The evolving landscape of advanced practice in Ireland is reflected in the growing body of research and clinical case studies led by Advanced Nurse Practitioners (ANPs), who continue to drive innovation, evidence-based practice, and improved patient outcomes across diverse clinical settings.
This section highlights recently published research and clinical case studies authored by Irish ANPs, showcasing their contributions to clinical excellence, service development, and professional leadership.
The effect of an advanced nurse practitioner-led menopause clinic on quality-of-life and menopausal symptoms
Author: Catriona Keye. RANP General Practice, PhD Candidate, University College Cork
First published online April 2, 2025, Sage Journals – Women’s Health
Background: Research suggests women feel there is a lack of information and support around menopause leading them to be unprepared for the transition. Menopause care requires the practitioner to provide women with accurate information regarding symptoms and treatment.
ANPs have been found to have the knowledge and skills to provide high-quality, safe, individualised holistic healthcare. An ANP-led menopause clinic was established following intense mentorship/competency assessment and completion of industry standard courses to ensure evidence-based best practice.
Objectives: To evaluate any change in quality-of-life (QoL) and menopause symptoms of patients pre- and post-education and initiation of menopause hormonal treatment (MHT) using the QoL assessment tool, the Greene Scale, in an ANP-led menopause clinic.
Design: This interventional study was carried using GUIDED, Guidance for reporting intervention development studies in health research. This quantitative audit used the Greene Scale tool to measure symptoms and QoL before and after the appointment with the ANP.
Methods: A search of the patient database was conducted to identify patients returning for the three-monthly review post initial consultation and initiation of MHT (n=15). Data was collected on the modified Greene Scale instrument. The sample was randomly selected by identifying every second patient on a single medical surgery database.
Statistical analysis was ascertained utilising central tendency excel functionality. The statistical significance of the data was assessed using a two-tailed paired t-test. p-values of less than 0.05 were considered statistically significant.
Results: An ANP-led menopause clinic in accordance with evidence-based guidelines, including education and treatment improved the overall QoL to a statistical significance. In addition, menopausal symptom reduction occurred in all 20 symptoms as measured in the modified Greene Scale, 19 of which to a statistical significance.
Conclusion: The study revealed an improvement in QoL and menopausal symptoms in an ANP-led menopause clinic. ANP-led menopause clinics could be a great addition to the workforce providing patients with timely menopause care. Further studies could build on this analysis by including other variables, such as comorbidities, demographics, and patient’s perspective.
Plain language summary: Women feel there is a lack of menopause information and support. Menopause care needs practitioners who can provide accurate facts on symptoms and treatment. Advanced nurse practitioners have the knowledge and skills to provide high quality, safe, individualised care.
An ANP-led menopause clinic was set up after the ANP completed menopause courses and mentorship. A study was undertaken to assess the impact on QoL and menopause symptoms before and after attending the ANP menopause clinic. The information was collected using a menopause symptom assessment tool called the Greene scale. The information was analysed using both excel and a two tailed paired t-test.
The ANP-led menopause clinic improved the overall QoL to a statistical significance and reduced menopausal symptoms in all 20 symptoms assessed, 19 symptoms were reduced to a statistical significance. ANP-led menopause clinics could be a great addition to the workforce providing patients with timely menopause care. Further studies could provide more information including co-morbidities, demographics and patient’s perspective.
Acknowledgements: Dr Jarlath Varley RCSI; Dr Alan Byrne, Scholarstown Family Practice; and Dr Anya Bowers.
Competing interests: The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author received no financial support for the research, authorship, and/or publication of this article.
Reference: Keye C. The effect of an advanced nurse practitioner led menopause clinic on QoL and menopausal symptoms. Women’s Health. 2025;21. doi:10.1177/17455057251324573.
Clinical decision-making in nursing advanced practice: A case study from general practice
Authors: Dr Theresa Lowry Lehnen, Advanced Nurse Practitioner General Practice, South East Technological University; Dr Martin Duignan, Doctor of Nursing, Royal College of Surgeons Ireland; and Barry McBrien, Assistant Professor of General Nursing, School of Nursing and Midwifery, Trinity College Dublin.
Published 9 Apr, 2025, Nursing Practice
Abstract: ANPs practice at a higher level of clinical capability, delivering autonomous and independent care across a range of healthcare settings. Their role involves expert clinical judgment, critical thinking, and evidence-based decision-making to assess, diagnose, and manage complex patient presentations. This study examines their role in clinical decision-making.
This case study highlights the ANP’s role in clinical decision-making, evidence-based practice, ethical care, and antimicrobial stewardship. It demonstrates an understanding and application of clinical decision-making in practice, highlighting the strengths and weaknesses of various models.
The study focuses on the treatment and management of urinary symptoms in a non-pregnant adult female patient attending a general practice nurse-led service, and highlights the complexity of managing patient expectations for antibiotics when they are not clinically indicated.
Combining the analytical and intuitive elements of cognitive continuum theory and applying the metacognitive ‘think and think again’ approach challenged the ANP’s existing model of decision-making resulting in shared and collaborative decision-making.
The case study balances clinical guidelines with patient concerns, considering interpersonal, environmental, and intrapersonal factors in decision-making; and reflects on challenges, ethics, and contemporary healthcare issues, particularly in relation to antimicrobial stewardship.
Ethical considerations: Antibiotic stewardship. ANPs have a responsibility to prescribe antibiotics appropriately to reduce resistance risk. This involves an understanding of the key criteria for antibiotic selection, pathology, and the therapeutic profile of chosen agents, ensuring treatment is rational, safe, and cost-effective.
Ethical responsibility includes antimicrobial stewardship, as well as clear communication and education for patients when antibiotics are not necessary. This responsibility extends beyond ethics to include practical aspects of patient care and health promotion.
Conclusion: This case study highlights the ANP’s role in clinical decision-making, ethical care, and evidence-based practice. It demonstrates an understanding and the application of clinical decision-making, evaluating the strengths and weaknesses of various models.
Integrating cognitive continuum theory and the ‘think and think again’ approach challenged the ANP’s existing model of decision-making and resulted in shared and collaborative decision-making.
The ANP balanced clinical guidelines with patient concerns, considering interpersonal, environmental, and intrapersonal factors in decision-making. This approach also required critical reflection on multifaceted challenges, ethical considerations, and contemporary healthcare issues particularly in relation to patient concerns and antibiotic stewardship.
The effective management of antibiotic prescribing requires a nuanced approach that balances clinical evidence with patient-centred care. ANPs are stakeholders in addressing the global challenge of antibiotic resistance through ethical decision-making, antimicrobial stewardship, and informed communication.
The case study exemplifies the integration of evidence-based practice, critical thinking, and collaborative decision-making to achieve optimal patient outcomes while promoting responsible antibiotic use.
Future research opportunities for ANPs could focus on strategies to address patient expectations for antibiotics in cases where they are unnecessary. This may include exploring the effectiveness of communication frameworks, shared decision-making approaches, and behavioural interventions to reduce inappropriate antibiotic prescribing, while concomitantly addressing the psychological and cultural factors that influence patient demand and ANP prescribing behaviours.
Competing interests: The authors declare no conflicts of interest.
Ethical approval: All procedures were performed in compliance with relevant laws and institutional guidelines and the appropriate institutional committee has approved them.
Funding: The authors received no financial support for the research, authorship, and/or publication of this case study/article.
Reference: Lehnen TL, Duignan M, McBrien B. Clinical decision-making in nursing advanced practice: A case study from general practice. Practice Nursing. 2025 Apr 2;36(4):128-38.
The full case study can be accessed on the IAANMP website at: https://iaanmp.com/clinical-decision-making-in-nursing-advanced-practice-a-case-study-from-general-practice-published-in-practice-nurse-uk-09-04-2024-authors-dr-theresa-lowry-lehnen-dr-martin-duignan-assist/
Assessing the landscape of quality care nursing metrics in general practice settings: A scoping review
Authors: Orla Loftus Moran, PhD Candidate University College Dublin, RANP General Practice; and Prof Mary Casey, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin
First published: 29 April, 2025, Wiley on-line Library.
Aim: To synthesise current evidence on the development and implementation of quality care metrics for nurses working in general practice.
Design: A scoping review guided by Arksey and O’Malley’s framework and the preferred reporting items for systematic reviews and meta-analysis for scoping reviews (PRISMA-ScR).
Method: Articles included peer-reviewed primary research, published in English between 1989 and 2024, reporting on the development, implementation, and evaluation of quality care nursing metrics in general practice settings.
EndNote was used for citation management, while Covidence facilitated screening and data extraction by four reviewers. The Donabedian model of quality care assessment (2005) and the WHO tool for primary care nurse competencies (2020) were used to synthesise the findings.
Data sources: A systematic search of PubMed, CINAHL, EMBASE, and Web of Science databases was conducted between June 2022 and June 2024. The search strategy was developed using ‘Population, Concept, and Context’ criteria, with keywords including ‘nurse’, ‘general practice’, ‘metric’, and ‘indicator’.
Results: Eleven studies conducted between 2005 and 2024 met the inclusion criteria. Five studies focused on quality care indicators or measures and six examined nurse competencies or standards of care.
Conclusion: Quality care metrics are underutilised in general practice. There is ambiguity in metric terminology and nursing roles, education, and primary care systems. Quality care metrics must align with nursing values, with digital technology, and leadership as core enablers.
Implications for the profession and/or patient care: Adoption of nursing metrics in general practice provides insights into nursing contributions to patient care. Standardising the definitions of nursing care metrics will enable valid and reliable comparisons.
Impact: Quality care nursing metrics will enable the nurse’s role to be manifested in general practice settings in relation to patient outcomes.
Reporting method: PRISMA reporting guidelines have been adhered to.
What does this paper contribute to the wider global clinical community? Understanding of the role of the nurse in general practice will support improved quality, safety, policy, and governance in general practice settings.
Patient or public contribution: No patient or public contribution.
Conflicts of interest: The authors declare no conflicts of interest.
Funding: This research was supported by the Judith Chavasse Scholarship from University College Dublin.
Reference: Loftus Moran O, Casey M. Assessing the landscape of quality care nursing metrics in general practice settings: A scoping review. J Adv Nurs. Published online April 29, 2025.
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