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Zusammenfassung. Hintergrund: Die Entwicklung von Advanced Practice Nurses (APN-Rollen) im akutstationären Setting in Deutschland ist stark von Kontextfaktoren abhängig. Diese Etablierung von APN-Rollen in der direkten Patientenversorgung stellt einen tiefgreifenden Organisationsentwicklungsprozess dar. Im Jahr 2010 begann im Florence-Nightingale-Krankenhaus in Düsseldorf die Implementierung von APN-Rollen. Ziel: Unsere Erfahrung in der Entwicklung von APN-Rollen und darüber hinaus die Identifikation von beeinflussenden Faktoren zu reflektieren. Die Erhebung fördernder und hemmender Faktoren soll zukünftige APN-Rollenentwicklungen und Interventionen unterstützen. Methoden: Mithilfe des Consolidated Framework for Implementation Research (CFIR) haben vier Pflegeexpertinnen APN einen teilstrukturierten Rückblick vorgenommen. Hierzu wurde der zyklische Prozess der kritischen Selbstreflexion nach Titchen (2009) verwendet. Ergebnisse: Die Einflussfaktoren wurden in Kategorien zusammengefasst. Differenziert dargestellt werden die Kategorien: Unterstützung durch die Managementebene, Erkennen von Veränderungsbedarf, Fachliche Expertise, Präsenz vor Ort, Selbstwirksamkeit und persönliche Eigenschaften sowie Rollenklarheit. Diskussion: Die Implementierung von APN-Rollen braucht Zeit und Ausdauer, sowohl von der Organisation als auch von den jeweiligen Pflegeexpert_innen APN. Die Erlangung von Rollenklarheit ist in diesem Prozess substanziell. Grenzen und Transfer: Dieser Reflexionsbericht stellt kontextbezogene Ergebnisse dar. Die identifizierten Einflussfaktoren können jedoch eine Hilfestellung für zukünftige Implementierungsprozesse und Entwicklungen von APN-Rollen darstellen.

Zusammenfassung. Hintergrund: Patient_innen mit Lymphomen, die mit Hochdosis-Chemotherapie (HDC) und autologer Stammzelltransplantation (ASZT) behandelt werden, sind mit einer lebensbedrohlichen Krankheit und einer stressvollen Therapie konfrontiert. Durch den Einsatz eines Advanced Nursing Practice (ANP)-Teams sollte diesen Patient_innen und ihren Angehörigen am Inselspital, Universitätsspital Bern eine kontinuierliche und bedarfsgerechte Betreuung über den ganzen Therapieverlauf geboten werden. Zu Erfahrungen von Betroffenen mit ANP ist wenig bekannt. Ziel: Mit dieser Studie wurde deshalb untersucht, wie diese Patient_innen und ihre Angehörigen die Betreuung durch das ANP-Team erlebten. Methode: Die qualitative Studie orientierte sich am Forschungsansatz “Interpretive Description”. Acht Paarinterviews mit Patient_innen und Angehörigen wurden durchgeführt und mittels reflexiver thematischer Analyse ausgewertet. Ergebnisse: Die Teilnehmenden erlebten eine kontinuierliche Begleitung durch die Pflegeberaterinnen über den ganzen Therapieverlauf hinweg, erfuhren fachliche, administrative und emotionale Unterstützung und fühlten sich kompetent informiert und beraten. Sie hatten eine gut erreichbare Ansprechperson für Fragen, zu der sie eine emotionale Beziehung aufbauten. Dadurch fühlten sich Patient_innen und Angehörige nicht nur ermutigt und bestärkt, sondern auch sicher und gut aufgehoben. Schlussfolgerung: Der Einsatz eines ANP-Angebots wird für Betroffene empfohlen, da die kontinuierliche Begleitung durch eine fachkompetente, mitfühlende, vertraute und engagierte Ansprechperson für sie unerlässlich war.

