Registered nurses in expanded roles improve care in nursing homes: Swiss perspective based on the modified Delphi method

• Published in: Journal of advanced nursing 2021-02, Vol.77 (2), p.742-754
• Main Authors: Basinska, Kornelia, Wellens, Nathalie I. H., Simon, Michael, Zeller, Andreas, Kressig, Reto W., Zúñiga, Franziska
• Format: Article
• Language: English
• Subjects: Advanced practice nurses; Aged; Clinical Competence; Clinical leadership; Clinical nursing; Competence; competencies; Delphi; Delphi method; Delphi Technique; Educational programs; expanded role; Health care; Humans; Leadership; Literature reviews; Medical personnel; model of care; Multicenter studies; nurse; Nurses; Nursing; Nursing care; Nursing Homes; Original Research: Empirical Research–Quantitative; outcomes; Quality of Health Care; RAND UCLA; Research Papers; Role models; Stakeholders; Switzerland; Teams
• ISSN: 0309-2402; 1365-2648
• DOI: 10.1111/jan.14644

Aim To define both competencies and envisaged outcomes for registered nurses in expanded roles in Swiss nursing homes to be implemented and evaluated within a new model of care. Background In regions where Advanced Practice Nurses are rare or absent, registered nurses take up clinical leadership and expanded roles. To allow effective implementation, monitoring and evaluation of these nurses, stakeholders need a shared understanding of the competencies they require and what outcomes they should achieve. Design RAND/UCLA Appropriateness Method – a modified Delphi method. Methods A critical literature review and case studies were conducted to identify possible competencies and outcomes for registered nurses in expanded roles. In 2017, a two‐round rating process and an in‐person panel discussion was completed by a group of multi‐professional stakeholders. Findings Two rounds generated 190 competencies and 72 outcomes relevant to registered nurses in expanded roles. Conclusion The relevant competencies and outcomes of registered nurses in expanded roles indicate their support for care teams and development of nursing care in nursing homes. Their geriatric expertise allows them to function as role models and innovators, reinforcing overall perceptions of nursing as a profession. These nurses are especially important in countries and settings where Advanced Practice Nurses are scarce or unavailable. Impact The identified competencies clarify the duties of expanded‐role registered nurses, thereby differentiating them from other care providers. Although conducted in the Swiss healthcare system, our methods and findings can be adapted to other healthcare settings. The results of this study will guide the development of an educational programme in a multi‐centre study to reduce avoidable hospitalizations, while the defined outcomes guide the evaluation of their impact. 目的 定义在瑞士养老院中,在新型护理模式下所实施并评估的,角色拓展的注册护士的能力和设想结果。 背景 在高级执业护士稀缺或缺乏的地区,注册护士充当了临床领导以及各种拓展的角色。为了能够有效实施、监测、评估这些护士,相关人员需要就他们所需的能力和应取得的结果达成共识。 设计 RAND/UCLA适当方法——改进的德尔菲法 方法 进行关键文献综述及个案研究,以识别注册护士的合理能力和结果,这些护士充当了各种拓展的角色。2017年,一组多专业的相关人员完成了两轮评分程序,并亲自参加了一场专题讨论会。 发现 两轮评分程序产生了190种能力和72种结果,均和充当了各种扩展角色的注册护士相关。 结论 充当各种扩展角色的注册护士,就其相关能力和结果而论,表明了他们在护理团队和养老院护理发展中的支撑作用。他们对老年人的专业知识使其成为榜样和创新者,巩固了护理作为一种职业的整体看法。在高级执业护士稀缺或缺乏的城市中,这些护士更为重要。 影响 这些能力可明确充当各种扩展角色的注册护士职责,将其区别于其他护理提供者。尽管是在瑞士医疗系统中进行,我们的方法和发现同样可适用于其他医疗环境。可利用本研究结果指导制定多中心研究的教育计划,减少可避免的住院治疗,并且,明确的结果将可适用于影响评估。