How do healthcare professionals and managers view the role of the advanced practice nurse?

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.

Contextual factors influencing the implementation of advanced practice nursing in Catalonia, Spain.

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.

Nurse-led clinical activity in kidney transplantation care in Spain: A cross-sectional observational study.

OBJECTIVES: 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. DESIGN: Descriptive, cross-sectional study. PARTICIPANTS AND MEASUREMENTS: 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. RESULTS: 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. CONCLUSION: 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. IMPLICATIONS FOR CLINICAL PRACTICE: 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.

Propuesta de modelo para la enfermera de práctica avanzada / Proposal of a model for advanced practice nurses

La propuesta que se presenta es fruto, por un lado, de los resultados del proyecto “IPACAT22: Consenso sobre los aspectos clave del modelo de la práctica avanzada en Cataluña”, realizado con la participación de 24 enfermeras representantes de asociaciones científicas enfermeras o multidisciplinares de Cataluña. Por otro lado, es también fruto del apasionante, relevante y a veces difícil debate entre los miembros del equipo con diferentes trayectorias profesionales y distintos puntos de vista que enriquecen el objetivo común. Es oportuno presentar los resultados del debate, basados en el rigor, y los resultados de los proyectos de investigación por la mejora y el avance de la enfermera de práctica avanzada. Este debate también desempeña un rol importante en el entorno profesional para ejercer un liderazgo efectivo en las organizaciones y en el sistema de salud. Estamos convencidas de que este documento puede ser un punto de partida para configurar el modelo de la enfermera de práctica avanzada en nuestro contexto.(AU)

The proposal presented is the result, on one hand, of the outcomes of the Project “IPACAT22: Consensus on the key aspects of the model for advanced practice in Catalonia”, prepared with the participation of 24 nurses representing multidisciplinary or nursing scientific associations of Catalonia. On the other hand, it is also the result of the exciting, relevant, and sometimes difficult discussion among the team members with different professional careers and point of views which enhance the common objective. It is appropriate to present the outcomes of this discussion, based on rigour and results of the research projects for the improvement and progress of advanced practice nurses. This discussion also represents a major role in the professional setting, to conduct an effective leadership in organizations and the health system. We are convinced that this document can be a starting point to set up the model for the advanced practice nurse in our setting.(AU)

Contextual factors of advanced practice nursing development: A network analysis.

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.

Advanced practice nurses: Analysis of their role from a multicentre cross-sectional 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.

Impact of the COVID-19 pandemic on stress, resilience and depression in health professionals: a cross-sectional study.

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.

The emerging role of the advanced practice epilepsy nurse: A comparative study between two countries.

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.

[Management and leadership of nursing services in the emergency plan for the pandemic COVID-19: the experience of the Clinic Hospital of Barcelona]. / Gestión y liderazgo de los servicios de Enfermería en el plan de emergencia de la pandemia COVID-19: la experiencia del Hospital Clínic de Barcelona.

At the international level, the enormous demand to manage the COVID-19 pandemic has posed a challenge both in the provision of personnel and in supplies and sanitary material. There is no precedent or publication related to the management and leadership of nursing services in Spain within the emergency plan for the COVID-19 pandemic. This article describes the experience of the Hospital Clinico de Barcelona in the current extraordinary circumstances that undoubtedly constitute a nursing management of enormous magnitude and unprecedented due to the high number of people affected and the extraordinary risk of healthcare personnel. Following national and international guidelines to alleviate the pandemic, protect health and prevent the spread of the outbreak. The ability to work as a team, emotional management and respect for organizational decisions have made it possible to face the challenges that the pandemic has put in place and that the Nursing Department can lead in a calm and orderly manner the different actions to perform. Lastly, it will be necessary to continue with an in-depth analysis of the situation and of the actions carried out in order to identify the areas for improvement as well as to evaluate the overall nature of the process.

Enfermeras de práctica avanzada: una solución para resolver las necesidades del sistema sanitario / No disponible

No disponible

Spanish version of the Satisfaction with Epilepsy Care questionnaire: Adaptation and psychometric properties.

OBJECTIVE: The objective of this study was to perform a cross-cultural adaption and psychometric evaluation of the Spanish version of the Satisfaction with Epilepsy Care (SEC) questionnaire and analyze patient satisfaction with epilepsy care. METHODS: Transcultural adaptation and validation of the SEC were carried out using translation and back-translation with pilot testing and an expert panel. The SEC-E (Spanish) was analyzed in 213 patients with epilepsy to examine construct and criterion validity and internal consistency. RESULTS: The SEC-E achieved conceptual, semantic, and content equivalence with the original version. For content validity, one question was eliminated from the original questionnaire as it has little relevance in our cultural setting. Positive correlations for criterion validity were obtained using the gold standard measure (Satisfaction in Hospitalized Patients scale). Construct validity replicated the three dimensions of the original questionnaire. The scale showed adequate reliability through internal consistency (Cronbach's α of 0.94) and temporal stability on retest (n = 85). Patients scored (0 to 100) 77.5 [standard deviation (SD): 19.9] for satisfaction with communication, 76.9 (SD: 17) for organization, and 67.2 (SD: 22.1) for information. SIGNIFICANCE: The SEC-E is a valid and reliable tool for the assessment of educational interventions aiming to improve the quality of care in patients with epilepsy in Spanish clinical practice. The results showed a good level of patient satisfaction with epilepsy care.

