Framework for Evaluating the Impact of Advanced Practice Nursing Roles

Advanced Nursing Roles for People With Cognitive Impairment and Their Relatives in Acute Care Hospitals: A Systematic Review

AIM

To systematically review advanced nursing roles in caring for people with cognitive impairment and their relatives in acute care hospitals, focusing on describing roles and intervention components.

DESIGN

Systematic review.

METHODS

We included qualitative and quantitative studies on nurses in advanced roles caring for people with diagnosed or suspected cognitive impairment and their relatives, assessing outcomes at patient, staff and organisational levels. Nurses' advanced role profiles ranged from nurse-led interventions up to Advanced Practice Nurses. We employed the Mixed Methods Appraisal Tool for critical appraisal and conducted a synthesis without meta-analysis using a content analysis approach.

DATA SOURCES

MEDLINE, CINAHL, Cochrane Library, ALOIS, Web of Science and LIVIVO up to May 2024, along with forward and backward citation tracking.

RESULTS

We included 48 studies that described 39 distinct interventions. The majority of these studies employed a quasi-experimental design. Most interventions involved Advanced Practice Nurses (n = 23) and focused on people at risk of or experiencing delirium (n = 22). Nurses in advanced roles predominantly engaged in tasks related to direct clinical practice, as well as coaching and guidance for patients, relatives and colleagues. Their responsibilities also included leadership, collaboration and consultation on a regular basis. Activities related to research and ethical decision-making were infrequently reported.

CONCLUSION

Many areas of responsibility of nurses in advanced roles align with the needs of hospitalised people with cognitive impairment. Nurses in advanced roles increasingly take on diverse activities across all competence domains of Advanced Practice Nursing, with a focus on coaching and guidance, as well as clinical practice, while leadership, collaboration, research and ethical decision-making become more prominent as their formal training advances.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Our comprehensive description of advanced nursing roles in the care of people with cognitive impairment provides a foundation for developing and refining such roles in hospitals.

REPORTING METHOD

We followed the PRISMA guideline and SWiM guideline for reporting.

PATIENT OR PUBLIC CONTRIBUTION

This study did not include patient or public involvement in its design, conduct or reporting.

TRIAL REGISTRATION

Prospero number: CRD42021265157.

Co-Designing Nurse Practitioner Roles in a Tertiary Hospital: A Qualitative Exploration of Patterns and Underlying Dynamics

AIMS

To explore patterns and dynamics during the co-design process of nurse practitioners' role development in three departments in a Belgian tertiary hospital.

DESIGN

Participatory action research was utilised in conjunction with principles of a Grounded Theory approach to explore patterns and dynamics.

METHODS

Sixteen meetings were conducted between January and June 2021 with interdisciplinary teams to develop the roles. Thirteen exploratory interviews were held with the stakeholders involved between March and June 2022. All meetings and interviews were recorded and transcribed verbatim. Data were systematically analysed using researcher triangulation and thematic analysis.

RESULTS

Stakeholders' initial conception of the nurse practitioner roles affected development. A dynamic interplay of individual, team-related and contextual (e.g., financial and legal) factors shaped these conceptions. Through co-design, stakeholders' conception evolved as insights were shared, misconceptions challenged and perspectives broadened. Physicians generally the developmental process, while nursing leadership was more fragmented.

CONCLUSION

This study identifies patterns and dynamics in interdisciplinary teams during the developmental process. The key findings underpin the crucial role of stakeholders' conceptions, use of co-design and leadership in this process. Therefore, a thorough understanding of initial conceptions is ess, and efforts should be directed towards providing sufficient knowledge and experience to prevent misconceptions. Additionally, this study emphasises the significance of a balanced team composition that incorporates diverse conceptions of the role. Finally, actions should be taken to empower leadership among nurses.

IMPACT

Identified dynamics offer insights for healthcare organisations developing nurse practitioner roles. Educational institutions can use these insights to enhance healthcare professionals' curricula, preparing healthcare professionals for evolving advanced nursing roles and leadership. Additionally, it emphasises the necessity for policy work to establish a legal framework for nurse practitioners in Belgium.

REPORTING METHOD

The 'Standards for Reporting Qualitative Research' were used for reporting.

PATIENT OR PUBLIC CONTRIBUTION

This study did not involve direct participation from patients or the public.

The psychiatric mental health nurse practitioner in the general practice: a realist evaluation multiple case study

BACKGROUND

Mental health problems are highly prevalent worldwide and the mental health system faces significant gaps in treatment coverage due to stigma, professional shortages and accessibility issues. In the Netherlands, patients first visit their general practitioner (GP) for mental health problems, with an increasing number of people seeking mental health counselling and treatment in general practice. Dutch general practices have been experimenting with deploying psychiatric mental health nurse practitioners (PMHNP) to enhance mental healthcare accessibility. How to best deploy this profession in the general practice team and everyday care, is yet unknown.

OBJECTIVE

This study aims to understand how deployment of the PMHNP in the general practice works and how it contributes to the accessibility and quality of mental primary healthcare and job satisfaction of professionals in the general practice.

METHODS

This multiple case study used principles of realist evaluation methodology for data collection and analysis focusing on context, mechanism and outcome (CMO). Seven general practices employing a PMHNP, were included. Data was collected through observations, interviews and group discussions with professionals working in the general practice and patients treated by the PMHNP. Cross-case analysis involved work sessions with professionals of these seven cases.

RESULTS

This study identified three mechanisms that provide insight into how deploying PMHNP contributes to improved experienced accessibility and quality of mental health care, enhances job satisfaction and reduces workload especially for the GP: (1) motivation and investment; (2) familiarity and trust; and (3) equivalence and autonomy. These mechanisms were triggered in a context with the presence of (1) a vision on mental health care in general practice, (2) physical attendance of the PMHNP, (3) a patient population suited to the expertise of the PMHNP, and (4) financial possibilities.

CONCLUSION

Participants in this study believe a transition in general practices is necessary to provide sustainable, lowtreshold mental healthcare in primary care setting. They see the PMHNP as the professional to fill this gap. To optimally deploy the PMHNP and ensure accessible, high-quality mental healthcare, the mechanisms of (1) motivation and investment, (2) familiarity and trust, and (3) equivalence and autonomy should be activated.

Barriers to early career development for Chinese nurses with master's degrees: A qualitative study

AIM

This study examined barriers to career development planning from the perspective of nurses with master's degrees in China.

BACKGROUND

The quality of nursing personnel is closely related to clinical nursing quality and patient satisfaction. Assisting highly educated nurses in career planning is crucial for reducing dropout rates. However, no domestic and international research has been done on the barriers to career development faced by highly educated nurses. Investigating these barriers can provide a foundation for developing targeted clinical nursing education and practice strategies.

DESIGN

Descriptive qualitative design.

METHOD

Data were collected through semi-structured interviews and analyzed using qualitative content analysis. Following the COREQ guidelines.

RESULTS

Seventeen nurses (two men and 15 women; age range: 26-29), reaching data saturation. Data analysis revealed eight subcategories in three categories: (1) transition shock, including the gap between nursing education and clinical practice, discrepancy between career growth expectations and clinical training system, and perceived professional crisis; (2) contextual elements, including external higher expectations, influence of leadership style, and limitations of the nursing standardized training system; and (3) lack of necessary support, including limitations of vocational development training programs in hospitals and schools and support requirements for the work environment.

CONCLUSION

The findings offer insights useful for nursing education experts and institutions and clinical nursing departments (especially their managers). Specifically, by clarifying the barriers faced by highly educated nurses in career development planning, the findings can inform the development of training systems and practices for enhancing highly educated nurses' career satisfaction and professional identity.

Implementing the Clinical Nurse Specialist Role in Hospital Settings: A Scoping Review

PURPOSE/AIMS

To understand, based on the literature, how to implement the role of a clinical nurse specialist (CNS) in the hospital setting.

DESIGN

A scoping review was conducted following the methodological framework of Arksey and O'Malley and the Joanna Briggs Institute.

METHOD

The search was conducted during March and April 2023 and was updated in November 2023. Electronic searches were conducted in the following major databases: PubMed, CINAHL, Web of Science, Scopus, PsycINFO, and Cochrane Library. Additionally, a "snowballing" strategy was used. A critical reading was conducted using the Joanna Briggs Institute methodological quality criteria. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for the Scoping Review guidelines were used.

RESULTS

Eleven relevant studies were included in this review. The primary results are presented in 4 sections related to the framework, process, components, and evaluation of the implementation of the CNS role. The findings of the reviewed studies suggest that the implementation process of the CNS is cyclical, variable, context-dependent, and multifactorial and can be assessed using the indicators of structure, process, and outcome.

