients......................................................................................................5
1.7 Search key terms....................................................................................................................6
CHAPTER 2: LITERATURE REVIEW.........................................................................................7
2.1 The role of assistant nurses towards the practitioners in health and social care....................7
Theme 2 The relationship between work of nurse practitioners and patient outcome alosng
with factor which are effecting working at medical care.........................................................10
CHAPTER 3..................................................................................................................................13
METHODOLOGY........................................................................................................................13
3.1 Introduction..........................................................................................................................13
3.2 Search strategy.....................................................................................................................13
3.3 Inclusion criteria..................................................................................................................13
3.4 Exclusion criteria.................................................................................................................13
3.5 Critical appraisal..................................................................................................................14
3.6 Data extraction.....................................................................................................................14
SECTION 4 RESULTS................................................................................................................16
4.0 CRITIQUE OF ARTICLES....................................................................................................16
SECTION 5...................................................................................................................................20
DISCUSSION OF RESULTS.......................................................................................................20
5.1 Introduction..........................................................................................................................20
THEMES 5.2 The impacts of the assistants practitioners role on quality of care along
with clinical outcomes and patient satisfactions...................................................................20
THEME 5.3 The implementation of the advance nurse practitioner as per the roles' ion the
acute hospitable setting..............................................................................................................21

THEME 5.4 The primary health care nurse of the future: Preliminary evaluation of the Nurse
Navigator role in integrated care...............................................................................................21
THEME 4 Nurse Practitioners and Physician Assistants in Acute and Critical Care: A Concise
Review of the Literature and Data 2008–2018..........................................................................22
Theme 5 Exploring the relationship between nursing identity and advanced nursing practice:
An ethnographic study...............................................................................................................22
LIMITATIONS..............................................................................................................................23
CONCLUSION AND RECOMMENDATIONS..........................................................................23
Conclusion.................................................................................................................................23
Recommendations......................................................................................................................24
REFERENCES..............................................................................................................................25

CHAPTER 1: INTRODUCTION
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 et.al., 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 et.al., 2016).
In order to meet the demand of nurses NHS is paying attention on involving associated
nurses in care units (Kasat and et.al., 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 et.al., 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 diaereses 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 et.al., 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

CHAPTER 2: LITERATURE REVIEW
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 et.al., (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 et.al., (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 et.al., 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 et.al., (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 et.al., (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
et.al., 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 et.al., (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.
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
et.al (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 et.al., (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 et.al (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 et.al., (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.
CHAPTER 3
METHODOLOGY
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 et.al., 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 et.al.,
(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.

SECTION 4 RESULTS
4.0 CRITIQUE OF ARTICLES
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
et.al., (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 et.al., (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 et.al., (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 et.al., (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 et.al., (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 et.al., (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 et.al., (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.

SECTION 5
DISCUSSION OF RESULTS
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.

LIMITATIONS
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.
CONCLUSION AND RECOMMENDATIONS
Conclusion
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.

Recommendations
 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.

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