NAME: PERPETUAL EHIMEN UMARU

STUDENT NUMBER: U2280674

EXAMINING THE FUNCTION OF ADVANCED PRACTICE NURSES IN

THE MANAGEMENT OF CHRONIC DISEASE IN ADULT PATIENTS

HMN3221-QGJ-YJ-2223 : DEVELOPING RESARCH KNOWLEDGE AND

EVIDENCE FOR ADULT NURSING PRACTICE

WORD COUNT: 3127

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ABSTRACT

Chronic diseases are currently the greatest cause of death and disability globally, and
the prevalence rate of chronic diseases is rising internationally (WHO, 2020; Cruz Note
et al., 2023). Thus, the demand for skilled adult nurses has become more pronounced
in managing chronic health diseases in healthcare settings (Cruz Note et al., 2023). The
aim of this research proposal is to evaluate the role of advanced practice nurses in the
management of chronic diseases in adult patients. The PICO model will be used in this
research study, which focuses on comparing advanced practice nurse (APN)-led
interventions with conventional approaches and assessing their impact on patient
outcomes, self-management skills, healthcare usage, and cost-effectiveness. Mixed-
methods will be used in this study to analyze electronic health records quantitatively and
conduct qualitative interviews, to provide insights into the function of advanced practice
nurses in improving chronic disease management. Result from these findings, will help
to inform healthcare policies, enhance patient outcomes, and optimize resource
allocation, and ultimately enhance the quality and cost-effectiveness of chronic disease
care management.

INTRODUCTION
Advanced nursing practice is supported by discipline-specific theoretical understanding
based on philosophical perspectives, ontological, epistemological, and methodological
frameworks based on an ethical attitude toward people and the world in which they live
(Scanlon et al., 2023). According to this perspective, advanced nurse practitioners
improve patient care and experiences while at the same time reducing the strain of
medical staff. This improves cost-effectiveness and efficiency of healthcare services
while also raising patient satisfaction levels overall (Scanlon et al., (2023). Carney
(2014) highlights the distinctive nature of advanced nursing practice, acknowledges the
essential skills and abilities of advanced nurse practitioners, and investigates facilitative
strategies in maintaining, implementing and supporting the role of advanced practice
nurses globally. Consequently, ongoing studies are required to map and monitor the
advancement of advanced nursing practice. Registered nurses can help primary care
offices with day-to-day patient care, education, self-management support, and chronic
disease management (Carney et al., 2014).

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Background
Chronic diseases are now the greatest cause of unnecessary death and disability
worldwide, and the prevalence and expense of chronic conditions are rising (Lukewich
et al., 2014). As the prevalence of chronic diseases rises, there is a greater emphasis
on the development of primary care strategies that improve healthcare delivery. Inter-
professional healthcare teams and chronic illness management strategies are examples
of innovations. One in every four adults in the United States has two or more chronic
diseases, according to Bodenheimer et al. (2015). Research suggests that patients
under the care of advanced practice nurses (APNs) experience improved management
of chronic conditions, enhanced medication adherence, better patient education, and
increased overall satisfaction with care (Mutagh et al., 2021; Cruz Note et al., 2023).

APNs (Advanced Practice Nurses) provide advanced nursing care, bridging the gap
between traditional nursing tasks and physician responsibilities. They are qualified to
perform comprehensive examinations, diagnose ailments, prescribe drugs, and develop
holistic treatment plans (American Association of Nurse Practitioners, 2021). This
increased scope of practice enables APNs to play a critical role in chronic disease
management, when personalized and complex care is required. The chronic disease
management landscape has changed to recognize the need of collaborative care
models, and APNs are well-suited to lead and participate in such models. According to
research, patients under the care of APNs have better chronic condition management,
improved medication adherence, better patient education, and higher overall
satisfaction with care (Mutagh et al., 2021). Advanced nurse practitioners enhance
healthcare delivery cost effectiveness, efficiency, and waste reduction, achieving
government efficiency savings targets (American Association of Nurse Practitioners,
2021).

