Abstract：
OBJECTIVE: To develop a framework to guide the successful integration of nurse practitioners (NPs) into practice settings and, working from a social justice lens, deliver comprehensive primary healthcare which advances health equity.
METHODS: Integrative review.
METHODS: The integrative review was informed by the Whittemore and Knafl\'s framework and followed the Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines. Quality was assessed using the Johns Hopkins Research Evidence Appraisal Tool. Findings were extracted and thematically analysed using NVivo. A social justice lens informed all phases.
METHODS: Databases, including CINAHL, PubMed, Scopus and Web of Science, were searched for peer-reviewed literature published in English between 2005 and April 2022.
RESULTS: Twenty-eight articles were included. Six themes were identified at the individual (micro), local health provider (meso), and national systems and structures (macro) levels of the health sector: (1) autonomy and agency; (2) awareness and visibility; (3) shared vision; (4) leadership; (5) funding and infrastructure; and (6) intentional support and self-care. The evidence-based framework is explicitly focused on the components required to successfully integrate NPs into primary healthcare to advance health equity.
CONCLUSIONS: Integrating NPs into primary healthcare is complex and requires a multilevel approach at macro, meso and micro levels. NPs offer the potential to transform primary healthcare delivery to meet the health needs of local communities. Health workforce and integration policies and strategies are essential if the contribution of NPs is to be realized. The proposed framework offers an opportunity for further research to inform NP integration.
UNASSIGNED: Nurse practitioners (NPs) offer the potential to transform primary healthcare services to meet local community health needs and advance health equity. Globally, there is a lack of guidance and health policy to support the integration of the NP workforce. The developed framework provides guidance to successfully integrate NPs to deliver comprehensive primary healthcare grounded in social justice. Integrating NPs into PHC is complex and requires a multilevel approach at macro, meso and micro levels. The framework offers an opportunity for further research to inform NP integration, education and policy.
CONCLUSIONS: What problem did the study address: The challenges of integrating nurse practitioners (NPs) into primary healthcare (PHC) are internationally recognized. Attempts to establish NP roles in New Zealand have been ad hoc with limited research, evidence-informed frameworks or policy to guide integration initiatives. Our review builds on existing international literature to understand how NPs are successfully integrated into PHC to advance health equity and provide a guiding framework. What were the main findings: Six themes were identified across individual (micro), local health provider (meso) and national systems and structures (macro) levels as fundamental to NP integration: autonomy and agency; awareness and visibility of the NP and their role; a shared vision for the direction of primary healthcare utilizing NP scope of practice; leadership in all spaces; necessary funding and infrastructure; and intentional support and self-care. Where and on whom will the research have an impact: Given extant health workforce challenges together with persisting health inequities, NPs provide a solution to delivering comprehensive primary healthcare from a social justice lens to promote healthcare access and health equity. The proposed evidence-informed framework provides guidance for successful integration across the health sector, training providers, as well as the NP profession, and is a platform for future research.
UNASSIGNED: This integrative review adhered to the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) method.
UNASSIGNED: No patient or public contribution.
METHODS: Integrative review.
METHODS: The integrative review was informed by the Whittemore and Knafl\'s framework and followed the Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines. Quality was assessed using the Johns Hopkins Research Evidence Appraisal Tool. Findings were extracted and thematically analysed using NVivo. A social justice lens informed all phases.
METHODS: Databases, including CINAHL, PubMed, Scopus and Web of Science, were searched for peer-reviewed literature published in English between 2005 and April 2022.
RESULTS: Twenty-eight articles were included. Six themes were identified at the individual (micro), local health provider (meso), and national systems and structures (macro) levels of the health sector: (1) autonomy and agency; (2) awareness and visibility; (3) shared vision; (4) leadership; (5) funding and infrastructure; and (6) intentional support and self-care. The evidence-based framework is explicitly focused on the components required to successfully integrate NPs into primary healthcare to advance health equity.
