Capstone Project: Introducing ANP Role in Saudi Primary Care Setting
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Capstone Project
AI Summary
This capstone project presents a quality improvement initiative aimed at introducing the Advanced Nurse Practitioner (ANP) role within a primary care setting in Saudi Arabia. The project employs the Knowledge-to-Action (KTA) cycle to address the current gap in ANP practice, where their skills are underutilized. The methodology includes problem identification, adaptation of best practices from the US, addressing barriers such as lack of defined roles and limited educational opportunities, implementation involving an ANP graduate, monitoring of queue lengths, wait times and patient satisfaction, and plans for sustainability through continuous review and curriculum adjustments. The project also considers ethical implications, seeking approval from the Institutional Review Board (IRB) to ensure responsible and accountable implementation. The goal is to improve patient care, increase access to healthcare, and optimize resource allocation within the outpatient department. The project provides a detailed plan for integrating ANPs, addressing challenges, and evaluating the impact on healthcare delivery in the KSA context. The project's ultimate goal is to demonstrate the ANP's potential to improve the overall quality of care in the Saudi Arabian healthcare system.
Introducing the Advanced Nurse Practitioner Role to a Primary Care Setting in Kingdom of Saudi
Arabia: A Quality Improvement Project
Introducing the Advanced Nurse Practitioner Role to a Primary Care Setting in Kingdom of
Saudi Arabia: A Quality Improvement Project
Amaal
Capstone Project Submitted for the Master of Science in Nursing: Advanced Practice
School of Nursing and Human Science
Month and Year of Submission
Arabia: A Quality Improvement Project
Introducing the Advanced Nurse Practitioner Role to a Primary Care Setting in Kingdom of
Saudi Arabia: A Quality Improvement Project
Amaal
Capstone Project Submitted for the Master of Science in Nursing: Advanced Practice
School of Nursing and Human Science
Month and Year of Submission
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Introducing the Advanced Nurse Practitioner Role to a Primary Care Setting in Kingdom of Saudi
Arabia: A Quality Improvement Project
4.0 Quality Improvement Methodology
The framework that guides the project methodology is the knowledge-to-action (KTA)
cycle (Graham et al. 2006; Straus et al., 2009). The KTA cycle helps to address the challenges
that emerge during the translation of scientific evidence into practice by preparing an individual
to deal with the various complex and intertwined factors that interfere with the successful uptake
of such evidence (Field et al. 2014). The KTA cycle is comprised of two major categories:
Knowledge and Action categories. Each category is subdivided into various phases. The
knowledge creation phase is deemed to be a funnel that regards knowledge as usable units that
are tailored to the action component. Knowledge is generated after making and inquiry and
engaging in extensive research to develop evidence in the form of guidelines, algorithms, or
pathways. The action phase entails the stepwise activities through which the knowledge is
actualized by aligning it to an identified problem and later evaluating outcomes while ensuring
their sustainability. In the current project, the evidence-based framework seeks to establish the
role of APNs in KSA in an area where these professionals are undermined; yet, they have the
skills and capabilities to improve the healthcare infrastructure. Such knowledge will be
actualized by following the phases as outlined below:
Phase 1: Problem Identification
There is a salient gap in APN practice because APNs do not get to practice, fully, as per
their trainings in KSA, where the focus will be on the Outpatient Department (OPD) where I
work. The quality improvement plan is based on the need to adapt standards, competencies, and
legal and ethical principles to guide ANP practice in the OPD. The role of ANPs in the context
of providing diagnostic and prescription services to patients needs to be clearly laid down. The
outpatient department is a host to patients with varied needs mainly seeking the attention of a
physician. However, due to long queues and associated long waiting times, the patients are often
disgruntled while the quality of care may be altered as physicians are compelled to attend more
Arabia: A Quality Improvement Project
4.0 Quality Improvement Methodology
The framework that guides the project methodology is the knowledge-to-action (KTA)
cycle (Graham et al. 2006; Straus et al., 2009). The KTA cycle helps to address the challenges
that emerge during the translation of scientific evidence into practice by preparing an individual
to deal with the various complex and intertwined factors that interfere with the successful uptake
of such evidence (Field et al. 2014). The KTA cycle is comprised of two major categories:
Knowledge and Action categories. Each category is subdivided into various phases. The
knowledge creation phase is deemed to be a funnel that regards knowledge as usable units that
are tailored to the action component. Knowledge is generated after making and inquiry and
engaging in extensive research to develop evidence in the form of guidelines, algorithms, or