Premature deaths from heart disease, stroke, and diabetes are predicted to cost $9
billion over the next decade (Russell et al., 2013). Health care practitioners must
collaborate with patients, cares, and professionals to get the optimal health outcome for
a patient with multimorbidity (Mair and Gallacher, 2017). Despite the growing body of
evidence supporting APNs' positive influence in chronic illness treatment, there is still a

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need for extensive study that elucidates the specific pathways via which APNs
contribute to patient outcomes.

Research Questions
The PICO model will be used to construct research questions for the present research
proposal that fully explain the specific population/participants under study, the
intervention being examined, any relevant comparisons, and the desired outcomes of
interest.

Table 1: PICO Framework for the present research idea

S/N Framework Research Questions

1 Population/Patient (P) In the context of chronic disease
management
2 Intervention (I) What specific roles and responsibilities do
advanced practice nurses (APNs) undertake
3 Comparison (C) In comparison to other healthcare providers
such as physician or registered nurse
4 Outcome (O) How do these roles influence patient
adherence to treatment, health education
and engagement in self-management
strategies

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Aims and Objectives of the Research
This study’s primary goal is to evaluate the responsibilities that advanced practice
nurses (APNs) play in treating adult patients with chronic illnesses.
The specific objectives of the study are;
i. To comprehensively assess the specific functions and responsibilities that
advanced practice nurses (APNs) assume in the treatment of adult patients with
chronic illnesses.
ii. To compare and contrast the roles of advanced practice nurses (APNs) in
chronic illness management for adult patients with those of other healthcare
providers such as physicians or registered nurses.
iii. To investigate how advanced practice nurses' (APNs') unique roles and
interventions affect patient adherence to treatment regimens, health education,
and active participation in self-management techniques.
Definition of Terms
Table 2: Key Terms of Glossary
Term Definition/Explanation
Advanced practice nurse Advanced practice nurses (APNs) are
highly skilled and licensed healthcare
professionals with advanced clinical skills
and knowledge. (American Association of
Nurse Practitioners, 2021).
Adult patient In this research, adult patient means a
patient of age eighteen (18) or older
diagnosed with chronic disease.
Health care providers In this research, it refers to an individual
health professional licensed to provide
healthcare diagnosis and treatment,
including medical doctors and registered
nurses.
Physician
Is a health professional who earned a
medical degree or a doctor of osteopathic

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 medicine, and is licensed to practice
medicine and treat and diagnose medical
conditions (American Association of
Nurse Practitioners, 2021)
Registered nurse Is a nurse who has graduated from a
nursing school or holds a bachelor's in
nursing, and who provides care for
patients, supports doctors, and educates
patients and the public about various
health conditions (Liquori et al., 2022).
Patient adherence It’s the degree to which patients correctly
follow medical advice from a healthcare
provider, such as the use of a medical
device, a healthy lifestyle, and therapy
sessions (A).
Function In the context of this research, function
refers to the unique roles and
responsibilities of advanced practice
nurses (APNs) in the management of
chronic diseases including patient
evaluation, health education, diagnosis
and treatments.

Research Design

The search study will be performed using a mixed-methods approach, including

qualitative and quantitative methods. This approach will allow for a complete
examination of advanced practice nurses' (APNs') roles, responsibilities, and
implications in the care of chronic diseases in adult patients; thus, this approach
involves analyzing the existing data collected from electronic health records and patient
surveys as described by Creswell and Poth, (2017); Polit and Beck (2017); Burns and
Groves (2019).

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The quantitative analysis will involve analyzing the existing patient information obtained
from electronic health records and patient surveys. The study will use retrospective
analysis to examine several patient outcomes such as disease control, medication
adherence, hospitalization rates, and patient satisfaction. To analyze the impact of APN
involvement on these outcomes, descriptive statistics and inferential analysis will be
used (Polit and Beck (2017) and Burns and Groves (2019).

