Background
Advanced practice nurse (APN) roles bring great added value to health systems. However, their integration into the health workforce and the sustainability of the role depend on contextual ...factors surrounding their implementation.
Aim
To explore the contextual factors that influence the organization, implementation, and performance of clinical practice among oncology APNs in Catalonia (Spain).
Methods
This is a descriptive qualitative study. A framework of contextual factors was applied to explore the perspectives of 14 oncology APNs in public hospitals in Catalonia by means of semistructured interviews. Data were analyzed according to the thematic analysis approach. The COREQ checklist was used to report the study.
Results
APNs in cancer care strongly depend on the hospital environment where they are introduced. Recognition by the multidisciplinary team, the existence of mentoring experiences, and networking between APNs are critical factors that can help or hinder the development and autonomy of the APNs. Likewise, support from nursing managers and directors is decisive in defining the professional profile, establishing accountability mechanisms, and securing financial resources, including economic recognition. Factors related to the external environment can also contribute, including a standardized national APN model and scientific societies.
Conclusions
Contextual factors around clinical practice, institutional structures, and professional networks are crucial determinants for adequately integrating APNs at the health system level.
Implications for nursing policy
Professional bodies and national nursing organizations should lay the groundwork for defining standards of practice and advocate for specific regulations. In addition, financial recognition and accountability mechanisms to assess the impact of their contribution should be a priority to ensure sustainability and APN satisfaction.
Background
Advanced practice nurses (APN) growth depends on the implementation and acceptance of APNs in each country.
Introduction
Given the diversity of the different contexts and varying ...population health needs where APNs are developing, this study focuses on exploring the viewpoints of the multidisciplinary and management team who have worked with APNs in public hospitals in Catalonia, Spain.
Methods
A cross‐sectional study with previously identified APNs, health professionals, and health managers. EVOHIPA, a valid and reliable scale, was used. The STROBE checklist was followed.
Findings
The results showed high levels of agreement among the 746 participants (predominantly physicians and nurses), with statements relating to the APN's contribution in enhancing care continuity and processes, resulting in safer and more patient‐centered care. The results showed low levels of agreement with statements relating to legal support for the APN position, regulation, and practice scope.
Discussion
The study provides discussion elements and reflection to determine the axes on which it will be necessary to act to promote APNs and their conditions of service in the context of practice within hospital teams.
Conclusion
The study highlights the differences in opinion on APN roles among health professionals and managers who have worked with APNs and allows exploring expectations about current changes in workflows and clinical activities among healthcare team members.
Implications for nursing and health policy
Results highlight the importance of fostering a common understanding among healthcare teams to maximize the benefits of collaborative work and recognize the significant contributions of APNs within the multidisciplinary team.
Health policy plays a crucial role in recognizing and promoting the contribution of APNs within hospital healthcare teams, acknowledging their autonomy and expertise in improving patient outcomes.
To explore the presence of specialist outpatient nursing activity in care for kidney transplant recipients in Spain and to determine the level of competence development of this activity according to ...the Advanced Practice Nurse model.
Descriptive, cross-sectional study.
All outpatient nurses specialising in renal transplantation in the 39 transplant hospitals in Spain were included. To fulfil the study objectives, an ad hoc questionnaire and the 'Advanced Practice Nurse Role Definition Instrument (IDREPA)' were administered to assess the nurses' level of competence development.
Of the facilities included in the study, 25 (64.1%) had posttransplant nursing activity, 13 (33.3%) had pretransplant nursing activity and 11 (28.2%) had nursing activity involving kidney donor candidates. Twenty-seven specialist nurse's offices were identified. The results of the IDREPA reflect the presence of advanced practice in the domains of 'expert care planning' and 'comprehensive care'. Three (11.1%) nurses met all criteria for advanced nursing practice.
The results on specialised outpatient nursing activity at the 39 transplantation facilities in Spain indicate a low presence of this type of activity, with an even lower presence of advanced practice nurses.