Implementation of an Advanced Nursing Practice to advance transcultural healthcare: A practical development project

Zusammenfassung. Hintergrund: Die Advanced Practice Nurse (APN) kann für Frauen mit einer gynäkologischen Krebserkrankung eine bedeutsame Unterstützung im Behandlungsprozess darstellen. In Österreich und der Schweiz steht die APN-Entwicklung allerdings erst am Anfang und es fehlt an systematisch entwickelten Konzepten. Fragestellung: Welche Merkmale sollte ein auf wissenschaftlichen Erkenntnissen basierendes APN-Konzept in der gynäkologischen Onkologie im Versorgungskontext Österreich und Schweiz beinhalten? Methode: Die Entwicklung des Konzepts erfolgte mit Hilfe einer Matrix, die basierend auf dem PEPPA plus-Framework entstand, Inhalte des Nursing Role Effectiveness Models (NREM) enthielt und Daten aus vier vorangegangenen Einzelstudien zusammenführte. Dreizehn Expertinnen und Experten aus Pflege und Medizin waren an der Vernehmlassung des Konzepts beteiligt. Ergebnisse: Unterteilt in Struktur-, Prozess- und Outcome-Kriterien beschreibt das Konzept zentrale Inhalte der APN-Rolle in der gynäkologischen Onkologie im Versorgungskontext Österreich und Schweiz. Zusätzlich werden die Beziehungen zwischen Struktur-Prozess, Struktur-Outcome und Prozess-Outcome dargestellt. Schlussfolgerungen: Das in dieser Studie entwickelte Konzept bietet eine Grundlage zur (1) weiteren Ausgestaltung einer APN-Rollenbeschreibung in der gynäkologischen Onkologie auf institutioneller Ebene sowie (2) curricularen Entwicklung entsprechender Studiengänge. Durch die gemeinsame Basis kann eine Harmonisierung der APN-Rolle im Versorgungskontext Österreich und Schweiz gefördert werden.

As Advanced Practice Nurse actively shaping nursing practice - A reflection

Living well at home with multimorbidity - A project on the contribution of advanced practice nursing in home health care

Support by an advanced nursing practice team - Experiences of patients with lymphoma and their family members. A qualitative study

Experiences of Advanced Practice Nurses with a clinical postgraduate education program in the context of their professional development

Effects of Guided Clinical Reasoning on the Advanced Nursing Process quality - An experimental intervention study

Zusammenfassung.Hintergrund: Um den zukünftigen Bedarf der Bevölkerung an medizinischen Leistungen abzudecken, sind neue Versorgungsmodelle gefragt. Der Aufbau von Advanced Nursing Practice (ANP) bietet eine Möglichkeit, diesen Herausforderungen mit neuen Angeboten zu begegnen. Im Inselspital, Universitätsspital Bern werden seit 2011 ANP-Angebote und entsprechende Advanced Practice Nurse-Rollen aufgebaut. Ziel: Es wird angestrebt, innovative und evidenzbasierte ANP-Angebote zu entwickeln, um die Versorgung für spezifische Patient(inn)engruppen und ihre Angehörigen auszubauen und mehr Sicherheit sowie bessere Ergebnisse zu erreichen. Methode: ANP-Angebote werden im Rahmen von Projekten, in enger Zusammenarbeit von Klinik und Bereich Fachentwicklung (BFE) der Direktion Pflege entwickelt. Zur Evaluation werden Struktur-, Prozess- und Ergebnisdaten erhoben. Ergebnisse: Heute sind fünf ANP-Angebote etabliert, acht weitere befinden sich im Aufbau. Die meisten Angebote sind auf eine langfristige Betreuung von Patient(inn)en mit chronischen Erkrankungen und ihre Angehörigen ausgerichtet. Zehn APN haben Anstellungen von 10 % bis 80 %, drei führen ein ANP-Team. Sie arbeiten zu über 50 % in der direkten klinischen Praxis, primär beratend. Ein ANP-Netzwerk verbindet APN und BFE, um Synergien und Austausch zu fördern. Schlussfolgerungen: Herausfordernd bei der Entwicklung von ANP-Angeboten sind oft die Ressourcen. Wesentlich für den nachhaltigen Erfolg sind ein adäquater Stellenumfang, die Unterstützung durch die Klinikleitung, das spitalweit gültige Konzept und der Aufbau im Rahmen von Projekten.

