Mapping advanced practice nurses' scope of practice, satisfaction, and drivers of role performance.

Background: Advanced Practice Nurse (APN) roles in Switzerland include Clinical Nurse Specialist (CNS), Nurse Practitioner (NP) and blended roles. The variety contributes to unclear profiles and scope of practice. Aim: To describe a) the performance of APN tasks according to Hamric's competencies, b) job satisfaction, and c) barriers and facilitators to role performance. Methods: Nationwide cross-sectional survey among clinically working APNs. Inclusion criteria: academic degree, role with advanced nursing competency. Analysis of quantitative and qualitative data using inferential statistics and content analysis. Results: Of the 222 APNs, 49% (n = 108) described themselves as CNSs, 37% (n = 81) as working in a blended role, and 15% (n = 33) as NP. APNs provided the greatest proportion of their tasks in the competency direct clinical practice and the least in ethical decision-making. Group comparisons between roles revealed significant differences in the competencies: direct clinical practice, guidance and coaching, leadership, and evidence-based practice. Job satisfaction was high (76%, n = 165), most often described by the category work content/role (e.g., defined scope of practice). The most frequent barrier to role performance was the category scope of practice (e.g., unclear responsibilities); the most frequent facilitator was the category professional recognition (e.g., respect). Conclusion: The study highlights current APN scope of practice and can support the advancement of the role through clinical practice, educational institutions, and research.

Validation of the newly developed Advanced Practice Nurse Task Questionnaire: A national survey.

AIM: To describe psychometric validation of the newly developed Advanced Practice Nurse Task Questionnaire. DESIGN: Cross-sectional quantitative study. METHODS: The development of the questionnaire followed an adapted version of the seven steps described in the guide by the Association for Medical Education in Europe. A nationwide online survey tested the construct and structural validity and internal consistency using an exploratory factor analysis, Cronbach's alpha coefficient and a Kruskal-Wallis test to compare the hypotheses. RESULTS: We received 222 questionnaires between January and September 2020. The factor analysis produced a seven-factor solution as suggested in Hamric's model. However, not all item loadings aligned with the framework's competencies. Cronbach's alpha of factors ranged between .795 and .879. The analysis confirmed the construct validity of the Advanced Practice Nurse Task Questionnaire. The tool was able to discriminate the competencies of guidance and coaching, direct clinical practice and leadership across the three advanced practice nurse roles clinical nurse specialist, nurse practitioner or blended role. CONCLUSION: A precise assessment of advanced practice nurse tasks is crucial in clinical practice and in research as it may be a basis for further refinement, implementation and evaluation of roles. IMPACT: The Advanced Practice Nurse Task Questionnaire is the first valid tool to assess tasks according to Hamric's model of competencies independently of the role or the setting. Additionally, it distinguishes the most common advanced practice nurse roles according to the degree of tasks in direct clinical practice and leadership. The tool may be applied in various countries, independent of the degree of implementation and understanding of advanced nursing practice. REPORTING METHOD: The STARD 2015 guideline was used to report the study. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

[The first steps of an ANP-team - challenges and chances of ANP-teams at the Children's University Hospital Zurich]. / «Wie ein ANP-Team laufen lernt¼ - Herausforderungen und Chancen von ANP-Teams am Universitätskinderspital Zürich.

In the past, various individual ANP-roles such as Clinical Nurse Specialist and Nurse Practitioner were developed in the USA and in several countries of Northern Europe. In Switzerland, the number of university-educated nurse specialists is still very limited. In order to promote sustainable progress in nursing practice despite of this background, Advanced Nursing Practice teams (ANP-teams) have continuously been established at Kinderspital Zurich for the last eight years. This approach has proven to be an excellent option especially in highly complex situations where targeted and adequate solutions for patients are a major issue. In this article, the structure of the ANP-teams is discussed, with the personnel mix as a key factor. Important supportive elements are a clear definition of tasks as well as an allocation of individual tasks to either clinical or conceptual groups. The ANP teams are highly motivated and goal-oriented, they integrate nurses with various backgrounds of experience or training whereby mutual learning is being encouraged.

