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28 p., ill., Bij consultaties denken de meeste Belgen spontaan aan een arts. In de praktijk zien we echter dat ook verpleegkundigen steeds vaker bepaalde consultaties uitvoeren. Dit gebeurt vooral in complexe situaties, waarbij een patiënt van zeer nabij moet worden opgevolgd of ondersteund. Is dat een wel goed idee? In andere landen, waar deze raadplegingen al verder ontwikkeld en geformaliseerd zijn, is de ervaring alleszins positief, en dit wordt bevestigd door talrijke wetenschappelijke publicaties. Op basis van een studie beveelt het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) aan om dit soort initiatieven ook in België verder te ontwikkelen, mits ze zorgvuldig worden omkaderd door afspraken met andere zorgberoepen op nationaal en lokaal niveau. Waarschijnlijk zal ook de wetgeving moeten worden aangepast, om te voorkomen dat verpleegkundigen tijdens de consultatie teveel worden beperkt in hun activiteiten, en om ervoor te zorgen dat de juiste competenties op de juiste plaats kunnen worden ingezet., VOORWOORD 1 -- 1. INLEIDING 4 -- 1.1. NIEUWE BEHOEFTEN, NIEUW PARADIGMA 4 -- 1.2. VERPLEEGKUNDIGE CONSULTATIES VOOR PATIËNTEN MET COMPLEXE AANDOENINGEN 5 -- 1.3. ONDERZOEKSVRAGEN EN METHODOLOGIE 6 -- 2. WAT IS DE POTENTIËLE MEERWAARDE VOOR PATIËNTEN EN DE ORGANISATIE VAN DE ZORG? 7 -- 2.1. EEN ALGEMEEN POSITIEVE IMPACT VOOR PATIËNTEN 7 -- 2.2. FINANCIËLE EFFECTEN NOG TE BEVESTIGEN 7 -- 2.3. TWEE CONCRETE VOORBEELDEN 7 -- 3. VERPLEEGKUNDIGE CONSULTATIES, IN BELGIË EN HET BUITENLAND 8 -- 3.1. EEN BEPERKEND WETTELIJK KADER 8 -- 3.2. ONDUIDELIJK GEDEFINIEERDE CONCEPTEN IN DE BELGISCHE CONTEXT 9 -- 3.3. WELKE PROFIELEN? 10 -- 3.3.1. In het buitenland 10 -- 3.3.2. In België 10 -- 3.4. IN WELKE CONTEXTEN? 11 -- 3.5. POSITIE TEN OPZICHTE VAN DE ARTS 12 -- 3.5.1. Substitutie, complementariteit of een mix van beide? 12 -- 3.5.2. Op vraag van de arts… of niet 12 -- 3.6. GEFORMALISEERDE SAMENWERKING 13 -- 4. MOGELIJKHEDEN OM DE UITROL VAN VERPLEEGKUNDIGE CONSULTATIES TE STIMULEREN 14 -- 4.1. VERDERE IMPLEMENTATIE VAN FUNCTIE- EN COMPETENTIEPROFIELEN 14 -- 4.1.1. Functiemodel 15 -- 4.1.2. Algemene profielen, specifieke afspraken 15 -- 4.2. OPLEIDINGEN HERZIEN 15 -- 4.2.1. Programma's in volle verandering 15 -- 4.2.2. Toelatingsvoorwaarden voor masteropleidingen bepalen 16 -- 4.3. REGISTREREN EN DOCUMENTEREN 16 -- 4.3.1. Kwaliteitswet 16 -- 4.3.2. Register van praktijken 16 -- 4.3.3. Permanente opleiding 17 -- 4.4. SPECIFIEKE BUDGETTEN EN STIMULANSEN VOORZIEN 17 -- 4.5. DE SCOPE OF PRACTICE AANPASSEN AAN DE VERANDERENDE BEHOEFTEN 18 -- 4.5.1. Medische handelingen, onder bepaalde voorwaarden en in bepaalde contexten 18 -- 4.5.2. Lijst van handelingen versus competentiegericht 19 -- 4.6. PILOOTPROJECTEN 19 -- 5. CONCLUSIE 20 -- AANBEVELINGEN 21 -- REFERENTIES 27