The Advanced Practice Nurse (APN) in gynaecological oncology - development of an evidence-based conceptThe aim of this study was to develop relevant contents of an evidence-based APN concept for gynaecological oncology in Austria and Switzerland.The concept was developed by using a matrix elaborated on the basis of the PEPPA plus framework, and complemented by elements of the Nursing Role Effectiveness Model (NREM). The matrix synthesised data from four previous conducted studies. Thirteen experts from nursing and medicine validated the concept.Divided into structure, process and outcome criteria, the concept describes main contents of an APN in gynaecological oncology within the Austrian and Swiss healthcare context. Further, relationships between structure-process, structure-outcome and process-outcome are described.The concept developed in this study provides a basis for (1) the future development of an APN role description in gynaecologic oncology on an institutional level and (2) curriculum development of corresponding degree programs. Due to the common basis, a harmonisation of APN in the Austrian and Swiss context might be supported.

Background: To cover future health care needs of the population, new care models are necessary. The development of advanced nursing practice (ANP) offers the opportunity to meet these challenges with novel services. At the Inselspital, Bern University Hospital, ANP services and corresponding advanced practice nurse (APN) roles have been developed since 2011. Purpose: The aim is to develop innovative and evidence based ANP services to supplement health care for specific patient groups and their family members with the goal to improve safety and achieve better outcomes. Methods: Project-based ANP services are developed in close collaboration of clinical departments and the Nursing Development Unit (NDU) of the Directorate of Nursing. Structure, process and outcome data are collected for evaluation. Findings: Currently, five ANP services are established and running, eight more are in the developmental phase. Most services address the long term care of patients with chronic illnesses and their family members. Ten APNs work between 10 % and 80 %, three are leading an ANP-team. APNs work over 50 % in direct clinical practice, primarily in counselling. An ANP network connects APNs and NDU, promoting synergy and exchange. Conclusions: The available resources often constitute a challenge for the development of ANP services. Vital for the long-term success are an adequate extent of the position, the support by department directorate, the conceptual framework that is implemented across the whole hospital, and the development within project structures.

Background: Patients with vulvar neoplasms report a lack of information, missing support in self-management and a gap in delivery of health care. Aim: The aim of the study was to investigate if written information or counseling based on the WOMAN-PRO II program are able to improve patient satisfaction and the delivery of health care from the health professional's perspective of women with vulvar neoplasms. Method: Patient satisfaction and the delivery of health care have been investigated as two secondary outcomes in a multicenter randomized controlled parallel-group phase II study (Clinical Trial ID: NCT01986725). In total, 49 women, from four hospitals (CH, AUT), completed the questionnaire PACIC-S11 after written information (n = 13) and counseling (n = 36). The delivery of health care was evaluated by ten Advanced Practice Nurses (APNs) by using the G-ACIC before and after implementing counseling based on the WOMAN-PRO II program. Results: There were no significant differences between the two groups identified (p = 0.25). Only few aspects were rated highly by all women, such as the overall satisfaction (M = 80.3 %) and satisfaction with organization of care (M = 83.0 %). The evaluation of delivery of health care by APNs in women who received counseling improved significantly (p = 0.031). Conclusions: There are indications, that the practice of both interventions might have improved patient satisfaction and counseling the delivery of health care. The aspects that have been rated low in the PACIC-S11 and G-ACIC indicate possibilities to optimize the delivery of health care.

The hospitalisation of a multiple disabled child is stressful for parents because they continue to carry out demanding care procedures in hospital. Yet, systematic knowledge of the parental experience and of their support needs is missing.How do parents experience the hospitalisation, and which support needs do they identify for this period? Methods: Twenty-six parents (24 mothers, 2 fathers) of 24 children with multiple disabilities have participated in this qualitative study. Between 1 January 2011 and 1 September 2013, semi-structured interviews were conducted in a children's university hospital. A qualitative content analysis formed the basis for the analysis.“Concerns for the child's well-being” was central for the parents and focussed on the areas of “Pain”, “Complications” and “Development”. Perception of the child's well-being governs the extent of the “Parents' Work” and defines the parental “Support needs” to “Receive information and training”, “Be known and experience continuity”, “Be taken seriously and experience communion”, “Be accompanied by experienced nurses”, and “Be relieved and get organisational support”.Parents work hard to safeguard the well-being of their hospitalised child with multiple handicaps. Care professionals can ease the parents' burden by promoting parental confidence in their child's welfare in hospital. This will be successful if continuity of care and competence are ensured, for instance if it is provided by nurses with Advanced Practice background.

