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      Clarification and development of advanced practice roles in a Swiss French university hospital: an action research study

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          Abstract

          Background

          The evolving healthcare landscape emphasizes the need for health systems to adapt to growing complexities, with new models of care enabling healthcare providers to optimize their scope of practice and coordination of care. Despite increasing interest in advanced practice, confusion persists regarding the roles and scopes of practice of healthcare providers, exacerbated by variations in regulations and titles. We sought to clarify the differences between specialized healthcare professionals, practitioners, and clinical specialists; to describe their roles; and to propose initiatives aimed at supporting the implementation of advanced practice within a university hospital.

          Methods

          An action research design was conducted in a Swiss university hospital by the deputy healthcare director, five clinical specialists, one nurse practitioner, one nurse specialist, and six managers. A multimethod approach was used to generate data, which included a literature review, meeting minutes, unstructured interviews, and a questionnaire assessing healthcare providers’ perceptions about the clinical specialist role. Semi-structured interviews and a group interview with nursing leaders from Swiss hospitals were conducted to understand their use of clinical roles at the advanced level. Unstructured interviews were reduced and organized into categories. Survey data were analyzed with descriptive statistics, and an inductive content analysis method was used for semi-structured interviews and the group interview.

          Results

          Managers and healthcare providers shared a vision of clinical specialists’ activities but emphasized the lack of clarity surrounding these functions. Role clarity was emphasized as crucial for sustainability of advanced practice. A model that defined healthcare specialist, practitioner, and clinical specialist roles was developed. It included title standardization, use of an implementation strategy, creation of a tool to facilitate profile selection, and implementation of a communication plan. Further initiatives aimed to enhance training funding, establish regulations, and optimize advanced practice implementation and governance within the hospital.

          Conclusions

          The study results encourage clarification of clinical roles to facilitate their implementation and optimize resources. They also suggest initiatives to support advanced practice implementation, such as a communication plan and an implementation strategy, reflection on the current governance model, and integration of advanced practice providers. Ongoing efforts involve collaboration with academics, managers, and discussions at the political level.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12913-025-12268-w.

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          Most cited references35

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          Three approaches to qualitative content analysis.

          Content analysis is a widely used qualitative research technique. Rather than being a single method, current applications of content analysis show three distinct approaches: conventional, directed, or summative. All three approaches are used to interpret meaning from the content of text data and, hence, adhere to the naturalistic paradigm. The major differences among the approaches are coding schemes, origins of codes, and threats to trustworthiness. In conventional content analysis, coding categories are derived directly from the text data. With a directed approach, analysis starts with a theory or relevant research findings as guidance for initial codes. A summative content analysis involves counting and comparisons, usually of keywords or content, followed by the interpretation of the underlying context. The authors delineate analytic procedures specific to each approach and techniques addressing trustworthiness with hypothetical examples drawn from the area of end-of-life care.
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            The qualitative content analysis process.

            This paper is a description of inductive and deductive content analysis. Content analysis is a method that may be used with either qualitative or quantitative data and in an inductive or deductive way. Qualitative content analysis is commonly used in nursing studies but little has been published on the analysis process and many research books generally only provide a short description of this method. When using content analysis, the aim was to build a model to describe the phenomenon in a conceptual form. Both inductive and deductive analysis processes are represented as three main phases: preparation, organizing and reporting. The preparation phase is similar in both approaches. The concepts are derived from the data in inductive content analysis. Deductive content analysis is used when the structure of analysis is operationalized on the basis of previous knowledge. Inductive content analysis is used in cases where there are no previous studies dealing with the phenomenon or when it is fragmented. A deductive approach is useful if the general aim was to test a previous theory in a different situation or to compare categories at different time periods.
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              Qualitative Data Analysis : An Expanded Sourcebook

              The latest edition of this best-selling textbook by Miles and Huberman not only is considerably expanded in content, but is now available in paperback. Bringing the art of qualitative analysis up-to-date, this edition adds hundreds of new techniques, ideas and references developed in the past decade. The increase in the use of computers in qualitative analysis is also reflected in this volume. There is an extensive appendix on criteria to choose from among the currently available analysis packages. Through examples from a host of social science and professional disciplines, Qualitative Data Analysis remains the most comprehensive and complete treatment of this topic currently available to scholars and applied researchers.
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                Author and article information

                Contributors
                Patrick.TeixeiraMachado@hug.ch
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                22 January 2025
                22 January 2025
                2025
                : 25
                : 119
                Affiliations
                [1 ]Care Directorate, Geneva University Hospitals, ( https://ror.org/01m1pv723) Rue Gabrielle-Perret-Gentil 4, Geneva, 1205 Switzerland
                [2 ]Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne and Lausanne University Hospital, ( https://ror.org/019whta54) Lausanne, Switzerland
                Article
                12268
                10.1186/s12913-025-12268-w
                11753075
                39844193
                9644567b-a427-4ff5-97c3-3c9019e14b75
                © The Author(s) 2025

                Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

                History
                : 9 September 2024
                : 13 January 2025
                Funding
                Funded by: Research fund of the Care Directorate of the Geneva University Hospitals
                Funded by: University of Geneva
                Categories
                Research
                Custom metadata
                © BioMed Central Ltd., part of Springer Nature 2025

                Health & Social care
                advanced practice,role clarification,action research
                Health & Social care
                advanced practice, role clarification, action research

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