Gestión y liderazgo de los servicios de enfermería en el plan de emergencia de la pandemia COVID-19: La experiencia del Hospital Clínic de Barcelona / Management and leadership of nursing services in the emergency plan for the pandemic COVID-19: the experience of the clinic hospital of Barcelona

A nivel internacional, la enorme demanda para gestionar la pandemia del COVID-19 ha supuesto un reto tanto en la provisión de personal cómo en suministros y material sanitario. No existe precedente ni publicaciones relacionadas con la gestión y liderazgo de los servicios de enfermería en España dentro del plan de emergencia de la pandemia COVID-19. En este artículo se describe la experiencia del Hospital Clínico de Barcelona en las circunstancias extraordinarias actuales que constituyen, sin duda, una gestión enfermera de enorme magnitud y sin precedentes debido al elevado número de personas afectadas y el extraordinario riesgo del personal sanitario. Siguiendo las orientaciones nacionales e internacionales para paliar la pandemia, proteger la salud y prevenir la propagación del brote. La capacidad de trabajo en equipo, la gestión emocional y el respeto a las decisiones organizativas han hecho posible que se hayan podido afrontar los retos que la pandemia ha puesto por delante y que desde la Dirección de Enfermería se pueda liderar de forma serena y ordenada las diferentes acciones a realizar. Por último, será necesario continuar con un profundo análisis de la situación y de las acciones desarrolladas para poder identificar las áreas de mejora, así como evaluar la globalidad del proceso

At the international level, the enormous demand to manage the COVID-19 pandemic has posed a challenge both in the provision of personnel and in supplies and sanitary material. There is no precedent or publication related to the management and leadership of nursing services in Spain within the emergency plan for the COVID-19 pandemic. This article describes the experience of the Hospital Clinico de Barcelona in the current extraordinary circumstances that undoubtedly constitute a nursing management of enormous magnitude and unprecedented due to the high number of people affected and the extraordinary risk of healthcare personnel. Following national and international guidelines to alleviate the pandemic, protect health and prevent the spread of the outbreak. The ability to work as a team, emotional management and respect for organizational decisions have made it possible to face the challenges that the pandemic has put in place and that the Nursing Department can lead in a calm and orderly manner the different actions to perform. Lastly, it will be necessary to continue with an in-depth analysis of the situation and of the actions carried out in order to identify the areas for improvement as well as to evaluate the overall nature of the process

Instrumentos de análisis para el desempeño de la enfermera de práctica avanzada / Analysis instruments for the performance of Advanced Practice Nursing

La Enfermería de Práctica Avanzada es una realidad en el contexto internacional desde hace ya varias décadas y, en los últimos años, también en España se están desarrollando nuevos perfiles que siguen este modelo. La consolidación de estos roles avanzados también ha propiciado la aparición de herramientas que intentan definir y evaluar sus funciones. Este estudio tiene como objetivo identificar y explorar los instrumentos existentes que permitan definir los dominios de la Enfermería de Práctica Avanzada. Se ha realizado una revisión de los cuestionarios e instrumentos existentes a nivel internacional, incluyendo un análisis del proceso de diseño, los dominios/dimensiones definidas, los principales resultados y la exploración de propiedades clinimétricas. Se han analizado 7 estudios, aunque no todos demostraron ser herramientas válidas, estables o fiables. Un instrumento incluido fue capaz de diferenciar entre las funciones de la enfermera de cuidados generales y la de práctica avanzada por el nivel de las actividades emprendidas en los 5 dominios descritos. Estas herramientas son necesarias para evaluar el alcance de los nuevos roles de la práctica avanzada en Enfermería que corresponden con otros modelos internacionales de competencias y dominios de práctica

Advanced Practice Nursing has been a reality in the international context for several decades and recently new nursing profiles have been developed in Spain as well that follow this model. The consolidation of these advanced practice roles has also led to of the creation of tools that attempt to define and evaluate their functions. This study aims to identify and explore the existing instruments that enable the domains of Advanced Practice Nursing to be defined. A review of existing international questionnaires and instruments was undertaken, including an analysis of the design process, the domains/dimensions defined, the main results and an exploration of clinimetric properties. Seven studies were analysed but not all proved to be valid, stable or reliable tools. One included tool was able to differentiate between the functions of the general nurse and the advanced practice nurse by the level of activities undertaken within the five domains described. These tools are necessary to evaluate the scope of advanced practice in new nursing roles that correspond to other international models of competencies and practice domains

Context and implementation of advanced nursing practice in two countries: An exploratory qualitative comparative study.

BACKGROUND: 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. PURPOSE: 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. METHODS: 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. FINDINGS: 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. DISCUSSION: 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.

Analysis instruments for the performance of Advanced Practice Nursing. / Instrumentos de análisis para el desempeño de la enfermera de práctica avanzada.

Advanced Practice Nursing has been a reality in the international context for several decades and recently new nursing profiles have been developed in Spain as well that follow this model. The consolidation of these advanced practice roles has also led to of the creation of tools that attempt to define and evaluate their functions. This study aims to identify and explore the existing instruments that enable the domains of Advanced Practice Nursing to be defined. A review of existing international questionnaires and instruments was undertaken, including an analysis of the design process, the domains/dimensions defined, the main results and an exploration of clinimetric properties. Seven studies were analysed but not all proved to be valid, stable or reliable tools. One included tool was able to differentiate between the functions of the general nurse and the advanced practice nurse by the level of activities undertaken within the five domains described. These tools are necessary to evaluate the scope of advanced practice in new nursing roles that correspond to other international models of competencies and practice domains.

Spanish version of the modified Advanced Practice Role Delineation tool, adaptation and psychometric properties.

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.

Profile of advanced nursing practice in Spain: A cross-sectional study.

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.