CONCLUSIONS: Integrating NPs into primary healthcare is complex and requires a multilevel approach at macro, meso and micro levels. NPs offer the potential to transform primary healthcare delivery to meet the health needs of local communities. Health workforce and integration policies and strategies are essential if the contribution of NPs is to be realized. The proposed framework offers an opportunity for further research to inform NP integration.
UNASSIGNED: Nurse practitioners (NPs) offer the potential to transform primary healthcare services to meet local community health needs and advance health equity. Globally, there is a lack of guidance and health policy to support the integration of the NP workforce. The developed framework provides guidance to successfully integrate NPs to deliver comprehensive primary healthcare grounded in social justice. Integrating NPs into PHC is complex and requires a multilevel approach at macro, meso and micro levels. The framework offers an opportunity for further research to inform NP integration, education and policy.
CONCLUSIONS: What problem did the study address: The challenges of integrating nurse practitioners (NPs) into primary healthcare (PHC) are internationally recognized. Attempts to establish NP roles in New Zealand have been ad hoc with limited research, evidence-informed frameworks or policy to guide integration initiatives. Our review builds on existing international literature to understand how NPs are successfully integrated into PHC to advance health equity and provide a guiding framework. What were the main findings: Six themes were identified across individual (micro), local health provider (meso) and national systems and structures (macro) levels as fundamental to NP integration: autonomy and agency; awareness and visibility of the NP and their role; a shared vision for the direction of primary healthcare utilizing NP scope of practice; leadership in all spaces; necessary funding and infrastructure; and intentional support and self-care. Where and on whom will the research have an impact: Given extant health workforce challenges together with persisting health inequities, NPs provide a solution to delivering comprehensive primary healthcare from a social justice lens to promote healthcare access and health equity. The proposed evidence-informed framework provides guidance for successful integration across the health sector, training providers, as well as the NP profession, and is a platform for future research.
