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

Academic training of nurses developing advanced practice roles

The nursing profession, without losing its essence, is in continuous evolution in order to face and respond to the ever-changing health challenges of the population. Advanced Practice Nursing is a clear example of this development. The performance of advanced practice roles entails greater responsibility, expansion and depth of nursing practice, which is only possible with additional education beyond the bachelor's degree - a master's or doctoral degree in nursing - and greater expertise in clinical practice in a particular area of specialization. Advanced practice nursing is intrinsically linked to the level of education since, further academic development of nursing promotes the advancement of autonomous practice. This article addresses the education of Advanced Practice Nurses, and focuses on its core aspects; providing detailed information on competencies, curricular structure, curriculum and key components of training programs. Finally, special mention is made of advanced role training in the critical care setting.

Evolution of advanced practice nursing in acute care in Germany: A cross-sectional study of nurses' scope of practice

AIM

To describe activities and professional characteristics of nurses in expanded roles in acute care in Germany and achieve a greater understanding of the current situation of advanced practice nursing.

BACKGROUND

Advanced practice nursing plays an important role in meeting increased demands in healthcare and promoting high-quality care.

INTRODUCTION

In Germany, advanced practice nursing is still at an early stage with a lack of studies describing the scope of practice of nurses in expanded roles.

METHODS

We conducted a cross-sectional-study using a paper-and-pencil questionnaire. In a nationwide convenience sample, we surveyed nurses with an academic degree, who work in an acute care hospital and take over expanded roles in direct patient care. Reporting followed the STROBE checklist.

RESULTS

Of 108 eligible nurses, 84 (77%) completed the survey. The majority had a Master's degree (63.1%) and the average work experience was 18.2 years. Participants carried out activities in all the domains that were queried (direct clinical practice, guidance and coaching, consultation, leadership and research) with differences within and between domains. Foci were on direct clinical practice and coaching and guidance.

DISCUSSION

In Germany, qualifications are nearing the international standard of advanced practice nursing. Results suggest that participants partly undertake activities within the scope of registered nurses' practice that do not correspond fully to their formal qualifications.

CONCLUSION AND IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY

In order to foster the role development of expanded practice nurses in Germany, political efforts are needed in terms of training (e.g. specific Master's programmes), funding of corresponding positions in practice and control mechanisms (e.g. professional registration).

What keeps you up at night? Moral distress in nurse leaders in the USA, Germany, Austria and Switzerland

PURPOSE

Nurse leaders are challenged by ethical issues in today's complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries.

DESIGN/METHODOLOGY/APPROACH

This descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries.

FINDINGS

The survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries.

ORIGINALITY/VALUE

Understanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.

Expanded nursing roles to promote person-centred care for people with cognitive impairment in acute care (ENROLE-acute): study protocol for a controlled clinical trial, process and economic evaluation

BACKGROUND

For people with cognitive impairment, hospitalisation is challenging and associated with adverse events as well as negative outcomes resulting in a prolonged hospital stay. Person-centred care can improve the quality of care and the experience of people with cognitive impairment during hospitalisation. However, current care processes in German hospitals are rarely person-centred. To enable successful implementation of person-centred care on hospital wards, change agents within the interprofessional team are key. The aim of this study is to test the feasibility and initial effects of a newly developed complex person-centred care intervention for people with cognitive impairment provided by expanded practice nurses in acute care.

METHODS

We will conduct an exploratory non-randomised controlled clinical trial with accompanying process and cost evaluation with three intervention and three control wards at one university hospital. The person-centred care intervention consists of 14 components reflecting the activities of expanded practice nurses within the interprofessional team on the intervention wards. The intervention will be implemented over a six-month period and compared with optimised care on the control wards. We will include people aged 65 years and older with existing cognitive impairment and/or at risk of delirium. The estimated sample size is 720 participants. The primary outcome is length of hospital stay. Secondary outcomes include prevalence of delirium, prevalence of agitation, sleep quality, and person-centred care. We will collect patient level data at six time points (t1 admission, t2 day 3, t3 day 7, t4 day 14, t5 discharge, t6 30 days after discharge). For secondary outcomes at staff level, we will collect data before and after the intervention period. The process evaluation will examine degree and quality of implementation, mechanisms of change, and the context of the complex intervention. The economic evaluation will focus on costs from the hospital's perspective.

DISCUSSION

The ENROLE-acute study will provide insights into the effectiveness and underlying processes of a person-centred care intervention for people with cognitive impairment provided by expanded practice nurses on acute hospitals wards. Results may contribute to intervention refinement and evidence-based decision making.

TRIAL REGISTRATION

Current controlled trials: ISRCTN81391868. Date of registration: 12/06/2023. URL: https://doi.org/10.1186/ISRCTN81391868.

The outcomes of postgraduate palliative care education and training: assessment and comparison of nurses and physicians

BACKGROUND

Within Germany, there is a heterogeneous range of training and continuing education in palliative care for different professional groups. The German Society for Palliative Medicine (DGP), together with the German Hospice and Palliative Care Association (DHPV), have defined quality requirements for postgraduate training in palliative care. These requirements include the evaluation of course structures and the assessment of outcomes.

AIM

To assess the 'learning gains' in palliative care nurses and physicians undertaking continuing education programmes, and evaluate the structures and processes. To identify if/how the continuing education programmes could be improved.

MATERIAL AND METHODS

The development of Nurses' and Physicians' learning was determined using a retrospective self-assessment procedure. The evaluation was based on learning objectives developed in the DGP Education Working Group, using a six-point Likert scale for each item, and space for 'free-text' comments. Assessments were conducted after training.

RESULTS

Five hundred twenty nine self-assessments were recorded (456 nurses / 73 physicians). An increase in learning is demonstrated in all areas (knowledge, skills, social and self-competence) for each profession. The greatest gain was in symptom control. However, there were significant differences in the extent of learning gains between nurses and physicians.

CONCLUSION

Analysis suggests current training results in improvements, but personal competences progress less than knowledge and skills. One way to improve this would be to introduce more interprofessional continuing education elements. Evaluation, as a basis for improving training concepts, is essential for continual development.

Nursing educators' collaboration and professional development: a cross-sectional study

OBJECTIVES

Teacher cooperation can be described as the collaboration of teachers in the form of exchange, synchronisation, and co-construction. The aim of this study was to determine if attitudes towards teacher collaboration, teacher self-efficacy, and perceptions of a safe team climate were related to teacher collaboration activities, as well as if these collaboration activities fostered professional development.

METHODS

An explorative study using an online questionnaire was conducted. A total of 202 (n=202) nursing educators participated. Scales measuring teacher collaboration, professional development, teacher self-efficacy, and safe team climate were used. Data analysis included explorative and confirmatory factor analysis, correlation analysis, and structural equation modelling.

RESULTS

The results showed a positive relation between teacher self-efficacy, perceptions of a safe team climate, and attitudes towards teacher collaboration with collaboration activities.

CONCLUSIONS

The results underline the importance of offering collaborative settings and opportunities for educators to reflect on their experiences during teacher training.