pathways. The action phase entails the stepwise activities through which the knowledge is
actualized by aligning it to an identified problem and later evaluating outcomes while ensuring
their sustainability. In the current project, the evidence-based framework seeks to establish the
role of APNs in KSA in an area where these professionals are undermined; yet, they have the
skills and capabilities to improve the healthcare infrastructure. Such knowledge will be
actualized by following the phases as outlined below:
Phase 1: Problem Identification
There is a salient gap in APN practice because APNs do not get to practice, fully, as per
their trainings in KSA, where the focus will be on the Outpatient Department (OPD) where I
work. The quality improvement plan is based on the need to adapt standards, competencies, and
legal and ethical principles to guide ANP practice in the OPD. The role of ANPs in the context
of providing diagnostic and prescription services to patients needs to be clearly laid down. The
outpatient department is a host to patients with varied needs mainly seeking the attention of a
physician. However, due to long queues and associated long waiting times, the patients are often
disgruntled while the quality of care may be altered as physicians are compelled to attend more
Introducing the Advanced Nurse Practitioner Role to a Primary Care Setting in Kingdom of Saudi
Arabia: A Quality Improvement Project
patients than they can handle (Almomani and AlSarheed 2016). There are various nurses in the
department who have studied APN, but they are not recognized as capable of providing
autonomous medical diagnoses (Hibbert et al. 2017). Hence, despite their qualifications and
skills, they remain docile; yet, they are capable of improving the overall quality of care delivered
at the OPD. Nonetheless, the advancing role of nurses has gained recognition, but there is a need
to develop a regulatory framework to guide the operations of these nurses. I, thereby, seek to
display the potential of an APN by empowering one APN with adequate knowledge and
experience to work as an independent entity.
Phase 2: Adaptation
There is no current program in KSA that can help to gain insight on how to go about the
introduction of ANPs. However, the organization will adapt knowledge from the United States
because it is a constellation of various countries representing different cultures. California is the
country with the largest Asian-American population, and the ANP role in this country will be
aligned to that of Saudi-Arabia based on the assumption that the county is a cultural
representation of the Asian beliefs and perceptions that prevail in KSA (Ghosh 2011). The
improvement plan will focus on licensure, scope of practice, standards, competencies, and ethical
and legal principles from case study reports, research papers, and press releases. Most of all, it
will be important to adopt the training and licensure schedules that leads to the acquisition of the
title of an ANP.
Phase 3: Barriers
The lack of a clearly defined role for ANPs poses as a significant challenge as it influences the
perceptions of physicians and managers. It is important to convenience the managers and
physicians about the role and integration of ANPs in the Out Patient Department (OPD). Hence,
meetings will be held with the physicians and OPD managers to clear doubts and misunderstand
the role. It would be a challenge to suddenly assign high-level duties to the specialists 1, as they
are called in KSA. Also, the challenge in assignment of duties is further exacerbated by the fact
that patients who have gotten used to seeking services from physicians would be expected to
develop the same confidence when been cared for by specialists 1 (Munce et al., 2013). There
have been limited educational opportunities for nurses to pursue advanced practice courses and
Arabia: A Quality Improvement Project
patients than they can handle (Almomani and AlSarheed 2016). There are various nurses in the
department who have studied APN, but they are not recognized as capable of providing
autonomous medical diagnoses (Hibbert et al. 2017). Hence, despite their qualifications and
skills, they remain docile; yet, they are capable of improving the overall quality of care delivered
at the OPD. Nonetheless, the advancing role of nurses has gained recognition, but there is a need
to develop a regulatory framework to guide the operations of these nurses. I, thereby, seek to
display the potential of an APN by empowering one APN with adequate knowledge and
experience to work as an independent entity.
Phase 2: Adaptation
There is no current program in KSA that can help to gain insight on how to go about the
introduction of ANPs. However, the organization will adapt knowledge from the United States
because it is a constellation of various countries representing different cultures. California is the
country with the largest Asian-American population, and the ANP role in this country will be
aligned to that of Saudi-Arabia based on the assumption that the county is a cultural
representation of the Asian beliefs and perceptions that prevail in KSA (Ghosh 2011). The
improvement plan will focus on licensure, scope of practice, standards, competencies, and ethical
and legal principles from case study reports, research papers, and press releases. Most of all, it
will be important to adopt the training and licensure schedules that leads to the acquisition of the
title of an ANP.