CONCLUSIONS

This scoping review provides relevant information to support the design of implementation and evaluation strategies for the role of the CNS in the hospital context. Based on the findings of the reviewed studies, a comprehensive strategy is suggested for implementing the role of the CNS in a hospital setting.

How can educational institutes in Switzerland prepare physiotherapy students to implement advanced practice roles - a view point paper

This viewpoint paper focuses on challenges for Swiss physiotherapy education institutes related to the transition towards evidence-based practice and the incorporation of advanced roles within the profession. To tackle such challenges, it is essential to establish structured pathways and competency frameworks and position physiotherapists as integral contributors to innovative healthcare.

Evaluation of a Model of Transitional Care After Preterm Birth on Parents' Mental Health and Self-Efficacy: A Randomized Controlled Pilot Trial

BACKGROUND/OBJECTIVES

Parents of premature infants experience depression, anxiety, post-traumatic stress disorder, and increased stress, which can negatively impact parent-infant relationships and infant development. To reduce negative consequences and optimally support families, we developed the Transition to Home model (TtH). In this randomized controlled pilot trial (RCT), the feasibility of performing an experimental study to analyse the effects of TtH on parental mental health over time was evaluated.

METHODS

The following domains were assessed: recruitment, follow-up and study burden, outcome measures used and parental mental health outcomes. We included n = 22 parent couples with their preterm infants in the control group and n = 23 in the intervention group. Depression, anxiety and post-traumatic stress disorders, parenting stress, and parental self-efficacy were assessed at five timepoints. The study burden was evaluated once at the end of the study.

RESULTS

The control and intervention groups had similar socio-demographic characteristics. The groups showed no differences in the mental health outcomes except for depression in mothers at T2 (p = 0.042) and T5 (p = 0.027) and state anxiety in fathers at T2 (p = 0.016).

CONCLUSIONS

This pilot RCT established a framework for the evaluation of the TtH model of care and demonstrated the viability of the evaluation scheme. The results confirm the suitability of the RCT's structure and the feasibility of the methods and instruments used. Minor adjustments are recommended to include a more diverse sample in future studies.

Nursing practice and advanced practice nurses in contrast media safety management

In diagnostic imaging departments, there has been a technological evolution in recent years. Progress made in interventional processes and the development of new treatments, as well as an increase in the number of diagnostic and therapeutic tests, has generated a growing and exponential need for specific care. Furthermore, the people who come to these departments are often in a vulnerable state and out of their comfort zone. The implementation of advanced practice nursing (APN) in the context of metabolic therapies and diagnostic imaging provides expert care with a holistic approach to patient care. It uses the nursing care process as a working method which, through research, logical analysis and critical reasoning, enables nursing care to be developed and applied. This approach contributes to safety management in the different processes in which it is engaged. The aim of this article is to highlight the interventions in which nursing practice can contribute to contrast media safety management in a diagnostic imaging department.

Essential core competencies for health policy graduates: a multi-method consensus type study

BACKGROUND

In light of the multi-faceted challenges confronting health systems worldwide and the imperative to advance towards development goals, the contribution of health policy graduates is of paramount importance, facilitating the attainment of health and well-being objectives. This paper delineates a set of core skills and competencies that are requisite for health policy graduates, with the objective of preparing these graduates for a spectrum of future roles, including both academic and non-academic positions.

METHODS

The study was conducted in three phases: a scoping review, qualitative interviews and the validation of identified competencies through brainstorming with experts. In the initial phase, a scoping review was conducted on the databases. The following databases were searched: PubMed, Scopus, Web of Science and Google Scholar search engine. Additionally, the WebPages of universities offering health policy programmes were manually searched. In the second phase, 36 semi-structured interviews were conducted with students, graduates and distinguished academics from Iran and other countries. These interviews were conducted in person or via email. In the third phase, the draft version of the competencies and their associated learning objectives, derived from the preceding stages, was subjected to independent review by an expert panel and subsequently discussed. In light of the expert panel's findings, the authors undertook a subsequent revision of the list, leading to the finalization of the core competencies through a process of consensus.

RESULTS

In the scoping review phase, the analysis included six studies and nine university curricula. The results of the scoping review could be classified into five domains: health system understanding, health policy research, knowledge translation, multidisciplinary work and knowledge of public health. In the second phase, six core competencies were extracted from the interviews and combined with the results of the first phase, which were then discussed by the expert panel at the third phase. The final five core competencies, derived from the brainstorming session and presented in no particular order, encompass health policy research, policy analysis, educational competencies, decision-making and multidisciplinary work.

CONCLUSIONS

It is essential that the curriculum is appropriate and contextually tailored, as this is crucial to foster multi-dimensional competencies that complement the specific disciplines of future health policy scholars. These scholars must possess the ability to genuinely serve their health systems towards achieving health-system goals and sustainable development.

Setting new priorities for nursing research: The updated Swiss Nursing Research Agenda-a systematic, participative approach

AIM

To identify current key areas for nursing research in Switzerland, we revised the Swiss Research Agenda for Nursing (SRAN) initially published in 2008.

BACKGROUND

By developing a research agenda, nursing researchers internationally prioritize and cluster relevant topics within the research community. The process should be collaborative and systematic to provide credible information for decisionmakers in health care research, policy, and practice.

SOURCES OF EVIDENCE

After a participative, systematic, and critical evaluation within and outside of the Swiss Association for Nursing Science, the updated SRAN 2019-2029 defines four research priorities (new models of care, nursing care interventions, work and care environment, and quality of care and patient safety) and four transversal themes (organization of research, research methodologies, research in health care policy and public health perspectives).

CONCLUSION

Adding to other national nursing research agendas, the categories are organized in a framework of key research priorities and transversal themes. They relate to the importance of global and local foci of research as well as challenges in health care services and policy systems. The agenda is an important prerequisite for enhancing the influence of nursing research in Switzerland and provides guidance for the next decade.

IMPLICATIONS FOR NURSING PRACTICE

The revised agenda ensures that research projects target key knowledge gaps and the discipline's core questions in respective countries.

IMPLICATIONS FOR HEALTH POLICY

Nursing research should inform and influence health policy on all institutional and political levels. Therefore, the integration of public health perspectives in research is one of the most important new aspects of SRAN 2019-2029.

Perception and Experience of Independent Consultations in Primary Healthcare among Registered Nurses in Kazakhstan: A Qualitative Study

(1) Background: The nursing profession has undergone a significant transformation not only in a formal context but also in terms of the increased educational competencies required of nurses and their preparedness to adapt to evolving roles and statuses. The aim of our study was to examine the experience of advanced practice nurses who conduct independent consultations on patients and to identify the main challenges they face in their practice. (2) Methods: We carried out 22 semi-structured interviews with nurses responsible for conducting independent consultations across three urban polyclinics located in Aktobe, Almaty, and Astana. All interviews were audio-recorded, transcribed verbatim, and subjected to qualitative content analysis. (3) Results: The content analysis revealed three main themes: "People awareness of the role of an independent nursing appointment", "Adaptation of the work environment", and "Confidence of nurses to provide independent services". (4) Conclusions: Limited competency among nurses and the absence of quality metrics for autonomous nursing consultations present substantial obstacles to assessing and enhancing the quality of care delivered by nurses in their independent roles. Developing and implementing quality indicators for independent nursing appointment, as well as additional training within the framework of interprofessional continuous education for nurses, are important steps toward enhancing the effectiveness, safety, and accessibility of nursing care.

The development of advanced practice nurses in Singapore

The development of advanced practice nursing has evolved globally over the past decades and has become an important component in the contemporary healthcare system. The term 'advanced practice nurse' is used to refer to nurses practising at a higher level than traditional nurses and is defined as a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice. In 2003, Singapore embarked on the development of advanced practice nurses as an initiative to improve the nursing professional image, retain excellent clinical nurses and fill the gaps in the provision of healthcare services for the ageing population. This paper documents Singapore's journey of advanced practice nursing development and shares our unique learning experience in the aspects of education, certification, registration and scope of practice.

The deployment of advanced practice nurses in the French health system: From clinics to professional networks

AIM

The aim of this study is to contribute to an understanding of the role deployment of advanced practice nurses (APNs) in French healthcare settings.

INTRODUCTION

The introduction of APNs was formalised in France by the decrees issued on 18 July 2018, which described the areas, activities and training of APNs.

BACKGROUND

A qualitative study on the role implementation of APNs was conducted between July 2021 and May 2022 following a call for projects launched by the Île-de-France Regional Health Agency to evaluate the deployment of APNs in the area.

METHODS

Data were collected through field observations and semi-structured interviews in order to explore both the APNs deployment processes in nine healthcare structures and the roles played by APN networks and associations with regard to the deployment of APN activities in their working environments.