The attitude of nurses influences their application of the Advanced Nursing Process. Studies reveal deficits in the application of the Advanced Nursing Process that is based on valid assessments and nursing classifications. These deficits affect decision-making and – as a result – nursing care quality. In German speaking countries nurses' attitudes towards nursing diagnoses as part of the Advanced Nursing Process were not yet measured.The aim of this study was to evaluate the effects of an educational intervention on nurses' attitude.A quasi-experimental intervention study was carried out in Austria and Germany. Before and after a standardised educational intervention 51 nurses estimated their attitude with the instrument Positions on Nursing Diagnosis (PND). Analyses were performed by Wilcoxon- and U-tests.Before the educational intervention the average attitude score of the Austrian nurses was more positive than in the German group. After the study intervention both groups regarded nursing diagnostics statistically significant more convincing and better understandable. However, both groups still described the application of the Advanced Nursing Process as difficult and demanding to perform.In the future, more attention should be given to the reflexion and development of nurses' attitude towards the Advanced Nursing Process because attitudes lead nurses' actions. In further studies influencing organizational and structural factors in diverse settings will be analysed.

Epilepsy is, after stroke, the second most prevalent neurological disease. The disease has a manifold etiology and symptoms and hence treatment options. From the patients who seek treatment in epilepsy centres, some suffer from psychogenic, non-epileptic seizures. Patient with epileptic seizures have to integrate a medication regimen into their lives, accept symptoms and change their life style to seizure preventing habits. Patients with non-epileptic seizures need psychotherapeutic treatment. Care has to be offered over long periods of time and needs to be tailored to very diverse patients' and family situations. Nurses in this field need broad knowledge about the diseases and treatments as well as enhanced skills in counselling and caring for these patients. Therefore the Swiss Epilepsy Centre in Zurich hired an Advanced Practice Nurse (APN) to increase patients' satisfaction with care and enhance nurses' skills and knowledge. This article analyses the work content of the advanced practice nurse and describes first experiences one year after the implementation of an APN-role. The APN worked half of her time in direct patient and family care. The rest of her work load concerned practice development in coaching and educating the nursing staff, being involved in projects and collaborating with the head nurse on specific topics. In conclusion, implementation of an advanced practice nurse has been shown to be beneficial since patients' feedback were very positive and the increase in nurses' skills and competencies has been assessed as noticeable.

