Advanced practice nursing in the field of pelvic floor disorder – Lessons learned 5 years after role implementation

Introduction

Pelvic floor disorder is a widespread chronic disease that confronts patients with a variety of physical and psychosocial challenges. An interprofessional team from a hospital region of eastern Switzerland created a specialized health service for this patient population and expressed the need for support by an APN to further develop interprofessional care. A retrospective look, 5 years after the role was implemented, reveals success factors, challenges and insights that can be utilized for similar and future projects.

Method and Analysis

In 2018 and 2019, a stakeholder-oriented, participatory evaluation research was conducted to shape the role of the APN in the field of pelvic floor disorders. Ten interviews with internal and external experts in the field of pelvic floor disorder were analysed by thematic qualitative text analysis according to Kuckartz. A comparison between the original and the current profile illustrates its further development. Internal controlling shows the workload and number of patient contacts over the years 2018 to 2023. From a management perspective, the organizational and professional policy challenges are highlighted.

Results

In 2018, the APN's scope of practice was described in eight areas, which were assigned to four APN competencies: direct clinical practice, collaboration, counselling, and evidence-based practice. In 2022, 1211 different patient cases were treated in 1956 APN consultations. 64% of patients were women with interstitial cystitis. The focus was on direct clinical practice along the entire treatment pathway. The APN is predominantly the first and ongoing point of contact and coordinator of interprofessional treatment. The APN focuses on counselling and educating patients and their relatives, in particular on self-management, for example, on the use of aids and the importance of self-care. The number and complexity of the diagnostic and treatment interventions carried out by the APN have increased and are supported by expanding and extending competencies. The difficulty of recruiting nurses with a Master's degree, the legally unclear competence profile of APNs and the lack of cost coverage for APN services posed challenges in the development of this patient-centred care model and required innovative solutions.

Discussion

The initially assumed scope of practice of the APN is still evident 5 years after implementation but is constantly evolving. Although delegated medical activities are carried out by the APN, the focus remains on the original nursing competences. The increase in the number of patients indicates the need for and successful establishment of the care model presented. Professional policy changes are urgently needed to enable the development of patient-centred, innovative APN roles, both financially and legally.