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.

[Pain assessment for children and adolescents with autism spectrum disorders (ASD): A systematic review]. / Évaluation de la douleur des enfants et adolescents avec troubles du spectre de l'autisme : une revue systématique.

OBJECTIVE: Pain in children and adolescents with autism spectrum disorders remains underdiagnosed due to their inherent communication difficulties. The goal of this review is to identify the most suitable methods for assessing pain in this population and for evaluating the specific perceptions of, or behavioural reactions to, pain whilst considering disorder severity and specifiers (with or without accompanying intellectual impairment, with or without accompanying language impairment). METHOD: A systematic review and analysis of the international literature was conducted. RESULTS: Fourteen studies were selected. No difference was found in pain-related behaviours based on the age or gender of children or adolescents with autism. Three studies showed pain-related behaviours in autism spectrum disorders to be similar to control groups. Other studies showed specific behavioural responses in autism spectrum disorders with a longer physiological and behavioural recovery time associated with an episode of acute pain in this population. Similarly, the three studies that focused on sensory perceptions of pain all showed differences in the autism spectrum disorders population compared to control groups. In hospital or daily life contexts, studies essentially showed idiosyncratic expressions, hypervigilance, motor agitation, negative emotional reactions, or vocalizations. Regarding the association of autism severity with hyposensitivity to pain, the results remain unclear even when language disorders or intellectual disabilities are also present (in conjunction with autism). The Non-Communicative Children Pain Checklist and its translation into French and Italian showed good internal validity and was used by almost half of the studies in hetero-assessment, mostly by parents. Studies recommend the inclusion of parents in the assessment in order to optimise the evaluation process. Similarly, analysis of parent/child/caregiver interviews from the studies highlights the importance of personalizing pain assessment of children and adolescents, taking into account subject-specific characteristics, pathology, and context. CONCLUSION: An integrative and personalized approach to pain assessment appears to be the most appropriate for enhancing the understanding and detection of pain in individuals with autism spectrum disorders. This approach aligns well with a care setting where a nominated professional with a good expertise in autism is responsible for pain assessment. Given the complexity of identifying pain in individuals with autism, further qualitative studies, in conjunction with new pain exploration technologies, are considered necessary as well as a more extensive categorization of the population studies.

Using the Delphi method to develop a clinical skills assessment tool for advanced practice nurses in psychiatry and mental health / Élaboration d'un outil d'évaluation des compétences en stage des étudiants infirmiers en pratique avancée, mention psychiatrie et santé mentale à partir d'une méthode Delphi

Introduction: In France, advanced practice for psychiatric and mental health nurses has been developing since 2019. The acquisition of clinical skills by advanced practice nursing students requires monitoring and evaluation. This article outlines the process for creating an internship logbook. Objective: To develop and verify a tool for assessing the skills of advanced practice nursing students specializing in psychiatry and mental health during the internship stage. Method: The Delphi method described by Hasson was used, with the aim of obtaining a consensus of over 80% of the experts consulted. Results: A panel of ten experts, all internship tutors at partner healthcare establishments of Aix Marseille University, was consulted twice. The internship logbook was composed of 68 items. Discussion: This tool is the product of a multidisciplinary process including nurses and psychiatric nurses. It can be adapted to a variety of learning environments and helps tutors track the acquisition of clinical skills during the internships, both through external and self-assessment. Conclusion: A new Delphi consultation will foster uptake of this tool. Advanced practice nurses in psychiatry and mental health will be included in the group of experts.

The creation and implementation of advanced practice nursing in France: Experiences from the field.

AIM: This paper describes the characteristics of the new advanced practice nursing roles in France, as well as their challenges and perspectives, and compares the French model with the recommendations of the International Council of Nurses. BACKGROUND: Advanced practice nursing is particularly well established in English-speaking countries. Since 2018, France has become the second French-speaking region to legalize and regulate advanced practice nurses. SOURCE OF EVIDENCE: The International Council of Nurses and French government websites, and scientific databases (PubMed, CINALH, Cochrane Library) were explored. Feedback from French nursing academics was also requested. DISCUSSION: The advanced practice nursing model in France is described according to the scope and conditions of professional practice. The educational program leads to a State diploma with master's degree, which it is mandatory to be a registered nurse. Remuneration depends on the sector of practice in the public hospital, primary care or private sector. Although there is no national strategy for the implementation of advanced practice nursing roles, research projects are being initiated to guide and evaluate the practice. Based on concordance analysis with the recommendations of the International Council of Nurses, the French advanced practice nursing model appears to be similar to the nurse practitioner model. CONCLUSION: Adjustments in the scope of practice and education can be expected as the implementation of these roles is evaluated. IMPLICATIONS FOR NURSING PRACTICE: This is a historical evolution of the nursing profession in France, for which communication with patients and healthcare professionals is essential. IMPLICATIONS FOR NURSING POLICY: The implementation of advanced practice nursing roles in clinical settings requires the development of national strategies to support initiatives and ensure the sustainability of these roles.