Management teams should consider investing in the quality of care provided by advanced nurse practice to ensure that suitable treatment is provided and better clinical outcomes are obtained.
•The complexity and difficulties involved with the development and implementation of advanced practice roles have resulted in slow and sporadic deployment within and across countries including Canada ...and Spain.•Examination and comparison of contextual factors showed multiple commonalities across two countries that influence advanced practice nursing development and implementation.•The results of this project have the potential to contribute significantly to define objectives, implementation and assess the elements characterizing the transferability, and implementation of advance practice nursing roles.•Assess and measure complex contextual characteristics is important if we aim to continue to develop greater international knowledge about what affects advanced practice development and implementation, in order to better inform local contexts.
The complexity and difficulties involved in the development and implementation of health innovations, such as advanced practice nursing roles, result in slow and sporadic international acceptance. To manage this complexity, it is advisable to deepen understanding of the context in which these innovation processes take place. However, there is little research specifically concerned with contextual factors that influence the implementation of advanced practice nursing roles.
To integrate results and develop a comprehensive understanding of the contextual factors that influence the development and implementation of advanced practice nursing in two countries, Canada and Spain.
The research method used was qualitative, descriptive, and explanatory. Different qualitative methods, a novel data-collection process, and perspectives from participants in various professional groups were used to triangulate the findings from both settings. Participants with diverse perspectives on practice, organization, and health and regulatory environments were engaged to participate in semistructured focus groups in Catalonia and individual interviews in Quebec. Data gathered were to provide information on a variety of context dimensions: understanding of advanced practice nursing; perceived needs to develop the role; and perceived barriers and facilitators present in the Catalan and Quebec contexts. Thematic analysis was carried out based on the theoretical proposals from the framework and triangulated for both sides.
Thirty interviews were conducted in Quebec and 44 in Catalonia. Integration of findings reflected a vast predominance of convergent themes despite differences in context and population characteristics. The study identified common and divergent contextual factors in advanced practice development and implementation in these settings. The same perceived barriers and facilitators were prominent almost evenly across all groups, although organizational and environmental themes were the most coded and discussed during interviews.
Understanding contextual factors will ultimately allow better understanding of complex phenomena in health care. Further reporting of contextual factors that influence the development and implementation of advanced practice nursing roles in other countries is required to compare innovative processes.
Aims
This study aimed to delineate the relationships between actors and contextual factors associated with the development of the advanced practice role in Catalonia.
Methods
A complementary data ...analysis was conducted based on the social network analysis (SNA) method. The primary study design was qualitative, descriptive and explanatory. Participants from diverse perspectives of practice, organization and external environment were engaged to participate in semi‐structured focus groups. Data collection was conducted between March and May 2016 in Catalonia, Spain. Participants were asked to report on various dimensions of the role development context: understanding of the role, felt needs, perceived outcomes, barriers and facilitators.
Results
Primary data analysis performed for 44 participants identified 71 related contextual factors associated with role development. Complementary network analysis revealed multiple relationships and agreements among participants and context‐related themes. Professional roles and disciplines clustered around topics show consensus and the significance of topics.
Conclusion
Understanding the level of interactions and consensus among participants and contextual factors will ultimately allow better insight into how complex contexts influence the development of advanced practice nursing in healthcare organizations. Significant, consensual contextual factors should be used to influence further development and implementation of new roles that affect patient care and outcomes.
Summary statement
What is already known about this topic?
Comprehensive understanding of context at various levels should generate greater knowledge about what affects advanced practice role development locally and globally.
What this paper adds?
Findings could help organizations to make sense of the full dimension of context and to predict or act on development of advanced practice nursing roles.
The implications of this paper:
Significant, consensual contextual factors should be used to influence further development and implementation of new roles that affect patient care and outcomes.
Aim
To describe the impact of the COVID‐19 pandemic on stress, resilience and depression in health professionals from a public hospital in Barcelona, Spain after the first peak of pandemic.