Phase 3: Barriers
The lack of a clearly defined role for ANPs poses as a significant challenge as it influences the
perceptions of physicians and managers. It is important to convenience the managers and
physicians about the role and integration of ANPs in the Out Patient Department (OPD). Hence,
meetings will be held with the physicians and OPD managers to clear doubts and misunderstand
the role. It would be a challenge to suddenly assign high-level duties to the specialists 1, as they
are called in KSA. Also, the challenge in assignment of duties is further exacerbated by the fact
that patients who have gotten used to seeking services from physicians would be expected to
develop the same confidence when been cared for by specialists 1 (Munce et al., 2013). There
have been limited educational opportunities for nurses to pursue advanced practice courses and
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Introducing the Advanced Nurse Practitioner Role to a Primary Care Setting in Kingdom of Saudi
Arabia: A Quality Improvement Project
associated specialist educational programmes; hence, nurses seeking to possess these skills have
been enrolling to universities outside the country. As it stands, I am in the first batch of the
newly introduced program and most of the nurses in KSA are expatriates which makes it difficult
to standardize practice due to variation in training, language, and experience (Hibbert, Al-Sanea,
and Balens, 2012).
Phase 4: Implementation
After getting permission from the healthcare facility’s administrator, I will meet with the
OPD manager to inform him of the proposed quality improvement plan. An APN who has
recently graduated from Prince Norah University will be involved in the implementation of the
quality improvement plan. There will be an introduction of the term ANP as a substitute for
specialists 1 among the healthcare providers and the general public. A streaming video on the TV
screen at the OPD’s waiting area will be used to notify patients about the new position and
associated role of an ANP. The OPD manager, with the help of a selected stakeholders’
committee, will devise guidelines and policies to guide ANP practice within the department by
highlighting what the ANP should and should not do. Expanding the role of the APN will mean
that the APN can diagnose, prescribe, and treat but with oversight from a physician (Simmons
University 2016).
Phase 5: Monitoring and Evaluation of Outcomes
Availability of the selected APN and guiding principles for work will ascertain the
implementation of the plan. The length of the queues will be monitored while wait times and
patient satisfaction will be used to determine the impact of the quality improvement plan. The
trend in the number of patients accessing healthcare services by comparing the statistics before
and after the introduction of ANPs in the unit will help to determine the impact of ANPs.
Phase 6: Sustainability
The fact that the process of laying out the responsibilities of ANPs is just getting started
means that there is a need for continued review of the guidelines based on the monitoring results
to help retain what works and make necessary adjustments to develop a clear scope of practice
and associate policies, expected competencies and standards of the ANPs and associated policies.
The evaluation outcome results will determine the needed number of additional ANPs and
nursing curriculum in the training institutions. Patients’ needs and preferences will be aligned to
Arabia: A Quality Improvement Project
associated specialist educational programmes; hence, nurses seeking to possess these skills have
been enrolling to universities outside the country. As it stands, I am in the first batch of the
newly introduced program and most of the nurses in KSA are expatriates which makes it difficult
to standardize practice due to variation in training, language, and experience (Hibbert, Al-Sanea,
and Balens, 2012).
Phase 4: Implementation
After getting permission from the healthcare facility’s administrator, I will meet with the
OPD manager to inform him of the proposed quality improvement plan. An APN who has
recently graduated from Prince Norah University will be involved in the implementation of the
quality improvement plan. There will be an introduction of the term ANP as a substitute for
specialists 1 among the healthcare providers and the general public. A streaming video on the TV
screen at the OPD’s waiting area will be used to notify patients about the new position and
associated role of an ANP. The OPD manager, with the help of a selected stakeholders’
committee, will devise guidelines and policies to guide ANP practice within the department by
highlighting what the ANP should and should not do. Expanding the role of the APN will mean
that the APN can diagnose, prescribe, and treat but with oversight from a physician (Simmons
University 2016).
Phase 5: Monitoring and Evaluation of Outcomes
Availability of the selected APN and guiding principles for work will ascertain the
implementation of the plan. The length of the queues will be monitored while wait times and
patient satisfaction will be used to determine the impact of the quality improvement plan. The
trend in the number of patients accessing healthcare services by comparing the statistics before
and after the introduction of ANPs in the unit will help to determine the impact of ANPs.
Phase 6: Sustainability
The fact that the process of laying out the responsibilities of ANPs is just getting started
means that there is a need for continued review of the guidelines based on the monitoring results
to help retain what works and make necessary adjustments to develop a clear scope of practice
and associate policies, expected competencies and standards of the ANPs and associated policies.
The evaluation outcome results will determine the needed number of additional ANPs and
nursing curriculum in the training institutions. Patients’ needs and preferences will be aligned to
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Introducing the Advanced Nurse Practitioner Role to a Primary Care Setting in Kingdom of Saudi
Arabia: A Quality Improvement Project
the healthcare provider in that female patients will be attended to by the ANPs in matters related
to sexuality, and the same goes for men in the context of conditions such as prostate cancer.
Ethical Considerations
The proposal will be presented to the Institutional Review Board (IRB) to seek ethical
approval that will ascertain that the plan is being conducted in a responsible and accountable
way. The plan should aim to yield positive outcomes and not expose the participants to harm or
risks.
Arabia: A Quality Improvement Project
the healthcare provider in that female patients will be attended to by the ANPs in matters related
to sexuality, and the same goes for men in the context of conditions such as prostate cancer.
Ethical Considerations
The proposal will be presented to the Institutional Review Board (IRB) to seek ethical
approval that will ascertain that the plan is being conducted in a responsible and accountable
way. The plan should aim to yield positive outcomes and not expose the participants to harm or
risks.
Introducing the Advanced Nurse Practitioner Role to a Primary Care Setting in Kingdom of Saudi
Arabia: A Quality Improvement Project
References
1. Aboshaiqah, A. 2015. Nursing work environment in Saudi Arabia. Journal of Nursing
Management, 23(4), pp.510-520.
2. Al Asmri, M., Almalki, M., Fitzgerald, G. and Clark, M. 2019. The public healthcare
system and primary care services in Saudi Arabia: a system in transition. Eastern
Mediterranean Health Journal.
3. Alghamdi, M. and Urden, L. 2015. Transforming the nursing profession in Saudi Arabia.
Journal of Nursing Management, 24(1), pp.E95-E100.
4. Al-Hanawi, M., Khan, S. and Al-Borie, H. 2019. Healthcare human resource
development in Saudi Arabia: emerging challenges and opportunities—a critical review.
Public Health Reviews, 40(1).
5. Al-jedai, A., Qaisi, S. and Al-meman, A. 2016. Pharmacy Practice and the Health Care
System in Saudi Arabia. The Canadian Journal of Hospital Pharmacy, 69(3).
6. Almomani, I. and AlSarheed, A. 2016. Enhancing outpatient clinics management
software by reducing patients’ waiting time. Journal of Infection and Public Health, 9(6),
pp.734-743.
7. Anderson, H., Adamson, J. and Birks, Y. 2018. Presenting the primary care team to the
public: a qualitative exploration of general practice websites. British Journal of General
Practice, 68(668), pp.e178-e186.
8. Barratt, J. and Thomas, N. 2018. Nurse practitioner consultations in primary health care:
a case study-based survey of patients’ pre-consultation expectations, and post-
consultation satisfaction and enablement. Primary Health Care Research & Development,
20B.
Arabia: A Quality Improvement Project
References
1. Aboshaiqah, A. 2015. Nursing work environment in Saudi Arabia. Journal of Nursing
Management, 23(4), pp.510-520.
2. Al Asmri, M., Almalki, M., Fitzgerald, G. and Clark, M. 2019. The public healthcare
system and primary care services in Saudi Arabia: a system in transition. Eastern
Mediterranean Health Journal.
3. Alghamdi, M. and Urden, L. 2015. Transforming the nursing profession in Saudi Arabia.
Journal of Nursing Management, 24(1), pp.E95-E100.
4. Al-Hanawi, M., Khan, S. and Al-Borie, H. 2019. Healthcare human resource
development in Saudi Arabia: emerging challenges and opportunities—a critical review.
Public Health Reviews, 40(1).
5. Al-jedai, A., Qaisi, S. and Al-meman, A. 2016. Pharmacy Practice and the Health Care
System in Saudi Arabia. The Canadian Journal of Hospital Pharmacy, 69(3).
6. Almomani, I. and AlSarheed, A. 2016. Enhancing outpatient clinics management
software by reducing patients’ waiting time. Journal of Infection and Public Health, 9(6),
pp.734-743.
7. Anderson, H., Adamson, J. and Birks, Y. 2018. Presenting the primary care team to the
public: a qualitative exploration of general practice websites. British Journal of General
Practice, 68(668), pp.e178-e186.
8. Barratt, J. and Thomas, N. 2018. Nurse practitioner consultations in primary health care:
a case study-based survey of patients’ pre-consultation expectations, and post-
consultation satisfaction and enablement. Primary Health Care Research & Development,
20B.
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Do you want full access?
Subscribe today to unlock all pages.
Trusted by 1+ million students worldwide
Introducing the Advanced Nurse Practitioner Role to a Primary Care Setting in Kingdom of Saudi
Arabia: A Quality Improvement Project
9. Bergman, K., Perhed, U., Eriksson, I., Lindblad, U. and Fagerström, L. 2013. Patients'
satisfaction with the care offered by advanced practice nurses: A new role in Swedish
primary care. International Journal of Nursing Practice, 19(3), pp.326-333.
10. Carnwell, R. and Daly, W. 2003. Advanced nursing practitioners in primary care settings:
an exploration of the developing roles. Journal of Clinical Nursing, 12(5), pp.630-642.
11. Carroll, C., Booth, A. and Cooper, K. 2011. A worked example of "best fit" framework
synthesis: A systematic review of views concerning the taking of some potential
chemopreventive agents. BMC Medical Research Methodology, 11(1).
12. Cowley, A., Cooper, J. and Goldberg, S. 2016. Experiences of the advanced nurse
practitioner role in acute care. Nursing Older People, 28(4), pp.31-36.
13. Duke, N. 2012. Exploring advanced nursing practice: past, present and future. British
Journal of Nursing, 21(17), pp.1026-1030.
14. Field, B., Booth, A., Ilott, I., and Gerrish, K. 2014. Using the Knowledge to Action
Framework in practice: a citation analysis and systematic review. Implementation
science, 9, pp. 172. DOI: 10.1186/s13012-014-0172-2.
15. Finfgeld-Connett, D. 2013. Use of content analysis to conduct knowledge-building and
theory-generating qualitative systematic reviews. Qualitative Research, 14(3), pp.341-
352.
16. Ghosh, Palash. 2011. “Top Five U.S. Counties with Largest Asian Populations.”
International Business Times [online] 22 February. Available at:
<https://www.ibtimes.com/top-five-us-counties-largest-asian-populations-photos-
706132> [Accessed 23 January 2020].
Arabia: A Quality Improvement Project
9. Bergman, K., Perhed, U., Eriksson, I., Lindblad, U. and Fagerström, L. 2013. Patients'
satisfaction with the care offered by advanced practice nurses: A new role in Swedish
primary care. International Journal of Nursing Practice, 19(3), pp.326-333.
10. Carnwell, R. and Daly, W. 2003. Advanced nursing practitioners in primary care settings:
an exploration of the developing roles. Journal of Clinical Nursing, 12(5), pp.630-642.
11. Carroll, C., Booth, A. and Cooper, K. 2011. A worked example of "best fit" framework
synthesis: A systematic review of views concerning the taking of some potential
chemopreventive agents. BMC Medical Research Methodology, 11(1).
12. Cowley, A., Cooper, J. and Goldberg, S. 2016. Experiences of the advanced nurse
practitioner role in acute care. Nursing Older People, 28(4), pp.31-36.
13. Duke, N. 2012. Exploring advanced nursing practice: past, present and future. British
Journal of Nursing, 21(17), pp.1026-1030.
14. Field, B., Booth, A., Ilott, I., and Gerrish, K. 2014. Using the Knowledge to Action
Framework in practice: a citation analysis and systematic review. Implementation
science, 9, pp. 172. DOI: 10.1186/s13012-014-0172-2.
15. Finfgeld-Connett, D. 2013. Use of content analysis to conduct knowledge-building and
theory-generating qualitative systematic reviews. Qualitative Research, 14(3), pp.341-
352.
16. Ghosh, Palash. 2011. “Top Five U.S. Counties with Largest Asian Populations.”
International Business Times [online] 22 February. Available at:
<https://www.ibtimes.com/top-five-us-counties-largest-asian-populations-photos-
706132> [Accessed 23 January 2020].
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Introducing the Advanced Nurse Practitioner Role to a Primary Care Setting in Kingdom of Saudi
Arabia: A Quality Improvement Project
17. Graham, I., Logan, J., Harrison, M., Straus, S., Tetroe, J., Caswell, W. and Robinson, N.
2006. Lost in knowledge translation: Time for a map?. Journal of Continuing Education
in the Health Professions, 26(1), pp.13-24.
18. Graham, I. and Tetroe, J. 2007. Some Theoretical Underpinnings of Knowledge
Translation. Academic Emergency Medicine, 14(11), pp.936-941.
19. Harmon, T., Liss, L., Umbricht, M., and Flesher, J. 2014. Process improvement &
evaluation (2nd ed.). Champaign, IL: Office of Community College Research and
Leadership, University of Illinois at Urbana-Champaign.
20. Hibbert, D., Al-Sanea, N. and Balens, J. 2012. Perspectives on Specialist Nursing in
Saudi Arabia: A National Model for Success. Annals of Saudi Medicine, 32(1), pp.78-85.
21. Jenkins, J., Docherty, M. and Cain, J. 2018. Advanced Nurse Practitioners impact across
Primary Care. International Journal of Integrated Care, 18(s2), p.340.
22. Kralewski, J., Dowd, B., Curoe, A., Savage, M. and Tong, J. 2015. The Role of Nurse
Practitioners in Primary Healthcare. Available from:
https://www.ajmc.com/journals/issue/2015/2015-vol21-n6/the-role-of-nurse-
practitioners-in-primary-healthcare?p=2 [Accessed July 24, 2015].
23. Martínez-González, N., Djalali, S., Tandjung, R., Huber-Geismann, F., Markun, S.,
Wensing, M. and Rosemann, T. 2014. Substitution of physicians by nurses in primary
care: a systematic review and meta-analysis. BMC Health Services Research, 14(1).
24. McDonnell, A., Goodwin, E., Kennedy, F., Hawley, K., Gerrish, K. and Smith, C. 2014.
An evaluation of the implementation of Advanced Nurse Practitioner (ANP) roles in an
acute hospital setting. Journal of Advanced Nursing, 71(4), pp.789-799.
Arabia: A Quality Improvement Project
17. Graham, I., Logan, J., Harrison, M., Straus, S., Tetroe, J., Caswell, W. and Robinson, N.
2006. Lost in knowledge translation: Time for a map?. Journal of Continuing Education
in the Health Professions, 26(1), pp.13-24.
18. Graham, I. and Tetroe, J. 2007. Some Theoretical Underpinnings of Knowledge
Translation. Academic Emergency Medicine, 14(11), pp.936-941.
19. Harmon, T., Liss, L., Umbricht, M., and Flesher, J. 2014. Process improvement &
evaluation (2nd ed.). Champaign, IL: Office of Community College Research and
Leadership, University of Illinois at Urbana-Champaign.
20. Hibbert, D., Al-Sanea, N. and Balens, J. 2012. Perspectives on Specialist Nursing in
Saudi Arabia: A National Model for Success. Annals of Saudi Medicine, 32(1), pp.78-85.
21. Jenkins, J., Docherty, M. and Cain, J. 2018. Advanced Nurse Practitioners impact across
Primary Care. International Journal of Integrated Care, 18(s2), p.340.
22. Kralewski, J., Dowd, B., Curoe, A., Savage, M. and Tong, J. 2015. The Role of Nurse
Practitioners in Primary Healthcare. Available from:
https://www.ajmc.com/journals/issue/2015/2015-vol21-n6/the-role-of-nurse-
practitioners-in-primary-healthcare?p=2 [Accessed July 24, 2015].
23. Martínez-González, N., Djalali, S., Tandjung, R., Huber-Geismann, F., Markun, S.,
Wensing, M. and Rosemann, T. 2014. Substitution of physicians by nurses in primary
care: a systematic review and meta-analysis. BMC Health Services Research, 14(1).
24. McDonnell, A., Goodwin, E., Kennedy, F., Hawley, K., Gerrish, K. and Smith, C. 2014.
An evaluation of the implementation of Advanced Nurse Practitioner (ANP) roles in an
acute hospital setting. Journal of Advanced Nursing, 71(4), pp.789-799.
Introducing the Advanced Nurse Practitioner Role to a Primary Care Setting in Kingdom of Saudi
Arabia: A Quality Improvement Project
25. Oliver, E. 2017. Driving the role of the advanced practitioner in primary care. Practice
Nursing, 28(1), pp.42-45.
26. Kooienga, S. and Carryer, J. 2015. Globalization and Advancing Primary Health Care
Nurse Practitioner Practice. The Journal for Nurse Practitioners, 11(8), pp.804-811.
27. Ljungbeck, B. and Sjögren Forss, K. 2017. Advanced nurse practitioners in municipal
healthcare as a way to meet the growing healthcare needs of the frail elderly: a qualitative
interview study with managers, doctors and specialist nurses. BMC Nursing, 16(1).
28. Simmons University. 2016. Where Can Nurse Practitioners Work without Physician
Supervision? [online] available from
https://onlinenursing.simmons.edu/nursing-blog/nurse-practitioners-scope-of-practice-
map/ Accessed 8 February 2020.
29. Swan, M., Ferguson, S., Chang, A., Larson, E. and Smaldone, A. 2015. Quality of
primary care by advanced practice nurses: a systematic review. International Journal for
Quality in Health Care, 27(5), pp.396-404.
30. The total population. 2020. General Authority for Statistics. Available from:
https://www.stats.gov.sa/en/indicators/1 [Accessed January 12, 2020].
31. Torrens, C., Campbell, P., Hoskins, G., Strachan, H., Wells, P., Cunningham, M.,
Bottone, H., Polson, R. and Maxwell, P. 2019. Barriers and facilitators to the
implementation of the advanced nurse practitioner role in primary care setting: a scoping
review. International Journal of Nursing Studies, p.103443.
32. Twinn, S., Thompson, D., Lopez, V., Lee, D. and Shiu, A. 2004. Determinants in the
development of advanced nursing practice: a case study of primary-care settings in Hong
Kong. Health and Social Care in the Community, 13(1), pp.11-20.
Arabia: A Quality Improvement Project
25. Oliver, E. 2017. Driving the role of the advanced practitioner in primary care. Practice
Nursing, 28(1), pp.42-45.
26. Kooienga, S. and Carryer, J. 2015. Globalization and Advancing Primary Health Care
Nurse Practitioner Practice. The Journal for Nurse Practitioners, 11(8), pp.804-811.
27. Ljungbeck, B. and Sjögren Forss, K. 2017. Advanced nurse practitioners in municipal
healthcare as a way to meet the growing healthcare needs of the frail elderly: a qualitative
interview study with managers, doctors and specialist nurses. BMC Nursing, 16(1).
28. Simmons University. 2016. Where Can Nurse Practitioners Work without Physician
Supervision? [online] available from
https://onlinenursing.simmons.edu/nursing-blog/nurse-practitioners-scope-of-practice-
map/ Accessed 8 February 2020.
29. Swan, M., Ferguson, S., Chang, A., Larson, E. and Smaldone, A. 2015. Quality of
primary care by advanced practice nurses: a systematic review. International Journal for
Quality in Health Care, 27(5), pp.396-404.
30. The total population. 2020. General Authority for Statistics. Available from:
https://www.stats.gov.sa/en/indicators/1 [Accessed January 12, 2020].
31. Torrens, C., Campbell, P., Hoskins, G., Strachan, H., Wells, P., Cunningham, M.,
Bottone, H., Polson, R. and Maxwell, P. 2019. Barriers and facilitators to the
implementation of the advanced nurse practitioner role in primary care setting: a scoping
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Introducing the Advanced Nurse Practitioner Role to a Primary Care Setting in Kingdom of Saudi
Arabia: A Quality Improvement Project
9.0 Appendices
Figure.1
The Knowledge to Action Framework: From Graham I, Logan J, Harrison M, Strauss S, Tetroe J, Caswell W,
Robinson N: Lost in knowledge translation: time for a map? The Journal of Continuing Education in the Health
Professions 2006, 26, p. 19. Reprinted with permission from John Wiley and Sons.
Arabia: A Quality Improvement Project
9.0 Appendices
Figure.1
The Knowledge to Action Framework: From Graham I, Logan J, Harrison M, Strauss S, Tetroe J, Caswell W,
Robinson N: Lost in knowledge translation: time for a map? The Journal of Continuing Education in the Health
Professions 2006, 26, p. 19. Reprinted with permission from John Wiley and Sons.
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