Living with multiple chronic diseases is complex and leads to enhanced care needs. To foster integrated care a project called "Living with chronic disease" (Leila) was initiated.The aim was to develop an Advanced Practice Nursing (APN) service in collaboration with medical centers for persons who are living with multiple chronic diseases. The following research questions were addressed: 1. What are patients' experiences, referring physicians and APNs with the Leila-Service? 2. How are referral processes performed? 3. How do the involved groups experience collaboration and APN role development?A qualitative approach according grounded theory of Corbin and Strauss was used to explore the experiences with the Leila project and the interaction of the persons involved. 38 interviews were conducted with patients who are living with multiple chronic diseases, their APN's and the referring physicians.The findings revealed "Being cared for and caring" as main category. The data demonstrated how patients responded to their involvement into care and that they were taken as serious partners in the care process. The category "organizing everyday life" describes how patients learned to cope with the consequences of living with multiple chronic diseases. "Using all resources" as another category demonstrates how capabilities and strengths were adopted.The results of the cooperation- and allocation processes showed that the APN recognition and APN role performance have to be negotiated. Prospective APN-services for this patient population should be integrated along with physician networks and other service providers including community health nursing.Hintergrund: Das Leben mit mehreren chronischen Krankheiten ist komplex und führt zu einer erhöhten Pflege- und Betreuungsbedürftigkeit. Zur Förderung der integrierten Versorgung wurde ein dreijähriges Projekt namens «Leben mit Langzeiterkrankung» (Leila) initiiert. Ziel: Das Projekt hatte zum Ziel, Leistungen von Pflegeexpertinnen in Advanced Practice Nursing (APN) für chronisch erkrankte Menschen in Zusammenarbeit mit Hausarztpraxen zu entwickeln. Folgende Fragestellungen wurden untersucht: 1. Wie erleben Patient(inn)en, Zuweisende und Pflegeexpertinnen APN das Leila-Dienstleistungsangebot? 2. Wie gestalten sich Zuweisungsprozesse? 3. Wie erleben die Beteiligten die Zusammenarbeit und die APN-Rollenausübung? Methode: Es wurde ein qualitativer Ansatz gemäß Grounded Theory nach Corbin und Strauss gewählt, um Erfahrungen mit Leila und Interaktionen der an Leila beteiligten Personen zu untersuchen. Dabei wurden 38 Interviews mit Patient(inn)en, die mit multiplen chronischen Krankheiten leben, deren betreuende Pflegeexpertinnen APN und zuweisenden Ärzt(inn)en durchgeführt und evaluiert. Ergebnisse: «Umsorgt werden und umsorgen» zeigte sich als zentrale Kategorie. Diese beschreibt wie auf die Patient(inn)en eingegangen wurde, sie einbezogen und ernst genommen wurden. Die Hauptkategorie «Den Alltag gestalten» zeigt, dass die Patient(inn)en lernten, mit den Folgen chronischer Erkrankungen im Alltag umzugehen. «Alle Ressourcen nutzen» legt dar, wie Potenziale und Stärken eingesetzt wurden. Schlussfolgerungen: Die Ergebnisse zu Zuweisungs- und Kooperationsprozessen ergaben, dass die APN-Rollenanerkennung und -ausübung noch ausgehandelt werden muss. Zukünftige APN-Angebote für diese Patient(inn)engruppe sollten nebst Ärztenetzwerken in weitere Dienstleistungen und die Spitex integriert werden.

Patient centred and individually-tailored counselling of older people with a chronic condition who live at home is a useful intervention to support their independence.The paper presents the development and psychometric testing of the APN-BQ Instrument, to measure patient-centeredness.To measure the quality of an in-home counselling intervention, a 23-item questionnaire was developed and tested with 206 people 80 years and older. Principal component analysis with Varimax Rotation was conducted (n = 206).Analysis revealed a four factor (fs = 0.91) model scoring in 19 items. All factors loaded0.45. Cronbach's alpha was 0.86. The utility and acceptance of the instrument was confirmed by the high response rate (100 %) and the fact that participants answered 98.8 % of all questions.The APN-BQ has shown to be a reliable Instrument with good content and construct validity. It is a tool for APNs to measure structure, process, and outcome quality of a patient-centred and individually-tailored counselling program, including the degree of patient participation, and patient empowerment.Hintergrund: Patientenzentrierte und individuell ausgerichtete Angebote, wie die häusliche Beratung durch Pflegeexpertinnen-APN (Advanced Practice Nurses), eignen sich besonders, chronisch kranke alte Menschen in einer möglichst selbstständigen Lebensführung zu unterstützen. Methode: Um die Qualität einer patientenzentrierten Beratung zu evaluieren, wurde ein 23-Item Instrument entwickelt und seine psychometrischen Eigenschaften mit einer Stichprobe von 206 Personen, die 80 Jahre und älter waren getestet. Ziel: Ziel dieses Artikels ist es, die Entwicklung und Evaluation des APN-BQ zu beschreiben. Die psychometrische Testung des Instruments erfolgte anhand einer Hauptkomponentenanalyse mit Varimax-Rotation. Ergebnisse: Die Analyse ergab eine stabile vier Faktorenstruktur (FS = 0,91) mit 19 Items. Alle Faktoren hatten eine Faktorladung0,45. Die interne Konsistenz der Gesamtskala ergab einen Wert von Cronbachs alpha 0,86. Die hohe Rücklaufquote der Fragebogen und die Tatsache, dass 98,8 % der Fragen beantwortet wurden, bestätigten die Anwendungsfreundlichkeit und Akzeptanz des Instruments. Schlussfolgerungen: Das APN-BQ erwies sich als zuverlässiges und in Bezug auf Inhalt und Konstrukt valides Instrument, die Struktur-, Prozess- und Ergebnisqualität einer patientenzentrierten Beratungsintervention in der gemeindenahen Versorgung sowie das Ausmaß der Partizipation und Selbstbefähigung (Empowerment) der zu Beratenden zu messen.

