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Van Hijfte L, Cambron M, Capron B, Dachy B, Decoo D, Dive D, Dubois B, Sankari SE, London F, Perrotta G, Popescu V, Van Pesch V, Van Wijmeersch B, Willekens B, Laureys G. Multiple Sclerosis Multidisciplinary Care: A National Survey and Lessons for the Global Community. Mult Scler Relat Disord 2024; 85:105540. [PMID: 38489948 DOI: 10.1016/j.msard.2024.105540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 01/31/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Access to, standardization and reimbursement of multidisciplinary care for people with MS (PwMS) is lacking in many countries. Therefore, this study aims to describe the current multidisciplinary care for people with MS (PwMS) in Belgium and identify benefits, needs and future perspectives METHODS: A survey for PwMS questioned various aspects of MS and viewpoints on care. For MS nurses (MSN) and neurologists, employment, education, job-content, care organization and perspectives were inquired. Descriptive and univariate statistics were performed RESULTS: The PwMS survey comprised 916 respondents with a mean age of 46±12.7 years and 75,4 % of the respondents being female. The majority of the participants had relapsing remitting MS (60.8 %) and the mean patient determined disease steps (PDDS) was 2.0 (IQR=3). 65.3 % and 60.4 % of the PwMS reported having access to a multidisciplinary team (MDT) or MSN. Access to an MSN was associated with more frequent disease modifying treatment (p=.015), spasticity (p=.042) and gait treatment (p=.035), but also more physiotherapy (p=.004), driver's license adjustment (p<.001) and a higher employment rate (p=.004). MDT access was associated with more frequent symptomatic bladder treatment (p=.047), higher physiotherapy rate (p<.001), higher work- (p=.002), insurance- (p<.001) and home support measures (p=.019). PwMS without an available MDT more often indicated that MS care needs improvement (p<.001). MSN's (n = 22) were mainly funded through various budgets, including hospital and neurology practice budgets. Finally, 69 % and 75 % neurologists (n = 62) working without an MSN or MDT stated a need of such support and 61 % agreed that MDT's should be organized at hospital-network level CONCLUSION: MDT and MSN availability may enhance medical and socio-economic support for PwMS. Guidelines, alignment and reimbursement are needed.
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Affiliation(s)
- Liesbeth Van Hijfte
- Ghent University Hospital, 4Brain Research Unit, Department of Neurology, Gent, Belgium.
| | - Melissa Cambron
- Sint-Jan Bruges Hospital, Department of Neurology, Brugge, Belgium
| | - Brigitte Capron
- CHU de Charleroi, Department of Neurology, Lodelinsart, Belgium
| | - Bernard Dachy
- Hôpital Brugmann, Université Libre de Bruxelles, Department of Neurology, Brussels, Belgium
| | - Danny Decoo
- AZ Alma, Department of Neurology, Eeklo, Belgium
| | | | - Bénédicte Dubois
- University Hospitals Leuven, Department of Neurology, Leuven, Belgium
| | - Souraya El Sankari
- Cliniques Universitaires Saint-Luc, UCLouvain, Department of Neurology, Brussels, Belgium
| | - Frederic London
- CHU UCL Namur, Université catholique de Louvain, Department of Neurology, Yvoir, Belgium
| | - Gaetano Perrotta
- Hôpital Erasme, Université Libre de Bruxelles, Department of Neurology, Brussels, Belgium
| | - Veronica Popescu
- University MS Centre (UMSC), Hasselt-Pelt, Belgium; Noorderhart Hospitals, Revalidation and MS, Pelt, Belgium
| | - Vincent Van Pesch
- Cliniques Universitaires Saint-Luc, UCLouvain, Department of Neurology, Brussels, Belgium
| | - Bart Van Wijmeersch
- University MS Centre (UMSC), Hasselt-Pelt, Belgium; Noorderhart Hospitals, Revalidation and MS, Pelt, Belgium
| | - Barbara Willekens
- Antwerp University Hospital, Department of Neurology and UNiCA (University Neuroimmunology Center Antwerp), Edegem, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Translational Neurosciences Research Group, Wilrijk, Belgium
| | - Guy Laureys
- Ghent University Hospital, 4Brain Research Unit, Department of Neurology, Gent, Belgium
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Van Hecke A, Decoene E, Embo M, Beeckman D, Bergs J, Courtens A, Dancot J, Dobbels F, Goossens GA, Jacobs N, Van Achterberg T, Van Bogaert P, Van Durme T, Verhaeghe S, Vlaeyen E, Goossens E. Development of a competency framework for advanced practice nurses: A co-design process. J Adv Nurs 2024. [PMID: 38586883 DOI: 10.1111/jan.16174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/23/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
AIMS The aim of the study was to develop a comprehensive competency framework for advanced practice nurses in Belgium. DESIGN A co-design development process was conducted. METHODS This study consisted of two consecutive stages (November 2020-December 2021): (1) developing a competency framework for advanced practice nurses in Belgium by the research team, based on literature and (2) group discussions or interviews with and written feedback from key stakeholders. 