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The Implementation of Advanced Practice Nursing in Catalonia

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The Implementation of Advanced Practice Nursing in Catalonia The implementation of Advanced Practice Nursing in Catalonia Sonia Sevilla Guerra Aquesta tesi doctoral està subjecta a la llicència Reconeixement 3.0. Espanya de Creative Commons. Esta tesis doctoral está sujeta a la licencia Reconocimiento 3.0. España de Creative Commons. This doctoral thesis is licensed under the Creative Commons Attribution 3.0. Spain License. UNIVERSITY OF BARCELONA FACULTY OF MEDICINE AND HEALTH SCIENCES Doctorate Programme in Medicine and Translational Research THE IMPLEMENTATION OF ADVANCED PRACTICE NURSING IN CATALONIA DISSERTATION TO OBTAIN THE DEGREE OF DOCTOR PRESENTED BY Sonia Sevilla Guerra Under the supervision oF: Dr. Adelaida Zabalegui Yárnoz Barcelona, 2018 UNIVERSITY OF BARCELONA FACULTY OF MEDICINE AND HEALTH SCIENCES Doctorate Programme in Medicine and Translational Research THE IMPLEMENTATION OF ADVANCED NURSING PRACTICE IN CATALONIA DOCTORAL THESIS Sonia Sevilla Guerra May 2018 DIRECTOR Dr. Adelaida Zabalegui Yárnoz SONIA SEVILLA GUERRA The Implementation oF Advanced Practice Nursing in Catalonia Doctoral Thesis Barcelona, May 2018 This is one for the good days. Thom Yorke ii ACKNOWLEDGEMENTS Firstly, I would like to express my most sincere gratitude to my PhD Director, Dr. Adelaida Zabalegui, For her knowledge, motivation, and drive vision in the project. Without her, none oF this work would have been possible. I would like to thank her continuous support; her guidance accompanied me For the past Four years oF research and writing oF this thesis. I could not have imagined having a better advisor and mentor For my PhD study. Besides my supervisor, I would like to thank my colleagues: Dr. Ester Risco, Mrs Maria Galisteo and Dr. Carlos Martínez For their dedication, insightFul comments and conFidence in this thesis, but also For their companionship and encouragement. My sincere thanks also go to Dr. Emmanuelle Jean who has provided me an opportunity to collaborate with her. Thank you For always challenging me and providing guidance and inspiration in this PhD. Thanks also, to Dr Kelly Kilpatrick and the rest of the team at the University oF Rimouski and the University oF Montreal in Canada For their experience and knowledge into the journey. Also, thank you to the European Academy oF Nursing Science, the Catalan Ministry oF Health, The Ministry oF International Relationships oF Quebec, the Nursing and Society Foundation oF Barcelona and the University oF Quebec at Rimouski For awarding me and the team the necessary Funding without which I would not have been able to undertake this doctorate; to them I also owe thanks For enabling the collaboration with Canada, which was key to the development oF the study. I would also like to express my gratitude to Mrs. Gemma Martínez, Director oF Nursing and to the Technical Committee oF the Nursing Directorate (CTDI) at the Hospital Clinic oF Barcelona For their support and participation in the study. Thanks, are particularly due to Mr. Josep Miranda, Dra. Maria Lombraña and doctoral candidate Montse Venturas For their special interest and encouragement in the most diFFicult moments. Special thanks to all my Fellow EANS PhD students and mentors, who For the past three years have shared common Feelings and inspirational discussions at the Summer School. In particular, thank you to Dr. Mariam Cerezuela and doctoral candidate Mrs Elena Salas, my Spanish counterparts in the summer school For accompanying me in this journey. I also would like to thank all the nurses and proFessionals that have participated in the study and in the Focus groups including high valued proFessionals From the iii Hospital Clinic Barcelona, the Nursing Council oF Barcelona, the Catalan Health Department, the Medical Council oF Barcelona, the IESE business school, the CatSalut, the University oF Barcelona, the University oF Vic and the UDINE group, among others; thanks to Dr. Adrianov Belchin For his expertise, support and statistical insights in the study; to Mr. Stephen Kelly For his implication and contributions into the writing oF the manuscripts; to Dr Picas For his drive and knowledge into the current context; and to Mrs Maika Aragunde For the day to day problem solving and the good moments. Thank you to my beloved Family: my parents Mª Dolores and Leonardo and my brother Daniel and Teresa For supporting me morally and emotionally throughout the writing oF this thesis and my liFe in general. I am also grateFul to my other Family members and Friends who have supported me along the way such as my Auntie and Uncle Esperanza and Paco and my late grandmother Esperanza. iv And last but not least, To my partner Joe and my daughter Audrey, only they know the eFForts put into this