...Background
The COVID‐19 pandemic in Spain has pushed boundaries in health systems and, especially, for health professionals. Analysis of resilience as an individual resource and it is essential to understand the mechanisms that make staff react unfavourably to stressors caused by the pandemic.
Design
A descriptive cross‐sectional study was designed.
Participants
Health professionals supervised by the nursing department, including registered nurses, health care assistants, health technicians, final year nurse student nurses, foreign nurses, and other nurse‐related health workers.
Methods
The study complies with the STROBE checklist for cross‐sectional studies. An online survey was administered to all health professionals supervised by the nursing department between 6 and 27 May 2020. The survey included the ER‐14 Resilience Scale, the widely‐used PHQ‐9 depression scale, the Spanish version of the Nursing Stress Scale, and an ad‐hoc questionnaire to obtain sociodemographic and occupational variables.
Results
A total of 686 participants answered the survey. Resilience was high or very high in health professionals, with an inverse correlation with stress and depression scores. Personal on fixed shifts showed better resilience. The most stressed health professionals were full‐time registered nurses, followed by health care assistants. Up to 25% of nursing professionals had depression.
Conclusion
Our study showed a high degree of resilience among nurse professionals despite the overwhelming nature of the COVID‐19 pandemic. Relevant signs of depression and stress were detected among participants. Occupational factors heavily influenced nurses’ resilience, stress and depression.
Implications for Nursing & Health Policy
Government policy shifts are needed in Spain to improve nurses’ workforce conditions, enhance the ratio of nurses to patient numbers, and avoid workforce losses. Maintaining the resilience of health professionals would assist in improving their health and their capacity to possible future emergency situations.
In this study, we described the profile of advanced nursing practice in Spain. A cross‐sectional study design was used to explore the extent and patterns of advanced nursing practice activity within ...the domains of expert care planning, integrated care, interprofessional collaboration, education, research, evidence‐based practice, and professional leadership. Data were collected in 2015/2016. Purposive sampling yielded a sample of 165 specialist and expert nurses employed by a dual tertiary and community hospital in an urban setting. The study included specialist and expert nurses who had a higher practice profile than registered general nurses. The performance of activities according to age, current position, years of experience, nursing grade, and education was compared. Practice domains were more strongly influenced by the predictors of nursing position and professional career ladder. Age and experience predictors were found to be weak predictors of advanced practice domains. This study offers essential information of the nursing workforce, and clarifies both the advanced nursing practice profile and nomenclature in the context of study.
Background
Stronger healthcare models are increasingly sought to address new population needs, health workforce inefficiencies and nursing shortages. One strategy is to focus on employees’ strengths ...to capitalize on their competencies and maximize their scope of practice.
Introduction
Globally, there is an exponential demand for advanced practice nursing services. This study aimed to identify the roles and positions of nurses who align with APN defining criteria at all levels of care in Catalonia, Spain.
Methods
The first step of the study included the translation and validation to Catalan of the Advanced Practice Nurse Role Delineation Tool (IDREPA) and step 2 comprised a multicentre cross‐sectional study, in which 126 healthcare centres participated: 1209 nurses were included in the study. The STROBE checklist was used to report this study.
Results
Transcultural equivalence and validation of the instrument showed a content validity index of 0.958 and the reliability of the questionnaire. The instrument identified 269 nurses who align with international APN defined criteria. They worked in specialized care, mental healthcare and primary and community care, especially in chronic conditions, ageing and end‐of‐life care.
Discussion
Most areas of Catalonia have access to nurses practicing at APN defining criteria. These nurses were developed as an optimal resource to respond to patient needs in the context of study. Both recognition and strategic implementation are necessary to apply their full competencies to solve healthcare problems.
Conclusion
Understanding the supply of services delivered by nurses practicing at an advanced level and their scope of practice may lay the foundations for effective workforce planning in a dynamic context. Nurses who align with APN defining criteria are working mainly in large acute services without regulation and recognition.
Implications for nursing
Advanced practice nurses show the value of their role and activities in healthcare services.
