Developing a public health policy-research nexus: An evaluation of Nurse Practitioner models in aged care
Introduction
The relationship between academic research and public policy is changing. Ever faster news media cycles constrain research input into conventional policy review cycles. Increased emphasis on value for money within taxpayer-funded programs requires evaluations to be more attuned to the efficiency and financial viability of policy initiatives. Growing interest in evidence-based policy in response to complex social problems demands that findings be relevant and more accessible to policy-makers. Together, these trends present new challenges which require new approaches to developing a nexus between research and policy within policy program evaluations.
This paper takes up the challenge of developing an evaluation that is based on a theoretical framework through five distinct steps. First, a brief summary of the policy history that underlies the establishment and support of Nurse Practitioners in aged care within Australia is presented. This is followed by an overview of the key objectives for a current evaluation of an Australian Government policy program in this space. Third, the paper details a theoretical approach that expands this evaluation beyond the assessment of program outcomes against objectives through a three-strand conceptual framework that provides a foundation for rigorous analysis. Finally, the evaluation is considered in the light of literature considering the development of a research-policy nexus in health. Due to this focus on describing an evaluation approach that responds to research-policy challenges identified in the literature, a detailed examination of the findings of the evaluation in relation to accessibility of health services and clinical practice is necessarily beyond the scope of this paper. However, what the paper does usefully present is an evaluation approach as an example of a careful synthesis of often conflicting policy and research priorities, while providing sufficient detail for the approach to be considered for use by others conducting public health policy evaluations.
Section snippets
Nurse Practitioners in aged care: the Australian policy context
Before considering the conceptual framework of this evaluation approach, it is important to take a moment to define the Nurse Practitioner role, as it differs between nations (Sibbald, Laurant, & Reeves 2006). In Australia, the role of Nurse Practitioner (NP) is defined as a Registered Nurse who is educated at Masters level and endorsed to function autonomously and collaboratively in an advanced and extended clinical role. The role may include (but is not limited to), assessment and management
About the NP Evaluation
The $18.7 m Nurse Practitioner – Aged Care Models of Practice Program (NP Program) is an initiative of the Australian Government to further grow the number of NPs providing aged care services (Department of Health and Ageing, 2011). In 2011, applications were invited for aged care models across Australia, from which approximately thirty models were selected by the Australian Government to be included in the NP Program. The models funded under the NP Program aim to:
- 1.
improve access to primary
Conceptual framework
The NP Evaluation assesses a policy program that aims to address an issue of national significance – improving access to affordable primary health care for the ageing population. Generating an evidence base for the evaluation, the models of care within it, and the effectiveness, viability, and sustainability of the NP role in aged care requires an approach which is theoretically informed and methodologically rigorous. However, the NP Evaluation also seeks to respond to calls for new conceptual
Discussion
The above conceptual framework includes as part of its development process four important approaches from public health literature that support a stronger research-policy nexus (i.e., including priorities from policy literature, communication and collaboration with multiple stakeholders, accessibility of formative findings for policy-makers, and mixed methods including local cases). It was developed not only as an attempt to evaluate the NP program, but also to address the mutual requirements
Conclusion
This is an overview of an evaluation approach currently being used to evaluate the impact of aged care NP services in Australia. While located in this specific context, this paper illustrates a response to emerging challenges for research and policy that are similarly experienced in other western nations. To do so, the paper has provided a review of the policy history behind the establishment of the NP role in Australia, as well as an overview of the aims that underpin both an initiative to
Acknowledgements
This paper is a contract material developed within the ‘Nurse Practitioner Aged Care Models of Practice National Evaluation’ project, which has been funded by the Australian Government Department of Health and Ageing. The authors also wish to acknowledge the contribution of the following University of Canberra and Australian National University researchers to the conceptual development and implementation of this project: Professor Rachel Davey (project director); Dr. Shannon Clark; Professor
Brenton Prosser is a senior research fellow to the Nurse Practitioners Aged Care Models of Practice Evaluation within the Centre for Research and Action in Public Health, University of Canberra. He is an adjunct in the School of Sociology at the Australian National University and in the School of Education at the University of South Australia.
References (50)
- et al.
Use of research to inform public policymaking
The Lancet
(2004) - et al.
Clinical update: survivorship care-models and programs
Seminars in Oncology Nursing
(2012) - et al.
How acceptable are primary health care nurse practitioners to Australian consumers?
Collegian
(2013) Patient satisfaction with nurse practitioner-delivered primary healthcare services
Journal of the American Academy of Nurse Practitioners
(2009)Will the NP workforce grow in the future? New forecasts and implications for healthcare delivery
Medical Care
(2012)National Health (Collaborative arrangements for nurse practitioners) determination 2010
(2010)National Competency Standards for Nurse Practitioners
(2012)Community health services in Australia
- et al.
Turtles all the way down: Bounded rationality in an evidence-based age
Policy Studies
(2012) - et al.
A meta-analysis of nurse practitioners and nurse midwives in primary care
Nursing Research
(1995)
Increasing the use of evidence in health policy: Practice and views of policy makers and researchers
Australia and New Zealand Health Policy
The two-communities theory and knowledge utilization
American Behavioral Scientist
Effectiveness of nurse practitioners in nursing homes: A systematic review
JBI Library of Systematic Reviews
Beyond the rhetoric: what do we mean by a ‘model of care’?
Australian Journal of Advanced Nursing
An exploration of nurse practitioner care to homebound frail elders
Journal of the American Academy of Nurse Practitioners
The invisible contract: Shifting care from the hospital to the home
Australian Health Review
New nurse practitioners to care for older Australians
The primary healthcare nurse practitioner role in Canada
Nursing Leadership
The Australian health care system
Addressing the research-practice gap in healthcare management
Journal of Public Health Management & Practice
Evaluating the impact of health promotion programs: Using the RE-AIM framework to form summary measures for decision making involving complex issues
Health Education Research
Evaluating the public health impact of health promotion interventions: The RE-AIM framework
American Journal of Public Health
Implementing research findings
British Medical Journal
Identifying trustworthy experts: How do policymakers find and assess public health researchers worth consulting or collaborating with?
PLoS ONE
The experience of Australian project leaders in encouraging practitioners to adopt research evidence in their clinical practice
Australian Health Review
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2018, CollegianCitation Excerpt :Other research has explored the role of NPs in a variety of settings, each differing in their context and particular focus whilst adding to the body of literature supporting an understanding of the role to healthcare delivery. Many of the studies report findings from particular aspects of the role such as patient satisfaction (Jennings, Clifford, Fox, O’Connell & Gardner, 2015) or improved outcomes when NPs work to full scope of practice (Oliver, Pennington, Revelle, & Rantz 2014), whilst others report on specific clinical contexts, such as aged care (Prosser et al., 2013), critical care (Jackson & Carberry, 2014), diabetes care (Murfet, Allen & Hingston, 2014) and mental health (Wand, D’Abrew, Barnett, Acret & White, 2015). Other studies have focussed on identifying clinical and non-clinical aspects of the role (Gardner & Gardner, 2005 National Nursing and Nursing Education Taskforce, 2005).
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2015, Evaluation and Program PlanningCitation Excerpt :The evaluation of the NP Program was selected as a case for this paper because the authors were chief investigators within this evaluation and, hence, had first-hand access to all information relating to the centralised ethics approval process. The specific objectives and methods of the national evaluation of the NP Program have been documented previously in this journal (Prosser, Clark, Davey & Parker, 2013). However, they can be briefly summarised as a mixed method evaluation approach (see Box 1), which includes quantitative data on access to health services and the economic viability of delivery models, as well as qualitative data on the critical factors in the effectiveness of these models and different accounts of stakeholder experiences.
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Brenton Prosser is a senior research fellow to the Nurse Practitioners Aged Care Models of Practice Evaluation within the Centre for Research and Action in Public Health, University of Canberra. He is an adjunct in the School of Sociology at the Australian National University and in the School of Education at the University of South Australia.
Shannon Clark is a post-doctoral fellow in the Centre for Research and Action in Public Health, University of Canberra. She is also a visiting fellow at the Australian Primary Health Care Research Institute at the Australian National University.
Rachel Davey is Director of the Centre for Research and Action in Public Health, University of Canberra. Her research focusses on the primary and secondary prevention of chronic disease and in evaluating public health interventions and innovative models of health service delivery.
Rhian Parker is a member of the Australian Primary Health Care Institute, Australian National University. Her research focusses on the organisation and delivery of primary health care services, with particular focus on nurses and preventive activities and on knowledge translation.