The qualitative analysis will be carried out by interviewing both advanced practice
nurses (APNs) and adult patients with chronic disease. This qualitative method will
provide a more nuanced knowledge of the role played by in chronic disease
management and will record patients' opinions on APN contributions. Thematic analysis
will be used to determine the themes and patterns in the interview data (Creswell and
Poth, 2017).

Search Strategies

The search strategy will be based on systematic and structured techniques to identify
pertinent literature from academic databases, peer-reviewed journals, and gray
literature sources. The main aim is to determine the studies that delve into the functions
and contributions of advanced practice nurses in the context of chronic disease
management for adult patients (Higgins, 2013).

Key words will be chosen to guide the search term s and Boolean operators. These
include “Advanced Practice Nurses” (APNs), “Adult Patients”, “Impact”, Patient
Adherence”, “Function”, Healthcare Providers”, Interdisciplinary care”, and “Patient
Outcomes to bring up most relevant research articles for this topic. The Boolean
phrases will be applied using AND/ OR to maximize the number of articles received. By
Boolean, this can improve search by giving an early indication of the quality of results,
therefore speeding up the refinement process (Higgins, 2013).

For the search, electronic databases such as PubMed, CINAHL, Scopus, and
PsycINFO will be used. The reference lists of the discovered publications, however, it
will be manually verified to verify completeness. Grey literature sources, such as
institutional repositories and government publications, will be investigated to broaden
the scope of the search (Higgins, 2013; Kitchenham, 2014).

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Some example of inclusion criteria will include the followings;

i. Studies published in the last 10 years, that is between 2013 and 2023
ii. Articles that offer perspectives on the functions and effects of advanced practice
nurses in the area of managing chronic diseases for adult patients will be taken
into consideration.
iii. Patients who have had a chronic illness and have undergone therapy.
iv. Patients who have dealt with the negative effects of a chronic illness

Some examples of exclusion criteria will include the followings;

i. Studies not in English

ii. Case reports not in English.
iii. Articles tangential to the research scope
iv. Patients who are undergoing other forms of treatment not due to chronic disease
or illness
v. Patients who have not experienced any chronic disease side effects

Prior to selection, all articles will be subjected to an ethical evaluation, which will be
detailed on a separate ethical review form. Because the time duration for this
assignment is limited, a predetermined number of appropriate articles will be picked
from the relevant database to be reviewed. Appendix 1 has a Gantt chart summarizing
the project's timeline. The PRISMA diagram (see appendix 2) will be used to select
relevant articles and determine which are most suitable for review, ensuring that the
most appropriate research is taken forward to be appraised, with the outcomes being
displayed using the diagram along with tables of key information. The PRISMA
declaration seeks to improve systematic review reporting, particularly for intervention or
assessment research, which is pertinent to this research proposal.

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DISCUSSION

The result obtained from the research will have a major implication towards improving
the chronic disease management, with the participation of advanced practice nurses
(APNs). This study used mixed methods technique that contributes to a better
understanding of advanced practice nurses (APNs), their function, impact on patient
outcomes, and the overall patient experience. By using quantitative analysis, the study
evaluates the medication adherence, hospitalization rates and disease control. Hence,
these indicators provide useful benefit of advanced practice nurses (APNs) in managing
chronic disease. However, the qualitative analysis collects nuanced view point from
APN and patients, which sheds more light on the multiple roles by APNs and other ways
by which their engagement promote patient participation, and empowerment (Dau’uglio
et al., 2019).

The information collected from the qualitative and quantitative analysis will allow
comprehensive evaluation of advance practice nurses’s (APNs) function in collaborative
healthcare approach with medical doctors, registered nurse and other licensed health
professionals. The findings from this research, will also provide patient
awareness/education, patient centered care, as well as patient self-management
measures. Thus, this is also very important for healthcare policy makers, administrators,
to recognize and capitalize on distinct talent in managing chronic disease among the
population (Dau’uglio et al., 2019).

Dissemination

The findings from this research will be disseminated through various channels including
scholarly publications, participation in academic gatherings (e.g conference) and
seminars. However, the information obtained is also useful in shaping healthcare
strategies, and endorsement of an interactive healthcare approach.

