Anneke J. A. H. van Vught

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.

Background: Older adults with frailty are at high risk of adverse outcomes during hospitalisation. To address this, two Acute Geriatric Community Hospitals (AGCH1 and AGCH2) were established in the Netherlands. This study examined similarities and differences in setting, staffing, care pathways, patient populations, outcomes, and improvement opportunities in the first quarter of 2024.Methods: We conducted a mixed-methods evaluation using questionnaires (n = 2), documents (n = 10), case vignettes (n = 20), case vignette surveys (n = 7), and focus groups (n = 2). Quantitative data on patients admitted between January 1 and March 31, 2024, (n = 161) were collected in aggregated form via the questionnaires and analysed descriptively; qualitative data were analysed thematically.Results: Both sites implemented the core model elements but varied in setting and staffing. Patients showed high multimorbidity with respiratory conditions and infections as common diagnoses. Across ten case vignettes per AGCH, experts reported variation in referral appropriateness. Mean length of stay was shorter at AGCH2 (9.0 vs. 12.5 days), while less patients were discharged home (51.7% vs. 70.3%). Focus groups highlighted seven improvement areas: referral, expectation management, discharge planning, IT integration, funding, and evening/night/weekend care.Conclusions: The two AGCHs appeared to have largely similar care pathways, patient populations, and improvement opportunities, but differed in context, staffing, and outcomes. Sustainable implementation requires continuous learning, clear referral pathways, and skill mix review; national scale-up demands effectiveness studies, role delineation, and defining core versus adaptable model elements.

Headaches cause high disease burden, and are often under-treated. Adequate treatment requires time and expertise, which can be limited in general practices

Background: Integrated Acute Care for Older People (IACOP) close to home is a promising approach to overcome care fragmentation, but little is know about effective meso- and macro-strategies to foster integration. This Realist Evaluation (RE) explores which strategies were employed and recommended in nine Dutch regional partnerships. Methods: The Rainbow Model, RE-theory, Coleman’s boat and ripple effects functioned as theoretical basis. We conducted a document analysis (n = 19), semi-structured interviews (n = 11) and two focus groups (n = 8). Participants were (project) managers, directors and experts. The qualitative data were clustered into guiding principles, underpinned with strategy-context-mechanism-outcome configurations. Results: Six guiding principles for transformation towards IACOP close to home emerged. Meso-level principles included: 1) committing to a shared regional IACOP vision and goals; 2) fostering a culture of collaborative and coordinated action; 3) prioritising, implementing and developing micro-level interventions systematically. Macro-level principles were: 4) ensuring congruent policy; 5) stimulating functional integration and 6) stimulating normative integration. Conclusions: Transforming towards IACOP close to home is complex and requires continuous action across integration levels, health practices and sectors. The meso-level principles guide regional partnerships in applying context-specific strategies; activating the underlying mechanisms for transformation like ‘enjoying the process’. Yet, successful transformation also hinges on actions by system stakeholders.

Objective Insights about what actions contributed to the development of an interprofessional learning and working culture were lacking for nursing homes. This study aimed to provide insight into the context and actions that trigger mechanisms for the development of an interprofessional learning and working culture in nursing homes. Study design Realist evaluation action research was conducted from 2019 to 2023. Setting and participants 11 teams in 6 Dutch nursing homes. Primary and secondary outcome measures Questionnaires, focus group interviews and observations were used to identify actions, context factors and mechanisms. We used retroductive analysis to discuss how actions were related to the development of the culture. Actions were evaluated in terms of context and manner in which they contribute to the development. Results 21 actions were identified and clustered into two themes. Theme 1: improving person-centred care. Actions activated the mechanisms of critical reflective behaviour and collective ownership in a context of, among other things, clear roles and tasks, a stable and competent team, the presence of case managers and facilitating organisational factors such as time for reflection. Theme 2: getting to know and understand each other’s expertise. Actions activated respectful relationships, collective ownership of goals and feeling appreciated for your work in a context of, among other things, team members who meet regularly and management supporting interprofessional working. Conclusions This research sheds light on how and in what manner-specific actions contribute to the development of an interprofessional learning and working culture in nursing homes. Depending on the context, the actions triggered the following mechanisms: critical reflective behaviour, collective ownership of goals, respectful/caring relationships and feeling appreciated for your work. These mechanisms are the underlying drivers of an interprofessional learning and working culture. This study provides valuable guidance for fostering collaborative and effective interprofessional dynamics in nursing homes.