work, without them nothing would have ever been possible. Thank you for your unconditional love. v vi TABLE OF CONTENTS ACKNOWLEDGEMENTS .................................................................................................... III ABBREVIATIONS ............................................................................................................... IX ABSTRACT ........................................................................................................................ XI RESUMEN ....................................................................................................................... XIII RESUM ........................................................................................................................... XVI LIST OF TABLES ................................................................................................................ XX LIST OF FIGURES .............................................................................................................. XX LIST OF ANNEXES............................................................................................................ XXI PREFACE ....................................................................................................................... XXIII CHAPTER I: INTRODUCTION .............................................................................................. 1 1. THE CONCEPT OF ADVANCED PRACTICE NURSING ............................................................. 3 1.1 Categorization of APNs ..................................................................................... 4 1.2 Spheres of practice ........................................................................................... 6 2. THEORETICAL DEVELOPMENT OF ADVANCED PRACTICE ........................................................ 9 2.1 Strong Memorial Hospital’ s Model of Advanced Practice Nursing ..................... 9 2.2 Hamric´s Model .............................................................................................. 10 2.3 Learning development Framework .................................................................. 11 3. INTERNATIONAL APN ROLE DEVELOPMENT.................................................................... 12 3.1 Context of APN in Catalonia, Spain .................................................................. 14 CHAPTER II: FRAMEWORK OF REFERENCE ....................................................................... 17 4. IMPLEMENTATION RESEARCH ..................................................................................... 19 4.1 Learning Evaluation Framework ...................................................................... 20 4.2 Context Analysis ............................................................................................. 22 CHAPTER III: AIM AND OBJECTIVES ................................................................................. 29 CHAPTER IV: CIENTIFIC PUBLICATIONS ............................................................................ 33 1. ARTICLE 1 ........................................................................................................... 37 vii 2. ARTICLE 2 ........................................................................................................... 49 3. ARTICLE 3 ........................................................................................................... 61 4. ARTICLE 4 ........................................................................................................... 71 9. ARTICLE 5 ........................................................................................................... 99 CHAPTER V: DISCUSSION ............................................................................................... 135 CHAPTER VI: APPICABILITY AND BENEFITS .................................................................... 149 CHAPTER VII: CONCLUSIONS ......................................................................................... 153 FUNDING....................................................................................................................... 159 ANNEXES ....................................................................................................................... 181 ANNEX 1: RESEARCH ETHICS COMMITTEE FOR ROLE ANALYSIS STAGE.......................... 183 ANNEX 2: CONSENT FORM FOR PARTICIPANTS OF ROLE ANALYSIS STAGE .................... 185 ANNEX 3: RESEARCH ETHICS COMMITTEE FOR CONTEXT ANALYSIS STAGE ................... 187 ANNEX 4: CONSENT FORM FOR PARTICIPANTS OF CONTEXT ANALYSIS STAGE .............. 189 ANNEX 5: IDREPA QUESTIONNAIRE ............................................................................. 195 ANNEX 6: FUNDING FROM THE GOVERNMENT OF CATALONIA .................................... 197 ANNEX 7: FUNDING FROM THE
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