RESULTS

The projects proved to be evolutionary, and their development was marked by various forms of APN isolation and multiple obstacles that were specific to their professional practice settings. Some APNs relied on a variety of forms of mutual assistance and advocacy deployed throughout APN networks and associations.

DISCUSSION

The deployment of APNs' role was impacted by diverse configurations of professional power relations and the nature of the obstacles that were structural for APNs in primary care. Their experience of isolation derived from the novelty of their role, the challenge they posed to the cohesion of the nursing profession and a lack of supportive policies for their deployment. Their participation in APN networks and associations enabled them to access advocacy and manage the uncertainties and unknowns related to the deployment of their activities.

CONCLUSION

The results suggest that the formalisation of schemes for mutual assistance among APNs and advocacy should be integrated into the guidelines for the implementation of their role.

IMPLICATIONS FOR NURSING POLICY

APN policy should strengthen a bottom-up approach, relying in particular on the development of different forms of collaboration and communication between APN networks and associations on the one hand and the public authorities on the other.

The Nurse Practitioner Role in Complex Malignant Hematology: A Qualitative Descriptive Study

OBJECTIVES

Internationally, there is limited evidence about the role and impact of nurse practitioners (NPs) in complex malignant hematology (CMH). In one Canadian CMH program, NPs have existed for 20 years but not been evaluated. This study aimed to understand stakeholder perceptions of CMH NP role structures, processes, and outcomes and the extent to which the role meets patient and health service needs.

METHODS

A qualitative descriptive study was conducted, guided by the PEPPA-Plus framework. Purposive sampling was used to recruit stakeholders who participated in focus groups and interviews. Content analysis was used to analyze the data.

RESULTS

Participants included patients (n = 8) and healthcare professionals (n = 27). Themes about structures related to evolution of the CMH Program, model of care, and need for strategic vision. Process themes related to provision of accessible, comprehensive, and holistic care and NP workload. Positive and negative outcomes and lack of outcome measurement were identified.

CONCLUSION

Structures related to patient and NP characteristics, organizational change, staffing, and how NP work is organized impacts on NP role implementation and outcomes. Organizational structures can be strengthened to improve the model of care and NP role implementation and workload. Value-added NP contributions related to providing comprehensive care with attention to safety and social determinants of health. Research is needed to evaluate NP role outcomes in CMH.

IMPLICATIONS FOR NURSING PRACTICE

The results can inform role design and organization policies and strategies to promote the recruitment, retention, and optimization of NP roles in CMH settings. Priorities for future research are also identified.

Advanced Practice Nurses and Their Roles in Swiss Cancer Care: A Cross-Sectional Study

OBJECTIVES

To examine the advanced practice nurse workforce in Swiss cancer care and how their roles are being implemented (eg, role structures, processes) to achieve optimal outcomes for patients and their families, care organizations, and the broader health care system.

METHODS

A cross-sectional study was conducted. The sample included master-prepared advanced practice nurses in cancer care, who completed an online questionnaire from December 2021 to January 2022. Thirty-nine items assessed structures (eg, role characteristics, utilization), processes (eg, role activities, interventions), and perceived outcomes (eg, for patients, the health care system) of advanced practice nurses in Swiss cancer care. Data from closed questions were analyzed using descriptive statistics. Data from open-ended questions were organized and summarized into categories related to domains of advanced practice nursing and its reported frequency by the advanced practice nurses.

RESULTS

The participating advanced practice nurses (n = 53), worked in half of the 26 Swiss cantons. Interventions were identified within nine categories, of which most were targeted to patients and their families (n = 7), followed by health care professionals (n = 2). Perceived positive outcomes were patient symptom management, length of hospital stay, and health care costs. Participants felt less confident in cancer care (eg, autonomous practice) and reported 15 professional development needs (eg, medical interventions, teaching).

CONCLUSIONS

This study provides a comprehensive examination of 53 advanced practice nurses, detailing the characteristics of their roles and utilization across various jurisdictions and health care settings. The results highlight the diverse dimensions of advanced practice nursing and its potential to enhance cancer services and outcomes in Switzerland. Opportunities for role development support and expansion are identified.

IMPLICATIONS FOR NURSING PRACTICE

More systematic health human resource planning is needed to expand the deployment of advanced practice nurses across jurisdictions, practice settings, and more diverse patient populations. Role development needs show the desire for specialized educational preparation in cancer care.

Advanced practice nurse roles in Europe: Implementation challenges, progress and lessons learnt

BACKGROUND

Advanced practice nursing (APN) roles offer improved access to care and increased quality and more timely care. Despite the advantages of APN roles, there is a disparity between European countries when it comes to implementing APN roles.

AIM

To explore the implementation of APN roles in a range of European countries and to explore what factors facilitate or hinder the implementation of these roles.

METHODS

A case study evaluation of the process of implementing APN roles. The sample included four countries where APN roles were well developed (Ireland, Spain, Norway and the United Kingdom) and four where APN roles were implemented (Estonia, Slovenia, Cyprus and Romania). Interviews were conducted with key informants (n = 28) from government departments, regulatory bodies, nursing associations and universities. The consolidated criteria for reporting qualitative research (CPREQ) has been used throughout.

LIMITATIONS

The small number of countries when considering the size of the region and key informants representing the view of only three to four people in each country.

RESULTS

Four themes were identified, including the rationale for the development of the roles, influence, the evolutionary nature of role development and evidence. The data also revealed a mismatch between the perceptions of how the roles develop among the different countries in the early stages of implementation.

CONCLUSION

Successful role implementation is dependent upon a tripartite approach between managers, practitioners and educators. An evolutionary approach to role development was used. Regulation and policy come later on in the process of implementation.

IMPLICATIONS FOR NURSING POLICY

APN policy should be based on patient needs rather than on the workforce or professional imperatives. The process of implementation can take 15-20 years in total. Recognising the importance of the relationships between service managers and educators is key to the early development of these roles.

Response and innovations of advanced practice nurses during the COVID-19 pandemic: A scoping review

AIM

Identify and map international evidence regarding innovations led by or involving advanced practice nurses in response to COVID-19.

BACKGROUND

COVID-19 necessitated unprecedented innovation in the organization and delivery of healthcare. Although advanced practice nurses have played a pivotal role during the pandemic, evidence of their contributions to innovations has not been synthesized. Evidence is needed to inform policies, practices, and research about the optimal use of advanced practice nurses.

METHODS

A scoping review was conducted and reported using the PRISMA-ScR checklist. Electronic databases were searched for peer-reviewed articles published between January 2020 and December 2021. Papers were included that focused on innovations emerging in response to COVID-19 and involved advanced practice nurses.

RESULTS

Fifty-one articles were included. Four themes were identified including telehealth, supporting and transforming care, multifaceted approaches, and provider education. Half of the articles used brief and mostly noncomparative approaches to evaluate innovations.

CONCLUSION

This is the first synthesis of international evidence examining the contributions of advanced practice nurses during the pandemic. Advanced practice nurses provided leadership for the innovation needed to rapidly respond to healthcare needs resulting from COVID-19. Innovations challenged legislative restrictions on practice, enabled implementation of telehealth and new models of care, and promoted evidence-informed and patient-centered care.

IMPLICATIONS FOR PRACTICE

Advanced practice nurses led, designed, implemented, and evaluated innovations in response to COVID-19. They facilitated the use of telehealth, supported or transformed models of care, and enabled health providers through education, mentorship, and mental health support.

IMPLICATION FOR POLICY

Advanced practice nurses are a critical resource for innovation and health system improvement. Permanent removal of legislative and regulatory barriers to their full scope of practice is needed.

Exploring Factors Affecting the Rollout of a Policy on Registered Advanced Nurse Practitioners in Ireland

Aim

To identify the barriers and enablers to the implementation of a national policy to increase and develop the advanced nurse practitioner (ANP) workforce in Ireland.

Background

The Department of Health (Ireland) introduced a policy to increase the number of ANPs to 2% of the nursing workforce. Evaluation provides information to inform successful policy implementation and development of ANP roles in healthcare services.

Methods

Qualitative descriptive design. Twenty candidate ANPs participated in four focus groups. Nine key stakeholders were also interviewed.

Results

Analysis identified four barriers: lack of infrastructural resources; delay in releasing and arranging replacements for candidate ANPs; role resistance from administration, allied healthcare professionals and other nurses; and lack of organisational readiness. The five enablers were: supportive physicians; Nursing and Midwifery Practice Development Units; supportive directors of nursing; role awareness and clarity; and educational preparation.

Conclusions

This evaluation identifies barriers and enablers to the implementation of a national policy to increase the critical mass of advanced practitioners within the healthcare services. Evaluation at the implementation phase informed the roll-out of future advanced practice initiatives. Implications for Nursing Management. To support advanced practice development, leadership, infrastructure, and resource planning are needed to harness known enablers and address identified barriers to the implementation and sustainability of these posts.

