Nienke Bleijenberg

Aim: To explore how Advanced Nurse Practitioners (ANPs) perceive and enact their role in community care and to provide insights into their role as described from their own views and experiences. Design: A qualitative, descriptive study. Methods: Online focus group discussions. Quotations were coded inductively and categorized by group codes to account for meanings in answers, fragments and words. Group codes were grouped into themes. Results: 27 Advanced Nurse Practitioners participated. Various role‐related themes were identified, including one main role: the Hybrid Professional, who acts as a liaison by utilizing network‐based competencies and combining competencies from the nursing and medical domains. Conclusion: Advanced Nurse Practitioners primarily work within their own practice setting, fulfilling various roles in community healthcare that align with the CanMEDS roles used in nursing and medical education. The combination of the nursing and medical domains yields a distinct level of performance, which defines the Advanced Nurse Practitioner domain in community healthcare. Owing to the diversity in role fulfilment among Advanced Nurse Practitioners and the absence of a unified vision, job crafting requires further elaboration and refinement. Implications for the Profession and Patient Care: Advanced Nurse Practitioners working in community healthcare settings are hybrid professionals who act as liaisons, combining aspects of both the nursing and medical domains. The results of this study will impact Advanced Nurse Practitioners in community care, supporting their network‐based competence, empowering job crafting and enhancing their role positioning. A shared international understanding and a unified vision of the Advanced Nurse Practitioner role, along with its alignment with other healthcare professionals, are essential for situating the role within a broad interprofessional context. Reporting Method: The COREQ checklist was used for reporting. Patient or Public Involvement: This study did not include patient or public involvement in its design, conduct or reporting.

The number of persons aged 65 and above is expected to rise sharply, accompanied by an increase in the proportion of older persons experiencing physical functioning problems. In 2023, 20.2% of the ...

The desire of older adults to remain in their homes despite health challenges, as well as the aging population and rising health care costs, has prompted a shift from institutional care to home-based care. This change places district nurses at the forefront of supporting older adults’ independent functioning. However, limited evidence exists on effective interventions by district nurses and using routine patient care data to enhance independence. To address this, a user-centered design approach was applied to develop and validate a dashboard providing district nurses with actionable insights to improve care quality and promote independence. The process followed a 4-phase iterative framework: user and domain analysis through focus groups and interviews, data preparation with anonymized patient data sets, dashboard prototyping, and evaluation through feedback from nurses and IT specialists. Iterative end-user involvement with district nurses, nursing assistants, researchers, and managers ensured relevance and usability. The final prototype includes functionalities for monitoring changes over time and linking problems to practical aids and intervention targets. The dashboard, tailored for district nurses, provides a tool to monitor and improve the independent functioning of older adults. Future research will evaluate the dashboard’s impact on nursing interventions and its effectiveness in enhancing independent functioning.

Background: Culture shapes care delivery, professional communication, and the development of trust between patients and providers. Culture encompasses identifiable elements, shared values and beliefs, and underlying assumptions that shape behaviour. The Emergency Department (ED) subculture arises from its complex, high-pressure focus on acute illness. ED professionals increasingly encounter older patients with frailty, whose complex but often non-urgent needs require more holistic, individualised care. However, the ED subculture may hinder the provision of appropriate geriatric emergency care. Despite its relevance, little is known of the influence of the ED subculture on the care for older patients. This study provides insight into the ED subculture in relation to the care of older patients with frailty by exploring its visible elements, shared values and beliefs, and underlying assumptions that shape behaviour. Methods: A qualitative, micro-ethnographic study was performed. Data were collected through topic-guided observations of ED professionals over twelve days, followed by interviews. Ethnographic methods were used to analyse the data, with iterative cycles of collection and analysis. Results: The themes ‘ Equality and professional solidarity as drivers of care delivery ’, and ‘ Responsibility and compassion in navigating the misalignment between emergency care and the needs of older patients with frailty ’ describe the ED subculture in relation to the care of older patients with frailty. The ED is highly structured, efficiency-driven, and professionals believe in equal care to all patients through responsibility and teamwork. Stabilising acute illness is prioritised during the initial assessment; other needs are considered once patients are stable or assertive. Professionals believe the ED is intended for acute problems; non-acute referrals of older patients are considered inappropriate. However, they value a strong moral responsibility, navigating between emergency care priorities and the needs of older adults with frailty. Conclusions: The ED subculture prioritises efficient, protocol-driven care and equal care for all patients, creating a challenge for delivering holistic, patient-centred care to older adults with frailty. Improving education and communication and integrating biopsychosocial principles into emergency care are essential. The ED subculture must be considered when developing and implementing future interventions to improve emergency care for older patients.

To implement state-of-the-art interventions that have the highest likelihood of being effective in their specific context, much effort should be concentrated on improving the development of evidence-based complex interventions in healthcare. Despite this, a misfit between a newly developed intervention and the implementation context can easily occur, often resulting in sub-optimal effectiveness. Therefore, it is crucial to address key uncertainties and questions during the development of complex interventions. This chapter focuses on the key uncertainties and related questions most closely associated with the implementation context: problem identification, needs analyses among care receivers and professionals, and current practice analysis. We describe how these uncertainties and questions can be addressed.