11 group discussions and seven individual interviews were conducted with various stakeholder groups with a total of 117 participants. RESULTS A comprehensive competency framework containing 31 key competencies and 120 enabling competencies was developed based on the Canadian Medical Education Directions for Specialists Competency Framework. These competencies were grouped into seven roles: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator and health promoter. CONCLUSION The developed competency framework has resemblance to other international frameworks. This framework emphasized the independent role of the advanced practice nurse and provided guidance in a clear task division and delegation to other professionals. It can provide a solid foundation for delivering high-quality, patient-centred care by advanced practice nurses in the years to come. IMPLICATIONS FOR THE PROFESSION This competency framework can guide further development of advanced practice nursing education in Belgium and represents a starting point for future evaluation of its feasibility and usability in education and clinical practice. Advanced practice nurses and healthcare managers can also use the framework as an instrument for personal and professional development, performance appraisal, and further alignment of these function profiles in clinical practice. Finally, this framework can inform and guide policymakers towards legal recognition of advanced practice nursing in Belgium and inspire the development of advanced practice nursing profiles in countries where these profiles are still emerging. IMPACT What problem did the study address? The absence of a detailed competency framework for advanced practice nurses complicates legal recognition, role clarification and implementation in practice in Belgium. A rigorously developed competency framework could clarify which competencies to integrate in future advanced practice nursing education, mentorship programs and practice. What were the main findings? The competency framework outlined seven roles for advanced practice nurses: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator, and health promoter. Differentiation from other expert nursing profiles and clinical autonomy of advanced practice nurses were pivotal. Where and on whom will the research have impact? The comprehensive competency framework for advanced practice nurses and the collaborative methodology used can inspire other countries where these profiles are still emerging. The competency framework can be used as an instrument for role clarification, performance appraisals, continuous professional development, and professional (e-)portfolios. The competency framework can guide policymakers when establishing Belgian's legal framework for advanced practice nurses. REPORTING METHOD The authors have adhered to CONFERD-HP: recommendations for reporting COmpeteNcy FramEwoRk Development in health professions. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution in the design of the study. A patient advisory panel commented on the developed competency framework.
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Affiliation(s)
- Ann Van Hecke
- Department of Public Health and Primary Care, University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Staff Member Centre of Expertise in Nursing, Ghent University Hospital, Ghent, Belgium
| | - Elsie Decoene
- Staff Member Centre of Expertise in Nursing, Ghent University Hospital, Ghent, Belgium
| | - Mieke Embo
- Department of Educational Studies, Faculty of Psychology and Educational Sciences and Expertise Network Health and Care, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Swedish Center for Skin and Wound Research (SCENTR), Nursing Science Unit, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Jochen Bergs
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
- Department of PXL-Healthcare, Center for Healthcare Innovation, PXL University of Applied Sciences and Arts, Hasselt, Belgium
| | | | - Jacinthe Dancot
- Nursing Department, Haute École Robert Schuman, Libramont, Belgium
- Public Health Sciences Department, University of Liège, Liège, Belgium
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Goddelieve Alice Goossens
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Nursing Center of Excellence, University Hospitals, Leuven, Belgium
| | - Noortje Jacobs
- Research Unit Health Promotion, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Theo Van Achterberg
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Peter Van Bogaert
- Center for Research and Innovation in Care, Department of Midwifery and Nursing Sciences, Antwerp University, Antwerp, Belgium
| | - Thérèse Van Durme
- Institute of Health and Society, UC Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Ellen Vlaeyen
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Eva Goossens
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Center for Research and Innovation in Care, Department of Midwifery and Nursing Sciences, Antwerp University, Antwerp, Belgium
- Department of Patient Care, Antwerp University Hospital, Antwerp, Belgium
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Gutiérrez-Rodríguez L, García-Mayor S, León-Campos Á, Gómez-González AJ, Pérez-Ardanaz B, Rodríguez-Gómez S, Fajardo-Samper M, Morilla-Herrera JC, Morales-Asencio JM. Competency Gradients in Advanced Practice Nurses, Specialist Nurses, and Registered Nurses: A Multicentre Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148415. [PMID: 35886267 PMCID: PMC9323129 DOI: 10.3390/ijerph19148415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 02/04/2023]
Abstract
(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.
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Affiliation(s)
- Laura Gutiérrez-Rodríguez
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Silvia García-Mayor
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Álvaro León-Campos
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
- Correspondence: ; Tel.: +34-951-952-879
| | - Alberto José Gómez-González
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Bibiana Pérez-Ardanaz
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | | | | | - Juan Carlos Morilla-Herrera
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - José Miguel Morales-Asencio
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.G.-R.); (S.G.-M.); (A.J.G.-G.); (B.P.-A.); (J.C.M.-H.); (J.M.M.-A.)
- Biomedical Research Institute of Málaga (IBIMA), 29010 Málaga, Spain
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