The role of an advanced practice midwife in perinatal mental health: Outlining the process of role development and implementation

INTRODUCTION

Perinatal mental health disorders (PMDs) are a global health concern. In industrialized countries, the prevalence of PMDs is estimated to be 20%, and they are associated with serious negative effects for women, their children and their families, along with high societal costs related to long-term impacts. In Switzerland, the PMD detection rate during obstetrical healthcare provision is very low (1-3%), and specialized healthcare services are limited. This study aimed to develop and implement an advanced practice midwife (APM) role at a Swiss obstetrics and gynecology hospital using the PEPPA framework to provide adequate screening and first-consultation services.

METHODS

The study uses a qualitative approach and follows the research stages using the 8-step from the participatory, evidence-based, patient-focused process for advanced practice nursing role development, implementation and evaluation (PEPPA) framework to develop and implement the APM role.

RESULTS

Utilizing the PEPPA framework, we were able to develop, implement, and evaluate the APM role in the field of perinatal mental health. Through appropriate screening and first-consultation services, we were able to identify affected women early and facilitate treatment.

CONCLUSIONS

In addition to stakeholder engagement and interprofessional collaboration, PEPPA serves as a beneficial framework for the process of role development, implementation, and evaluation in the midwifery profession. This study aims to assist midwives with Master's degrees in establishing corresponding roles within their practice areas, thereby enhancing care delivery. Furthermore, the current APM approach is intended to be continuously evaluated to gain new insights into its effectiveness.

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.

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.

[Advanced nursing practice model for head and neck cancer: A practice development project]

Advanced nursing practice model for head and neck cancer: A practice development project Abstract. Background: Head and neck cancer confronts patients and their families with big challenges due to complex treatments as well as changes in vital functions and appearance. They require multifaceted support and benefit from coordinated, interprofessional collaboration and advanced nursing practice. Problem/aim: In a tertiary head and neck cancer center, a coordinating contact person was missing for patients, families and the care team. Therefore, a project was launched to develop an advanced nursing practice program. Methods: Methods included an advanced nursing practice concept, approaches for practice development, and action research. The project consisted of four phases: Stakeholder analysis and literature review were followed by the definition of the advanced nursing practice program, which was then tested during a pilot phase, and evaluated using structural/process data and stakeholder interviews. Results: Evidence-based, continuous, person-centered care was improved across the care continuum for patients/families. The nurses' expertise was supported and the collaboration with internal/external clinicians was facilitated. Patients/families valued the continuity offered by the advanced practice nurse. Discussion: The methodological approaches supported a goal-oriented approach; especially participatory practice development helped to address employees' concerns. Limitations/transfer: To date, a sustainable program cannot yet be warranted. For similar projects, an approach with stakeholder analysis, multidisciplinary focus, and early evaluation planning is recommended.

Clinical nurse specialist role implementation structures, processes and outcomes: Participatory action research

AIM

To develop, implement and evaluate the clinical nurse specialist's role within a specialist medical healthcare hospital. A secondary aim was to assess the feasibility of the 'Clinical Nurse Specialist Conceptualisation, Implementation, and Evaluation framework' in the role implementation.

BACKGROUND

Implementation of advanced practice nursing roles is an increasing practice around the globe; however, the implementation of these roles is multidimensional, complex process. Clear implementation strategies are needed.

DESIGN

Participatory action research was conducted in Finland between 2017-2018.

METHODS

The researchers adopted an outsider approach to work with staff, considered as co-researchers, within two participating units. A combination of several methods, such as focus group interviews, action-learning groups and researcher reflective field journal, was used to gather data. The 'Clinical Nurse Specialist Conceptualisation, Implementation, and Evaluation framework' was used to structure the processes undertaken, and the Donabedian structure, process and outcome model was used to structure and analyse the results. The study was reported using the EQUATOR guideline for participatory action research.

RESULTS

The results demonstrated the complexity of the role implementation process. Four implementation themes of need analysis, role design, role implementation and role evaluation were examined and described through their structures, processes and outcomes. The 'Clinical Nurse Specialist Conceptualisation, Implementation and Evaluation framework' was validated for its appropriateness guiding the role implementation process.

CONCLUSIONS

Role implementation is a complex process which structured, practical guidelines may facilitate. The examined framework may facilitate the role implementation process conducted within organisations.

RELEVANCE TO CLINICAL PRACTICE

This research provides complimentary information for individuals and organisations aiming to develop a clinical nurse specialist or other advanced practice nursing roles. Furthermore, we describe a participatory action research process, which offers the means for self-reflection and planning of purposeful actions to improve the conditions of clinical practice.