The aging population presents challenges for healthcare, particularly in maintaining the functional independence of older adults. The Decision Support Tool for Functional Independence was developed to identify declines in functional independence and promote collaboration between healthcare professionals. The DST-FI is specifically designed to support interprofessional collaboration between medical and social care providers, such as GPs, physiotherapists, nurses, and social workers. This study examines the barriers and facilitators to implementing the tool in primary care. This study was conducted in the Netherlands and included thirteen healthcare professionals—general practitioners, physiotherapists, practice nurses, community nurses, occupational therapists, and social workers—as well as two focus groups with older adults. The study was guided by the Consolidated Framework for Implementation Research (CFIR). A combination of deductive and inductive thematic analysis was used to identify and explore barriers and facilitators to implementation. Key facilitators included the tool’s potential to enhance collaboration, support informed decision-making, and address societal pressures related to aging. However, four main barriers emerged: limited applicability for specific client groups (e.g., individuals with cognitive impairments or low health literacy), time constraints, issues of ownership among stakeholders, and challenges in preventive outreach. The diversity and complexity of factors influencing the implementation of the Decision Support Tool for Functional Independence highlight the need for multifaceted, tailored strategies. Future research should focus on developing customized approaches to overcome identified barriers, exploring adaptations for a broader audience, and determining the appropriate healthcare professionals for the tool’s practical application. The potential of the tool to foster interprofessional collaboration between general practitioners, physiotherapists, nurses, and social workers. and alleviate societal challenges, emphasizing its relevance in primary care.

The increasing complexity of healthcare needs driven by an ageing population places pressure on district nursing care. Many vulnerable older adults prefer to remain at home, requiring care coordinated with general practitioners and other professionals. This demand for integrated care is further challenged by a shortage of nursing professionals and the lack of standardised approaches to measure care quality. This article identifies the key requirements for implementing a learning healthcare system in district nursing care, using patient outcome data to foster continuous improvement and create a more adaptive, evidence-based, and patient-centred approach. This paper synthesises findings from multiple studies conducted as part of a PhD thesis, utilising a multi-method approach. These methods include examining patient outcomes in district nursing care and evaluating necessary cultural, organisational, and financial changes. Four key requirements were identified: (1) standardising patient outcome measures; (2) fostering a data-driven culture and strengthening professional autonomy; (3) enhancing organisational support and integrated care; and (4) adopting financing models that incentivise continuous learning and quality improvement. Implementing a learning healthcare system with patient outcome data in district nursing care requires a transformative shift. Standardising outcome measures, investing in information systems, and promoting continuous learning are crucial. Aligning financial incentives with patient outcomes, strengthening professional autonomy, and enhancing organisational support can make district nursing more responsive and capable of meeting complex needs. The described requirements are essential for advancing district nursing care through a more adaptive, evidence-based, and patient-centred approach.

Aim and Objectives: To provide an in‐depth insight into the barriers, facilitators and needs of district nurses and nurse assistants on using patient outcomes in district nursing care.Background: As healthcare demands grow, particularly in district nursing, there is a significant need to understand how to systematically measure and improve patient outcomes in this setting. Further investigation is needed to identify the barriers and facilitators for effective implementation.Design: A multi‐method qualitative study.Methods: Open‐ended questions of a survey study (N = 132) were supplemented with in‐depth online focus group interviews involving district nurses and nurse assistants (N = 26) in the Netherlands. Data were analysed using thematic analysis.Results: Different barriers, facilitators and needs were identified and compiled into 16 preconditions for using outcomes in district nursing care. These preconditions were summarised into six overarching themes: follow the steps of a learning healthcare system; provide patient‐centred care; promote the professional's autonomy, attitude, knowledge and skills; enhance shared responsibility and collaborations within and outside organisational boundaries; prioritise and invest in the use of outcomes; and boost the unity and appreciation for district nursing care.Conclusions: The preconditions identified in this study are crucial for nurses, care providers, policymakers and payers in implementing the use of patient outcomes in district nursing practice. Further exploration of appropriate strategies is necessary for a successful implementation.Relevance to clinical practice: This study represents a significant step towards implementing the use of patient outcomes in district nursing care. While most research has focused on hospitals and general practitioner settings, this study focuses on the needs for district nursing care. By identifying 16 key preconditions across themes such as patient‐centred care, professional autonomy and unity, the findings offer valuable guidance for integrating a learning healthcare system that prioritises the measurement and continuous improvement of patient outcomes in district nursing.Reporting Method: Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.Patient of Public Contribution: No patient or public contribution.

Needs assessment is the starting point of good home care as it determines which care is necessary, based on the needs of patients, their personal situation, and social context. There are indications that practice variation in needs assessment exists among home care nurses. However, little is known about potential explanations for this variation. Therefore, we explored potential explanations for practice variation in other areas and examined whether these explanations can be applied to explain variation in needs assessment in home care nursing. We conducted a scoping review of the literature on practice variation in (1) needs assessment in home care nursing, (2) home care nursing in general, and (3) medical care in general, with searches in PubMed and CINAHL. We assessed over 6,000 references. Ultimately, 386 studies were included. Explanations for practice variation were grouped into micro, meso and macro level. This scoping review provided insight into a wide variety of variables that might play a role in explaining practice variation in (needs assessment in) home care nursing, such as availability of guidelines, organisational culture, team norms, resources, and preferences of patients. However, the small literature on needs assessment by home care nurses devoted more attention to patients and their social context, compared to the literature on practice variation in general. We discuss how and to what extent these variables could relate to practice variation in (needs assessment in) home care nursing. Future research should empirically examine the role of these variables in explaining the observed practice variation.