Transformation of healthcare is necessary to ensure patients receive high-quality care. Working with the evidence-based practice (EBP) principles enables nurses to make this shift. Although working according to these principles is becoming more common, nurses base their actions too much on traditions and intuition. Therefore, to promote EBP in nursing practice and improve related education, more insight into nurses' needs is necessary to overcome existing EBP barriers. To identify the current needs to work with EBP principles among hospital and community care nurses and student nurses. A qualitative, exploratory approach with focus group discussions. Data was collected between February and December 2020 through 5 focus group discussions with 25 nurses and student nurses from a hospital, a community care organisation, and nursing education schools (bachelor and vocational). Data were analysed using reflexive thematic analysis, and the main themes were synchronised to the seven domains from the Tailored Implementation for Chronic Diseases (TICD) checklist. Nurses and student nurses experience EBP as complex and require more EBP knowledge and reliable, ready-to-use evidence. They wanted to be facilitated in access to evidence, the opportunity to share insights with colleagues and more time to work on EBP. The fulfilment of these needs serves to enhance motivation to engage with evidence-based practice (EBP), facilitate personal development, and empower nurses and student nurses to take more leadership in working according to EBP principles and improve healthcare delivery. Nurses experience difficulties applying EBP principles and need support with their implementation. Nurses' and student nurses' needs include obtaining more EBP knowledge and access to tailored and ready-to-use information. They also indicated the need for role models, autonomy, incentives, dedicated time, and incorporation of EBP in daily work practice.

Background: Psychiatric-mental health nurse practitioners (PMHNPs) in the Netherlands have been allowed to perform the role of coordinating practitioner (CP) since 2018. This role is reserved for mental health care specialists who are trained and qualified at the master's degree level. Earlier studies have not addressed how PMHNPs perform that role and what mechanisms and contextual factors determine their performance. This understanding could help optimize their performance in this role and promote effective deployment of PMHNPs in mental health care. Purpose: To understand how PMHNPs perform this role and what mechanisms and contextual factors underlie that performance. Methodology: A multiple case study involving PMHNPs who work in various settings as CPs. Data were collected and analyzed using the realistic evaluation approach. Results: We identified four mechanisms related to the performance of PMHNPs in the role of CP: (1) autonomous performance; (2) unique expertise; (3) accessibility, availability, and professional involvement; and (4) additional roles. The extent to which these mechanisms are present is largely determined by organizational factors, team factors, and individual factors. Conclusions: Psychiatric-mental health nurse practitioners are seeking to identify and interpret the role of CP. This study helps to elucidate the mechanism of role performance by PMHNPs and what they should focus on to deliver effective and patient-centered mental health care. Implications: Policymakers, health care professionals, and educators should consider the mechanisms and contextual factors to facilitate and support PMHNPs' employment and training in the role of CP.

The objective of this rapid scoping review is to provide an overview of studies from northwest Europe that describe and evaluate community care delivered by a nurse practitioner (NP) in a team of healthcare professionals. In particular, we explore the roles of NPs within community care, the perceived impact at the patient and informal caregivers levels, and influencing factors (facilitating and impeding). This rapid scoping review was performed in accordance with Prisma RR guidelines. Data were collected from online databases between October and December 2020 and an update in March 2023. Medline was used for the search string, and the following databases were searched: Cinahl, Cochrane, Embase, Medline, and Web of Science (WoS). All studies described the roles of NPs, including their tasks and responsibilities in community care. The main findings about the roles were that NPs in community care diagnose, treat patients, and support and advise informal caregivers. They refer and perform case management for (frail) older people. They train DNs and take on project and strategic management roles. The results showed that the NP meets the increasing and complex care demands in patients’ homes. The main findings about the perceived impacts were that patients and informal caregivers were generally satisfied with the deployment of the NP. Healthcare professionals experienced the benefits of NPs working in community care. Some healthcare professionals were sceptical when the role was first introduced, but attitudes improved after they worked alongside NPs. Other influencing factors were the competences of the NP, i.e., have a pioneering mentality, a clear vision, and a job profile from community care organisations, and having to collaborate with allied healthcare professionals. However, implementation of the NP in community care is still in its infancy in northwest Europe. This review will help policy makers and professionals understand the potential impact of this role and enhance it in the context of community care.

Background: Previous studies in somatic health care revealed that patients find nurse practitioners reliable, helpful, and empathic and feel empowered, at peace, and in control when cared for by nurse practitioners (NPs). Only one study so far considered what value people with severe mental illness (SMI) attached to treatment by a psychiatric mental health nurse practitioner (PMHNP). Purpose: To explore what meaning people with SMI associate with the care provided by a PMHNP. Methodology: A qualitative study from a phenomenological perspective was conducted, in which 32 people with SMI were interviewed. Data were analyzed using Colaizzi's seven-step method and the metaphor identification procedure (MIP). Results: Eight fundamental themes emerged: (1) impact of the PMHNP on well-being, (2) feeling connected with, and (3) acknowledged by the PMHNP; (4) the PMHNP's care (not) needed; (5) perception of the PMHNP as a person; (6) shared decision-making; (7) PMHNP's expertise; and (8) flexibility of contact with the PMHNP. MIP analysis revealed six metaphors: PMHNP is a travel aid, means trust, is a combat unit, means hope, is an exhaust valve, and a helpdesk/encyclopedia. Conclusions: The interviewees highly appreciated the treatment and support by the PMHNP for the impact on their well-being. Thanks to the connection with and recognition by the PMHNP, they felt empowered, human, and understood. Challenged by the PMHNP, they focused on possibilities to strengthen self-confidence and self-acceptance. Implications: For further positioning of and education for PMHNPs, it is recommended to consider the meaning people with SMI associate with treatment and support by a PMHNP.

Introduction Healthcare is changing due to the ageing of the general population, complex care demands and growing attention to person-centred care. To deal with these changes and provide the best possible person-centred care, the different professionals in nursing homes should all collaborate intensively. However, most professionals work within the field of their own expertise and share very little knowledge, experiences and insights. A lack of an interprofessional learning and working culture also prevents professionals with different expertise from working and learning intensively together to achieve high-quality person-centred care. There is a gap of knowledge about how to develop such a culture. Our aim is to provide insights into what actions, in what context and to what extent can contribute to an impactful development of an interprofessional learning and working culture. Methods and analysis The realist action research design will be applied. It consists of three iterative steps: plan, act and observe, and reflect. First, we will formulate the theory about interprofessional learning and working culture and measure this culture by means of interviews, focus groups and questionnaires. Second, we will apply the nine principles of Practice Development to coach professionals from six Dutch nursing homes to improve their interprofessional learning and working culture. Finally, we will evaluate the impact of the changed attitudes and skills on healthcare practice. Ethics and dissemination Approval for the project was given by the Hogeschool van Arnhem en Nijmegen (HAN) Research Ethics Committee, the Netherlands, registration number EACO 164.12/19. All organisations, professionals and residents/family members will be informed verbally and by letter about the study and asked for informed consent. The results will be presented in peer-reviewed scientific journals, professional journals and at symposia and conferences. The findings will be transferred to an online toolbox and e-learning modules for graduated professionals and students.