Specifying Advanced Practice Nursing in Hospital at Home for Older Adults Living With Chronic Conditions: A...

To explore stakeholder perspectives on the functions, role configuration, boundaries, organisational conditions and safeguards of an Advanced Practice Nursing integrated care intervention within Hospital at Home for older adults living with chronic conditions, and how these perspectives inform its development-phase.

Qualitative stakeholder interview study.

Eight semi-structured interviews were conducted with clinical, managerial, strategic and community-interface stakeholders in a regional health system where Hospital at Home was under development. Data were analysed using the Framework Method within an abductive, programme theory-informed approach.

Stakeholders framed Hospital at Home as a response to system pressure and transition risks and emphasised eligibility, reassessment and escalation criteria. They described functions attributed to Advanced Practice Nursing, including assessment, diagnostic reasoning, treatment adjustment, monitoring, coordination, transition work and escalation. Analysis identified Nurse Practitioner and Clinical Nurse Specialist contributions, situating autonomy and hybrid competencies. Medical partnership, hospital-community articulation, information systems, diagnostic access, financing and governance were described as conditions for safe enactment of roles. Safeguards concerned high-risk procedures, caregiver burden, equity, anticipated acceptability and role tensions.

The findings informed a development-phase specification of Advanced Practice Nursing within Hospital at Home, comprising clinical functions, role contributions, organisational conditions and safeguards.

Future operationalisation of Advanced Practice Nursing within Hospital at Home should address role differentiation, escalation pathways, medical partnership, caregiver support, equity safeguards and organisational arrangements before feasibility testing.

The study addressed insufficient specification of Advanced Practice Nursing within Hospital at Home. Stakeholders identified differentiated role contributions, organisational conditions and safeguards requiring operationalisation before feasibility testing. The findings inform clinicians, managers and policy stakeholders planning hospital-level care at home for older adults.

This study is reported in accordance with the Consolidated Criteria for Reporting Qualitative Research reporting guideline.

No patients, family caregivers or members of the public were involved in the design, conduct, analysis, interpretation or reporting of this study.