Wound management provided by advanced practice nurses: a scoping review

OBJECTIVE

The objective of the review was to map the similarities and differences in the wound care practices of nurse practitioners, clinical nurse specialists, and advanced practice registered nurses, globally.

INTRODUCTION

Advanced practice nurses have graduate education and advanced scope of practice. Adding advanced wound care training to their skill set provides an opportunity for advanced practice nurses to provide wound care.

INCLUSION CRITERIA

This review considered for inclusion studies of advanced practice nurses globally who are registered nurses with graduate-level education and advanced training (certification/education) in wound care in any setting.

METHODS

The review was conducted using JBI methodology for scoping reviews. The databases searched included MEDLINE, CINAHL, ProQuest Nursing and Allied Health, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus, and ProQuest Dissertations and Theses. To reflect changes in the advanced practice nursing scope of practice, searches were limited to articles published from 2011 onward. Articles in languages other than English were translated. Two reviewers independently reviewed titles and abstracts; relevant sources were retrieved in full and screened for eligibility against the inclusion criteria. An additional independent reviewer resolved any disagreements. Data were extracted using a data extraction tool. Extracted data included similarities and differences in wound care practice (type of wound, practice setting, treatments).

RESULTS

There were 2504 abstracts screened, and 158 articles were screened at full text. Seven articles were included in this review: 3 sources from the United States, 2 from Australia, and 1 each from Canada and The Netherlands. All 7 sources focused on nurse practitioners. Wound care education varied from certification in wound ostomy to a master's education in wounds. The practice setting varied; there were 2 primary care clinics, 2 community clinics, a wound care center; a suburban hospital, and a study that included tertiary, community, and residential care. Treatments varied, but the sources specific to pressure injuries discussed assessments, cleansing, dressings, topical products, and offloading surfaces/equipment. One source examined the impact of hiring nurse practitioners as wound care consultants. Sources that discussed treatments for various wounds described comprehensive assessments, diagnostic investigations, referrals, wound management, and medications prescribed.

CONCLUSIONS

This review outlined the characteristics of advanced practice nurses providing wound care and their practice settings, types of wounds, and treatments provided. Many articles on advanced practice nurses with advanced wound care expertise lack a description of the graduate-level education and/or the specifics regarding wound care certification. This prevents comparison of advanced practice nurses with each other and with other providers regarding the impact that advanced practice nurses have on the health care system in relation to wound care, including cost, access to services, and patient satisfaction.

Practice patterns, role and impact of advanced practice nurses in stroke care: A mixed-methods systematic review

AIM(S)

To undertake a systematic review of the practice patterns and roles of advanced practice nurses (APNs) in inpatient and outpatient stroke-care services; and to evaluate the impact of APN-led inpatient and outpatient stroke-care services on clinical and patient-reported outcomes.

DESIGN

A mixed-methods systematic review.

METHODS

A systematic search was conducted across six electronic databases for primary studies. Data were synthesised using a convergent integrated approach. DATA SOURCES (INCLUDE SEARCH DATES) *FOR REVIEWS ONLY: A systematic search was conducted across PubMed, CINAHL, Cochrane Library, Embase, PsycInfo and ProQuest Dissertations & Theses Global, for primary studies published between the inception of the databases and 3 November 2022.

RESULTS

Findings based on the 18 included primary studies indicate that the APNs' roles have been implemented across the continuum of stroke care, including pre-intervention care, inpatient care and post-discharge care. Practicing at an advanced level, the APNs engaged in clinical, operational and educational undertakings across services and disciplines. Positive clinical and patient-reported outcomes have been attributed to their practice.

CONCLUSION

The review highlights the critical role of APNs in improving stroke care, especially in the pre-intervention phase. Their clinical expertise, patient-centered approach and collaboration can transform stroke care. Integrating APNs into stroke care teams is essential for better management and outcomes in light of the increasing stroke burden.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Healthcare institutions should integrate APNs to enhance pre-intervention stroke care, improve diagnostic accuracy and expedite treatment. APNs can prioritise patient-centric care, including assessments, coordination and education. Medication reconciliation, timely rehabilitation referrals and lifestyle modifications for secondary stroke prevention are crucial. Implementing advanced practice nursing frameworks ensures successful APN integration, leading to improved stroke care and better patient outcomes in response to the growing stroke burden.

IMPACT (ADDRESSING)

What problem did the study address? Poor clarity of the role of advanced practice nurses among patients, physicians, healthcare professionals, health policymakers and nurses. What were the main findings? Advanced practice nurses practise across the continuum of stroke care, mainly in pre-intervention care which takes place before initiating treatment, inpatient care and post-discharge care. The implementation of the advanced practice nurse role in stroke care has contributed positively to clinical and patient-reported outcomes. Where and on whom will the research have an impact? Insights from the review are envisioned to inform healthcare policymakers and leaders in the implementation and evaluation of the APN role in stroke care.

REPORTING METHOD

Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution. TRIAL AND PROTOCOL REGISTRATION: https://figshare.com/ndownloader/files/41606781; Registered on Open Science Framework osf.io/dav8j.

Evaluation of the implementation of advanced practice nursing roles in France: A multiple case study

AIMS

The aims of the study were to describe the processes used to introduce advanced practice nursing roles and factors that facilitated or hindered role implementation, examine the time advanced practice nurses (APNs) spend in role activities and how these activities relate to domains of advanced practice nursing and examine how implementation processes influenced APN integration within healthcare teams.

DESIGN

A multiple case study was conducted.

METHODS

Five cases were included, representing the four population areas approved for advanced practice nursing in France. Data were collected from January to March 2021 using observation, interview and document analysis methods. Data were examined using thematic analysis.

RESULTS

Participants included APNs (n = 5), nurses/allied health providers (n = 5), physicians (n = 5), managers (n = 4) and decision-makers (n = 4). Stakeholder engagement and leadership provided by decision-makers, managers, physicians and APNs facilitated role implementation. Poor stakeholder role understanding, uncertain role funding, and the COVID-19 pandemic hindered role implementation. APNs spent the most time in clinical activities. Participants perceived the integration of APNs within the healthcare team and their impact on patient care to be positive.

CONCLUSION

Stakeholder engagement and organizational and APN leadership facilitated the implementation of the roles, especially related to team-based patient care. Further efforts are needed to strengthen APN involvement in non-clinical activities and address role barriers.

IMPLICATIONS FOR NURSING AND PATIENT CARE

Systematic and system-wide approaches are needed to improve role clarity, role autonomy and health systems integration of APNs. Research should examine patient perspectives about APNs in France.

IMPACT

The results highlight how policies can create favourable conditions for advanced practice nursing role implementation in France. Internationally, this study serves as a reminder to APNs and nurse leaders about the strategies for and importance of implementation evaluation to support the optimal development of advanced practice nursing roles.

REPORTING METHOD

The study reporting followed the Consolidated Criteria for Reporting Qualitative Research.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Stepping outside national borders: International active learning educational collaboration events

AIM

This paper discusses the benefits of international collaborations for advanced practice nursing education. It identifies new perspectives and innovative practices to enhance cultural competency.

BACKGROUND

Competent, well-trained advanced practice nurses (APNs) are necessary to provide high-quality and safe patient care, improve access to care, and address health disparities that are no longer geographically bound. In 2021, an international network of advanced practice educators established an active learning program to teach students their role in global citizenship and increase awareness of health disparities. APN students from Scotland, Wales, Minnesota, Houston, and Rotterdam participated in presentations, online discussions, and in-country scholarships.

SOURCES OF EVIDENCE

Growing health disparities have created the need for efficient international collaboration to develop new concepts, approaches, and bidirectional exchange of experiences, culture, and knowledge. Integrating global health into curricula engages students' curiosity and integrates education, research, practice, and leadership while improving cultural competency.

DISCUSSION

Forty-two students participated in the international presentations. The students strongly believed in the benefit of international collaboration and the need for a universal role for the advanced practice nurse. They responded positively to sharing cultural and clinical experiences.

CONCLUSION

The recent global health challenge supported the development of innovative methods to deliver education and created an opportunity for advanced practice students to develop cultural competence and critical thinking. Collaborative solutions are essential to education and healthcare as we move forward in the 21st century.

IMPLICATIONS FOR NURSING PRACTICE

Robust international collaborations have enabled the development of cultural competence and critical thinking. These are crucial elements for advanced practice roles.