279 p., ill., LIST OF FIGURES 6 -- LIST OF TABLES 8 -- LIST OF ABBREVIATIONS 9 -- SCIENTIFIC REPORT 11 -- 1 INTRODUCTION 11 -- 1.1 DEFINING ADVANCED PRACTICE NURSING 12 -- 1.1.1 Definition International Council of Nurses (ICN) 12 -- 1.1.2 Hamric and Hanson’s integrative model of advanced practice nursing 12 -- 1.1.3 Canadian Medical Education Directives for Specialists (CanMEDS) 14 -- 1.2 HETEROGENEITY IN ADVANCED PRACTICE NURSING 14 -- 1.2.1 Difference between clinical nurse specialist and nurse practitioner 14 -- 1.2.2 Task substitution versus task supplementation 15 -- 1.3 SCOPE 15 -- 1.3.1 Nursing consultations 15 -- 1.3.2 Complex health conditions 16 -- 1.4 RESEARCH QUESTIONS AND METHODS 17 -- 2 UMBRELLA REVIEW OF THE EFFECTIVENESS OF NURSING CONSULTATIONS ON PATIENT AND ORGANISATIONAL OUTCOMES 18 -- 2.1 KEY POINTS 18 -- 2.2 INTRODUCTION 18 -- 2.3 METHODOLOGY 19 -- 2.3.1 Design 19 -- 2.3.2 Search strategy 19 -- 2.3.3 Eligibility criteria 20 -- 2.3.4 Study selection 22 -- 2.3.5 Data extraction and synthesis 22 -- 2.3.6 Quality appraisal 23 -- 2.4 RESULTS 23 -- 2.4.1 Results of the search 23 -- 2.4.2 Characteristics of the included studies 24 -- 2.4.3 Impact on patient outcomes 27 -- 2.4.4 Impact on organisational outcomes 33 -- 2.4.5 Nursing consultations on advanced level 34 -- 2.4.6 Nursing consultations per disease group 34 -- 2.5 DISCUSSION 35 -- 2.6 CONCLUSION 38 -- 3 INTERNATIONAL COMPARISON OF THE ORGANISATION AND IMPLEMENTATION OF NURSING CONSULATIONS 38 -- 3.1 KEY POINTS 38 -- 3.2 INTRODUCTION 39 -- 3.3 METHODOLOGY 40 -- 3.3.1 Design 40 -- 3.3.2 Identification and selection of best-practice regions 41 -- 3.3.3 Data collection in the short-listed regions 44 -- 3.3.4 Data analysis, synthesis and validation 45 -- 3.4 RESULTS 46 -- 3.4.1 Overview of key informants 46 -- 3.4.2 Characteristics of nursing consultations 46 -- 3.4.3 Context factors influencing implementation of nursing consultations 54 -- 3.5 DISCUSSION 57 -- 4 NURSING CONSULTATIONS IN BELGIUM: CURRENT CONTEX

35 p., ill., Lorsqu’il est question de consultations, la majorité des Belges pensent sans doute spontanément au médecin. Sur le terrain, on voit toutefois que les infirmiers aussi sont de plus en plus amenés à assurer certains types de consultations, en particulier dans des situations complexes où le patient a besoin d’être plus étroitement suivi ou accompagné. Une bonne idée ? Dans d’autres pays où cette approche est déjà plus développée et plus formalisée, l’expérience semble en tout cas concluante, et les publications scientifiques abondent dans le même sens. Sur la base d’une nouvelle étude, le Centre Fédéral d’Expertise des soins de santé (KCE) recommande de poursuivre le développement de ce type d’initiative en Belgique, à condition qu’elles soient soigneusement encadrées par des conventions interprofessionnelles au niveau national et local. Il sera probablement aussi nécessaire d’adapter la législation pour éviter que des règles trop contraignantes ne limitent les infirmiers dans les activités qui s’inscrivent dans le cadre de leurs consultations, tout en s’assurant d’avoir les bonnes compétences au bon endroit., PRÉFACE 1 -- 1. INTRODUCTION 4 -- 1.1. À NOUVEAUX BESOINS, NOUVEAU PARADIGME 4 -- 1.2. CONSULTATIONS INFIRMIÈRES POUR LES PATIENTS AVEC DES PROBLÈMES DE SANTÉ COMPLEXES 5 -- 1.3. QUESTIONS DE RECHERCHE ET MÉTHODOLOGIE 6 -- 2. QUELLE PLUS-VALUE POTENTIELLE POUR LES PATIENTS ET L’ORGANISATION DES SOINS ? 7 -- 2.1. UN IMPACT GLOBALEMENT POSITIF POUR LES PATIENTS 7 -- 2.2. DES EFFETS FINANCIERS À CONFIRMER 7 -- 2.3. DEUX EXEMPLES CONCRETS 8 -- 3. CONSULTATIONS INFIRMIÈRES, EN BELGIQUE ET AILLEURS 9 -- 3.1. UN CADRE LÉGAL LIMITANT 9 -- 3.2. DES CONCEPTS MAL DÉFINIS DANS LE CONTEXTE BELGE 9 -- 3.3. QUELS PROFILS ? 10 -- 3.3.1. À l’étranger 11 -- 3.3.2. En Belgique 11 -- 3.4. DANS QUELS CONTEXTES ? 12 -- 3.5. QUEL POSITIONNEMENT PAR RAPPORT AU MÉDECIN ? 13 -- 3.5.1. Substitution, complémentarité ou un peu des deux ? 13 -- 3.5.2. À la demande du médecin… ou pas 13 -- 3.6. UNE COLLABORATION FORMALISÉE 14 -- 4. PISTES POUR STIMULER LE DÉPLOIEMENT DE LA CONSULTATION INFIRMIÈRE 15 -- 4.1. POURSUIVRE L’IMPLÉMENTATION DES PROFILS DE FONCTIONS ET DE COMPÉTENCES 15 -- 4.1.1. Échelle de fonctions 15 -- 4.1.2. Profils génériques, accords spécifiques 15 -- 4.2. REPENSER LES FORMATIONS 16 -- 4.2.1. Des programmes en pleine mutation 16 -- 4.2.2. Définir les conditions d’accès aux formations de master 16 -- 4.3. ENREGISTRER ET DOCUMENTER 16 -- 4.3.1. La Loi Qualité 16 -- 4.3.2. Registre des pratiques 16 -- 4.3.3. Formation continue 17 -- 4.4. PRÉVOIR DES BUDGETS/INCITANTS SPÉCIFIQUES 18 -- 4.5. ADAPTER LE CHAMP DE PRATIQUE À L’ÉVOLUTION DES BESOINS 18 -- 4.5.1. Des actes médicaux, à certaines conditions et dans certains contextes 18 -- 4.5.2. Liste d’actes vs champ de compétences 19 -- 4.6. PROJETS PILOTES 19 -- 5. CONCLUSION 20 -- RECOMMANDATIONS 22 -- RÉFÉRENCES 28

