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To investigate factors influencing the implementation of advanced practice nursing roles within healthcare organisations in seven European countries from the perspective of advanced practice nurses.
A cross-sectional survey was conducted between September 2021 and December 2022, involving advanced practice nurses from Belgium, Finland, Germany, Iceland, Ireland, Spain and the Netherlands. The countries were selected to represent different stages of implementing advanced practice nursing roles, from emerging to well-established.
A self-administered questionnaire was used to address five domains: patient care, practice patterns, policy and legal, educational and workforce-related factors. Descriptive statistics, chi-squared tests and correspondence analysis were employed to identify patterns and country-specific differences across these domains of implementation factors.
A total of 491 advanced practice nurses participated in the study. While almost three-quarters of the participants indicated satisfaction with their job, the study highlighted multifaceted factors influencing the implementation of advanced practice nursing roles across countries. The Netherlands, Ireland and Belgium reported mainly facilitators, whereas Finland, Iceland and Germany noted barriers or a lack of knowledge. Spain mostly reported neutral or moderate positions. Key challenges included role ambiguity, interprofessional collaboration gaps, limited managerial support, workload imbalances, limited mentorship and underutilised competencies. Results also indicated that advanced practice nurses are partially hindered by operating in isolation from other professions.
The findings emphasise the need for robust organisational support, interprofessional collaboration and clear role definitions to facilitate the integration of advanced practice nursing roles. Addressing professional isolation through networking and mentorship is crucial to sustaining the advanced practice nursing workforce.
Policy should prioritise support for advanced practice nursing, including structured mentoring and networking opportunities. Further research on advanced practice nurses' well-being and long-term role sustainability in Europe is recommended.
What problem did the study address? What were the main findings? Where and on whom will the research have an impact?
This study reported factors influencing advanced practice nurse role implementation across seven European countries with different levels of role development. Key challenges included role ambiguity, interprofessional collaboration gaps and limited support. The findings can guide healthcare managers and policymakers on the key factors to consider when integrating advanced practice nursing roles into their teams.
To measure the outcome of the implementation of a multifaceted educational intervention on the impact of moral distress among critical care nurses.
The complex nature of critical care settings exaggerates different morally distressing situations that require ongoing development of interventions to mitigate the impact of moral distress. Despite the availability of research that has addressed moral distress among nurses in the literature, there is a debate about the effectiveness of the applied interventions in reducing moral distress.
A quasi-experimental pretest-posttest control group study design.
Critical care nurses in two public hospitals in the Emirate of Abu Dhabi, UAE enrolled in a study that extended over 6 months. Hospital A was assigned as an experimental group (n = 76) and received four educational sessions and three booster sessions. Hospital B was assigned as a control group (n = 82) and didn't receive any moral distress-related education. The Measure of Moral Distress for Health Care Professionals questionnaire and the Moral Distress Thermometer were utilised to measure the participants' moral distress frequency, intensity, and composite scores pre- and post-intervention and identify the outcomes.
The multifaceted educational intervention exhibited statistically significant reductions in the experimental group frequency, intensity, and composite moral distress scores post-test. Conversely, moral distress scores were increased among the control group. Moreover, the intervention significantly reduced the number of nurses who intended to leave their positions from 58 nurses to 47 nurses in the experimental group.
The multifaceted educational intervention exerts positive outcomes in reducing moral distress across all the dimensions and improving the nurses' retention.
The intervention provides materials that could enhance the nurses' moral knowledge and skills. It provides different tools, techniques, and strategies to help the nurses address and manage their moral distress.
To explore the priorities of women mothering children in the context of intimate partner violence and to understand what shapes those priorities.
A qualitative study using interpretive description, informed by Feminist Intersectionality adhering to the COREQ guidelines.
Thematic analysis was used to analyse the data.
Dialogic, semi-structured interviews were conducted with a community sample of 20 adult Canadian women who were mothering dependent children (under 18 years) in the context of recent intimate partner violence from a current or former partner.
Women's main priorities focused on their own and their children's well-being and creating stability related to housing and finances. Three themes identified: it's all about the kids; my safety…totally disregarded; and I have to take care of him. Multiple external factors (coercive control, structural inequities, assumptions about mothering) shape priorities and the tensions arising from competing priorities women felt compelled to address simultaneously.
Priorities of women mothering in the context of intimate partner violence are complex, shaped not only by what they want but by the limited options available to them given constraints such as income, employment, housing and service responses. Coercive control, structural inequities and assumptions about mothering are important factors influencing mothers' priorities and experiences. Better understanding mothers' priorities can support better tailored policies, services and nursing practice.
Structural inequities that negatively impact health and well-being by limiting access to resources and the supports needed to enhance health can be better recognized and addressed through a trauma and violence informed care approach.
This study addressed understanding the priorities of women mothering in the context of intimate partner violence. This research will impact women mothering in the context of intimate partner violence who receive care from nurses and other providers as well as those who provide care.
This study adhered to relevant EQUATOR guidelines (the COREQ checklist).
The women who took part in the interviews for this study did not participate in the study design, analysis or manuscript preparation.
The exploration of conceptual equivalence within the process of the cross-cultural adaptation of tools is usually neglected as it generally assumed that the theoretical construct of a tool is conceptualized in the same way in both the original and target culture. This article attempts to throw light on the contribution of the evaluation of conceptual equivalence to the process of adaptation, and for tool development. To illustrate this premise, the example of the cross-cultural adaptation of the Patients' Perception of Feeling Known by their Nurses (PPFKN) Scale is presented.
An adapted version of the Sousa and Rojjanasrirat (Journal of Evaluation in Clinical Practice, 2011, 17(2), 268–274) guidelines was used to translate and culturally adapt the PPFKN Scale to Spanish language and culture. A qualitative descriptive study was added to the traditional process of translation and pilot study to explore the concept in the target culture and recognize conceptual equivalence.
Experts in the tool concept, bilingual translators and the author of the tool participated in the translation of the original tool into Spanish. A pilot study of the Spanish version with a sample of 44 patients and a panel of six experts from different fields evaluated its clarity and relevance. In addition, seven patients participated in a descriptive qualitative study using semi-structured individual interviews to explore the phenomenon in the new culture. A content analysis following the Miles, Huberman & Saldaña (Qualitative data analysis, a methods sourcebook, 2014) approach was used to analyze qualitative data.
The cross-cultural translation and adaptation of the PPFKN scale into Spanish required a thorough revision. More than half of the items needed discussions to reach consensus regarding the most appropriate Spanish term. In addition, the study confirmed the four attributes of the concept identified in the American context and allowed for new insights within those attributes to appear. Those aspects reflected characteristics of the phenomenon of being known in the Spanish context and were added to the tool in the format of 10 new items.
A comprehensive cross-cultural adaptation of tools should incorporate, together with the study of linguistic and semantic equivalence, the analysis of the conceptual equivalence of the phenomenon in both contexts. The identification, acknowledgment and study of the conceptual differences between two cultures in relation to a phenomenon becomes an opportunity for deeper study of the phenomenon in both cultures, for understanding of their richness and depth, and for the proposal of changes that may enhance the content validity of the tool.
The evaluation of conceptual equivalence of tools within the process of cross-cultural adaptation will make it possible for target cultures to rely on tools both theoretically sound and significant. Specifically, the cross-cultural adaptation of the PPFKN scale has facilitated the design of a Spanish version of the tool that is linguistically, semantically and theoretically congruent with Spanish culture. The PPFKN Scale is a powerful indicator that evidences nursing care contribution to the patient's experience.
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