Implications for mental health workforce strategy, professional training and supervision of more widespread adoption of the multi-professional Responsible Clinician role: Results of a qualitative inquiry

Within mental health legislation in England and Wales the Responsible Clinician for specific patients should be the Approved Clinician with the most appropriate expertise to meet their primary assessment and treatment needs. The study aimed to explore nurse and psychologist perspectives on becoming a Responsible Clinician in the context of their limited uptake of the role and calls for an increase in advanced practice roles within mental health. It comprised a qualitative inquiry in the form of a thematic analysis of 12 semi-structured interviews. Four sub-themes emerged under the theme of 'becoming a Responsible Clinician'. They were: (i) the Responsible Clinician amongst other roles; (ii) developing in the role; (iii) working with psychiatrist colleagues; and (iv) organisational context. Responsible Clinicians were juggling the role with other senior clinical responsibilities, often without a coherent programme of ongoing educational development or organisational support structures. If mental health service provider organisations adopt this extended role more widely then role-specific support and supervision arrangements should be in place as part of a coherent workforce strategy. This is particularly important given the legal and ethical responsibilities of the Responsible Clinician.

Examining advanced nursing practice in Hong Kong and Guangzhou

Objective

There were studies evaluating advanced nursing practice independently in the mainland and Hong Kong Special Administrative Region of China, but there was no attempt to make a comparison of practice between them. This study employed a case study method to examine and compare advanced nursing practice in Hong Kong and Guangzhou.

Method

Purposive sampling method was used to recruit 24 advanced practice nurses (APN) who came from the specialty of medical, surgical and pediatric in Hong Kong and Guangzhou. A questionnaire survey and semi-structured interview were conducted to solicit quantitative and qualitative data for exploring the structure-process-outcome of advanced nursing practice. The structure component explored the factors influencing advanced nursing practice. The process part examined APN role components and illustrations of exemplary advanced nursing practice. The outcomes described outcome indicators that best reflected advanced nursing practice.

Findings

Findings revealed that in the structure domain, APN education and career development, team approach in healthcare, and support from management, physicians and professional associations were important contextual factors for APN development in both cities. For the process domain, participants had at least 80% of their time practicing independently/interdependently and were engaged in APN activities including direct/indirect patient care, research/project work, initiation of staff and patient protocols. All participants demonstrated competencies with impacts on patient, service and profession in their description of exemplary practice. Participants from both cities ranked patient-related outcomes as top indicators for their advanced nursing practice.

Conclusion

This study has revealed that APNs in Guangzhou and Hong Kong shared similar work involvement and impacts and their demonstrated competencies were on par with international counterparts. Continued efforts need to be put in establishing formal APN education, clear clinical career pathway and title protection to empower nurses to provide optimal care to the fullest extent that they are prepared for.

Structure evaluation of the implementation of geriatric models in primary care: a multiple-case study of models involving advanced geriatric nurses in five municipalities in Norway

Background

The Advanced Geriatric Nurse role recently has been introduced into Norway’s primary healthcare system, and our study’s purpose was to examine the implementation of models of care developed for Advanced Geriatric Nurse in primary care. With a structure evaluation, we tried to identify conditions that affect the implementation of different models of care and understand how these conditions affected the realisation of each model’s intentions and goals.

Methods

An embedded multiple-case study was used that included five Norwegian municipalities and seven AGNs. The study included data from August 2014 through September 2018. We used data from 25 semi-structured face-to-face interviews with AGNs and stakeholders, documents and statistical information. We used a cross-case procedure with an emphasis on case findings for the analysis of the multiple case study.

Results

We analysed the structure-related conditions on two levels: the meso-level and the micro-level. On the meso-level, we found that the conditions that affected the implementation of the different models of care were related to each municipality’s structure characteristics, stakeholders’ involvement in the design of the models of care, the clarity of the models and their goals, the evaluation of the models and their adaptation. At the micro-level, we found that the conditions that affected the models’ implementation were related to the collaboration within the implemented models of care, the role clarity of Advanced Geriatric Nurses themselves and adjustments within the models.

Conclusions

The implementation of the AGN role in Norway seems to have been implemented in ways that can impact patients and municipalities positively. Potential improvements include extensive stakeholder involvement, improved roles, goal clarity and better documentation of structures and outcomes. The models’ dynamic nature seemed to be a beneficial characteristic, but adaptation should be systematic and a necessary time should be considered for a new model of care to be integrated and produce results.