Early diagnosis of chronic kidney disease in patients with diabetes in France: multidisciplinary expert opinion, prevention value and practical recommendations

Diabetes is the leading cause of end-stage kidney disease (ESKD), accounting for approximately 50% of patients starting dialysis. However, the management of these patients at the stage of chronic kidney disease (CKD) remains poor, with fragmented care pathways among healthcare professionals (HCPs). Diagnosis of CKD and most of its complications is based on laboratory evidence. This article provides an overview of critical laboratory evidence of CKD and their limitations, such as estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (UACR), Kidney Failure Risk Equation (KFRE), and serum potassium. eGFR is estimated using the CKD-EPI 2009 formula, more relevant in Europe, from the calibrated dosage of plasma creatinine. The estimation formula and the diagnostic thresholds have been the subject of recent controversies. Recent guidelines emphasized the combined equation using both creatinine and cystatin for improved estimation of GFR. UACR on a spot urine sample is a simple method that replaces the collection of 24-hour urine. Albuminuria is the preferred test because of increased sensitivity but proteinuria may be appropriate in some settings as an alternative or in addition to albuminuria testing. KFRE is a new tool to estimate the risk of progression to ESKD. This score is now well validated and may improve the nephrology referral strategy. Plasma or serum potassium is an important parameter to monitor in patients with CKD, especially those on renin-angiotensin-aldosterone system (RAAS) inhibitors or diuretics. Pre-analytical conditions are essential to exclude factitious hyperkalemia. The current concept is to correct hyperkalemia using pharmacological approaches, resins or diuretics to be able to maintain RAAS blockers at the recommended dose and discontinue them at last resort. This paper also suggests expert recommendations to optimize the healthcare pathway and the roles and interactions of the HCPs involved in managing CKD in patients with diabetes.

Current status of and future perspectives on care for cancer survivors in China

Cancer is currently a major public health issue faced by countries around the world. With the progress of medical science and technology, the survival rate of cancer patients has increased significantly and the survival time has been effectively prolonged. How to provide quality and efficient care for the increasingly large group of cancer survivors with limited medical resources will be a key concern in the field of global public health in the future. Compared to developed countries, China's theoretical research and practical experience in care for cancer survivors are relatively limited and cannot meet the multi-faceted and diverse care needs of cancer patients. Based on the existing models of care worldwide, the current work reviews care for cancer survivors in China, it proposes considerations and suggestions for the creation of models of cancer care with Chinese characteristics in terms of optimizing top-level system design, enhancing institutional mechanisms, accelerating human resource development, and enhancing self-management and social support for patients.

The first positive evidence that training improves triage decisions in Greece: evidence from emergency nurses at an Academic Tertiary Care Emergency Department

BACKGROUND

Triage refers to the process of patient prioritisation in the emergency department (ED). This is based on the severity of the patient's illness and is performed by emergency nurses (ENs). This has a pivotal role in ensuring patient safety and in ensuring that the ED operates smoothly - so continuous and accurate training are essential. As Emergency Nursing has been formally established in Greece since 2019, it is of the uppermost importance that all Greek ENs should be trained in the use of a standardised triage system. The present study aimed to evaluate the effect of triage training of ENs in the use of the Swiss Triage System (STS) after an intervention of one week.

METHODS

The effect of triage training was studied experimentally by comparing performance before and one week after training. A sample of thirty-six ENs from the University Department of Emergency Medicine at AHEPA University Hospital took part. The role of training in triage by the STS was assessed by completing the same self-administered questionnaire before and after a 45-minute e-learning program (presentation video of STS but with simulation scenarios) which was available during the period of a week. The post-training test was taken 2 weeks later, after the training process.

RESULTS

The most promising finding was that there was a significant improvement in the number of correct answers after the training in triage (p<0.001). A significant improvement was also detected (p<0.001) in the questions that tested vigilance in providing safe health services by ENs, whereas there was no significant association between the number of correct answers and years of emergency experience or level of education, - either before or after the intervention.

CONCLUSIONS

Triage training seems to successfully improve effective and efficient triage. To the best of our knowledge, this is the first study that has demonstrated that triage training has a significant positive impact on triage performance by ENs in Greece. It is planned to support these findings by real time studies in an ED.

Developing a core competency framework for advanced practice nursing in mainland China: a sequential exploratory study

BACKGROUND

Advanced Practice Nursing (APN) have been highly valued and an integral part of the health care system. Development and establishment of new APN roles is a complex process that has resulted from a wide variety of reasons, key component is a lack of a competency map delineation and role evaluation. Currently, however, competence framework has not been compared at an international level. In mainland China, APN have been introduced in some organizations but their competency domains have not yet been clearly defined, this study aimed to identify the core competencies for advanced practice nursing.

METHODS

This study was performed in two phases: first, in-depth and semi-structured individual interviews with 46 participants from key stakeholders were carried out followed by a qualitative content analysis, then an item pool of core competencies was constructed by extracting data from the first phase and the results from previous studies, scales and documents; second, a Delphi technique was conducted with the participation of 28 experts from 7 areas of China to form the final core competency framework for advanced practice nursing.

RESULTS

Through the qualitative phase, the core competency framework with six domains and 70 items emerged and then entered into the Delphi phase. Twenty-eight of 30 experts finished 2 rounds of Delphi approaches. The final core competencies for advanced practice nursing consisted of six domains with 61 items, including direct clinical nursing practice, research and evidence-based nursing practice, professional development, organization and management, mentoring and consultation, and ethical/legal practice.

CONCLUSION

This core competency framework consisted of six domains with 61 items can be used in competency-based education to cultivate advanced practice nurses as well as competency level assessment.

Role development, implementation and evaluation of nurse practitioners in a Belgian university hospital: a mixed methods study protocol

INTRODUCTION

Due to the increased prevalence of chronic conditions, multimorbidity and an increased complexity of care, the burden on healthcare teams is high resulting in unmet needs of patients and their family and a high workload on healthcare professionals. To respond to these challenges, care models integrating nurse practitioners were introduced. Despite the proven benefits, implementation in Belgium is at an early stage. The aim of this study is to develop, implement and evaluate nurse practitioner roles in a Belgian university hospital. Insights into development and implementation processes can inform healthcare managers and policymakers for future (nationwide) implementation.

METHODS AND ANALYSIS

For the development, implementation and (process-)evaluation of nurse practitioner roles in three departments in a Belgian university hospital, a participatory action research approach involving interdisciplinary teams of healthcare professionals, healthcare managers and researchers will be used. To investigate the effectiveness at patient (eg, quality of care), healthcare providers (eg, team effectiveness) and organisational level (eg, utility) a longitudinal (matched controlled) pre-post mixed methods study will be set up. Quantitative data (surveys, data from electronic patient files, administrative files) will be analysed using SPSS V.28.0. Qualitative data will be collected throughout the whole process and will consist of the meetings, (focus group) interviews and field notes. All qualitative data will be analysed thematically both across-case and within-case. This study is designed and will be reported based on the Standard Protocol Items: Recommendations for Interventional Trials 2013 statement.

ETHICS AND DISSEMINATION

Ethical approval for all parts of this study was obtained from the Ethics Committee of the participating university hospital (February-August 2021). All participants throughout the study parts will receive written and verbal information and will be asked written consent. All data will be stored on a secured server. Only the primary researchers will have access to the data set.

TRIAL REGISTRATION NUMBER

NCT05520203.

[The contribution of advanced practice nurses in Swiss family practices: Multiple case study design]

The contribution of advanced practice nurses in Swiss family practices: Multiple case study design Abstract. Background: The increase in chronic diseases, multimorbidity and shortage of health professionals make it essential to adapt primary health care. New models of care are needed which are oriented towards patient needs and thus ensure comprehensive care for chronically ill people. In this context, there is great potential for the use of advanced practice nurses in Swiss family practices. Aims: In this study we investigated the contribution of advanced practice nurses in the interprofessional context in two family practices. Methods: We conducted a multiple case study design. We investigated two advanced practice nurses, located in family practices in rural and in mountainous regions. We used qualitative and quantitative methods. As an intermediate step, within-case analyses were performed and we summarized data inductively to create case vignettes. Results: The cases showed that advanced practice nurses contribute to self-management, prevention and health promotion in complex, stable and unstable patients. These areas have not been covered adequately by other health professionals in family practices. They strengthened interface management through hybrid employment and flexible, addressee-appropriate communication. Conclusions: Similarities and differences between family practices with and without new professional roles should be elicited to specifically identify gaps in care for the chronically ill.

