| 1. |
- Goemaes, Régine, et al.
(författare)
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Factors influencing the implementation of advanced midwife practitioners in healthcare settings : A qualitative study
- 2018
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Ingår i: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 66, s. 88-96
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore factors influencing the implementation of advanced midwife practitioner roles.DESIGN: Semi-structured individual face-to-face and focus group interviews were conducted. Data analysis was performed using the Framework Method.SETTING AND PARTICIPANTS: A purposive sample (n = 32) included chief nursing officers, middle managers, head midwives/nurses, primary care team leaders, midwives with and without advanced midwife practitioner roles, heads of midwifery educations, and obstetricians.FINDINGS: Budgetary constraints on a governmental and healthcare organizational level were mentioned as main barriers for role implementation. The current fee-for-service financing model of healthcare professionals was also seen as an impediment. Obstetricians considered the implementation of advanced midwife practitioner roles as a possible financial and professional threat. Documenting the added value of advanced midwife practitioner roles was regarded a prerequisite for gaining support to implement such roles. Healthcare managers' and midwives' attitudes towards these roles were considered essential. Participants warned against automatically transferring the concept of advanced practice nursing to midwifery. Although participants seldom discussed population healthcare needs as a driver for implementation, healthcare organizations' heightened focus on quality improvement and client safety was seen as an opportunity for implementation. University hospitals were perceived as pioneers regarding advanced midwife practitioner roles.KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Multiple factors influencing role implementation on a governmental, healthcare organizational, and workforce level illustrate the complexity of the implementation process, and highlight the need for a well-thought-out implementation plan involving all relevant stakeholders. Pilot projects for the implementation of advanced midwife practitioners in university hospitals might be useful.
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| 2. |
- Goemaes, Régine, et al.
(författare)
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Time use of advanced practice nurses in hospitals : A cross-sectional study
- 2019
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 75:12, s. 3588-3601
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To examine the use of time by advanced practice nurses and time use differences according to type of healthcare organization, work experience, and supervisor.DESIGN: A cross-sectional, observational study.METHODS: Non-participant observations were executed in Belgium (October 2015-January 2016). Time use was categorized in domains (patient/family, team, healthcare organization) and roles (clinical expert, educator/coach, change agent/innovator, researcher, leader, collaborator, and ethical decision-making facilitator). Proportional working time in domains and roles was calculated. Chi-squared tests identified differences in time use according to type of healthcare organization, number of years of work experience, and type of hierarchical/functional supervisor.RESULTS: Participants mainly devoted time to the patient/family domain (30.78%) and the clinical expert role (34.19%). The role of leader and ethical decision-making facilitator covered, respectively, 4.84% and 0.07% of participants' time. Time distribution in domains and roles differed between participants in university and peripheral hospitals.CONCLUSION: Activities were executed in all domains and roles, except for the ethical decision-making facilitator role. Further research could uncover barriers and facilitators for role execution, especially about leadership and ethical decision-making.IMPACT: Advanced practice nurses, supervisors and policymakers could act to optimize advanced practice nurses' scope of practice.
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| 3. |
- Goossens, Joline, et al.
(författare)
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Barriers and facilitators to the provision of preconception care by healthcare providers : A systematic review
- 2018
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Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 87, s. 113-130
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Healthcare providers play an important role in providing preconception care to women and men of childbearing age. Yet, the provision of preconception care by healthcare providers remains low.OBJECTIVES: To provide an overview of barriers and facilitators at multiple levels that influence the provision of preconception care by healthcare providers.DESIGN: A mixed-methods systematic review.DATA SOURCES: PubMed, Web of Science, CINAHL, The Cochrane Library, and EMBASE were systematically searched up to April 27, 2017. The search strategy contained MeSH terms and key words related to preconception care and healthcare providers. Reference lists of included studies and systematic reviews on preconception care were screened.REVIEW METHODS: Publications were eligible if they reported on barriers and facilitators influencing the provision of preconception care by healthcare providers. Data were extracted by two independent reviewers using a data extraction form. Barriers and facilitators were organized based on the social ecological model. The methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme Qualitative checklist for qualitative studies, the Quality Assessment Tool for quantitative studies, and the Mixed Methods Appraisal Tool for mixed methods studies.RESULTS: Thirty-one articles were included. Barriers were more reported than facilitators. These were situated at provider level (unfavourable attitude and lack of knowledge of preconception care, not working in the field of obstetrics and gynaecology, lack of clarity on the responsibility for providing preconception care) and client level (not contacting a healthcare provider in the preconception stage, negative attitude, and lack of knowledge of preconception care). Limited resources (lack of time, tools, guidelines, and reimbursement) were frequently reported at the organizational and societal level.CONCLUSIONS: Healthcare providers reported more barriers than facilitators to provide preconception care, which might explain why the provision of preconception care is low. To overcome the different client, provider, organizational, and societal barriers, it is necessary to develop and implement multilevel interventions.
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| 4. |
- Van Hecke, Ann, et al.
(författare)
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Leadership in nursing and midwifery : Activities and associated competencies of advanced practice nurses and midwives
- 2019
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Ingår i: Journal of Nursing Management. - : John Wiley & Sons. - 0966-0429 .- 1365-2834. ; 27:6, s. 1261-1274
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore the practice profile and competencies of advanced practice nurses (APNs) and midwives (AMPs), and factors associated with task non-execution.Background: Advanced practitioner roles are increasingly implemented internationally. Unofficial role introduction led to confusion regarding task performance. Studies examining associations between APNs'/AMPs' task performance and competency levels, and factors associated with task non-execution are lacking.Method: A cross-sectional study among APNs/AMPs in Flanders (Belgium) explored tasks and competencies in seven domains: clinical/professional leadership, change management/innovation, research, clinical expertise/guidance/coaching, consultation/consultancy, multidisciplinary cooperation/care coordination and ethical decision-making. Task performance and competency level frequencies were calculated. Regression analysis identified factors associated with task non-execution on domain/item level.Results: Participants (n = 63) executed tasks in all domains. Task non-execution related to research and clinical expertise was associated with work setting; task non-execution regarding care coordination and ethical decision-making was associated with competency perception. Several tasks were performed by few APNs/AMPs despite many feeling competent. Five of ten tasks performed by fewest participants belonged to the leadership domain.Conclusion and implications for nursing and midwifery management: Supervisors could play an important part in APNs'/AMPs' role development, especially regarding leadership and tasks executed by few participants. Future studies should provide in-depth knowledge on task non-execution.
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