[A challenge in spite of acceptance - how mothers of newborn babies with a "cleft" experience the transition from the hospital back home]. / Trotz Akzeptanz bleibt die Herausforderung - Wie Mütter eines Neugeborenen mit einer <> den Ubergang vom Spital nach Hause erfahren.

There is almost no empirical data about how mothers of newborn babies with a cleft lip and/or palate manage the transition from the hospital to home. This qualitative study therefore focuses on the experiences of mothers of newborn babies with a cleft lip and palate. Two problem-oriented interviews were conducted with five women. Using a qualitative content analysis, one main category and four sub-categories were defined. The main category called "receive the right kind of help" shows that the women depended on different types of support, concerning various topics from the diagnosis to everyday family life. This is reflected in the sub-categories: a) it is the way it is, b) sudden disappearance of the child, c) time-consuming and difficult nutrition and d) master everyday family-life. These sub-categories display the experiences of mothers of newborn babies with a cleft lip and palate during the transition from hospital to home and point to the big challenge of these mothers in transition. Most important is that health professionals seek to better understand mothers' experiences in this important phase in order to optimize both the support in hospital and outpatient facilities.

[A method combination for Advanced Nursing Practice projects]. / Eine Methodenkombination für pflegerische Praxisentwicklungsprojekte.

In order to offer Advanced Nursing Practice (ANP) in Switzerland, some practice development projects have been established with the goal to enable entire nursing teams to become ANP Teams. These ANP Teams are led by ANP nurses with a high expertise in the specific practice area. The combination of the three methods action research, project management and evaluation research have proven useful for the ANP nurse as project leader. Action research is viewed as the leading force because of its scientific methods that allow focusing on practice problems and actions. With project management methods, the ANP project can be organized in an effective and efficient way. Evaluation research offers methods to systematically evaluate the project at the level of patients, team, and organization. The combination of these different methods allows the ANP nurse to work systematically and flexibly and improves results.

[Outcomes and experiences of caring for families with children with cleft lip and palate at the Children's Hospital of Zurich]. / Die Arbeit mit Familien von Kindern mit Lippen-Kiefer-Gaumenspalte: Erste Ergebnisse betreffend Evaluation eines Praxisentwicklungsprojektes aus dem Kinderspital Zürich.

The development and establishment of Advanced Nursing Practice is an important step toward an effective and sustainable care. Five diploma nurses of the Children's Hospital of Zurich started an ANP project in the field of children with cleft lip and palate under the guidance of an ANP Nurse. The purpose of this project was to address the needs of the families and to establish state-of-the-art care. Action research methodology built the background because it offers methods that connect theory and practice. Family management and organizational elements (project team, organization and new services) were the basic elements of the project. The goal of this paper is to present the first evaluation of this project. For instance, today, the families have the opportunity to visit the hospital before the first surgery. For the children, pain management and nutrition after surgery were adapted to state of the art knowledge. The evaluation also shows areas that need to be further developed in the future. The results emphasize, that the ANP-team projects with family management as core activity empowered the team members and led to an adaptation of nursing practices towards the needs of the families.

Experiences of parents with caring for their child after a cancer diagnosis.

Children and adolescents with cancer are increasingly treated and cared for at home; hospital stays are reduced to a minimum. Taking care of a sick child at home has an impact on the entire family: the sick child, the siblings, and the parents. This qualitative study examines the experiences of parents taking their child home for the first time after the diagnosis. Parents of 10 children newly diagnosed with cancer were interviewed twice around the time of the first discharge; data were analyzed using content analysis methodology. Findings illustrated parents' preparation of and experiences around their child's first discharge, the huge amount of new and changed tasks parents have to fulfill at home when caring for their child with cancer, and consequences for the parents. By providing individualized information and instruction, by having parents anticipate potential problems and solutions, and by describing available community support and integrating district nurses as well as other parents with the same experiences more frequently, health care professionals in the hospital can optimize discharge planning for these parents.