[Role understanding of expert nurses in primary and acute care in Germany: A descriptive cross-sectional study]

Role understanding of expert nurses in primary and acute care in Germany: A descriptive cross-sectional study Abstract. Background: Innovative care concepts are necessary to cope with the increase in complex care situations due to a rising number of older people with chronic diseases and a simultaneous shortage of nursing and medical staff. In the context of the implementation and development of new, innovative nursing roles, an unclear role understanding is considered a barrier. Aim: Description of expert nurses' (EN) role understanding in primary and acute care in Germany. Method: Using questionnaires, EN are asked cross-sectionally about role clarity, competencies and performance as well as perceived autonomy and interprofessional collaboration. Results are analysed descriptively. Results: A total of eight (primary care) and 14 (acute care) EN completed the questionnaires. The majority of EN often/very often perform both the clinical (77.5% and 85.7%, respectively) and the expert role (75% and 78.6%, respectively) and indicate that they can explain their role to patients (75% and 92.9%, respectively) and physicians (87.5% and 90.9%, respectively). Having a high degree of autonomy is more likely to be perceived by EN working in acute care. Conclusion: Although there are similarities in terms of role understanding, EN working in acute care can apparently benefit from already established structures, which is reflected, among other things, in their perceived autonomy.

Emergency Nurses' Competency in the Emergency Department Context: A Qualitative Study

Background

The availability of clear emergency nurses' competencies is critical for safe and effective emergency health care services. The study regarding emergency nurses' competencies remained virtually limited.

Purpose

This study aimed to explore the emergency nurses' competencies in the clinical emergency department (ED) context as needed by society.

Methods

This qualitative study involved focus group discussions in six groups of 54 participants from three EDs. The data were analysed using grounded theory approach including the constant comparative, interpretations, and coding procedures; initial coding, focused coding and categories.

Results

This study revealed 8 core competencies of emergency nurses: Shifting the nursing practice, Caring for acute critical patients, Communicating and coordinating, Covering disaster nursing roles, Reflecting on the ethical and legal standards, Researching competency, Teaching competencies and Leadership competencies. The interconnection of the 8 core competencies has resulted in 2 concepts of extending the ED nursing practice and demanding the advanced ED nursing role.

Conclusion

The finding reflected the community needs of nurses who work in ED settings and the need for competency development of emergency nurses.

Implementierung einer „Nurse Practitioner“-Rolle in der stationären Chirurgie

Zusammenfassung. Hintergrund: Die Studie beschreibt die Einführung und Erprobung einer Nurse-Practitioner-Rolle in der akutstationären Chirurgie in einem schweizerischen Krankenhaus über ein Jahr. Der Einsatz Nurse Practitioner kann die Kontinuität in der Betreuung, die Versorgungsqualität und die Patientensicherheit verbessern. Ziel: Aufgezeigt werden die kurzfristigen Ergebnisse einer solchen Rolle im stationär chirurgischen Bereich nach einem Jahr Laufzeit. Die Zielgrößen umfassten neun Messkriterien. Methode: Die Evaluation erfolgte mittels eines Mixed-Methods-Ansatzes, teilweise im Prä-post-Vergleich. Quantitativ wurden Anzahl betreute Patient_innen, Austrittszeit, interprofessionelle Zusammenarbeit, Liegedauer, Störungen im Alltag und die Verfügbarkeit der Austrittsdokumente erfasst. Die qualitative Erfassung beinhaltete das Erleben der Beteiligten. Ergebnisse: Die Ergebnisse der Evaluation weisen auf einen Mehrwert durch die neue Rolle hin. Hinweise finden sich in der Betreuungskontinuität und Zugänglichkeit in medizinischen Fragen der Beteiligten sowie in der Optimierung der Patient_innenprozesse. Erschwerend erwies sich die gesetzlich ungeklärte Situation in der Schweiz. Schlussfolgerungen: Die Stärke dieser Rolle lag in der Erhöhung der Betreuungskontinuität, der Verbesserung der Ansprechbarkeit in medizinischen Fragen für Patient_innen und Pflegende sowie in der Optimierung der Patientenprozesse und damit auch der Patientensicherheit. Die gesetzlichen Vorgaben bezüglich der Kompetenzen erschweren derzeit den Einsatz von Nurse Practitioner im stationären Bereich.

The evolution of advanced nursing practice: Gender, identity, power and patriarchy

To address longstanding workforce shortages, increase efficiency and control the costs associated with the modern health-care provision, there has been a worldwide policy to promote increased flexibility within the health-care workforce. This is being done primarily by extending the 'scope of practice' of existing occupational roles into what is referred to as 'advanced' practice. The development of the advanced practice nurse (APN) has occurred within the context of a shortage of medical staff, and the need to control cost. However, the means by which substantially repurposed occupational groups such as these, are incorporated into complex, hierarchical organisations such as the UK national health service (NHS) remains poorly understood. Using modern sociological theory, the development of the APN role has been examined in terms of power, control, professional identity and gender relations. Each of the theoretical approaches used adds to the quality of the discussion, although none provide a comprehensive picture. However, when synthesised, they do provide an enhanced insight into the evolution of the role. It is argued here that by critically examining the development of the APN role, this will enable both a better understanding of, and the means to influence, its future direction of travel.

Evaluation of the implementation of an online psychiatric nurse practitioner program for primary care nurse practitioners: Use of a Participatory Evidence-Informed (PEPPA-Plus) framework

To address a growing need for primary care nurse practitioners to provide mental health care, grant support was obtained to create an accelerated online post-master's psychiatric-mental health nurse practitioner (PMHNP) program. A participatory evidence-informed framework (PEPPA-Plus) was used to 1) evaluate the program structures and processes from the perspectives of program graduates, and within this context, to evaluate outcomes following graduation, and 2) to evaluate the impact of the program through the implementation of the dual nurse practitioner role. Approximately half (56%) of the graduates completed a 40-item web-based survey. Ninety-nine percent of those who had taken the PMHNP exam were certified as PMHNPs, 99% were dually certified as primary care NPs, 86% reported that their scope of practice had changed to include the delivery of more mental health care services, and 27% were providing both mental and physical health care in integrated care settings. The vast majority (90%) reported a moderate to very high level of confidence in their PMHNP competency, 60% were teaching psychiatric-mental health nursing as preceptors, educators, or new program directors and 29% were providing care in communities with <50,000 residents. Over half of the graduates were committed to staying in their current practice position for at least the next five years. These findings demonstrate the success of the online program in producing graduates who utilize dual NP competencies in practice, at least 25% of whom are treating populations in non-urban settings, in integrated care settings, and treating populations with high social and environmental risk factors.

Competency Gradients in Advanced Practice Nurses, Specialist Nurses, and Registered Nurses: A Multicentre Cross-Sectional Study

(1) Background: Identifying differences in the competencies of different areas of nursing is a crucial aspect for determining the scope of practice. This would facilitate the creation of a formal structure for clinical practice in advanced and specialised services. The aims of this study are to analyse the distribution of advanced competencies in registered, specialist and advanced practice nurses in Spain, and to determine the level of complexity of the patients attended by these nurses. (2) Methods: A cross-sectional study was developed on registered, specialist and advanced practice nurses, all of whom completed an online survey on their perceived level of advanced competencies and their professional characteristics. (3) Results: In total, 1270 nurses completed the survey. Advanced practice nurses recorded the highest self-perceived level of competency, especially for the dimensions of evidence-based practice, autonomy, leadership and care management. (4) Conclusions: Among registered, specialist and advanced practice nurses, there are significant differences in the level of self-perceived competencies. Patients attended by advanced practice nurses presented the highest levels of complexity. Understanding these differences could facilitate the creation of a regulatory framework for clinical practice in advanced and specialized services.

Comparative Analysis of Advanced Practice Nursing: Contextual and Historical Influences in North American and German-Speaking European Countries

This article compares the professionalization and educational standards of Advanced Practice Nursing in the United States, Canada, Germany, Austria, and Switzerland with specific attention to geographical, political, and professional factors - both current and historical - influencing the evolution of these nurse leaders. A review of the literature, scientific articles, governmental regulatory texts, and legislative codes from each country, was performed. Patterns related to the geographical, political and professional context of nursing in each country were identified with comparative insights on the evolution of the discipline. Advancement of the nursing discipline is apparent in each country over the last century, although at differing rates. The disparity in development and level of autonomous practice for Advanced Practice Nurses in each country can be better understood in the context of historical, geographical, political and professional development. This review of the literature was combined with a comparative analysis and offers insights to inform nurses in education, leadership, practice, and advocacy interested in advancing the professionalization of advanced practice nursing internationally.

Process evaluation of a multi-disciplinary complex intervention to improve care for older patients with chronic conditions in rural areas (the HandinHand Study): study protocol

BACKGROUND

To improve health care in rural areas, especially for increasing numbers of people with chronic diseases, academically qualified nurses could take over expanded roles to meet the challenges of an ageing society and a decreasing number of General Practitioners (GPs). In the project "HandinHand" (HiH), qualified nurses (Expert nurses, ENs) will carry out home visits to older people with chronic diseases over a period of six months. ENs will prepare a care plan in cooperation with GPs to stabilise the care situation and avoid unplanned hospital admissions and GP visits. The process evaluation aims to provide an in-depth analysis of the implementation process and gather important information on barriers and facilitators to the implementation of ENs as a complementary health care structure in primary care, taking into account several context factors.