Implications for health policy
Promoting the establishment of APN defining criteria that includes credentialing and a regulatory framework within international guidelines should be a priority to make an impact on healthcare policy.
ABSTRACT
Aims and objectives
The aim of the study was to compare advanced practice in epilepsy nurses in Spain and United Kingdom, identifying differences in the domains of standard advanced ...practice.
Background
Europe has recently faced the challenge of providing high‐quality care for patients with epilepsy, a disease that generates many health demands. In some countries, such as the United Kingdom, advanced practice nursing is well established and could serve as a guide for implantation in countries where it is still in development, as is the case of Spain.
Design
A multicentre cross‐sectional descriptive cohort study compared differences in the roles of advanced practice nurses in Spain and the United Kingdom.
Methods
The Advanced Practice Role Delineation Tool and its validated Spanish version were administered using an online questionnaire in a cohort of advanced practice epilepsy nurses in both countries. A convenience sample was recruited between January to December 2019. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.
Results
Most United Kingdom nurses in our sample came from community environments, in contrast to Spanish nurses who worked in hospital. All domains analysed in the survey had significantly higher scores in the United Kingdom than in the Spanish cohort, especially in the research and leadership domains.
Conclusions
The advanced practice role in Spain is underdeveloped compared with the United Kingdom. Differences in the settings of advanced roles in epilepsy nurses may be explained by greater community practice in the United Kingdom and differences in organisational and health systems.
Relevance to clinical practice
Our study showed the need to implement specific policies to develop advance practice nurse roles in Spain to improve the quality of care of patients with epilepsy.
SUMMARY STATEMENT
What is already known about this topic?
Professional nursing practice has been expanded to adapt to new health and social requirements.
Internationally, there are instruments that ...describe and measure specific nursing activities and domains covered by advanced practice nurses. The modified Advanced Practice Role Delineation tool has been shown to be a valid, reliable instrument for predicting the extent of advanced practices across different organizations in contemporary society.
At a time when advanced practice nursing roles are emerging in Spain, clarification of roles and delineation of functions is required using well‐adapted, precise tools to avoid confusion and role ambiguity.
What this paper adds?
Results of this study support the adaptation, validity, and reliability of the Spanish version of the modified Advanced Practice Role Delineation tool.
Results confirm the reliability of the tool, which was estimated through internal consistency and test‐retest stability. The tool showed evidence of acceptable psychometric properties for use in a nursing and midwifery population in the Spanish context.
The results provide a framework for delineating and measuring the extent of advanced nursing domains and activities in the study context.
The implications of this paper:
The findings should be used to explore and develop emerging advanced nursing practices in Spain. The tool will be useful to measure the extent of advanced nursing practice and activities within the study population and to influence role delineation.
The tool could help to overcome role ambiguity and false expectations that could benefit future practice, professional development, and policy regarding advanced nursing practice.
It will also allow comparison of advanced practice roles with those in other international contexts.
Background
Role clarity is vital to avoid confusion and role ambiguity within nursing. There is a need for valid, reliable tools that can delineate the profile of advanced nursing practice to measure the extent of advanced practices in Spain.
Aim
The main purpose of this study was to translate, cross‐culturally adapt, and psychometrically test the Spanish version of the modified Advanced Practice Role Delineation tool.
Design
The study was designed to follow symmetrical translation and cognitive debriefing to determine conceptual equivalence. A cross‐sectional survey was conducted to examine content validity and psychometric tests.
Methods
Data were collected over 6 months in 2015 and 2016. The study had a purposive sample of specialist nurses and nurses with an extended practice profile beyond that of a general nurse.
Results
The study achieved conceptual, semantic, and content equivalence of the items. The results provided support for the instrument's validity and reliability in advanced practice nursing in a tertiary and community hospital. The tool showed internal consistency, with a Cronbach's alpha coefficient of 0.86 and stability over time.
Conclusion
The findings should influence future nursing practice, research, and leadership while allowing assessment of Spanish advanced practice roles in an international context.
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