The Advanced Practice Nursing Data Collection Toolkit: A Compendium of Research Tools

Julie U. Vohra, MSc; Denise Bryant-Lukosius, MScN, PhD


October 07, 2009

In This Article

Conceptual Framework

The APN Toolkit is organized using the steps of the PEPPA framework for role development, implementation, and evaluation.[7] The PEPPA framework provides APN researchers, healthcare providers, administrators, and policy makers with a guide to promote optimal role development and effective use of APNs, and to conduct meaningful evaluations of these roles with a 9-step process. Each step outlines specific objectives and guiding questions to identify information needs and to promote the use of evidence-based approaches for APN role planning, implementation, or evaluation. The PEPPA framework uses a "structure -- process -- outcome" approach recommended by Donabedian[8,9] for evaluating healthcare services.


Structures include physical and practical resources and characteristics of the APN, the patient population, and the work environment that can influence how APN roles are developed and implemented.[7] The work environment includes factors such as: organizational structure and culture; societal demands and expectations for nursing and healthcare services; workforce practice trends and economic issues within the broader healthcare system; government funding, healthcare policies, and legislation; practice, research, education, political, regulatory, and credentialing issues within the nursing profession; and education, role development, and social supports specific to APN.[5]


Processes are what the APN does in the role and how various activities are implemented across all role dimensions, including clinical practice, education, research, organizational leadership, and professional development.[7] For example, clinical role processes could include how patients are referred and the types and frequency of APN care or services provided, or how APNs interact and collaborate with patients, other nurses, health providers, and health services.


Outcomes are the results or consequences of both APN role structures and processes.[7] In other words, APN role supports and resources (structures) and how the APN role is implemented (processes) directly influence the impact of APN roles or extent to which expected outcomes are achieved. Outcomes can be assessed from the perspectives of patients, health providers, organizations, and/or healthcare systems, depending on the dimension, service, or activity of the APN role that is of interest.

At this time, there is no consensus or agreed upon format for categorizing potential outcomes of APN roles. For example, Kleinpell[10] identifies outcomes in relation to care, patients, and performance. Sidani and Irvine[11] assess cost and quality of care outcomes related to ACNPs; these include clinical outcomes and symptoms, complications, patient functional status, knowledge of disease and treatment, and satisfaction with care. Byers and Brunell[12] summarize short and long-term clinical outcomes that concern health-related quality of life, perceptions of care, functional status, and resource use.

For the purposes of the APN Data Collection Toolkit, outcome-related instruments have been categorized pragmatically to reflect areas of high interest and the number of tools available in the literature. These headings include patient and provider satisfaction, health status, quality of care, and health systems and costs.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: