Framework for Evaluating the Impact of Advanced Practice Nursing Roles.

PURPOSE: To address the gap in evidence-based information required to support the development of advanced practice nursing (APN) roles in Switzerland, stakeholders identified the need for guidance to generate strategic evaluation data. This article describes an evaluation framework developed to inform decisions about the effective utilization of APN roles across the country. APPROACH: A participatory approach was used by an international group of stakeholders. Published literature and an evidenced-based framework for introducing APN roles were analyzed and applied to define the purpose, target audiences, and essential elements of the evaluation framework. Through subsequent meetings and review by an expert panel, the framework was developed and refined. FINDINGS: A framework to evaluate different types of APN roles as they evolve to meet dynamic population health, practice setting, and health system needs was created. It includes a matrix of key concepts to guide evaluations across three stages of APN role development: introduction, implementation, and long-term sustainability. For each stage, evaluation objectives and questions examining APN role structures, processes, and outcomes from different perspectives (e.g., patients, providers, managers, policy-makers) were identified. CONCLUSIONS: A practical, robust framework based on well-established evaluation concepts and current understanding of APN roles can be used to conduct systematic evaluations. CLINICAL RELEVANCE: The evaluation framework is sufficiently generic to allow application in developed countries globally, both for evaluation as well as research purposes.

Early education and counselling of patients with acute coronary syndrome. A pilot study for a randomized controlled trial.

BACKGROUND: At time of discharge, patients with acute coronary syndrome often have a knowledge deficit regarding their disease, further treatment and necessary behavioural changes. It is well known that self-efficacy as a prerequisite for behavioural changes can be influenced by patient education. This study investigated whether an individualized education programme starting early in the cardiac care unit enhanced self-efficacy and rehabilitation programme attendance, and was feasible and satisfying for patients. METHODS AND DESIGN: In a pilot randomized controlled trial, 40 patients with acute coronary syndrome were enrolled. The intervention group received in addition to standard care an early individual needs-oriented educational session in the cardiac care unit and subsequently one on the ward addressing risk factors, medication and self-management as well as referral to a rehabilitation programme by a nurse. Self-efficacy was assessed twice, at attendance in a rehabilitation programme six weeks after discharge. The participants' satisfaction with the intervention was assessed qualitatively. RESULTS: When controlling for anxiety and depression, the intervention group showed significant better self-efficacy scores on the ability to control the symptoms (p=0.034). When controlling additionally for age, no significant differences could be detected. The attendance of a rehabilitation programme was higher in the intervention group. The participants in the intervention group reported high satisfaction with the early education. CONCLUSION: Early education seems to benefit patients with acute coronary syndrome. In light of increased confidence to control one's symptoms and the higher attendance in rehabilitation programmes, as well as a high satisfaction with the intervention, a full powered study will be pursued.

[Needs-oriented education for patients with acute coronary syndrome]. / Individualisierte Schulung und Beratung auf der Intensivpflegestation bei Patienten mit akutem Koronarsyndrom: Ein Pilotprojekt zur Forschungsanwendung.

Information regarding disease and therapy are provided to patients with acute coronary syndrome in the early phase of hospitalisation, often only based on individual preferences of each healthcare professional. Patients' information needs are not systematically assessed and therefore the individual information needs of the patient are unknown. In a pilot project at a cardiology care unit (CCU) of a university hospital, the information needs of acute coronary syndrome patients were systematically assessed with the Cardiac Patient Learning Needs Inventory (CPLNI) and an education and counselling session was provided to the patients. The project was evaluated by investigating patients' assessment of the questionnaire, patients' satisfaction with the education and patients' perceived subjective increase of knowledge. For analysis descriptive statistics and content analysis were used. Five women and five men with acute coronary syndrome participated in the pilot study. The results showed that the patients could indicate their information needs. The interviewed patient's reported an increase in their knowledge about cardiac disease and self management, and a high level of satisfaction with the intervention. Based on these positives results we suggest an early systematic assessment of information needs and an individualised education for patients with acute coronary syndrome in cardiology care units.