BACKGROUND: Older people in the emergency department (ED) represent a growing population and increasing proportion of the workload in the ED. This study investigated the support for frail older people in the ED, by exploring the collaboration between the geriatric services (GS) and the EDs in Belgian hospitals. METHODS: An electronic cross-sectional survey in all Belgian hospitals with an ED (n = 100) about care aspects, collaboration, education and infrastructure for older patients in the ED was collected. Descriptive analyses were performed at national level. RESULTS: Forty-nine of 100 surveys were completed by the GS. The heads of the ED returned only 12 incomplete questionnaires and these results are therefore not reported. Twenty-six of the 49 heads of GSs (53%) indicated that there was an agreement, mainly informal, between the geriatric and the emergency department concerning the management of older people on the ED. A geriatrician was available for specific problems, by phone or in person, in 96% of the EDs during daytime on weekdays. Almost all responding hospitals (96%) had an inpatient geriatric consultation team, of which 85% was available for specific problems at the ED, by phone or bedside during the daytime on weekdays. Twenty-nine heads of the GSs (59%) reported that older patients were screened at ED admission during the day to identify 'at risk' patients. The results of the screening were used in the context of further treatment (76%), to decide on hospital admission (27%), or to justify admission on a geriatric ward (55%). In the year preceding the survey, 25% of the responding hospitals had organised geriatric training for ED healthcare workers. Thirty-four heads of the GS (69%) felt that the infrastructure of the ED was insufficient to give high-quality care for older persons. CONCLUSION: Collaborations between EDs and GS are emerging in Belgium, but are currently rather limited and not yet sufficiently embedded in the ED care. Exploratory studi

Objectives: The aim of this study is to describe a large-scale, Belgian implementation project about geriatric assessment (=GA) in daily oncology practice and to identify barriers and facilitators for implementing GA in this setting. Design / setting / participants: The principal investigator of every participating hospital (n=22) was invited to complete a newly developed questionnaire with closed- and open-ended questions. The closed-ended questions surveyed how GA was implemented. The open-ended questions identified barriers and facilitators for the implementation of GA in daily oncology practice. Descriptive statistics and conventional content analysis were performed as appropriate. Results: Qualifying criteria (e.g. disease status and cancer type) for GA varied substantially between hospitals. Thirteen hospitals (59.1%) succeeded to screen more than half of eligible patients. Most hospitals reported that GA data and follow-up data had been collected in almost all screened patients. Implementing geriatric recommendations and formulating new geriatric recommendations at the time of follow-up are important opportunities for improvement. The majority of identified barriers were organizational, with high workload, lack of time or financial/staffing problems as most cited. The most cited facilitators were all related to collaboration. Conclusion: Interventions to improve the implementation of GA in older patients with cancer need to address a wide range of factors, with organization and collaboration as key elements. All stakeholders, seeking to improve the implementation of GA in older patients with cancer, should consider and address the identified barriers and facilitators., SCOPUS: ar.j, info:eu-repo/semantics/published

Objectives: The aim of this study is to identify treating physicians' general experiences and expectations regarding geriatric assessment (GA) in older patients with cancer. Materials and Methods: A survey was carried out in 9 Belgian hospitals, which participated in a national GA implementation project focusing on older patients with cancer. A newly developed questionnaire was completed by their treating physicians. Data collection comprised of reviewing hospital data, general respondent data, and treating physicians' general experiences and expectations regarding GA. Descriptive statistics were calculated. Results: Eighty-two physicians from 9 hospitals participated. The GA team composition can vary substantially, with a nurse as core member. Ideally, all older patients with cancer in whom a treatment decision is necessary, should benefit from the GA. Nearly all GA domains are reported as very important. Availability of GA results can be improved. Treating physicians want geriatricians to coordinate geriatric recommendations related to the identified GA problems, and expect from trained healthcare workers (THCWs) to collect GA data, to report GA results, and to follow-up the implementation of geriatric recommendations. Conclusion: This study identifies relevant information for improving the implementation of GA in older patients with cancer in Belgium and reveals priorities for a THCW from the treating physician's point of view. To increase the effectiveness of GA, further efforts are needed to improve the implementation of geriatric recommendations.