Factors influencing the implementation of Epilepsy Specialist Nurse role: Using the Consolidation Framework for Implementation Research

Abstract

Background Research to support the added value of including Epilepsy Specialist Nurses as members of the multidisciplinary team is developing, yet little information exists on factors influencing the translation of these roles into practice. Aim To describe the enabling and inhibiting factors to the implementation of the Epilepsy Specialist Nurse role in the Republic of Ireland. Methods A qualitative design involving semi‐structure interviews, observation and analysis of documents, such as portfolios was used. The sample included 12 Epilepsy Specialist Nurses, 24 multidisciplinary team members, and 35 individuals with epilepsy and family members. Data were analysed using the Consolidation Framework for Implementation Research. Reporting rigour is demonstrated using the COREQ checklist (See Appendix S1). Results While there was overwhelming support for the role, barriers and enablers were identified across all domains of the Consolidation Framework for Implementation Research. Enablers included national policies and guidelines, leadership from senior nursing and medical colleagues, climate of learning and mentorship, networking opportunities, infrastructural supports and competence of Epilepsy Specialist Nurses. Barriers included the limited consideration of service expansion and the increasingly complex nature of clinical cases on workload capacity. Deficits in infrastructural supports, challenges in relation to role preparation, role implementation and role responsibility, including concerns around lone practitioner models and concerns that the role was a cost‐saving measure, also emerged as potential barriers to future sustainability. Conclusion The Consolidation Framework for Implementation Research offers researchers a pragmatic typology for analysing interrelationships between enabling and inhibiting factors that impact implementation of advanced practice roles, across different evidence sources, disciplines and boundaries. Relevance to clinical practice In order to secure role sustainability, managers need to address the rate of service expansion, models of role development, deficits in supports and perceived motivations for role development on the quality, acceptability and sustainability of services provided.

The emerging role of the advanced practice epilepsy nurse: A comparative study between two countries

“…Overall, it is important to incorporate prescribing, research and leadership in APN, to implement the full scope of advanced practice (Kennedy, 2019). This would require support for epilepsy nurses from their institutions and teams, recognising their value and capacities (Higgins et al, 2020). Spanish policies for APN are needed, following the model of the UK (NHS, 2017).…”

Determining the role and responsibilities of the community epilepsy nurse in the management of epilepsy

“…Ultimately, this can impact skill development, career progression, and workforce planning (Epilepsy Nurse Specialist Association, 2012; Gardner et al, 2016;Higgins et al, 2019aHiggins et al, , 2019bLocatelli et al, 2021;Manzanares et al, 2021). ENs who predominantly work in the NFP sector faced additional challenges in their role working with a disconnected network of care and siloed governance structures across Australia related to the fragmented health and social care systems (Higgins et al, 2020;Schroeder & Cutler, 2021).…”

Implementation of the Nurse Practitioner as Most Responsible Provider model of care in a Specialised Mental Health setting in Canada

“…2016; Wand & Fisher 2006), community outpatient clinics (Bitto 2020; Higgins et al . 2020), and various other social service settings such as correctional facilities (Wong et al . 2018) is well established.…”

“…The implementation of NP as the MRP in the mental health setting is one solution to address the growing demand of mental health services. The expansion of the NP role in diverse settings such as primary care (Gysin et al 2019), emergency departments (Boman et al 2021;Doetzel et al 2016;Wand & Fisher 2006), community outpatient clinics (Bitto 2020;Higgins et al 2020), and various other social service settings such as correctional facilities (Wong et al 2018) is well established. Starting in the United States, the specialised development of the Mental Health Nurse Practitioner (MHNP) designation has spread globally (Gysin et al 2019).…”