Practicing on the verge: Nurse practitioner capability development in the care of individuals with opioid use disorder
Bibliographic record
Abstract
Nurse practitioner treatment of opioid use disorder in North America has been made possible by changes to prescriptive authority over the past decade and necessitated by the ongoing opioid overdose and poisoning epidemic. As advanced practice nurses, nurse practitioners have traditionally been evaluated using competency-based models. While competency-based education delineates measurable activities and skills, capability has the potential to describe advanced practice nursing within complex clinical settings, especially because the term is inclusive of variation in practice environment. For this thesis I aimed to clarify how capability is described in the global literature about advanced practice nursing and education (Phase 1), and to explore how nurse practitioners experienced capability development in the context of treatment of opioid use disorder (including safe supply) in primary care settings (Phase 2). I conducted a scoping review using the JBI methodology, followed by a phenomenographic study with a purposive sample of 21 nurse practitioners treating opioid use disorder in Canada and the United States. Finally, I synthesized findings from the phenomenographic study in the context of the scoping review results (Phase 3). Nurse practitioners experienced capability development as a process of knowledge acquisition, knowledge integration, evolving practice perspectives, practice adaption, and becoming expert. Although capability is described variously, there was congruence between what is written in the literature and results of the phenomenographic study, including the ability of nurse practitioners to critically evaluate clinical scenarios, identify knowledge gaps, and provide creative leadership to address care needs. Understanding capability in the context of opioid use disorder treatment has the potential to provide greater self-understanding for nurse practitioners and a clearer framework for articulating nurse practitioner contributions to the opioid overdose crisis to regulators, policy makers, and the public.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.019 | 0.043 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.006 | 0.007 |
| Scholarly communication | 0.008 | 0.008 |
| Open science | 0.001 | 0.010 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".