An overview of the SCAPE study: An evaluation of Clinical Specialist Advanced Practice roles

1. An overview of the SCAPE study: An evaluation of Clinical Specialist & Advanced Practice roles

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3. 3 Aim To produce a focused evaluation of the clinical services provided by clinical nurse and midwife specialists (CNS/CMS) and advanced nurse and midwife practitioners (ANP/AMP) in Ireland.

4. 4 Objectives (1) To develop and validate a tool to determine outcomes for clinical services of specialists and advanced practitioners. To compare clinical outcomes in care environments with and without the clinical input of specialists and advanced practitioners as part of the care team. To examine the impact of the specialists’ and advanced practitioners’ clinical interventions/care on service users’ experience of care.

5. 5 Objectives (2) To explore service users’ well-being and satisfaction with care received from accredited specialist and advanced practitioner post-holders. To explore the financial implications of specialist and advanced practitioner posts for the Irish health services, in terms of efficiency and effectiveness.

6. 6 Methodology and Design

7. 7 Phase 1:Focus Groups, Systematic review, concept analysis and Delphi Survey Literature review work Focus Groups Delphi Study

8. 8 What we did

9. 9 Focus Groups & interviews Eight focus groups with 4 different health professional groups were undertaken. Sixty- three people took part. We included Clinical Nurse and Midwife Specialists, Advanced Nurse Practitioners, Directors of Nursing or Midwifery and Consultants, Assistant Directors of Nursing and Clinical Nurse Managers, and Staff Nurses. Individual interviews of service users.

10. 10 Examples of Outcomes Identified in Focus Groups Decrease in Morbidity Decrease in Mortality Increased in knowledge of service users/family Promote self management Increase in Adherence Earlier diagnosis and intervention Reduce exacerbations of condition. Prevent complications Holistic assessment, identifying problems beyond those they presented with.

11. 11 Literature Work A detailed literature review, including a concept analysis of ‘advanced practice,’ was undertaken and a systematic review is also being undertaken to identify the effects of health care interventions provided by specialist and advanced practice nurses and midwives, and is nearing completion.

12. 12 Concept analysis of Advanced Practice: What this told us was The complexity of ‘advanced practice’ roles is articulated internationally, no real consensus Many different views of the advanced practice role Yet, also considerable consensus that advanced practice brings benefits to clinical practice. Challenge is to provide the evidence that advanced practice ‘works’

13. 13 Example of Advanced Practice Attributes Use of knowledge in practice Critical thinking & analytical skills Clinical judgement & decision making skills Professional leadership & clinical inquiry Coaching & mentoring skills Research skills Direct clinical care Collaboration Coaching & guidance Research Ethical decision making Consultation Leadership Changing practice

14. 14 Systematic Review Types of interventions Any healthcare intervention provided by practitioners practising at a ‘higher level’. This will include clinical and educational interventions. Types of outcomes All outcomes reported extracted (duplicates removed)

15. 15 Findings to date 27 reviews identified Outcomes across all reviews extracted, duplicates removed. Helped inform the development of round 1 instrument for Delphi study Quality assessment ongoing

16. 16 Delphi Survey Purpose of the DELPHI is to develop a comprehensive, validated toolkit to determine outcomes for clinical services of clinical nurse and midwife specialists and advanced nurse and midwife practitioners.

17. 17 Delphi The DELPHI is a 3 round survey for both ANP/AMP and CNS/CMS. Invited all ANPs and CNSs to take part, 670 CNS and 47 Advanced Practitioners agreed CNS 42% response rate, ANP 64% response rate High levels of item endorsement evident in both surveys Data analysis still on-going

18. 18 Generic minimum dataset-ANP/AMP Provisional as in process of verifying through evaluative survey of 400 key stakeholders 51 items Examples ‘Communication’ ‘Patient/client satisfaction with information’ ‘Quality of life-Physical’

19. 19 Generic minimum dataset-CNS/CMS Provisional (verification process underway) 47 items Examples ‘Utilisation of clinical guidelines’ ‘Research awareness in clinical practice’

20. 20 Verification Process Other health care professionals (approx. 400) invited to review datasets for relevancy using modified Content Validity Index Provides evidence on other health care professionals perception of the relevance of generic minimum dataset of indicators that should be routinely recorded to evaluate specialists’ and advanced practitioners’ perceptions of the impact of their role on service users and other health professionals

21. 21 Finally for Phase 1: The Evaluative survey Evaluate role using generic datasets Sample All clinical specialists and advanced practitioners Propose electronic distribution But will also attempt to populate instruments with outcomes specific to specific roles, so will ask practitioners to identify any outcomes that are specific to their role.

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26. 26 Summary – what phase we are at Phase III Interpretation and confirmation (or refutation) of findings Will involve: Data scrutiny (key findings, structure) Data comparison Interviews with policy makers (10) Validation Phase III Interpretation and confirmation (or refutation) of findings Will involve: Data scrutiny (key findings, structure) Data comparison Interviews with policy makers (10) Validation

27. 27 Thank you for your support and participation