Barriers and Facilitators
Seen as a facilitator of APN role implementation, these individuals should receive information about the APN role and have an opportunity to clarify role expectations.
Stakeholders
In this step, each stage of framework may be revisited.
Step 9/Long-term monitoring of the APN role and Model of Care
General consensus is that APNs require this level of education.
Graduate level education
This model of care is potentially of value for outpatient delivery of palliative care.
Telehealth
Inadequate infrastructure and resources is reported as a barrier to APN role implementation. Provide an example.
Office space, clerical support, pager, phone, clinical examination space
In this step participants consider availability, accessibility, awareness, appropriate use, and affordability of health services and human resources for meeting health care demands
Step 3/ Determine need for new model of care.
This type of APN would typically be found in FHTs, they also may have the role of being primary care provider.
Nurse Practitioner
This author's 2005 model (structure-process-outcomes) was included in PEPPA Plus.
Donabedian's (2005) model for evaluating quality of care.
Lack of clear role supervision is a barrier to APN role implementation for this reason. I.e.) There is often dual reporting to nursing and non-nursing directors.
Competing expectations
A working group of NPs notes that patients with endometriosis are presenting to Emergency Departments with poor pain management post-op. These NPs are engaging in which step of the PEPPA Framework?
Step 1/Define patient population and current model of care.
The NP Lead position came out of a lack of a provincial plan for ______ and _____ of NPs in BC.
Retention and recruitment
The PEPPA framework is useful for introducing and evaluating advanced practice nursing roles. What does PEPPA stand for?
Participatory, Evidence-based, Patient-centered process for APN development. [implementation and evaluation]
The need for conceptually stronger __________ designs to improve the quality of research and to address knowledge gaps about cost effectiveness and how APN roles contribute to improve patient, provider, and health system outcomes.
Evaluation
Differing from stakeholders, these individuals actively define tasks and work as planners, leaders, data collectors and decision-makers.
Participants
APN roles require multiple domains, name two.
Possible answers: clinical practice, education, research, professional development, and leadership
Three stages of APN role development in the PEPPA Plus framework are:
Introduction, implementation, and long-term sustainability
As demonstrated by the NP Lead position, strong _______ is needed to implement and sustain NP role. *hint: One article suggested transformational.
Leadership
In this step, patient's with dementia, their families, Alzheimer Society of Canada, geriatricians, and NPs working in gerontology come to consensus that the supply of geriatricians is insufficient to meet patient needs. They would like to see shorter wait times to dementia diagnosis and treatment.
Step 4/ Identify priority problems and goals to improve the model of care
APN role implementation requires patience. For novice CNS, for example, full role implementation took this many years.
3-5 years
In this stage of role development in the PEPPA Plus framework, the needs for role revision and support are identified
Long-term sustainability