Role Development, Implementation and Evaluation of Nurse Practitioners (NUPRA)

Ghent University Hospital (UZ)

Status: Active, not recruiting

Conditions: Implementation Research; Quality of Care; Nurse Practitioners

Treatments: Other: Care provided by the Nurse Practitioner

Study type: Observational

Funder types: Other

Identifiers

NCT05520203

B6702021000046 (Other Identifier)

B6702021000685 (Other Identifier)

B6702021000300 (Other Identifier)

B6702021000479 (Other Identifier)

KW2196/DVE/001/001

Details and patient eligibility

About

Hospitals face new challenges in providing sustainable high quality care as the prevalence of chronic conditions, multimorbidity and the complexity of care increases. The high burden on healthcare teams, the growing costs and the increasing scarcity in healthcare providers (HCPs) result in unmet needs of patients and their families and a high workload on HCPs. Worldwide there is growing recognition that new care models integrating nurse practitioners (NPs) in interdisciplinary teams could contribute to respond to these challenges.

ANP is defined as an "advanced practice nurse (APN) who integrates clinical skills associated with nursing and medicine in order to assess, diagnose and manage patients in primary healthcare settings and acute care populations as well as ongoing care for populations with chronic illness".

Despite the proven benefits of integrating NPs in interdisciplinary teams, the introduction of NPs in Belgium is at an early stage. Advanced practice nurses, including NPs, are formally recognized in Belgium since 2019, but there is still no legal framework in which additional rights or agreements compared to other nursing groups are defined. Given the early stage of introduction, little is known about the development, implementation and impact of NPs in the Belgian health care context. Insights in implementation processes and the effectiveness of NP roles at different levels can inform healthcare managers and policy makers for future (nation-wide) implementation in a hospital setting.

The overall objective of this longitudinal pre-post mixed methods study is to develop, implement and evaluate the integration of the role of NPs in four different departments in a Belgian university hospital.

Full description

A mixed methods design is used to enrich the gathered data, resulting in an integrated approach for addressing the complexity of this study. This method creates the opportunity to triangulate and integrate quantitative and qualitative data resulting in a complete and nuanced understanding of complex phenomena . Several strategies are used to enhance the internal validity of the quantitative part. At first, all questionnaires that will be used will be validated and selected after thorough consideration of several researchers with experience in mixed methods implementation research. Secondly, using a wide range of outcome indicators, increases the ability to distinguish confounding from independent variables. Thirdly, if possible a matched controlled group will be used to compare outcomes. Internal validity of qualitative data will be ensured in the stage of data collection by involving researchers who did not participate in the PAR-process to conduct the interviews and focus group interviews. In the stage of data analysis, internal validity of the qualitative data will be enhanced by systematically organizing and coding data and triangulation (data and researcher). Analysis and comparison of the four different settings will reinforce the external validity and transferability of the findings.

Enrollment: 1,000 estimated patients

Sex: All

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion criteria

Patients/parents

Inclusion Criteria:

• Admitted on the participating ward (digestive surgery) or diagnosed stable liver cirrhosis or pediatric epilepsy
• Be conscious
• Speak Dutch

Exclusion Criteria:

• Dementia or other severe cognitive/mental disorders

Health care providers

Inclusion Criteria:

• Have at least three months of clinical experience on the ward
• Key stakeholders in the process of development, implementation and/or evaluation

Exclusion Criteria:

• No contact with the nurse practitioner
• Internship

Trial design

1,000 participants in 3 patient groups

Patient - cohort 1

Description:

Patients (and their parents) recruited before introduction of the NP

Treatment:

Other: Care provided by the Nurse Practitioner

Patient - cohort 2

Description:

Patients (and their parents) recruited after introduction of the NP

Treatment:

Other: Care provided by the Nurse Practitioner

Healthcare providers

Description:

Healthcare providers involved in the process of development, implementation and evaluation as well as all healthcare providers who come into close contact with the Nurse Practitioner

Treatment:

Other: Care provided by the Nurse Practitioner