METHODS

Based on the Medical Research Council (MRC) Framework for complex interventions, a logic model was developed and applied as the basis for data collection. Qualitative and quantitative data will be collected during the study. A mixed methods approach should allow to gain important insights from participants (e.g. ENs, GPs, patients) involved in the study as well as relevant stakeholders. Semi-structured interviews and surveys will be conducted. Data analysis will be based on the logical model, combining qualitative and quantitative data. Qualitative data will be analysed inductively-deductively using qualitative thematic framework analysis.

DISCUSSION

The process evaluation will provide guidance and conclusions on further development and transferability. Of particular interest is the expanded role of ENs in primary care, which has barely been implemented in Germany and can be seen as a precursor to the development of an Advanced Practice Nursing (APN) role in primary care.

[Building partnerships from the training of advanced practice nurses]

The introduction of advanced practice nurses in France is recent. It requires the development of partnerships from the training stage onwards, in order to promote the integration of these new professionals in the field. In this sense, the university and the university hospital of Bordeaux, in Gironde, have undertaken joint actions.

Evaluation of an APN service in acute inpatient care of patients with a malignant brain tumor: a qualitative study in a Swiss university hospital / Evaluation eines APN-Angebots in der akut-stationären Versorgung von Patienten und Patientinnen mit malignem Hirntumor: eine qualitative Studie in einem Schweizer Universitätsspital

Background

Caring for patients with a malignant brain tumor is complex and requires a high degree of coordination. The disease reduces life expectancy and affects quality of life. Therefore, patients often depend on the support of their relatives. To achieve better care for such patients and their relatives, a Department of Neurosurgery at a Swiss university hospital introduced a Nurse Practitioner (NP) and their service in 2017. 18 months after implementation, an evaluation of this NP role was conducted. It was aimed for to explore the experience of the interprofessional health care team.

Method

A qualitative research design was used. Eight individual interviews and one focus group interview were conducted with representatives of the interprofessional health care team. Using a literature-based structured interview guide, the experience of participants was explored. Interviews were analyzed thematically.

Results

The NP and their service was appreciated. Collaboration with the medical profession and the coordination of profession-specific demands also improved. The NP as a constant person of contact had a positive effect on the continuity of care e.g., with regard to discharge management. Medical doctors and registered nurses experienced an improved patient satisfaction. Further need for improvement was identified regarding the clarification of the NP role and the interprofessional collaboration.

Conclusion

The study reports on the successful introduction of an NP and their service in oncological care; it demonstrates that the implementation of this role can also be beneficial in acute inpatient care.

A multidisciplinary learning approach: training, preparation and role transition

AIM

To explore trainee and qualified advanced practitioner learning experiences, how training has prepared learners for clinical practice and role transition. Evaluation of a multidisciplinary learning approach was sought, identifying its impact on developing collaborative learning and working partnerships.

DESIGN AND METHODS

A small-scale, mixed-methods cross-sectional study was used to gather descriptive data. Convenience sampling was used with two groups: trainees and qualified advanced (paediatric) nurse practitioners/advanced clinical practitioners (ANPs/ACPs). All participants had completed or were undertaking master's level training. An anonymous, voluntary online survey was used to gather quantitative and qualitative data reflecting participant learning experiences. Evaluation research methodologies and their application were examined through exploration of three advanced practice frameworks and a well-established framework for evaluation of training.

FINDINGS

Overall, responses indicate positive learning experiences, and that current and previous ANP/ACP training in the UK does adequately prepare trainees for practice. However, further improvements in curriculum content are suggested. Consistent with the literature, collaborative multidisciplinary teaching, learning and mentorship were identified as key elements in the learning process and role transition.

Enhancing Parents' Well-Being after Preterm Birth-A Qualitative Evaluation of the "Transition to Home" Model of Care

There are few programs available aimed at preventing short- and long-term negative consequences after preterm birth and covering the entire care continuum. The “Transition to Home (TtH)” model is such a program, offering structured, individual support for families with preterm infants before and after hospital discharge. This study gathers and examines the parents’ views of receiving support from an interprofessional team under the TtH model of care during hospitalization and after discharge. Using a qualitative explorative design, 39 semi-structured interviews with parents were analyzed thematically. From this analysis, three main themes were identified: (1) TtH and the relevance of continuity of care; (2) Enhancement of parents’ autonomy and self-confidence; (3) Perception of interprofessional collaboration. Within these themes, the most relevant aspects identified were continuity of care and the appointment of a designated health care professional to anchor the entire care continuum. Emotional support complemented by non-medical approaches, along with strength-based and family resource-oriented communication, also emerged as key aspects. Continuous, family-centered care and well-organized interprofessional collaboration promote the well-being of the family after a premature birth. If the aspects identified in this study are applied, the transition from hospital to home will be smoothened for the benefit of affected families.

Guidelines for artificial intelligence in medicine: A literature review and content analysis of frameworks (Preprint)

Background

Artificial intelligence (AI) is rapidly expanding in medicine despite a lack of consensus on its application and evaluation.

Objective

We sought to identify current frameworks guiding the application and evaluation of AI for predictive analytics in medicine and to describe the content of these frameworks. We also assessed what stages along the AI translational spectrum (ie, AI development, reporting, evaluation, implementation, and surveillance) the content of each framework has been discussed.

Methods

We performed a literature review of frameworks regarding the oversight of AI in medicine. The search included key topics such as “artificial intelligence,” “machine learning,” “guidance as topic,” and “translational science,” and spanned the time period 2014-2022. Documents were included if they provided generalizable guidance regarding the use or evaluation of AI in medicine. Included frameworks are summarized descriptively and were subjected to content analysis. A novel evaluation matrix was developed and applied to appraise the frameworks’ coverage of content areas across translational stages.

Results

Fourteen frameworks are featured in the review, including six frameworks that provide descriptive guidance and eight that provide reporting checklists for medical applications of AI. Content analysis revealed five considerations related to the oversight of AI in medicine across frameworks: transparency, reproducibility, ethics, effectiveness, and engagement. All frameworks include discussions regarding transparency, reproducibility, ethics, and effectiveness, while only half of the frameworks discuss engagement. The evaluation matrix revealed that frameworks were most likely to report AI considerations for the translational stage of development and were least likely to report considerations for the translational stage of surveillance.

Conclusions

Existing frameworks for the application and evaluation of AI in medicine notably offer less input on the role of engagement in oversight and regarding the translational stage of surveillance. Identifying and optimizing strategies for engagement are essential to ensure that AI can meaningfully benefit patients and other end users.

Process optimization in breast imaging: Exploring advanced roles for medical radiation technologists

INTRODUCTION

Medical imaging (MI) is a critical service that underpins the care journey for many who enter the healthcare system. The subspecialty of Breast Imaging (BI) represents a complex and multi-modality MI setting with a well-defined role in the healthcare system. BI holds great potential as a setting to consider opportunities for a medical radiation technologist's (MRT) current role to be modified and leveraged to fulfill novel and advanced roles to optimize patient-centered service.

METHODS

This study was conducted in three interrelated BI clinics, all at large urban academic hospitals with a common operational infrastructure. It involved three phases; (i) mapping processes and workflows in BI (ii) identification and characterization of care delivery problems (CDPs) within these process maps, and prioritization of opportunities where task shifting might leverage enhanced knowledge, skills, and judgement of MRTs to optimize care. The PEPPA framework - a systematic planning tool for the development and implementation of advanced practice nursing (APN) roles⁵ - was used, with the first five of nine steps considered in scope for this pilot project.

RESULTS

Twelve distinct BI processes were identified and mapped as swimlane charts; a single clerical workflow leading up to patient check-in to the BI department, and 11 subsequent clinical processes. Each map included swimlanes for MRTs, radiologists, and clerical staff, as relevant, and included processes ranging from routine mammogram and ultrasound orders to stereotactic-guided core biopsies and rapid diagnostic workflows. Across the maps, 9 CDPs were identified; scheduling, radiologist availability, incorrect orders, and coordination of externally-acquired imaging and consults. The inpatient process map had the most instances of CDP identified, and the radiologist availability CDP was flagged most frequently across processes. Characterization of the root causes of each CDP led to common reflections on team and task factors, including inefficiencies in communication or division of responsibilities, or availability of resources or team members to support workflows. Consultations based on the resultant maps and CDPs led to identification of the following potential advanced roles for MRTs; review and decision-making relating to imaging acquired externally prior to patient appointments, exam ordering and protocoling in defined scenarios, and task-shifting of certain clinical procedures such as breast screening ultrasounds and contrast-enhanced mammography.