Estratégia de implementação para a prática avançada de enfermagem na Atenção Primária à Saúde no Chile

Resumo Objetivos: (i) Delinear os passos e progressos realizados pelo Chile para implementar a prática avançada do papel da enfermagem usando o Enfoque PEPPA (Participatory Evidence-based Patient-focused Process) como guia, (ii) demonstrar a eficácia da estrutura do PEPPA para a identificação de barreiras e guiar o processo de implementação, e (iii) discutir os próximos passos para a implementação do papel da enfermagem. Métodos: O enfoque inclui nove etapas em um processo flexível e iterativo. Resultados: O presente estudo fornece uma análise aprofundada das atividades empregadas para cada etapa do Enfoque PEPPA e sua contribuição para o desenvolvimento do papel da enfermagem na prática avançada no Chile. Em particular, as atividades de participação das partes interessadas foram essenciais para informar os principais decisores e formuladores de políticas de saúde sobre o papel das práticas avançadas de enfermagem, obtendo sua adesão e apoio ao papel da enfermagem e estabelecendo um consenso sobre suas prioridades. As estratégias usadas para superar alguns desafios na implementação das etapas do PEPPA também são discutidas, juntamente com os próximos passos para avaliar e monitorar a implementação e o estabelecimento do papel da enfermagem na prática avançada a longo prazo. Conclusão: O Enfoque PEPPA fornece diretrizes importantes para os países em que a prática avançada do papel da enfermagem está recém sendo introduzida, por meio da identificação e análise de barreiras para o delineamento eficaz do papel e sua implementação exitosa.

Gezielte Entwicklung von Advanced Practice Nurse-Rollen für spezifische Patient(inn)engruppen in einem Schweizer Universitätsspital

Zusammenfassung.Hintergrund: Um den zukünftigen Bedarf der Bevölkerung an medizinischen Leistungen abzudecken, sind neue Versorgungsmodelle gefragt. Der Aufbau von Advanced Nursing Practice (ANP) bietet eine Möglichkeit, diesen Herausforderungen mit neuen Angeboten zu begegnen. Im Inselspital, Universitätsspital Bern werden seit 2011 ANP-Angebote und entsprechende Advanced Practice Nurse-Rollen aufgebaut. Ziel: Es wird angestrebt, innovative und evidenzbasierte ANP-Angebote zu entwickeln, um die Versorgung für spezifische Patient(inn)engruppen und ihre Angehörigen auszubauen und mehr Sicherheit sowie bessere Ergebnisse zu erreichen. Methode: ANP-Angebote werden im Rahmen von Projekten, in enger Zusammenarbeit von Klinik und Bereich Fachentwicklung (BFE) der Direktion Pflege entwickelt. Zur Evaluation werden Struktur-, Prozess- und Ergebnisdaten erhoben. Ergebnisse: Heute sind fünf ANP-Angebote etabliert, acht weitere befinden sich im Aufbau. Die meisten Angebote sind auf eine langfristige Betreuung von Patient(inn)en mit chronischen Erkrankungen und ihre Angehörigen ausgerichtet. Zehn APN haben Anstellungen von 10 % bis 80 %, drei führen ein ANP-Team. Sie arbeiten zu über 50 % in der direkten klinischen Praxis, primär beratend. Ein ANP-Netzwerk verbindet APN und BFE, um Synergien und Austausch zu fördern. Schlussfolgerungen: Herausfordernd bei der Entwicklung von ANP-Angeboten sind oft die Ressourcen. Wesentlich für den nachhaltigen Erfolg sind ein adäquater Stellenumfang, die Unterstützung durch die Klinikleitung, das spitalweit gültige Konzept und der Aufbau im Rahmen von Projekten.

Implementation of a gerontology nurse specialist role in primary health care: Health professional and older adult perspectives

AIMS AND OBJECTIVES

To explore an innovative primary healthcare gerontology nurse specialist role from the perspectives of older people and health professionals.

BACKGROUND

Primary care is struggling to meet the needs and demands of complex older people. New models which incorporate holistic assessment and care coordination are necessary.

DESIGN

A qualitative descriptive general inductive design was used.

METHODS

Older people at risk of health and functional decline were identified and received a comprehensive gerontology assessment and care coordination. Older adults (75 years+) enrolled within one of three primary healthcare practices in Auckland, New Zealand were eligible. Healthcare professionals directly involved with the primary healthcare gerontology nurse specialist model were invited for study participation. Face-to-face interviews were held with five older people and six health professionals were interviewed by telephone. A semistructured interview guide was used for all interviews. A general inductive approach was undertaken for analysis to systematically identify codes and themes.

