Schwingrouber Jocelyn, Bryant-Lukosius Denise, Kilpatrick Kelley, Mayen Sandrine, Colson Sébastien
Faculté des Sciences Médicales et Paramédicales, Nursing School, CEReSS, Aix-Marseille Université, Marseille, France.
Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
J Adv Nurs. 2024 Mar;80(3):977-992. doi: 10.1111/jan.15840. Epub 2023 Sep 1.
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.
A multiple case study was conducted.
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.
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.
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.
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.
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.
The study reporting followed the Consolidated Criteria for Reporting Qualitative Research.
No Patient or Public Contribution.
本研究的目的是描述引入高级实践护理角色所采用的流程以及促进或阻碍角色实施的因素，考察高级实践护士（APN）在角色活动上花费的时间以及这些活动与高级实践护理领域的关系，并考察实施流程如何影响APN在医疗团队中的融入。
进行了一项多案例研究。
纳入了五个案例，代表法国批准开展高级实践护理的四个人口区域。2021年1月至3月期间，采用观察、访谈和文献分析方法收集数据。使用主题分析法对数据进行分析。
参与者包括APN（n = 5）、护士/专职医疗人员（n = 5）、医生（n = 5）、管理人员（n = 4）和决策者（n = 4）。决策者、管理人员、医生和APN提供的利益相关者参与和领导力促进了角色实施。利益相关者对角色的理解不足、角色资金不确定以及新冠疫情阻碍了角色实施。APN在临床活动上花费的时间最多。参与者认为APN融入医疗团队及其对患者护理的影响是积极的。
利益相关者参与以及组织和APN的领导力促进了这些角色的实施，尤其是与基于团队的患者护理相关的角色。需要进一步努力加强APN参与非临床活动并消除角色障碍。
需要采取系统和全系统的方法来提高APN的角色清晰度、角色自主性和在卫生系统中的融入度。研究应考察法国患者对APN的看法。
研究结果凸显了政策如何能够为法国高级实践护理角色的实施创造有利条件。国际上，本研究提醒APN和护士领导者注意实施评估的策略及重要性，以支持高级实践护理角色的最佳发展。
本研究报告遵循了定性研究报告的统一标准。
无患者或公众贡献。