CONCLUSION

Advanced practice for MRTs holds great potential to address system inefficiencies in breast imaging, if approached systematically and with the primary objective to optimize care. Future work will consider trial and evaluation of pilot roles that incorporate advanced opportunities identified in this project.

[As Advanced Practice Nurse actively shaping nursing practice - A reflection]

As Advanced Practice Nurse actively shaping nursing practice - A reflection Abstract. Background: The development of Advanced Practice Nurses (APN-roles) in Germany in the acute inpatient setting is heavily dependent on context factors. Establishing APN-roles in patient care represents a significant organisational development process. In the year 2010 the Florence-Nightingale-Hospital in Düsseldorf began the implementation of APN-roles. Aim: To reflect our experiences in the development of APN-roles and furthermore the identification of influencing factors. Understanding facilitators and barriers intends to support future APN-role developments and interventions. Methods: Four Advanced Practice Nurses carried out a partially structured review, with the help of the Consolidated Framework for Implementation Research (CFIR). For this purpose, the cyclical process of critical self-reflection according to Titchen (2009) was used. Results: The influencing factors were summarised in categories. The categories presented are: support from management, recognising the need for change, professional expertise, presence on site, self-efficacy and personal characteristics and role clarity. Discussion: The implementation of APN-roles requires time and perseverance, both from the organization as well as from the respective Advanced Practice Nurse. To achieve role clarity is, in this process, substantial. Boundaries and Transfer: This review presents context-related results. However, the identified influencing factors could provide a helpful framework for future implementation processes and developments of APN-roles.

Patient-reported experiences of consultation with an advanced nurse practitioner: Factor structure and reliability analysis of the patient enablement and satisfaction survey

AIM

The aim was to analyse the psychometric properties of a patient-reported-experience measure, the Patient Enablement and Satisfaction Survey (PESS), when used to evaluate the care provided by Advanced Nurse Practitioners (ANPs) in terms of factor structure and internal consistency. The PESS is a 20-item, patient-completed data collection tool that was originally developed to measure patient experience and enablement following consultation with nurses in general practice.

DESIGN

Cross-sectional survey; validity and reliability analysis.

METHODS

The sample in this study consisted of 178 patients who consulted with 26 ANPs working in four different specialities. Data were collected between June and December 2019. An exploratory factor analysis of the PESS was conducted to determine convergent validity which was supported by parallel analysis and the traditional Kaiser criterion. The internal consistency of individual PESS items was determined via Cronbach's alpha, McDonald's omega, the Average Variance Extracted tests and item-subscale/total score correlations.

RESULTS

A three-factor structure (PESS-ANP) was found through exploratory factor analysis and this was supported by parallel analysis, the traditional Kaiser criterion and the percentage of variance explained criterion. A high degree of internal consistency was reported across all factors. One question was omitted from the analysis ('Overall Satisfaction') following the identification of problematic cross-loadings. The three factor solution was identified as: patient satisfaction, quality of care provision and patient enablement.

CONCLUSION

The findings of this study propose a three-factor model that is sufficiently reliable for analysing the experience and enablement of patients following consultation with an ANP.

IMPACT

Increasingly, patient-reported experience measures are being used to evaluate patients' experience of receiving care from a healthcare professional. The PESS was identified to be reliable in evaluating the experience of patients who receive care from an ANP while a three-factor structure was proposed that can capture specific attributes of this care.

Experiences of out-of-hours task-shifting from GPs: a systematic review of qualitative studies

Background

The current GP workforce is insufficient to manage rising demand in patient care within out-of-hours (OOH) primary care services. To meet this challenge, non-medical practitioners (NMPs) are employed to fulfil tasks traditionally carried out by GPs. It is important to learn from experiences of task-shifting in this setting to inform optimal delivery of care.

Aim

To synthesise qualitative evidence of experiences of task-shifting in the OOH primary care setting.

Design & setting

Systematic review of qualitative studies and thematic synthesis.

Method

Electronic searches were conducted across CINAHL (Cumulative Index of Nursing and Allied Health Literature), PsychINFO, Cochrane, MEDLINE, Embase, and OpenGrey for qualitative studies of urgent or OOH primary care services, utilising task-shifting or role delegation. Included articles were quality appraised and key findings collated through thematic synthesis.

Results

A total of 2497 studies were screened, of which six met the inclusion criteria. These included interviews with 15 advanced nurse practitioners (ANPs), three physician assistants (PAs), two paramedics, and a focus group of 22 GPs, and focus groups with 33 nurses. Key findings highlight the importance of clearly defining and communicating the scope of practice of NMPs, and of building their confidence by appropriate training, support, and mentoring.

Conclusion

While NMPs may have the potential to make a substantial contribution to OOH primary care services, there has been very little research on experiences of task-shifting. Evidence to date highlights the need for further training specific to OOH services. Mentorship and support to manage the sometimes challenging cases presenting to OOH could enable more effective OOH services and better patient care.

[An exploratory study of hospital stakeholders' perceptions on the introduction of advanced practice nurses]

Introduction : One solution proposed by the authorities to address public health issues is to deploy a new category of professionals with a greater range of skills : advanced practice nurses (APNs). The literature identifies the complexity of the deployment projects of these professionals. The PEPPA model approved by the International Council of Nurses is the reference model for the introduction of APNs. The objectives of this study were to explore various stakeholders' perceptions on the introduction of APNs into health institutions, in order to propose recommendations to support the institutions.Method : A multicenter qualitative study was conducted in France's Provence-Alpes-Côte d'Azur region with physicians, managers, nurses, patients, and advanced practice students.Results : APNs are beneficial for patients and the health system, but their introduction into health institutions brings with it risks, primarily linked to their integration. APN introduction projects need to be well planned and should prioritize their integration.Discussion : Results consistent with the PEPPA model identified seven recommendations to facilitate the successful introduction of APNs into hospitals.Conclusion : This work needs to be continued with studies related to the out-of-hospital setting and the evaluation of the successfulness of APNs' introduction.

Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review

OBJECTIVES

In response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the UK. This review was undertaken to establish a baseline of evidence on ACP roles and their outcomes, impacts and implementation challenges across the UK.

DESIGN

A scoping review was undertaken following JBI methodological guidance.

METHODS

13 online databases (Medline, CINAHL, ASSIA, Embase, HMIC, AMED, Amber, OT seeker, PsycINFO, PEDro, SportDiscus, Osteopathic Research and PenNutrition) and grey literature sources were searched from 2005 to 2020. Data extraction, charting and summary was guided by the PEPPA-Plus framework. The review was undertaken by a multi-professional team that included an expert lay representative.

RESULTS

191 papers met the inclusion criteria (any type of UK evidence, any sector/setting and any profession meeting the Health Education England definition of ACP). Most papers were small-scale descriptive studies, service evaluations or audits. The papers reported mainly on clinical aspects of the ACP role. Most papers related to nursing, pharmacy, physiotherapy and radiography roles and these were referred to by a plethora of different titles. ACP roles were reported to be achieving beneficial impacts across a range of clinical and health system outcomes. They were highly acceptable to patients and staff. No significant adverse events were reported. There was a lack of cost-effectiveness evidence. Implementation challenges included a lack of role clarity and an ambivalent role identity, lack of mentorship, lack of continuing professional development and an unclear career pathway.

CONCLUSION

This review suggests a need for educational and role standardisation and a supported career pathway for advanced clinical practitioners (ACPs) in the UK. Future research should: (i) adopt more robust study designs, (ii) investigate the full scope of the ACP role and (iii) include a wider range of professions and sectors.

Betreuung durch ein Advanced Nursing Practice-Team - Erfahrungen Lymphombetroffener und ihrer Angehörigen

Support by an advanced nursing practice team - Experiences of patients with lymphoma and their family members. A qualitative study Abstract. Background: Patients with lymphomas who are treated with high-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) are confronted with a life-threatening disease and a stressful therapeutic procedure. An advanced nursing practice (ANP) team was established at the Inselspital, Bern University Hospital to provide continuous, need-based care to these patients and their family members throughout the entire course of therapy. Little is known about experiences of concerned persons. Objective: With this study, patients' with lymphomas treated with HDC and ASCT and their family members' experiences of the care provided by the ANP team were explored. Methods: The qualitative research approach "interpretive description" provided orientation. Eight couple interviews with patients and their family members were conducted and evaluated by means of reflexive thematic analysis. Results: The participants experienced continuous caring by the nurse consultants throughout the entire course of therapy and received professional, administrative, and emotional support. They felt competently informed as well as advised, and had an easily accessible contact person for questions to whom they had built up an emotional relationship. This not only encouraged and strengthened them, but also provided security and the feeling of being in good hands. Conclusion: It is recommended to offer an ANP service to those affected, as for them the continuous support of a proficient, compassionate, familiar and committed contact person was essential.