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Support
The research proposal on examining the function of advanced practice nurses (APNs)
in the management of chronic disease in adult patients requires initial support from the
module tutor and also from the ethics panel. This research will also consume time as
more resources and support are required to carry out the investigation, which includes
theoretical and practical support. The theoretical support includes patient care,
evidence-based practice, and interdisciplinary collaboration. However, practical support
requires healthcare workers (doctors and registered nurse), patient engagement, cost-
effective care, and the involvement of advanced practice nurses (APNs).

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REFERENCES

American Association of Nurse Practitioners (AANP) (2021). NP Fact Sheet.

https://www.aanp.org/advocacy/advocacy-resource/position-statements/nurse-
practitioner-practice

Bodenheimer, T., Bauer, L., Syer., and Olayiwola, J.N. (2015). RN Role reimagined:
How empowering registered nurses can improve primary care. Oakland, CA:
California HealthcareFoundation.13(10),1-66.Retrievedfrom:
http//hqontario.ca/en/documents/eds/2013/full-report-OCDM-specialized-
nursing.pdf

Burns, N., and Grove, S. K. (2019). Understanding nursing research: Building an

evidence-based practice. Elsevier.

Carney, M, (2014). Regulation of advanced nurse practice: its existence and regulatory
dimensions from an international perspective. Journal of Nursing Management. https://
onlinelibrary.wiley.com/doi/epdf/10.1111/jonm.12278 [accessed 20/03/2020].

Cruz Neto, J., Santos, P. S. P. D., Oliveira, C. J. D., Silva, K. V. L. G. D., Oliveira, J. D.
D., and Cavalcante, T. F. (2023). Contributions of Advanced Practice Nursing to
Primary Health Care: A Scoping Review. Aquichan, 23(1).

Dall'uglio, I., Fiorini, J., Moles, R. F., and Pedrao, L. J. (2019). Nurse practitioners:
Roles, responsibilities, and practice in the Brazilian Unified Health System.
Revista Gaucha de Enfermagem, 40, e20180119.

Hansen-Turton, T., Ware, J., and McCue, D. (2017). Nurse practitioners in primary care.
Springer.
Higgins, J. P and Green, S. (2013). Cochrane handbook for systematic reviews of
interventions (Vol. 4). John Wiley & Sons.

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Kahale, L. A., Elkhoury, R., El Mikati, I., Pardo-Hernandez, H., Khamis, A. M.,
Schünemann, H. J., and Akl, E. A. (2021). Tailored PRISMA 2020 flow diagrams for
living systematic reviews: a methodological survey and a
proposal. F1000Research, 10.

Kitchenham, B. (2014). Procedures for performing systematic reviews. Keele, UK, Keele
University, 33(2004), 1-26.

Liquori, G., De Leo, A., Di Simone, E., Dionisi, S., Giannetta, N., Ganci, E., and Napoli,
C. (2022). Medication Adherence in Chronic Older Patients: An Italian Observational
Study Using Medication Adherence Report Scale (MARS-5I). International Journal of
Environmental Research and Public Health, 19(9), 5190.

Lorig, K. R., Sobel, D. S., Stewart, A. L., Brown Jr, B. W., Bandura, A., Ritter, P. and
Holman, H. R. (2001). Evidence suggesting that a chronic disease self-
management program can improve health status while reducing hospitalization:
a randomized trial. Medical care, 39(11), 1217-1223.
Lukewich, J., Edge, D. S., VanDenKerkhof, E., and Tranmer, J. (2014, February).
Nursing contributions to chronic disease management in primary care. The Journal
of Nursing Administration,44(2),103–110.

Mair, F. S. and Gallacher, K. I. (2017). Multimorbidity: what next? British Journal of

General Practice, 67(659), 248-249.

Murtagh, S., McCombe, G., Broughan, J., Carroll, Á., Casey, M., Harrold, Á., and
Cullen, W. (2021). Integrating primary and secondary care to enhance chronic
disease management: a scoping review. International journal of integrated
care, 21(1).

Polit, D. F and Beck, C. T. (2017). Nursing research: Generating and assessing

evidence for nursing practice. Wolters Kluwer.

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Russell, G. M., Dahrouge, S., Hogg, W., Geneau, R., Muldoon, L., and Tuna, M. (2013).
Managing chronic disease in ontario primary care: the impact of organizational
factors. Annals of Family Medicine, 7(4), 309-318. https://doi.org/10.1370/afm.982

Scanlon, A., Murphy, M., Smolowitz, J., and Lewis, V. (2023). Advanced Nursing
Practice and Advanced Practice Nursing roles within low and lower‐middle‐income
countries. Journal of Nursing Scholarship, 55(2), 484-493.

World Health Organization. (2020). Chronic diseases and health promotion.

https://www.who.int/chp/en/

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APPENDICES

Appendix 1: Hierarchy of Evidence

Wallace, S. S., Barak, G., Truong, G., & Parker, M. W. (2022). Hierarchy of Evidence
Within the Medical Literature. Hospital Pediatrics, 12(8), 745-750.

Appendix 2: Gantt chart of Research Process

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Appendix 3: PRISMA Flow chart

Kahale, L. A., Elkhoury, R., El Mikati, I., Pardo-Hernandez, H., Khamis, A. M.,
Schünemann, H. J., and Akl, E. A. (2021). Tailored PRISMA 2020 flow diagrams for
living systematic reviews: a methodological survey and a
proposal. F1000Research, 10.

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 MSc Nursing Research Ethics Review Form

NAME: PERPETUAL EHIMEN UMARU

STUDENT NUMBER: U2280674

Title of the Project: Examining the function of advanced practice nurses in the
management of chronic diseases in adult patients

Methodology
The present study will employ mixed method approach (including qualitative and
quantitative approach) to evaluate the roles or function of advanced practice nurses
(APNs) in chronic disease management in adult patient. This study will adhere to
ethical research etiquettes including privacy, confidentiality in analyzing and handling
data, thus it does not involve the followings elements. The research will analyze existing
data and interviews with advanced practice nurses, avoid direct contact with
participants, and not access identifiable personal data. It will focus on the professional
roles of APNs in chronic disease management, without involving students as research
assistants. The internal research team will conduct the study without joint responsibility
with external researchers (World Medical Association, 2013).

Main Ethical Issues

The present research study does involve direct contact with human participants; thus, it
will take biomedical ethical principles into consideration. These include privacy and
confidentiality, data security and integrity, proper informed consent, disclosure of
potential bias, ensuring literature reviews meet ethical standards, and appropriate data
usage (World Medical Association, 2013; Godecharle et al., 2013; American
Psychological Association, 2020).

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Ethical Procedure

In the context of the present research study, ethical guidelines will be incorporated by
seeking ethical approval from the institution's ethics committee (Resnik, 2011), using
recent citations and references, maintaining privacy and confidentiality of the data,
following best practices for data storage and management (Europian Commission,
2018), providing transparent and accurate attribution to the sources used in the
literature review (American Psychological Association, 2020), and maintaining research
integrity (Europian Commission, 2018). By addressing these key elements, this
procedure will ensure the ethical conduct of the research proposal in accordance with
established ethical principles and guidelines.

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REFERENCES

American Psychological Association. (2020). Publication Manual of the American

Psychological Association (7th Ed.). American Psychological Association.

European Commission. (2018). Turning FAIR data into reality: Final report and action
plan. European Commission Expert Group on Turning FAIR Data.

Godecharle, S., Nemery, B. and Dierickx, K. (2013). Guidance on research integrity: No

union in Europe. The Lancet, 381(9872), 1095-1096.

Resnik, D. B. (2011). What is ethics in research & why is it important? National Institute
of Environmental Health Sciences.

World Medical Association. (2013). Declaration of Helsinki: Ethical Principles for

Medical Research Involving Human Subjects. JAMA, 310(20), 2191-2194.

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