Die Betreuung von chronisch kranken Kindern und Jugendlichen mit multiplen Einschränkungen ist komplexer geworden und stellt Gesundheitseinrichtungen und Fachpersonen vor Herausforderungen. Neue Versorgungsmodelle wie die Implementierung von Advanced Practice Nursing sind angemessen, um auch zukünftig qualitativ hochstehende Versorgung zu gewährleisten. Im Kinderspital Zürich sichern Advanced Practice Nurses (APNs) die komplexe Betreuung der betroffenen Familien. Ziel dieser Studie ist, die Tätigkeiten der APNs Kontinenz und Wundpflege aus interdisziplinärer Sicht auf ihre Qualität und ihren Nutzen zu untersuchen. Einem Mixed Method-Ansatz folgend wurden Handlungen und Nutzen der APNs anhand von zehn qualitativen Interviews und einer parallelen Fragebogenerhebung (N = 96) evaluiert. Die Resultate zeigen die Umsetzung zentraler APN-Kompetenzen und weisen eine hohe Qualität der Tätigkeiten aus. Der Nutzen umfasst positive Auswirkungen auf die betroffenen Kinder und Familien und das interdisziplinäre Fachpersonal. Eine professionelle Wundversorgung und das Erlangen von Kontinenz wurden als Effekte identifiziert.

Individuals with chronic heart failure are a vulnerable group of patients, with a poor prognosis and frequent hospitalisations. Research shows that multidisciplinary education outpatient programmes for heart failure (HF) increases the quality of life of these patients and decreases mortality and rehospitalisation respectively. As a result of this research, the University Hospital Basel has developed and implemented a multidisciplinary, nurse-led inpatient programme. The article describes the development and difficulties of the programme from its beginning until the verification of its effectiveness. Based on a systematic review of the literature and principles of action research the programme was developed by a group of nurses specialised in HF and two physicians under the guidance of an Advanced Practice Nurse student. The group developed a patient pathway and guidelines describing education, skills training sessions for patients, as well as descriptions of responsibilities and tasks of the different members of the multidisciplinary team. To date, an individualised programme with information material and specific documentation is offered to patients who receive personalised recommendations before their discharge. For the nurses the implementation of the programme was a new challenge of structured counselling in their normal "busy" routine because of this challenge the nurses needed continuing coaching.

Current demographic developments and the high prevalence of chronic conditions require new approaches to nursing care of the elderly population in Switzerland. New care models need to be developed that go beyond traditional nursing practice with its focus on the individual. Existing preventive home visit and case management programmes have mostly focussed on the young old with the goal to maintain functional health and prevent institutionalisation. Families, who play a crucial role in the care of the elderly at home, were not included. The purpose of this article is to describe the development of the SpitexPlus Project, which is directed at people 80 years and older and their families, irrespective of their health status and social situation. It aims to improve self-care capabilities and quality of life in people 80+ and their families and to enable them to manage the challenges of daily life at home. Evidence based nursing interventions, based on the principles of health promotion, empowerment, family centeredness, and partnership were developed. The development of the programme phases, interventions, and the role of the advanced practice nurses are described in detail. Potential benefits for nursing practice are delineated.

Advanced Nursing Practice seems to be an answer to the complex challenges of the health system. However, the quality of Advanced Nursing Practice is researched by comparison to medical care. These attempts to legitimise Advanced Nursing Practice decrease the potentials of nursing care. In contrast to this, a prospect for Advanced Nursing Practice should be derived from the core of nursing, namely the relation to the life-world of the clients, the closeness to the clients and their families, and the opportunity for consistency in health care. This vision has to be realised by means of autonomy and responsibility in nursing care. The competence to autonomous and responsible decision-making is based on an educational process, where the ability to perceive the situation of client as changeable is developed.

In the past, various individual ANP-roles such as Clinical Nurse Specialist and Nurse Practitioner were developed in the USA and in several countries of Northern Europe. In Switzerland, the number of university-educated nurse specialists is still very limited. In order to promote sustainable progress in nursing practice despite of this background, Advanced Nursing Practice teams (ANP-teams) have continuously been established at Kinderspital Zurich for the last eight years. This approach has proven to be an excellent option especially in highly complex situations where targeted and adequate solutions for patients are a major issue. In this article, the structure of the ANP-teams is discussed, with the personnel mix as a key factor. Important supportive elements are a clear definition of tasks as well as an allocation of individual tasks to either clinical or conceptual groups. The ANP teams are highly motivated and goal-oriented, they integrate nurses with various backgrounds of experience or training whereby mutual learning is being encouraged.

At the Solothurn Hospitals (soH), 13 academically educated nurses are responsible for the development of nursing care with the goal to improve patient-oriented, effective, appropriate, and economic care. The strategy contains three priorities: a) expert care of single patients in demanding situations, b) sustained application of organisational methods such as primary nursing, nursing process, and skill/grade mix, and c) design and management of practice development projects related to specific patient groups. A first evaluation with qualitative and quantitative methods showed that the exemplary care of single patients by expert nurses was evaluated as positive for the patients as well as for the teams on two wards by nurses who were interviewed. After the introduction of primary nursing, the application rate was 81 to 90 % and the introduction of fall prevention methods in geriatric rehabilitation decreased the fall rate from 8.2 to 5.5 per 1000 patient days. A comparision with the literature shows that the expert nurses of soH perform both, working at the bedside and being responsible for practice development projects, as specialised Advanced Practice Nurses (APNs). APNs at the Solothurn Hospitals work also as generalists when organisational methods need to be consolidated. Their successes depend from their integration into the hierarchy and both, into the nursing as well as into the interprofessional teams. Competencies in Transformational Leadership also are essential at all management levels.

This article aims to provide an insight into the role as an Advanced Nurse Practitioner in Thoracic Surgery employed within the United Kingdom's National Health Service (NHS). Day-to-day duties were comprised of 7 Domains of Competence namely: management of patient's health status, nurse-patient relationship, teaching and coaching, professional role, managing and negotiating the health care delivery service, quality management, and cultural competence. These elements were enhanced further by becoming an independent and supplementary nurse prescriber, which helped to augment a seamless service delivery. The role formed an integral part in ensuring multi-disciplinary team cohesion and dynamics as well as the provision of continuity of care for both patients' and their families, across all health care settings.

In 2000, the Institute of Nursing Science in Basel started with a clinically oriented Master programme in Advanced Nursing Practice (ANP). The nursing expertise achieved with this degree includes enhanced skills and know-how in a specialised area. Together with their nurse colleagues, the clinically, scientifically, and practice-orientated Advanced Practice Nurses (APNs) support and develop nursing practice in Switzerland further, especially for chronically ill and geriatric patients. It is estimated that 25 % of older adults aged 80-years and older experience at least one hospitalisation per year. Beside the acute diagnosis, they suffer from several chronic illnesses. These highly complex and fragile patients need to be cared for by nurses with enhanced practice skills in gerontology. At the acute geriatric ward of the University Hospital Basel a practice development project is ongoing under the guidance of an APN to support person-oriented, geriatric care. The practice development project is led by the principles of action research. The circular process of "look-think-act" facilitates the critical examination of nursing practice. First results show shorter length of hospital stay for patients and improved job-satisfaction and self-efficacy for nurses. This article shortly reveals the history of ANP and highlights the development, implementation, and first results of the practice development project.

The role of Breast Care Nurses (BCNs) has been discussed since Breast Centres have been opened in Germany. This article introduces the concept of the Breast Care Nurses on a national and an international level in the context of Advanced Nursing Practice (ANP). Within a descriptive study, graduates of a German BCN-education programme were interrogated regarding their current work, their main activities as a BCN, about general conditions in their work environment, experienced barriers, and supporting factors. 122 questionnaires were evaluated. The return rate was 71 % (n = 171). Results showed that 58.1 % (n = 71) of the graduates were employed as a Breast Care Nurse, however only 28.1 % (n = 20) in a full-time and 35.2 % (n = 25) in a part-time position. This first German study about BCN-services showed a lack of basic work conditions, for example regarding a consultation room, access to literature, or templates for documentation. In the discussion part, the situation of the BCNs is reviewed in the German context and in relation to ANP concepts as well as regarding future demands for the position of a BCN.