Impact of Assistant Practitioners in UK NHS Critical Care Settings

This dissertation investigates the impact of assistant practitioners within UK NHS critical care units, focusing on their roles, contributions, and effects on patient outcomes. The study begins with an introduction outlining the background, justification, aim, objectives, and research questions, framed using the PICO framework. The dissertation then presents a comprehensive literature review, analyzing scholarly papers on the role of assistant nurses and practitioners, their responsibilities, and their contributions to healthcare delivery, especially in the context of critical care. The methodology section details the search strategy, inclusion and exclusion criteria, critical appraisal methods, and data extraction techniques used in the study. The results section offers a critique of the articles reviewed, followed by a discussion of the findings, organized around key themes such as the impact of assistant practitioners on care quality, clinical outcomes, and patient satisfaction, as well as the implementation of advanced nurse practitioners in acute hospital settings. The dissertation also addresses limitations and concludes with recommendations for future research and practice, providing a detailed analysis of the evolving role of assistant practitioners in the UK healthcare system.

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.