UNASSIGNED: This integrative review adhered to the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) method.
UNASSIGNED: No patient or public contribution.
摘要：
目的：制定一个框架，指导护士执业人员（NPs）成功融入实践环境，从社会正义的角度工作，提供全面的初级医疗保健，促进健康公平。
方法：综合综述。
方法：综合审查以Whittemore和Knafl的框架为依据，并遵循系统审查和荟萃分析指南的首选报告。使用约翰霍普金斯大学研究证据评估工具评估质量。提取结果并使用NVivo进行主题分析。社会正义的镜头告知了所有阶段。
方法：数据库，包括CINAHL，PubMed,Scopus和WebofScience,检索了2005年至2022年4月之间以英文发表的同行评审文献。
结果：共28篇。在个人(微观)确定了六个主题，当地卫生提供者(中观)，（1）自主性和机构；（2）认识和知名度；（3）共同愿景；（4）领导；（5）资金和基础设施；（6）有意支持和自我照顾。基于证据的框架明确关注成功将NPs整合到初级医疗保健中以促进健康公平所需的组件。
结论：将NPs整合到初级医疗保健中是复杂的，需要在宏观，中观和微观层面。NPs提供了改变初级医疗保健服务以满足当地社区健康需求的潜力。如果要实现NPs的贡献，卫生人力和融合政策和战略至关重要。拟议的框架为进一步研究提供了机会，以告知NP集成。
执业护士（NPs）提供了改变初级卫生保健服务的潜力，以满足当地社区的卫生需求和促进卫生公平。全球范围内,缺乏指导和卫生政策来支持NP劳动力的整合。开发的框架为成功整合NPs提供指导，以提供基于社会正义的全面初级医疗保健。将NP整合到PHC中是复杂的，需要宏观的多层次方法，中观和微观层面。该框架为进一步研究提供了一个机会，为NP整合提供信息，教育和政策。
结论：研究解决了什么问题：将执业护士（NPs）纳入初级卫生保健（PHC）的挑战是国际公认的。在新西兰建立NP角色的尝试是有限的研究，以证据为依据的框架或政策，以指导整合计划。我们的审查建立在现有国际文献的基础上，以了解NPs如何成功整合到PHC中，以促进健康公平并提供指导框架。主要发现是什么：六个主题是跨个人(微观)确定的，地方卫生提供者（中观）和国家系统和结构（宏观）水平是NP整合的基础：自治和代理；NP及其作用的认识和可见性；利用NP实践范围对初级卫生保健方向的共同愿景；所有空间的领导；必要的资金和基础设施；以及有意的支持和自我保健。研究将在何处以及对谁产生影响：鉴于现有的卫生人力挑战以及持续的卫生不平等，NPs提供了一个解决方案，从社会正义的角度提供全面的初级医疗保健，以促进医疗保健服务和健康公平。拟议的循证框架为整个卫生部门的成功整合提供了指导，培训提供者,以及NP专业，是未来研究的平台。
■此综合审查遵循系统审查和荟萃分析（PRISMA）方法的首选报告。
■没有患者或公众捐款。
方法：综合综述。
方法：综合审查以Whittemore和Knafl的框架为依据，并遵循系统审查和荟萃分析指南的首选报告。使用约翰霍普金斯大学研究证据评估工具评估质量。提取结果并使用NVivo进行主题分析。社会正义的镜头告知了所有阶段。
方法：数据库，包括CINAHL，PubMed,Scopus和WebofScience,检索了2005年至2022年4月之间以英文发表的同行评审文献。
结果：共28篇。在个人(微观)确定了六个主题，当地卫生提供者(中观)，（1）自主性和机构；（2）认识和知名度；（3）共同愿景；（4）领导；（5）资金和基础设施；（6）有意支持和自我照顾。基于证据的框架明确关注成功将NPs整合到初级医疗保健中以促进健康公平所需的组件。
结论：将NPs整合到初级医疗保健中是复杂的，需要在宏观，中观和微观层面。NPs提供了改变初级医疗保健服务以满足当地社区健康需求的潜力。如果要实现NPs的贡献，卫生人力和融合政策和战略至关重要。拟议的框架为进一步研究提供了机会，以告知NP集成。
执业护士（NPs）提供了改变初级卫生保健服务的潜力，以满足当地社区的卫生需求和促进卫生公平。全球范围内,缺乏指导和卫生政策来支持NP劳动力的整合。开发的框架为成功整合NPs提供指导，以提供基于社会正义的全面初级医疗保健。将NP整合到PHC中是复杂的，需要宏观的多层次方法，中观和微观层面。该框架为进一步研究提供了一个机会，为NP整合提供信息，教育和政策。
结论：研究解决了什么问题：将执业护士（NPs）纳入初级卫生保健（PHC）的挑战是国际公认的。在新西兰建立NP角色的尝试是有限的研究，以证据为依据的框架或政策，以指导整合计划。我们的审查建立在现有国际文献的基础上，以了解NPs如何成功整合到PHC中，以促进健康公平并提供指导框架。主要发现是什么：六个主题是跨个人(微观)确定的，地方卫生提供者（中观）和国家系统和结构（宏观）水平是NP整合的基础：自治和代理；NP及其作用的认识和可见性；利用NP实践范围对初级卫生保健方向的共同愿景；所有空间的领导；必要的资金和基础设施；以及有意的支持和自我保健。研究将在何处以及对谁产生影响：鉴于现有的卫生人力挑战以及持续的卫生不平等，NPs提供了一个解决方案，从社会正义的角度提供全面的初级医疗保健，以促进医疗保健服务和健康公平。拟议的循证框架为整个卫生部门的成功整合提供了指导，培训提供者,以及NP专业，是未来研究的平台。
■此综合审查遵循系统审查和荟萃分析（PRISMA）方法的首选报告。
■没有患者或公众捐款。