RESULTS

Data analysis revealed two central themes from the older people perspective: "holistic expertise" and "communication." Two main themes were identified from the health professional perspective: "competency" and "service delivery." Results showed the gerontology nurse specialist role was highly regarded by both older people and the health professionals. The in-home comprehensive geriatric assessment was identified as greatly beneficial.

CONCLUSIONS

The competence and care coordination of the gerontology nurse specialist reduced fragmentation and were deemed immensely valuable. Care coordination should be recognised as a key component to meeting the complex needs of at-risk older people in the community.

RELEVANCE TO CLINICAL PRACTICE

The expert knowledge of the gerontology nurse specialist and in-home comprehensive geriatric assessment were crucial aspects of the new model. Equally important was the assimilation of primary and secondary care infrastructure to upskill and deliver mentorship to the gerontology nurse specialist.

Exploring an Unknown Territory: "Sleeping Beauties" in the Nursing Research Literature

BACKGROUND

Sleeping Beauties (SBs) are publications that are scarcely cited in the years immediately following publication but then suddenly become highly cited later. Such publications have unique citation patterns and can reveal important developments in the field in which they appear.

OBJECTIVES

No holistic analysis of nursing SBs has been done yet. The aim of this study was to identify and analyze the SB phenomenon in the nursing research literature.

METHOD

The corpus for the nursing SB identification was harvested from the Web of Science Core Collection (Thomas Reuters) for the period 1934-2015. Citation histories of 212,239 publications were screened. From those, 3,209 publications with more than 100 citations were selected for analysis. We used our own software and applied the van Raan (2004) and Baumgartner (2010) criteria for SBs-a 5-year sleeping period with at most 10 citations during that time, an average of at least five citations per year after the first 10 years, with at least 100 citations in total. The knowledge context for SBs was determined using citing papers. All citing papers were analyzed with the help of VOSviewer software.

RESULTS

Nine publications were identified as SBs (prevalence of 0.004%). The length of sleep duration ranged from 5 to 10 years (M = 6.8, SD = 2.0), depth of sleep ranged from 0.2 to 0.8 citations (M = 0.6, SD = 0.2), and awake intensity ranged from 6.4 to 15.0 citations (M = 11.0, SD = 3.8). The average number of citations to SBs was 229. Most nursing SBs were produced in the United States (n = 8) from top institutions in journals with high-impact factors. Nursing SBs covered topics including resilience, sampling in qualitative research, metasynthesis, postoperative pain in children, dementia rating scales, care of patients with Alzheimer's disease, nursing theory related to fatigue mechanisms in cancer patients, and family participation during resuscitation. Nursing SBs were cited by authors from a large number of institutions and countries; the number of publications citing nursing SBs is growing exponentially and showing increasing and global interest in the research presented in them.

DISCUSSION

This study demonstrated that SBs in nursing are similar to other scientific disciplines. Existence of SBs suggests that nursing knowledge accumulation is supported by research and professional processes similar to those that emerged in other academic disciplines.

Implementation strategy for advanced practice nursing in primary health care in Latin America and the Caribbean

Advanced practice nursing (APN) is a term used to describe a variety of possible nursing roles operating at an advanced level of practice. Historically, APN roles haves evolved informally, out of the need to improve access to health care services for at-risk and disadvantaged populations and for those living in underserved rural and remote communities. To address health needs, especially ones related to primary health care, nurses acquired additional skills through practice experience, and over time they developed an expanded scope of practice. More recently, APN roles have been developed more formally through the establishment of graduate education programs to meet agreed-upon competencies and standards for practice. The introduction of APN roles is expected to advance primary health care throughout Latin America and the Caribbean, where few such roles exist. The purpose of the paper is to outline an implementation strategy to guide and support the introduction of primary health care APN roles in Latin America and the Caribbean. The strategy includes the adaptation of an existing framework, utilization of recent research evidence, and application of knowledge from experts on APN and primary health care. The strategy consists of nine steps. Each step includes a national perspective that focuses on direct country involvement in health workforce planning and development and on implementation. In addition, each step incorporates an international perspective on encouraging countries that have established APN programs and positions to collaborate in health workforce development with nations without advanced practice nursing.

Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health

Objective:

to examine advanced practice nursing (APN) roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health.

Method:

we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health.

Results:

given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation.

Conclusions:

given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries.