A new role profile for nurses with expanded competencies promoting person‑centered care in long‑term care: a mixed‑methods intervention development study

Background
The number of residents in nursing homes and the complexity of their care needs increase. A higher rate of nurses with higher qualification level is associated with a positive impact on patient outcomes such as quality of care, reduction of unplanned hospitalizations and emergency department use, and mortality. In Germany, defined role profiles for registered nurses with Bachelor’s degree in long-term care are lacking and only few of these nurses work in direct resident care.

Objective
To develop a new role profile for nurses with expanded competencies to improve care for residents with complex care needs in long-term care.

Methods Design:
Mixed-methods intervention development study following the PEPPA framework (Participatory, evidence-based, patient-focused process for advanced practice nursing role development, implementation, and evaluation).
We conducted sub-studies:
1. Three systematic literature reviews (on complex care needs, reasons for unplanned nursing home transfers to acute care, and context factors for decisions about transfers).
2. A multiple case study including five cases of nursing home residents to identify root-causes for unplanned transfers to acute care. Data collection: residents’ chart reviews and semi structured interviews with residents (n = 3), family (n = 4), and care providers (n = 11). Data analysis: root-cause analysis with event flow diagrams and qualitative content analysis of interviews to identify fields of action for the role profile.
3. Two participatory stakeholder workshops (n = 18 participants) to develop and refine intervention components and implementation strategies.

Results
The new role profile comprises four competence areas: 1. Managing chronic diseases; 2. Empowerment and communication; 3. Person-centered care network; and 4. Organization. Main implementation strategy enabling nurses to fulfil the role profile is a 300-h additional qualification program. Further strategies on the organizational level are shared goal setting and allowing for adaptability of the intervention by defining mandatory and optional intervention components.