109 4.3 Evaluation

The PEPPA Framework

A Participatory, Evidence-informed, Patient-Centred Process for Advanced practice nursing (APN)^[1] role development

• Adaptation of two frameworks
• Shaped on the principles and values consistent with advanced practice nursing
• Engaging stakeholders as participants
• Planning and Implementation
• Ongoing evaluation and improvement

PEPPA Framework Toolkit:

• Designed to determine gaps between current roles
• Nine key steps for assessing need for an APN as well as developing, implementing and evaluating this role in the practice setting

Strengths of the PEPPA Framework:

• Engaging stakeholders in the process gives opportunities to establish the need and identify shared goals of a clearly defined APN role
• Promotes increased understanding of the APN role and optimal use of APN expertise
• Creates environmental conditions necessary to support APN role through planning strategies
• Provides the basis for prospective evaluation, and thus continued improvement of the APN role
• Limitations of the PEPPA Framework:
• Efforts and resources to implement may appear overwhelming
• Values often conflict with the bureaucratic and disease-focused culture of health care systems
• Strong administrative and organizational support that values patient-focused, multi-disciplinary, and goal-oriented care is required to overcome these barriers
• Application of framework heavily dependant on the quality of group function and leadership
• Lack of resources to support activities, lack of physician support, inability to access data to accurately determine needs and priority problems, lack of evaluation expertise, and frequent turnover in APNs
• Stakeholder reluctance